7_white paper hospital without walls

The “Hospital Without Walls” for the 21st Century

What is the “Hospital Without Walls”?

The hospital has been the centre of our model of acute and emergency care since the inception of the NHS in the late forties. However the Royal College of Physicians (RCP) “Future Hospital: caring for Medical patients” paper and current NHS Strategy challenges whether the traditional hospital can provide “the integration, collaboration, communication, and information sharing needed to care for today’s typical patients, many of whom are elderly, have multiple and complex illnesses, and are often confused.”

The RCP proposed an alternative to the traditional model, the “Hospital Without Walls”.

This “Hospital Without Walls” vision changes how we currently deliver acute care, and raises the question of how the software, systems and solutions used by the NHS should integrate all aspects of care provision, across acute, community, social care, health and social services. The increasing need for this integration, and the need to extend it beyond the hospital premises and out into the whole healthcare economy, embodies the “hospital without walls” concept and gives Patient Flow solutions a particular challenge, particularly in supporting the transparency and information sharing agenda.

Andy McKee, ExtraMed Product Manager, Hospedia Ltd

7

Contents

Integration and Information ............................................................................................................................ 3

The Clinical Coordination Centre ................................................................................................................. 3

Considering Patient Experience .................................................................................................................. 4

Electronic Patient Records and Patient Administration Systems ........................................... 4

The Software, The Backbone ...................................................................................................................... 5

About ExtraMed3 .................................................................................................................................................. 5

Unified Communications .................................................................................................................................. 6

Is it possible? ........................................................................................................................................................... 7


©Hospedia Ltd 2014 November 2014

Integration and Information

The Future Hospital paper recommends that responsibility for care be shared between patients and practitioners in

hospitals and community care, and be “continuously supported by a virtual dialogue.” This dialogue incorporates

acute hospitals, community hospitals, care homes, social services, mental health trusts and ambulance services,

and will rely on the effective use of IT systems to share and update information outside the hospital boundaries.

Those systems must be designed to facilitate a shared view of patient care and flow individually and collectively,

across highly complex healthcare economies.

Information flow is key; seamlessly coordinating this level of interaction between widely disparate services, while

maintaining security and patient care, will drive the need for software solutions that can represent all of the

stakeholders within a single view (using multiple systems) and deliver patient-centred information that flows with the

patient as they cross organisational boundaries.

The Clinical Coordination Centre

At the core of the Future Hospital vision sits the Clinical Coordination Centre (CCC) – an operations hub where

an array of screens will display

critical information including patient

flow across the hospital, individual

patient care status and updates, and

standard protocols and alerts.

In healthcare economies across the

globe we are seeing the emergence

of similar solutions to address the

rising complexity and expectations

placed on managing acute care. If

we look to the United States we can

see a rising interest in the “Air Traffic

Control” model – indicating that the

requirement for integrated views

of care extends across healthcare

models.

It’s not just healthcare itself that drives this need, the involvement of various organisations operating in the

healthcare space also affect the needs and requirements of providers. The influence of Accountable Care

Organisations in the US, and Clinical Commissioning Groups in England, will create demand for increasingly integrated

views which will grow as all healthcare organisations seek to manage the operation, reporting and communication

of complex flows seamlessly. Centralising this information, in a Clinical Coordination Centre, may become the gold

standard in handling this complexity.



Presenting the information required by a Clinical Coordination Centre, in meaningful ways, requires not only the

software solutions that can provide that information but also hardware that can display it clearly and accessibly.

That hardware goes beyond the “mission control” style set-up of the CCC, and extends to the wards, the community

teams and other associated healthcare providers. Whether it takes the form of high-end display screens or mobile

devices, the right hardware can make the information available where it’s needed, when it’s needed, and should not

be forgotten in discussions that tend to focus on software needs.

Considering Patient Experience

From the patient’s point of view, the number of separate departments, consultants and even organisations involved

in their care can be overwhelming. The authors of the Future Hospital envisage a system whereby patients are not

“discharged”, but that care is seamless both in and out of hospital.

While the gold standard of a shared patient record may be attainable in the future, the immediate concern of

providers should be to ensure that useful data is already being shared. If not the entire patient record, at least basic

information in patient care and treatment supporting patient flow should be accessible to all applicable services -

which patients are attending, where, and the basic information required to complete each patient’s care.

The intention of the hospital without walls is to create a healthcare environment where patients are able to move

throughout their journey feeling like everyone they come into contact with is fully informed about their care plan,

their needs and their issues. Only through integration, information sharing and communication can this be achieved.

Electronic Patient Records and Patient Administration Systems

Although the UK is not the only country in the world currently struggling to achieve success in consistently and

completely sharing patient records effectively with all stakeholders, this failure is a big concern to the authors of

the Future Hospitals report and NHS in general. Finding a way to improve this situation must be a priority. PAS and

EPR systems have long been the cornerstone of information within the hospital, and as an embedded part of the

healthcare system, this is likely to remain the case for the foreseeable future.

However, delivering an integrated EPR system that meets the need of the hospital is a significant financial and

operational investment, with full benefits often not realised for years. While the EPR system is an essential part

of the modern hospital the question is whether or not these single systems can deliver the level of flexibility and

openness that the hospital without walls model demands when managing complex patient flows, and therefore

demonstrate their value beyond the purely financial, or whether they can be integrated with other solutions to a level

that creates a unified view of patient care across the whole healthcare economy.



The Software, The Backbone

Underpinning the concepts of the hospital without walls

and the Clinical Coordination Centre is the need for powerful

software solutions; solutions that have been fundamentally

designed for the level of integration required to support the

needs of the future hospital.

