peter mcmahon
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© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Digital by Default or Digital by Design
Peter McMahon
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 2
HP Confidential
Hospitals face substantial challenges
Increasing healthcare costs
Improving quality of patient care
Low productivity, stagnant even declining
Regulatory imperatives
Clinical staff shortages
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 3
HP Confidential
Where do we need to improve?
20-40% 2
WHO’s estimate of all health spending wasted through inefficiencies in the system
19.3% 1
The average proportion of time a nurse spends on direct patient care during the active nursing part of a shift
5.4% 3
Average annual increase in recurrent health expenditure in Australia
1 A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? Permanente Journal, Summer 2008 2 World Health Report (2010), Background Paper 28, data sourced from WHO National Health Accounts 2009 3 The Australian Institute of Health and Welfare 2010: Health expenditure Australia 2008-09. Health and welfare expenditure series no. 42.
• Improve productivity
• Reduce inefficiency
• Spend the $ wisely with a view to sustainability
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 4
HP Confidential
Considerations in new facility
Limited funding and focus needs to cover:
• The building itself – with considerations for a 70 year + lifespan
• Patient experience and flow
• Clinical department considerations
• Changing demographics and long term sustainability
• Integration of research and teaching organisations
• New equipment – F&F, biomedical, communications, building systems, patient interactive, end user devices
• Pharmacy, lab, imaging, outpatients, ED, ambulatory
… Oh, and your Information & Communications Technology (ICT)
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 5
HP Confidential
What you will invest in – by default…
PAS CIS LAB RAD
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 6
HP Confidential
But wait, there’s more…
PAS CIS LAB RAD
Pharma
CathLab
NICU
Onc
Dietary
Dept CISs
AIS
BYOD Nav
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 7
HP Confidential
So it seems you will have a “digital hospital”
Your investment in clinical and operational technology means that the hospital will be “digital” whether you plan it that way or not; whether you allocate funding to “digital hospital” or not.
So, will you be digital by default? Or digital by design?
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 8
HP Confidential
Without a plan, there will be piecemeal integration
Technology “Hairball” Integration “Hairball”
Costly to establish
Costly to maintain
Compromises agility
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 9
HP Confidential
Digital Hospital – by Default
User access complexities, multiple/shared sign-ons and barriers to mobility
for clinicians
Inefficient use of infrastructure tools and
technologies due to broad range of underpinning
technologies
Stretched ICT staff without critical
support skills. Clinical staff performing ICT support
functions.
Disparate and incompatible applications
& technologies with resulting integration
challenges
Constant pressure on budgets to do more with
less, reduce ICT costs
Unclear TCO/value of ICT services to the
business
Inadequate executive oversight of ICT
investments
Departmentally driven investment undermines
need for enterprise wide interoperability
Redundancies in a diverse application & technology
portfolio
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 10
HP Confidential
What’s the solution?
Devolve responsibility?
• Let departments make their own decisions using their own budgets, after all they are the experts…
Take control and dictate?
• The only way to get an environment that is secure and works is to centralise it all…
Or create an ARCHITECTURE (an enterprise architecture) that allows the digital environments within the hospital to integrate and to support the clinical and operational processes?
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 11
HP Confidential
Digital Hospital – by design
To achieve this integrated and underpinning information fabric, you need a combination of architecture and technology.
