The University of Pittsburgh Medical Center teamed with IBM to implement SmartRoom, a workflow optimization system that guides nursing decisions and activities through interactive, in-room solutions.

1. UPMC reshapes the
nursing unit with
SmartRoom
A few years ago, the University of Pittsburgh Medical Center (UPMC)
Overview and IBM decided to build on their shared vision of the future of
healthcare by forming a unique and far-reaching partnership aimed at
The need
developing and commercializing new clinical solutions. One of
UPMC sought to improve the workflow
efficiency in its nursing units to enhance UPMC’s defining qualities as an organization is a pervasive entrepre-
the quality of care, reduce costs/errors neurial culture driven by an intense commitment to improving patient
and leverage its nursing resources more care through clinical innovation. IBM’s partnership with UPMC taps
effectively.
directly into this quality and demonstrates how a shared vision of
The solution healthcare innovation can produce real results.
Supported by its innovative
partnership with IBM, UPMC developed
As the current national discussion around healthcare reform has shown,
SmartRoom, a workflow optimization
system that leverages clinical intelli- the battle to improve healthcare delivery—to make it safer, more
gence to guide nursing decisions and efficient and more cost effective—has many fronts. One of the most
activities. important is the inpatient nursing unit environment within hospitals,
What makes it smarter which in many ways represents the backbone—the “front line”—of the
As nurses address ad hoc challenges healthcare delivery system. As the point of most intensive contact
on the fly, SmartRoom’s underlying clin- between caregivers and patients, nursing units are the scene of a con-
ical algorithms automatically adapt the
stant choreography of activities, the majority of which are routine and
prioritization of tasks, ensuring that
patients get the right treatment at the predictable. Patients are monitored and tested, administered medica-
right time—thus improving care and tions, and, if necessary, repositioned while in their beds to avoid
reducing errors. pressure ulcers—all in strict accordance with guidelines around timing,
The result frequency and dosage. That’s just a sampling.
“Our aim is to provide the right care, at
the right time, all the time. SmartRoom
is an example of how our partnership
with IBM is helping us meet that goal.”
—Tami Minnier, RN, chief quality officer,
UPMC

2. Mixing the routine and the unpredictable
Business benefits Around this core framework of tasks, nursing staff are also required to
respond to ad hoc situations that routinely pull them away from their
● Reduction in time spent completing
documentation of nursing tasks
more structured regimens. This may include consulting with attending
physicians, handling emergency situations, answering questions from
● Expected reduction in medical errors patients’ families and above all, providing compassionate care at the
● Additional time that nurses can use to patient’s bedside. It also includes the kind of critical thinking required
focus on compassionate caregiving to spot and solve problems. On top of all this, nursing units need to
● Easier allocation of work among nurs- make a seamless handoff from one shift to the next to ensure not only
ing unit staff continuity of care, but also that clinical “red flags” are not missed in
● Improved patient satisfaction the transition. For nursing staff, it’s a tall order that relies heavily on
memory, direct face-to-face communication and lots of walking.
● More seamless hand off of patient
information between shifts
Within this task mix, UPMC saw the opportunity to improve the qual-
● Improved identification and tracking ity of care and timeliness of completed tasks by structuring those parts
of patient problems
of the nursing unit workflow where practical and by providing nursing
● Helps to ensure timeliness of tasks staff with information support that enables them to focus less on
performed, such as turning patients at
risk of bed ulcers remembering their complex list of “to do’s” and—once they’re done—
easily recording them as completed at the point of care. Leveraging its
● Nursing management has better data
on what time requirements are
own clinical expertise and IT staff, UPMC designed and implemented
needed on nursing units each and a workflow module known as SmartRoom, which uses interactive, in-
every hour room screens to present nurses and nursing support personnel with a
prioritized sequence of tasks to be performed for a given patient (in
that patient’s room), as well as a prompted suggestion on which room
they need to go to next.
Smarter healthcare: Leveraging intelligence to guide the nursing workflow
Instrumented In-room sensing devices authenticate nursing staff and trigger the
retrieval and display of relevant patient information.
Interconnected SmartRoom connects UPMC’s clinical knowledge base and best
practices in real time to nurses on the floor.
Intelligent Algorithms developed by UPMC clinical staff control the prioritiza-
tion of nursing tasks, ensuring the right treatment at the right time.