The Clinical Coordination Centre concept presents challenges

for software developers used to dealing with relatively static

patient groups inside a single organisation, with a need to

progress to presenting complex data sets in meaningful ways.

The value is in useful, usable information, presented in such

a way as to avoid information overload. Whatever the answer

is, it is unlikely to be as simplistic as a series of dials on a

dashboard, as traditional models have employed.

Delivering IT systems which support a seamless view of patient

care will require close cooperation between system providers

in ways not yet envisaged, but which are likely to push the

existing models of healthcare integration beyond the current

limitations of HL7. There’s no single, out-of-the-box solution that

can meet all of the needs of the future hospital, and the ability

to share snapshots of capacity and demand, escalation alerts,

and patient focused information will require software providers

to develop new ways of working with each other, to the benefit

of the users and the patients.

Existing software that has been designed to be seamlessly

integrated into the healthcare space, such as ExtraMed Patient

Flow Management, is known as third generation software.

Unlike previous iterations of development, where required

features and modules are added onto existing systems,

in third generation software the development starts again

from the beginning. Instead of modules developed in silos

to meet individual needs, the overall system is considered,

developed and future-proofed. The platform is re-engineered

to be efficient, using the same logic across all elements to

allow future expansion to occur without the need for each

section of the system to be updated independently. This

style of redeveloping healthcare systems for the future will

become increasingly important, with requirements changing

and increasing rapidly as we move towards the “without walls”

model.

About ExtraMed3

Designed to apply the significant benefits

of integrated systems to healthcare,

ExtraMed3 has been reengineered from its

roots in patient flow management, taking

into account user feedback, to create a

fully integrated system that can be adapted

and upgraded with ease. The Hospedia

Clinical Workflow Platform provides a robust

open API which gives IT departments the

ability to deeply integrate with existing

applications (or even build new Apps on an

existing platform).

The system provides a comprehensive

toolkit to manage patient care and the

patient journey, from pre-admission to

post-discharge. The benefits of ExtraMed3

extend beyond clinical efficiencies and

patient experience, with significant cost

savings validated by Deloitte, showing that

the system can deliver annual cost savings

of £4.3m through reducing length of stay,

clinical efficiencies worth £170k per annum,

and £840k worth of annual savings through

the prevention of hospital infections.



In all areas of healthcare, software developers need to

recognise that data is expanding - not only is it coming in

from a wider variety of sources than ever before, it is also

being shared with and used by a wider group of stakeholders.

Multiple systems within a hospital, sources outside the hospital

walls, and stakeholders that work both in and out of the

physical hospital location, are all relying on up to date, shared

data. There is a significant need to need to understand the

different “personas” using the information available, and ensure

that information is presented appropriately no matter what the

audience. Although the definition of the data to be shared will

be determined by the organisations themselves, the method of

presentation is an area that software developers must address.

Information Governance (IG) and risk management are

two areas that software solutions must get right, to

ensure that enabling the sharing of information between

organisations achieves the goal of smooth and effective

patient handover without any compromise to confidentiality.

This is a considerable challenge. To begin the process of

integration, developers should engage with IG teams and

senior management, who can support quick progress in this

area by identifying data that could be shared without risking

confidentiality.

Unified Communications

Unify’s Unified Communications (UC)

solutions bring together voice, mobility,

Web collaboration, video, messaging, and

contact centre applications into a single,

purpose-built unified user experience.

These solutions empower today’s

anywhere healthcare workers with tools

to communicate and collaborate more

effectively. Combined Patient Flow and UC

solutions can support the Hospital Without

Walls by providing the user with information

about and access to a patient’s care team

in real time.

Supporting virtual board meetings with

widely dispersed teams, supporting direct

access to effective communication for ad-

hoc meetings about patient care (rather

than waiting for scheduled reviews) to

facilitate speedy decision making and

bringing teams together to deal with

operational issues in real time.

Unify, formerly Siemens Enterprise

Communications, has teamed with

Hospedia, to deliver the UK’s first UC

enabled point-of-care patient workflow

solution. The net result recovers lost time

and productivity that yields significant hard

and soft savings, and increases patient

satisfaction.



Is it possible?

The goal of achieving the “Hospital Without Walls” is a noble one, with significant benefits to healthcare

organisations, staff and patients, bringing healthcare to the leading edge of technology and service. There are,

however, some significant hurdles to overcome, and the traditionally poor application of national IT projects in the

healthcare space will no doubt contribute to hesitancy from stakeholders.

The fundamental principles of this proposed model are integration and communication, and software services must

rise to the challenges of the evolving needs of the healthcare economy. Through 3rd generation software and

carefully thought-out development and integration, these challenges and needs can most certainly be met. The

crucial component at this early stage is the desire to make this work, the drive to see the NHS evolve into a world-

leading consumer of technology to support its activities.



About Hospedia

Hospedia is the world’s leading provider of point of care systems in healthcare. Hospedia’s Patient Centred Care

Platform provides patient media, patient engagement and clinical workflow solutions that support hospitals, staff,

patients and visitors worldwide, through powerful software, hardware and integration capabilities. The Platform

delivers a range of services that make a real difference to patient care while providing clinical efficiencies and

substantial financial benefits.

If this white paper has been of interest, and you would like more information about how Hospedia solutions can

be implemented to support your hospital priorities, please contact our team of experts. Our team can work with

you to help build a business case for individual circumstances, formulate an implementation plan that works

around operational requirements and assess how to tailor the service to your specific needs.

[email protected]

7_white paper hospital without walls

Documents

traditional hospital

acute care

hospital boundaries

hospital premises

social care

community care

future hospital paper

care homes