1. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
DigitalbyDefaultor
DigitalbyDesign
Peter McMahon

2. © 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

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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-HospitalTime and MotionStudy: How Do Medical-SurgicalNurses Spend Their Time? Permanente Journal, Summer 2008
2 World Health Report (2010), BackgroundPaper 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 $ wiselywitha view to sustainability

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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)

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What you will invest in – by default…
PAS CIS LAB RAD

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But wait, there’s more…
PAS CIS LAB RAD
Pharma
CathLab
NICU
Onc
Dietary
Dept CISs
AIS
BYOD
Nav

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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?

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Without a plan, there will be piecemeal integration
Technology“Hairball”Integration “Hairball”
Costly to establish
Costly to maintain
Compromises agility

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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

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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?

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HP Confidential
Digital Hospital – by design
To achieve this integrated and underpinning information fabric, you need a
combination of architecture and technology.

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HP Confidential
What is Possible Today

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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

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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

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You need to recognise the real (hidden?) investment in ICT
PAS CIS LAB RAD
Pharma
CathLab
NICU
Onc
Dietary
Dept CISs
AIS
BYOD
Nav

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HP Confidential
And DESIGN a sustainable approach to integration
Pharma
CathLab
NICU
Onc
PAS CIS LAB RAD
Dietary
Dept CISs
AIS
Nav
BYOD

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HP Confidential
Creating a sustainable architecture and maximising ROI
Integration Engine
Staff
Scheduling
Staff
Scheduling
PayrollPayroll
Materials
Mgmt
Materials
Mgmt
FinanceFinance
EPR/EMREPR/EMR
HIS/PASHIS/PAS
PACS/RISPACS/RIS
LISLIS
MaternityMaternity
OR
Scheduling
OR
Scheduling
Building Automation System
Mechanical
Lighting
Hydraulic
ChuteSystem
Electrical
Escalator
Caroussel
Vertical
Transp-
AGV
Pneumatic
Tube
Building Automation SystemBuilding Automation System
MechanicalMechanical
LightingLighting
HydraulicHydraulic
ChuteSystemChuteSystem
ElectricalElectrical
EscalatorEscalator
CarousselCaroussel
Vertical
Transp-
Vertical
Transp-
AGVAGV
Pneumatic
Tube
Pneumatic
Tube
Hospital/Clinical Information SystemHospital/Clinical Information System
Active
Directory
VideoConfVideoConf
VoIP
Telephony
VoIP
Telephony
Audit
Repository
Wayfinding&
Signage
Wayfinding&
Signage
KioskSoftwareKioskSoftware
BedsideTerminalsBedsideTerminals
PA-SystemPA-System
BACNet, OPC, WS
TAP,ESPA4.4.4
HL7/WS
WS
WS
WS
LDAP
Dashboard/
NurseStation
Dashboard/
NurseStation
Unified CommunicationUnified Communication
Video/Audio Video/Audio
FireAlarmSystemFireAlarmSystem
SecuritySecurity
NurseCallNurseCall
E-mailE-mail
IMIM
IVPumpsIVPumps
MonitorsMonitors
Power
Systems
Power
Systems
……..……..
Medical Device
Middleware
Medical Device
Middleware
LocationSystemLocationSystem
External OrganizationsExternal Organizations
Staff Sup. Service NurseClinician Patient
• Take work out of the
system
• Intelligent workflows
• Actionable alerts
• Value adaptability
and standards

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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

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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

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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 SystemsIdentity 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
IntegrationEngine
HealthInformationBroker
EHR/EMR
Other Clinical
Systems
Orchestration
Choreography
Events
Reference Data
Metrics
Correlations
Asset Management
Asset Management
ProjectCo
Processes
StateCo
Processes

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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

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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.

24. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.
Thankyou.
Questions?
pmcmahon@hp.com