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 12
HP Confidential
What is Possible Today
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 13
HP Confidential
HP’s Digital Hospital Maturity Model
IT Domains
Facilities
Medical
Communications
Level 5
Adaptive
Level 4
Managed
Level 3
Co-ordinated
Level 2
Connected
Level 1 Initial
Level 6
Optimised
Speed Innovation to Practice, Improve Operational Efficiencies, Improve Quality of Care
• Primitive building and
security systems • Dependence on
human surveillance
• Building and security
systems integrated • Single card based
facility access
• Tasks communicated
electronically to mobile decides
• RTLS location awareness
• Closed loop task
mgmt with escalation • Role-based two factor
authentication
• Demand based
delivery of services • Bulk reconfiguration
of security privileges in near real time
• TBD
• Stand alone
modalities • Wholly paper Patient
Record
• Post-care updating of
basic EMR • Modalities accessed
and viewed separately to patient record
• Ability to view some
aspects of EMR from a central point
• Modality/ Lab/Rad outputs attached to EMR
• Full EMR update at
point of care • Some clinical decision
support • Modality/Lab/ Rad/
Meds fully integrated
• Fully integrated EMR
across facility • Support for
personalised medicine
• TBD
• Dependent on wired
telecomms • Manual routing of all
requests
• Combination of wired
and wireless comms • Some requests rules
based
• Ubiquitous wireless • Comms routed and
escalated automatically
• Presence managed • Comms routed to
nearest available
• Device independent
• TBD
• Tribal • Opportunistic
• Budget driven • Departmental
• Rationalised
• Virtualised • Facility-centric • Multi-Year Plan
• Semantically
interoperable • Care Community
Oriented
• TBD
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 14
HP Confidential
IT Domains
Facilities
Medical
Communications
Level 5
Adaptive
Level 4
Managed
Level 3
Co-ordinated
Level 2
Connected
Level 1 Initial
Level 6
Optimised
Speed Innovation to Practice, Improve Operational Efficiencies, Improve Quality of Care
• Primitive building and
security systems • Dependence on
human surveillance
• Building and security
systems integrated • Single card based
facility access
• Tasks communicated
electronically to mobile decides
• RTLS location awareness
• Closed loop task
mgmt with escalation • Role-based two factor
authentication
• Demand based
delivery of services • Bulk reconfiguration
of security privileges in near real time
• TBD
• Stand alone
modalities • Wholly paper Patient
Record
• Post-care updating of
basic EMR • Modalities accessed
and viewed separately to patient record
• Ability to view some
aspects of EMR from a central point
• Modality/ Lab/Rad outputs attached to EMR
• Full EMR update at
point of care • Some clinical decision
support • Modality/Lab/ Rad/
Meds fully integrated
• Fully integrated EMR
across facility • Support for
personalised medicine
• TBD
• Dependent on wired
telecomms • Manual routing of all
requests
• Combination of wired
and wireless comms • Some requests rules
based
• Ubiquitous wireless • Comms routed and
escalated automatically
• Presence managed • Comms routed to
nearest available
• Device independent
• TBD
• Tribal • Opportunistic
• Budget driven • Departmental
• Rationalised
• Virtualised • Facility-centric • Multi-Year Plan
• Semantically
interoperable • Care Community
Oriented
• TBD
HP’s Digital Hospital Maturity Model
Closed loop task mgmt with escalation Role-based two factor authentication
Full EMR update at point of care Some clinical decision support Modality/Lab/ Rad/ Meds fully integrated
Presence managed
Comms routed to nearest available
Virtualised
Facility-centric Multi-Year Plan
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 15
HP Confidential
You need to recognise the real (hidden?) investment in ICT
PAS CIS LAB RAD
Pharma
CathLab
NICU
Onc
Dietary
Dept CISs
AIS
BYOD Nav
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 16
HP Confidential
And DESIGN a sustainable approach to integration
Pharma
CathLab
NICU
Onc
PAS CIS LAB RAD
Dietary
Dept CISs
AIS
Nav BYOD
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 17
HP Confidential
Creating a sustainable architecture and maximising ROI
Integration Engine
Staf
f Sc
hedu
ling
Staf
f Sc
hedu
ling
Payr
oll
Payr
oll
Mat
eria
ls
Mgm
tM
ater
ials
M
gmt
Fina
nce
Fina
nce
EPR
/EM
REP
R/E
MR
HIS
/PA
SH
IS/P
AS
PAC
S/R
ISPA
CS/
RIS
LIS
LIS
Mat
ern
ity
Mat
ern
ity
OR
Sc
hedu
ling
OR
Sc
hedu
ling
Building Automation System
Mec
hani
cal
Ligh
ting
Hyd
rau
lic
Chu
te S
yste
m
Elec
tric
al
Esca
lato
r
Car
ouss
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Ver
tica
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ansp
-
AG
V
Pneu
mat
ic
Tube
Building Automation SystemBuilding Automation System
Mec
hani
cal
Mec
hani
cal
Ligh
ting
Ligh
ting
Hyd
rau
licH
ydra
ulic
Chu
te S
yste
mC
hute
Sys
tem
Elec
tric
alEl
ectr
ical
Esca
lato
rEs
cala
tor
Car
ouss
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arou
ssel
Ver
tica
l Tr
ansp
-V
erti
cal
Tran
sp-
AG
VA
GV
Pneu
mat
ic
Tube
Pneu
mat
ic
Tube
Hospital/Clinical Information System Hospital/Clinical Information System
ActiveDirectory
Vid
eo C
onf
Vid
eo C
onf
VoI
P Te
leph
ony
VoI
P Te
leph
ony
AuditRepository
Way
find
ing
&
Sign
age
Way
find
ing
&
Sign
age
Kios
k So
ftw
are
Kios
k So
ftw
are
Bed
sid
e Te
rmin
als
Bed
sid
e Te
rmin
als
PA-S
yste
mPA
-Sys
tem
BACNet, OPC, WS
TAP,
ESP
A 4
.4.4
HL7/WS
WSWS
WS
LDAP
Das
hboa
rd/
Nur
se S
tati
on
Das
hboa
rd/
Nur
se S
tati
on
Unified CommunicationUnified Communication
Video/Audio Video/Audio
Fire
Ala
rm S
yste
mFi
re A
larm
Sys
tem
Secu
rity
Secu
rity
Nur
se C
all
Nur
se C
all
E-m
ail
E-m
ail
IMIM
IV P
umps
IV P
umps
Mon
itor
sM
onit
ors
Pow
er
Syst
ems
Pow
er
Syst
ems
……
..……
..
