THIS ARTICLE APPEARED IN ‘CANADIAN HEALTHCARE TECHNOLOGY’ (June/July 2016)
Technology is transforming the health care industry in startling ways. Whether it’s social media allowing healthcare facilities to reach patients more quickly, new technologies improving research so experts can make care more effective, or information technology making care safer through more reliable information-keeping practices, technology is now giving the healthcare industry a timely upgrade. Yet, despite the deployment within health systems of a variety of advanced technologies intended to improve patient care, too often such technologies operate in silos, reside in disparate systems within the hospital, and generally fail to achieve the hoped-for patient outcomes.
The “Smart” Hospital
It is possible today to create a technologically “Smart” hospital environment where advanced technologies are integrated and transform care delivery. The main features of a “Smart” hospital depend on the preferences of a particular health system, but can include:
- Establishing a common framework to exchange information to automate workflows;
- Optimizing information exchange through a software platform that facilitates the interoperability of information shared across multiple devices;
- Automating and making systems and devices interoperable;
- Leveraging predictive analytics to make new intelligence available to assist decision making;
- Creating ambient intelligence that recognizes the presence of humans;
- Making the hospital context aware so devices recognize individuals or situational contexts;
- Enabling a degree of semi-autonomous (customized) functions;
- Making all functions are available through mobile devices; and
- Enabling a platform that allows for pervasive computing (works on any device, location, or format).
Innovations in pervasive computing and ambient intelligence now make the Smart hospital a possibility, allowing hospitals to re-organize their care delivery model to embrace a connected health strategy that leverages digital communications and the Internet of Things (IoT). The IoT is a new pervasive computing paradigm in which everyday objects become capable of both adding information to the network and responding to information from the network, and interacting with each other in ways that help to improve patient outcomes.
The Internet of Healthcare Things (an official mark of Mackenzie Health) builds on the IoT, and allows a health system to deploy a compelling patient healthcare strategy. Such a strategy is enabled today by some key functionalities, including: Information Communication and Automation Technology (ICAT); the use of IP addressable communications and medical devices, sensor systems, embedded systems, intelligent building systems, and hospital information systems, and; a blend of bidirectional communication and cognitive analytics. Ultimately, the goal of the Smart hospital is to transform the hospital experience to make it patient-centred, staff-centred, and hospital-centred.
The Smart hospital should also be designed to integrate with other initiatives structured to improve patient health and safety, whether provincial, federal, local, and of course with the strategies, in Ontario, of Local Health Integration Networks (LHINs). Finally, the Smart hospital should focus on innovation, and driving improvements in health care delivery, hospital process redesign, efficiency, and financial performance. As noted above, the Smart hospital is a flexible concept that can be adjusted to include and reflect the aspirations of individual health systems.
Managed ICAT Services
Having a Smart hospital vision is critical, but having the right platform to enable the Smart hospital vision is equally important. The Managed ICAT Services (MIS) platform brings the pieces together to deliver important components of the vision. Built on the Managed Equipment Services (MES) platform, which has been successfully implemented several times in Canada, the MIS platform includes, among other features, (a) a flexible, long-term program, ranging from 10 to 15 years, (b) a predictable equipment and services investment plan (ESIP) and services model that guarantees equipment replacement (refresh), (c) a stable payment stream which is equalized throughout the term, (d) a contract that allows for the transfer of risk to the party best suited to manage it, and (e) a structure that ensures higher accountability and coordination between the parties. With MIS, a single service provider manages the purchase, implementation and support of equipment and services from multiple suppliers, and consolidates maintenance and services. A service desk function is set up for ICAT-related issues and technology upgrades. To incent and sustain the desired level of performance, financial penalties are applied against performance deficiencies.
The MIS model establishes a long-term, sustainable operations-focused partnership, one that facilitates stable, predictable pricing for the term of the contract, and in which various risks are transferred to the service provider (ie, implementation, pricing and service risks). Importantly, the MIS model encourages innovation and forms the bedrock on which the Smart hospital vision rests.
In this model, the MIS service provider is required to actively support the delivery of the Smart hospital vision, as defined by the health system. The service provider provides the information technology expertise and advice needed to help the health system achieve its data exchange and interoperability objectives.
The MIS service provider also supports the delivery of the health system’s planning principles, some of which may include, for example, optimizing the patient and family experience through the eyes of the patient; organizing the services so they maximize the efficient delivery of quality patient care, and; supporting change through flexible facility design. Importantly, the service provider organizes the health system’s access to specific industry experts, in line with its vision, and coordinates their work effort for the benefit of the health system. In all cases, the health system establishes its own planning principles, which the MIS provider is mandated to support and deliver.
The purpose of deploying advanced technologies is to accelerate and further the exchange of information within health systems to improve healthcare delivery. So far, health information systems (HIS) and electronic health systems (EHR) have played an important role in upgrading care delivery. MIS goes further, however, by providing a comprehensive infrastructure that brings together clinical and business information systems. MIS forms the financial, procurement and legal platform that health systems require to allow the Internet of Healthcare Things to be deployed in the creation of the Smart hospital.