E ll i Q litExcellence in Quality

© 2008 Hewlett-Packard Development Company, L.P.The information contained herein is subject to change without notice

Digital Hospital in Practiceg pHigh Value Asset Tracking

for Healthcarefor HealthcareDiane Beattie

Integrated VP Health Information and CIO

London Health Sciences CentreLondon Health Sciences Centre

One of Canada’s largest teaching g ghospitalsThree campus sitesOver 10,000 staff membersAnnual patient care activity– 795,700 outpatients visits– 146,600 emergency visits– 40 000 admissions40,000 admissions

Patient information stored on 7 million visits

St. Joseph’s Health Care, L dLondon

Ambulatory care, mental health, yrehabilitation, complex care, veterans care, long term careFive sitesFive sitesOver 5,100 staff membersAnnual patient care activity– 479,000 outpatients visits– 25,418 day surgeries– 47 600 annual urgent care visits– 47,600 annual urgent care visits

Patient information stored on one million individuals

Governance OverviewGovernance Overview

LHSC and SJHC Structure– A shared CEO – Cliff Nordal– Integrated Vice Presidents and Senior

Medical DirectorsMedical Directors– Citywide departments

• London Laboratory Services Group (LLSG), Healthcare Materials Management Services (HMMS)

– Integrated departments• Information Management, Biomedical

Engineering– Individual departments

• Finance, Human Resources

London Health Sciences Centre and St J h’ H lth C L dSt. Joseph’s Health Care, London

Provide majority of acute and ambulatory j y yservices for approximately 1.5 million patients

Affiliated with the University of Western Ontario and more than 30 other educational institutionseducational institutions

London’s largest employerg y

Home to Lawson Health Research Institute and CSTARand CSTAR

We Believe Enabling Technologyg gy

Provides care givers a greater sense of g gcontrol 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”

We Believe Enabling TechnologyWe Believe Enabling Technology

Enhances timely collaborationEnhances timely collaboration among caregiversAccess to clinical information is enhancedFacilitates the multiple care transactions that are always in motionMoves us closer to offeringMoves us closer to offeringHigh Tech: High Touch care

Our EPR Definition

RegionalHospitals Community

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HomeCareRegional

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pLTC Facilities

CPOEClinical

Clinical Decision

ServicesHospitalsLTC Facilities

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- Focus

ED Patient

OrdersAutomation

ElectronicSi t PACS Blood Peri-Operative

ManagementReporting

ChronicDiseaseMngmt

Pharmacy

ClinicalDocumentation

Decision Support

Tran

sf

on We are here

GeneralLab PowerChart Pathology

Tracking

Dictation&

Transcription

ChartCoding &

CIHIAbstracting

PatientScheduling

Radiology,Nuclear

Med

ChartDeficiency

ChartTracking

PatientRegistration

Signature PACS Bank Care

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Upgrade

What is a Digital Hospital or H lth S tHealth System

Enables the Organization to leverage its t ti l f d li i hi h litpotential for delivering higher quality care

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 b t IT di l i ti dbetween IT medical, communication and building technologies to create a real-time information environment

So What Do Care Givers Thi k d W tThink and Want

U d t d th “A t f th P ibl ”Understand the “Art of the Possible”

Needs to be aligned with their strategic initiatives and drivers

They need to be engaged in the process

Architectural Business ITAssessmentWorkshop

Day 2 AM

RecapDay 1 AM

Introduction

Business IT

pFormat Technical

View

Recap

BusinessView

Introduction

Strategic

Wrap-upWrap-up

Day 2 PM

Recap

Day 1 PM

Recap

ImplementationView

Wrap up

FunctionalView

Wrap up

Tactical

Wrap-upWrap-up

Digital Hospital I f W k hInfrastructure Workshops

FFocus on:1) Business goals and objectives2) E t i th P i iti ti f2) Engagement in the Prioritization of

required functions3) Develop a high level solution and3) Develop a high level solution and

validate the implications4) Create an implementation roadmap

that is aligned with the priorities identified in 1 and 2 above

Key Elements of HPGM for ITSABased on stakeholder participationBased on stakeholder participationOrganized as a set of four fundamental viewsfundamental viewsExpressed as principles, models, and standardsand standards

Functional

Businessview

Technicalview

Functionalview

StakeholdersPrinciplesPrinciples

Implementationview

PrinciplesPrinciplesStandardsStandards

ModelsModels

HPGM for ITSA SummaryyThe HP approach for the DHI solution architecture is:architecture is:– Based on stakeholder participation– Organized as a set of four fundamental views– Motivated by key business

drivers, goals, and metrics– Expressed as a set of principles, Functional

Businessview

p p p ,models, and standards

– Linked to actions to ensure timely progress

Technicalview

Functionalview

p g– Supported by an extensible framework

of methods, tools, and techniquesImplementation

view

Why We Chose RFID First?Why We Chose RFID First?

