2. Digital Hospital in Practice
g p
High Value Asset Tracking
for Healthcare
Diane Beattie
Integrated VP Health Information
and CIO
3.
4. London Health Sciences Centre
One of Canada’s largest teaching
g g
hospitals
Three campus sites
Over 10,000 staff members
Annual patient care activity
– 795,700 outpatients visits
– 146,600 emergency visits
– 40 000 admissions
40,000
Patient information stored on 7
million visits
5. St. Joseph’s Health Care,
L d
London
Ambulatory care, mental health,
y
rehabilitation, complex care, veterans
care, long term care
Five sites
Over 5,100 staff members
Annual patient care activity
– 479,000 outpatients visits
– 25,418 day surgeries
– 47 600 annual urgent care visits
47,600
Patient information stored on one million
individuals
6. Governance Overview
LHSC and SJHC Structure
– A shared CEO – Cliff Nordal
– Integrated Vice Presidents and Senior
Medical Directors
– Citywide departments
• London Laboratory Services Group (LLSG),
Healthcare Materials Management Services
(HMMS)
– Integrated departments
• Information Management, Biomedical
Engineering
– Individual departments
• Finance, Human Resources
7. London Health Sciences Centre and
St J
St. Joseph’s H lth C
h’ Health Care, L d
London
Provide majority of acute and ambulatory
j y y
services for approximately 1.5 million
patients
Affiliated with the University of Western
Ontario and more than 30 other
educational institutions
London’s largest employer
g y
Home to Lawson Health Research Institute
and CSTAR
8.
9. We Believe Enabling Technology
g gy
Provides care givers a g
g greater sense of
control in workplace
Creates an aura of an “enlightened
organization”
Reduces “non value” repetitive work
Leads to more timely patient care
decisions
Mitigates “errors” and “hassle factor”
10. We Believe Enabling Technology
Enhances timely collaboration
among caregivers
Access to clinical information is
enhanced
Facilitates the multiple care
transactions that are always in
motion
Moves us closer to offering
High Tech: High Touch care
11.
12. Our EPR Definition
Integration
Family
Physician
- Partially Complete
Home
Regional
Regional Care
Hospitals
p Community
Hospitals
I
LTC Facilities Services
S i
LTC Facilities
formation
CPOE Clinical - Focus
Clinical Decision
Transf
Documentation Support
Management Chronic
Orders
Reporting Disease Pharmacy
Foundation
Automation
Electronic Mngmt Blood Peri-Operative ED Patient We are here
Signature
Si t PACS
Bank Care Tracking
- Revise and
Radiology,
Chart Chart Patient
Notes Nuclear Chart
General
Dictation Med
Deficiency
Coding &
Tracking
Patient
Registration Upgrade
& PowerChart Pathology
Lab CIHI Scheduling
Transcription
Abstracting
13. What is a Digital Hospital or
H lth S t
Health System
Enables the Organization to leverage its
potential for delivering hi h quality care
t ti l f d li i higher lit
in increasingly efficient ways though the
use of IT and process redesign
Relies on technology as an integral and
fundamental part of its business strategy
Goes beyond advanced clinical systems
and includes additional integration
between IT medical, communication and
b t di l i ti d
building technologies to create a real-time
information environment
14. So What Do Care Givers
Thi k and W t
Think d Want
Understand the “Art f the P
U d t d th “A t of th Possible”
ibl ”
Needs to be aligned with their
strategic initiatives and drivers
They need to be engaged in the
process
15.
16. Architectural Business IT
Assessment
Day 1 AM Day 2 AM
Workshop p Introduction Recap
Format Strategic Business Technical
View View
Wrap-up Wrap-up
Day 1 PM Day 2 PM
Recap Recap
Tactical Functional Implementation
View View
Wrap-up
Wrap up Wrap-up
Wrap up
17. Digital Hospital
I f
Infrastructure W k h
Workshops
Focus on:
1) Business goals and objectives
2) E
Engagement in th P i iti ti of
t i the Prioritization f
required functions
3) Develop a high level solution and
validate the implications
4) Create an implementation roadmap
that is aligned with the priorities
identified in 1 and 2 above
18. Key Elements of HPGM for ITSA
Based on stakeholder participation
Organized as a set of four
fundamental views
Expressed as principles, models,
and standards
Business
view
Functional
view
Technical
Stakeholders view
Principles
Standards Implementation
Models view
19. HPGM for ITSA Summary
y
The HP approach for the DHI solution
architecture is:
– Based on stakeholder participation
– Organized as a set of four fundamental views
– Motivated by key business Business
view
drivers, goals, and metrics
– Expressed as a set of p
p principles,
p , Functional
models, and standards view
– Linked to actions to ensure timely Technical
p g
progress view
– Supported by an extensible framework
Implementation
of methods, tools, and techniques view
20.