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3. Bringing intelligence to the bedside
Solution components UPMC’s SmartRoom solution is supported by real-time linkages back
into key clinical systems such as pharmacy and lab services. At any
Software
● IBM WebSphere® Message Broker
given time, the underlying workflow module compiles a list of required
● IBM WebSphere Application Server tasks from various backend systems, using algorithms derived from
UPMC nursing staff activities that indicate the order in which tasks
Servers
should be done. To control access to this information, SmartRoom
● IBM BladeCenter® HS21
employs indoor positioning technology from IBM Business Partner,
Services Sonitor Technologies, which uses in-room ultrasound sensing devices
● IBM Global Business Services® to identify the nurse—or any other hospital staff member—entering
● IBM Global Technology Services
the room. Once authenticated, the nurse calls up the task list on the
IBM Business Partner display screen within the room. Upon performing the task, the nurse
● Sonitor Technologies can easily confirm on the touch screen that it was completed, and this
triggers the automatic updating of the appropriate electronic records.
Additional clinical information can be pulled up in the room with the
patient’s permission.
“SmartRoom improves
the quality of care by Importantly, UPMC designers realized that the true test of
providing information SmartRoom’s effectiveness is its ability to adapt to the decidedly non-
linear nature of the average nurse’s task sequence. Interruptions in the
directly to the bedside— core workflow can range from brief (getting a blanket for a patient or
where it’s needed most— new physician orders) to prolonged (an extended discussion with a
patient’s family). In either case, time lapses and priorities change. The
not to a computer in the
intelligence of the UPMC solution is seen in its ability to dynamically
hallway or to a worksta- adapt the task list based on the comparative time sensitivity of the
tion at the nursing different tasks on the list. This means, for instance, that a task initially
placed fourth on the priority list could be escalated to the number one
desk.” priority, if not performed within a specific timeframe. This rules- and
intelligence-based adaptability ensures that UPMC patients receive the
—David Sharbaugh, senior director of
UPMC’s Center for Quality Improvement and
Innovation
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4. right treatment at the right time. While technology enables this intelli-
gence in the form of algorithms, the logic that guides it comes directly
from the clinical knowledge of UPMC nurses and physicians. Rather
than trying to industrialize nursing or deploy a new gadget, this tech-
nology is making routine tasks easier and allowing nurses more time to
do what they are trained for—critical thinking and spending time with
patients at the bedside.
UPMC’s SmartRoom solution is a textbook example of the technology
and strategic benefits of its partnership with IBM. After developing its
own prototype of the solution using home-grown technology, UPMC
worked with IBM to create more open interfaces with backend sys-
tems. Using IBM WebSphere® Message Broker to create an enterprise
service bus between the solution and its clinical systems, UPMC was
able to redesign the solution using a service-oriented architecture
(SOA) with open interfaces. In addition to making it easier to
deploy the SmartRoom solution more broadly within UPMC, this
SOA-centric approach also facilitates UPMC and IBM’s joint strategy
of offering innovative clinical solutions like SmartRoom to other
healthcare providers as commercial offerings. Moreover, UPMC can
deploy such solutions on its existing virtualized infrastructure (powered
by IBM hardware and software), which help guarantee the high levels
of availability that all clinical applications require.
Improving patient care is the fundamental driver behind all of
UPMC’s clinical innovations, and represents the primary benefit
of the SmartRoom initiative, explains David Sharbaugh, senior director
of UPMC’s Center for Quality Improvement and Innovation.
“SmartRoom improves the quality of care by providing information
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5. directly to the bedside—where it’s needed most—not to a computer in
the hallway or to a workstation at the nursing desk,” says Sharbaugh.
“The less nurses have to focus on mundane, predictable tasks, the more
they can focus on the human, compassionate side of patient care.” The
same dynamic holds true for the time spent documenting completed
tasks. By sharply reducing this part of the nursing workload—the
reduction was 57 percent in the initial 22-bed evaluation unit—
SmartRoom enables nursing staff to spend more time at the bedside
and less walking to and from a computer terminal. Finally, SmartRoom
is also expected to improve patient safety by providing nursing staff
with bedside access to detailed, up-to-the-minute information on not
only prescriptions and doses, but also allergies and risk factors such as
patient falls—all of which give caregivers the tools they need to make
the right clinical decisions.
Changing the patient experience
UPMC also designed the SmartRoom solution to alleviate the disori-
entation that hospital stays can induce in patients. The ability to send
and receive emails, for example, provides patients with a crucial link to
friends and family. More powerful is the way SmartRoom removes the
“mystery” element of hospital stays by letting patients know who just
entered the room, what tests or procedures they have scheduled that
day and what they can expect to experience. These are just some of the
ways UPMC expects greater control to translate into higher patient
satisfaction.
Chief quality officer Tami Minnier, RN sees the SmartRoom project as
embodying the vision that guides UPMC’s innovation efforts. “Our
aim is to provide the right care, at the right time, all the time,” says
Minnier. “SmartRoom is an example of how our partnership with
IBM is helping us meet that goal.”
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6. For more information
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Produced in the United States of America
July 2010
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