Medical Device Middleware
Medical Device Middleware
Loca
tion
Sys
tem
Loca
tion
Sys
tem
External OrganizationsExternal Organizations
Staff Sup. Service NurseClinician Patient
• Take work out of the system
• Intelligent workflows
• Actionable alerts
• Value adaptability and standards
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 18
HP Confidential
The HP digital hospital solution and approach reduces costs
Integrated environment
Systems used more efficiently and effectively
More timely and accurate information
Service oriented architecture environment
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 19
HP Confidential
Akershus University Hospital, Norway
The hospital
• Serving an aging population of 450,000
• Obsolete and failing facilities replaced
The decision
• Build the most modern university hospital in Europe, fully equipped with the latest digital technologies
The results
• 50% reduction in adverse events
• 20% shorter length of stay
• 20% increase in activity covered by only a 2.7% increase in staff
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 20
HP Confidential
Example of integration between a StateCo & ProjectCo
Integration Engine: A Model to Consider
• Integration of State Health ICT systems is a StateCo responsibility via a Health Information Broker (HIB)
• Integration of ProjectCo systems is a ProjectCo responsibility via the HP Integration Engine (IE)
• Orchestration and Choreography between StateCo and ProjectCo is achieved and simplified via interfaces between the IE and HIB
ProjectCo Systems StateCo Systems Identity and Access
Management
IPPABX
Real Time Location
System
Security
Audio Visual Systems
Facility Service
Management
Catering
Building Management
Systems
Nurse Call
Wayfinding
Logistics, AGV,
Pneumatic tube
Identity and Access
Mangement
Patient Administration
System
Pharmacy
Pathology
Radiology
Help Desk
Supply Chain
Linen Supply
Inte
gra
tion
En
gin
e
He
alth
Info
rma
tion
Bro
ke
r
EHR/EMR
Other Clinical
Systems
Orchestration
Choreography
Events
Reference Data
Metrics
Correlations
Asset Management
Asset Management
ProjectCo
Processes
StateCo
Processes
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 21
HP Confidential
ICT: a small cost centre
• The bulk of costs are salaries (66%)
• Goods supplies 14%
• ICT is a small part
• ICT is the KEY to making personnel more efficient, data more accessible and reducing overall TCO
Pay cents to save dollars
Source: Australian Institute of Health and Welfare, Recurrent expenditure, public hospitals, 2009–10
ICT: a component of Administrative expenses
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 22
HP Confidential
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 23
HP Confidential
Conclusion
When planning a hospital, the quality of the interactions between different stakeholders, care providers and areas of the hospital as they support the patient journey will be one of the determinants of outcomes and efficiencies. ICT has a role to play in the quality of those interactions.
So, a planned “Digital Hospital” is one of the opportunities to increase productivity and improve outcomes in the health system, and it’s a proven way to drive efficiency and save money.
This won’t happen by default.
The journey has to consider all aspects of the hospital – not just medical or communications, facilities or ICT; it’s the interaction of the various domains that releases the real value.
Nothing happens in isolation…
So, when you are planning your hospital, understand that you will be a digital hospital but that the choice – “digital by design” or “digital by default” is yours.
© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Thank you. Questions?