21. Why We Chose RFID First?
Becoming a mainstream technology for
g gy
logistics operations
Asset location and tracking
– People (eg. Infants, elderly, staff)
– Equipment
Identification
– Positive identification of patient, staff,
medications
State monitoring
– Environmental conditions (eg. Temperature,
humidity)
22. The RFID Opportunity
Asset loss 15% or greater
Asset utilization currently 35-40%
Equipment search times of 30
minutes or greater
Productivity loss for Biomedical
Engineering for preventative
maintenance due to equipment
being in use
se
Labour costs for environmental
monitoring
Inventory management
23. Principles for the Project
Solve a real problem
p
– Ability to locate not just any infusion pump, but
the right infusion pump
– Predictable sizing of fleet replacement
Engage Clinical Staff
Maximize the deliverables
– Enhanced wireless network
– Multidimensional expansion
• More assets within the same footprint
• More locations to track the same assets
24. Principles for the Project
Leverage existing assets
– Citywide wireless network infrastructure
in all clinical locations
– PCs and thin clients located within the
target locations
– Fleet of infusion pumps used within
Paediatrics environment
– Partnerships with Hewlett Packard and
p
Cisco Systems
25. Project Goals
Clinical/Medical Staff
– E h
Enhance patient care th
ti t through rapid l
h id location of
ti f
equipment
• Goal: location of the right device in less than 2 minutes
100% of the time for clinical users
Biomedical Engineering
– Quickly locate broken equipment and support
preventative maintenance efficiencies
– Reduced time to locate devices by Biomedical
Engineering staff
Hospital Operations
– Fleet rightsizing
• Device utilization to be calculated using busy/idle
statistics gathered as part of the trial
• Equipment movement patterns to be reviewed
26. Solution Partners
HP
– Project management, relationship with
Cisco and LHSC/SJHC
Cisco
Ci
– LHSC and SJHC network infrastructure
is Cisco-based
– Relationship to Aeroscout
Aeroscout
– Industry leadership position,
relationship with Cisco
27. Implementation Overview
All technology proven in a test
environment prior to implementation
200 pumps tagged
p p gg
Pilot ran for five weeks
45 minute training for clinical staff
staff,
Biomedical engineering, help desk
personnel
User feedback solicited using
vendor-supplied rewards; Tim’s
cards and an iPod raffle
28. Project Milestones
Spring 2008
– Wireless network modifications,
including migration to Lightweight
Wireless Access Point Protocol,
addition access points to support
location services, removal of IPX
,
routing, introduction of location
appliance
29. Project Milestones
Summer 2008
– Tagging of infusion pumps
– Creating of training literature
– Stakeholder communication and
training
– Implementation
p
– Gathering of user feedback
– Measurement of project deliverables
against plan
– Development of calculator to determine
future expansion costs
36. Tag Button Configuration
Primary (large) button press
– Press once to set pump status to IN USE
Primary (large) button long press
– Press and hold for 5 seconds to set pump status to AVAILABLE
Secondary (small) button long press
– Press and hold for 5 seconds to set pump status to REQUIRES
MAINTENANCE
Using the buttons will help you locate
“available” pumps – the system is
only as g
y good as the users
using it!! Primary Secondary
37. Feedback
“It's a great step in the right
It s
direction”
“I know it's not perfect y , but it
p yet,
seems pretty good”
“We should tag harder-to-find
g
devices, pumps aren't that hard to
find”
“We need to make sure everyone
uses the buttons on the tags, not
everyone i ”
is”
38. Benefits and ROI
Direct Benefits
and ROI
Reduced Capital & Regulatory Improved
Increase Revenues
Operational Expenses
p p p
Compliance Quality of Care
y
Reduce purchase of
p Increase regulatory
g y Reduced safetyy Increased patient
p
new equipment compliance rates incidents throughput
Reduce rental costs Reduce staff time Reduced wait times Increased capacity of
Reduce shrinkage spent on manual Increased staff time critical departments
y
Staff efficiency searching, logging with patients (OR/ER)
and monitoring Increased staff
procedures productivity
39. Implementation Challenges
Technical
– Removal of IPX traffic from the wireless
network; affected all notebook images,
Workstations on Wheels
– Repositioning of existing Access Points;
confusion with contractors on coverage service
vs. location-based service
– Tag quality; we may have received a bad batch
– Location accuracy; assets shown on the wrong
side of external walls
– Quality of maps when drilling down on a large
scale map; room numbers unreadable
40. Implementation Challenges
People and Change
– Communication and training for all staff
who handle a pump
– Staff forgetting to push the “busy”
indicator button on the tag while pump
in use
– Staff claiming “ownership” of the device
41. What Did We Learn
Working together is a daily
experience
Projects have to be driven by
j y
business needs not I.T.
Circle back
– Implementation is just the beginning
Communicate, communicate,
communicate
– Change management is key
Strong partnerships
42. What Did We Learn
People Perspectives
– Find an effective means of communicating with
clinical staff; email isn't necessarily the best
– Education and training for end users is
essential
– Get everyone on board quickly. Show the
benefit of the system and get everyone
comfortable with the system so they can focus
on their jobs and find pumps quickly
– Budget the correct amount of time for project
staff to dedicate to a project; Don’t layer on top
of other project and support activities
– Determine early adopter areas and have project
team and stakeholders sign off prior to
implementation
43. Lessons Learned
Project Perspectives
j p
– Allow time to recalibrate in the middle of the
Implementation. Wireless isn't an exact
science. Environmental factors may impact
y p
progress (traffic flow, building construction,
materials, liquids, etc.)
– Take special care of tag location and mounting
p g g
methods on assets. Make them easy to use for
staff pressing tag buttons to change status
– Allow budget and time for p p training of
g proper g
technical/project staff
44. Next Steps
Evaluate RFID expansion to other
devices and areas
Link asset tracking to other
g
initiatives such as positive patient
identification
Leverage expanded wireless
infrastructure on other projects such
as SSmartPhone i
Ph integration,
i
reduction of pager requirements
45. Future RFID Healthcare Ideas
Real-time Workflow &
Equipment Temperature
T t Patient &
Asset Resource
Maintenance Monitoring Staff Safety
Management Management