Becoming a mainstream technology for g gylogistics operationsAsset location and tracking– People (eg. Infants, elderly, staff)– Equipment

IdentificationIdentification– Positive identification of patient, staff,

medications

State monitoringState monitoring– Environmental conditions (eg. Temperature,

humidity)

The RFID OpportunityThe RFID Opportunity

Asset loss 15% or greaterAsset utilization currently 35-40%Equipment search times of 30 minutes or greaterProductivity loss for Biomedical Engineering for preventative maintenance due to equipment being in sebeing in useLabour costs for environmental monitoringmonitoring Inventory management

Principles for the ProjectPrinciples for the Project

Solve a real problemp– 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

Principles for the ProjectPrinciples for the Project

Leverage existing assetsLeverage existing assets– Citywide wireless network infrastructure

in all clinical locations– PCs and thin clients located within the

target locationsFleet of infusion pumps used within– Fleet of infusion pumps used within Paediatrics environment

– Partnerships with Hewlett Packard and pCisco Systems

Project GoalsProject GoalsClinical/Medical Staff

E h ti t th h id l ti f– Enhance patient care through rapid location of 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 OperationsHospital Operations– Fleet rightsizing

• Device utilization to be calculated using busy/idle statistics gathered as part of the trial

• Equipment movement patterns to be reviewedEquipment movement patterns to be reviewed

Solution PartnersSolution Partners

HP– Project management, relationship with

Cisco and LHSC/SJHCCiCisco– LHSC and SJHC network infrastructure

is Cisco-based– Relationship to Aeroscout

Aeroscout– Industry leadership position,

relationship with Cisco

Implementation OverviewImplementation Overview

All technology proven in a testAll technology proven in a test environment prior to implementation200 pumps tagged p p ggPilot ran for five weeks45 minute training for clinical staff45 minute training for clinical staff, Biomedical engineering, help desk personnelUser feedback solicited using vendor-supplied rewards; Tim’s cards and an iPod raffle

Project MilestonesProject Milestones

Spring 2008Spring 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

Project MilestonesProject Milestones

Summer 2008– Tagging of infusion pumps– Creating of training literature– Stakeholder communication and

training– Implementationp– Gathering of user feedback– Measurement of project deliverables

against planagainst plan– Development of calculator to determine

future expansion costs

Solution Architecture

AeroScout

b lMobileView4.0

Location Engine

Wi-Fi

Network

Wi-Fi Tags, clients, integrated sensors

Device TaggingDevice Tagging

Device TaggingDevice Tagging

Device TaggingDevice Tagging

Coverage – 2nd FloorCCTC and PCCU

Filtering Searches

Can search by:Can search by:– Name (Department, – BME number))– Category– Status– Location– Group

Tag Button ConfigurationTag Button Configuration

Primary (large) button pressPrimary (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 good as the users y gusing it!! Primary Secondary

FeedbackFeedback

“It's a great step in the rightIt s a great step in the right direction”“I know it's not perfect yet, but it p y ,seems pretty good”“We should tag harder-to-find gdevices, pumps aren't that hard to find”“We need to make sure everyone uses the buttons on the tags, not

i ”everyone is”

Benefits and ROIDirect Benefits

and ROI

Reduced Capital & Operational Expenses

Regulatory Compliance

Improved Quality of Care Increase Revenuesp p p y

Reduce purchase of Increase regulatory Reduced safety Increased patient pnew equipmentReduce rental costsReduce shrinkageStaff efficiency

g ycompliance ratesReduce staff time spent on manual searching, logging

yincidentsReduced wait timesIncreased staff time with patients

pthroughputIncreased capacity of critical departments (OR/ER)y

and monitoring procedures

Increased staff productivity

Implementation ChallengesImplementation 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 wallsside of external walls– Quality of maps when drilling down on a large

scale map; room numbers unreadable

Implementation ChallengesImplementation Challenges

People and ChangePeople and Change

– Communication and training for all staffCommunication and training for all staff who handle a pump

– Staff forgetting to push the “busy” indicator button on the tag while pump in usein use

– Staff claiming “ownership” of the device

What Did We LearnWhat Did We Learn

Working together is a dailyWorking together is a daily experienceProjects have to be driven by j ybusiness needs not I.T.Circle back– Implementation is just the beginning

Communicate, communicate, communicate– Change management is key

Strong partnerships

What Did We LearnWhat Did We LearnPeople Perspectives– Find an effective means of communicating with

clinical staff; email isn't necessarily the best– Education and training for end users is

essentialessential– 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 quicklyon 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

Lessons LearnedLessons Learned

Project Perspectivesj p– Allow time to recalibrate in the middle of the

Implementation. Wireless isn't an exact science. Environmental factors may impact y pprogress (traffic flow, building construction, materials, liquids, etc.)

– Take special care of tag location and mounting p g gmethods on assets. Make them easy to use for staff pressing tag buttons to change status

– Allow budget and time for proper training of g p p gtechnical/project staff

Next StepsNext Steps

Evaluate RFID expansion to otherEvaluate RFID expansion to other devices and areasLink asset tracking to other ginitiatives such as positive patient identificationLeverage expanded wireless infrastructure on other projects such

S Ph i ias SmartPhone integration, reduction of pager requirements

Future RFID Healthcare Ideas

Real-time Equipment T t

Workflow & Patient &

Asset

Management

Equipment

Maintenance

Temperature

Monitoring Resource

Management

Patient &

Staff Safety

Technology for better business and health outcomes