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The “Hospital Without Walls” for the 21st Century
What is the “Hospital Without Walls”?
The hospital has been the centre of our model of acute and emergency care since the inception of the NHS in the late forties. However the Royal College of Physicians (RCP) “Future Hospital: caring for Medical patients” paper and current NHS Strategy challenges whether the traditional hospital can provide “the integration, collaboration, communication, and information sharing needed to care for today’s typical patients, many of whom are elderly, have multiple and complex illnesses, and are often confused.”
The RCP proposed an alternative to the traditional model, the “Hospital Without Walls”.
This “Hospital Without Walls” vision changes how we currently deliver acute care, and raises the question of how the software, systems and solutions used by the NHS should integrate all aspects of care provision, across acute, community, social care, health and social services. The increasing need for this integration, and the need to extend it beyond the hospital premises and out into the whole healthcare economy, embodies the “hospital without walls” concept and gives Patient Flow solutions a particular challenge, particularly in supporting the transparency and information sharing agenda.
Andy McKee, ExtraMed Product Manager, Hospedia Ltd
7
Contents
Integration and Information ............................................................................................................................ 3
The Clinical Coordination Centre ................................................................................................................. 3
Considering Patient Experience .................................................................................................................. 4
Electronic Patient Records and Patient Administration Systems ........................................... 4
The Software, The Backbone ...................................................................................................................... 5
About ExtraMed3 .................................................................................................................................................. 5
Unified Communications .................................................................................................................................. 6
Is it possible? ........................................................................................................................................................... 7
The “Hospital Without Walls” for the 21st Century
Page 3 ©Hospedia Ltd 2014 November 2014
Integration and Information
The Future Hospital paper recommends that responsibility for care be shared between patients and practitioners in
hospitals and community care, and be “continuously supported by a virtual dialogue.” This dialogue incorporates
acute hospitals, community hospitals, care homes, social services, mental health trusts and ambulance services,
and will rely on the effective use of IT systems to share and update information outside the hospital boundaries.
Those systems must be designed to facilitate a shared view of patient care and flow individually and collectively,
across highly complex healthcare economies.
Information flow is key; seamlessly coordinating this level of interaction between widely disparate services, while
maintaining security and patient care, will drive the need for software solutions that can represent all of the
stakeholders within a single view (using multiple systems) and deliver patient-centred information that flows with the
patient as they cross organisational boundaries.
The Clinical Coordination Centre
At the core of the Future Hospital vision sits the Clinical Coordination Centre (CCC) – an operations hub where
an array of screens will display
critical information including patient
flow across the hospital, individual
patient care status and updates, and
standard protocols and alerts.
In healthcare economies across the
globe we are seeing the emergence
of similar solutions to address the
rising complexity and expectations
placed on managing acute care. If
we look to the United States we can
see a rising interest in the “Air Traffic
Control” model – indicating that the
requirement for integrated views
of care extends across healthcare
models.
It’s not just healthcare itself that drives this need, the involvement of various organisations operating in the
healthcare space also affect the needs and requirements of providers. The influence of Accountable Care
Organisations in the US, and Clinical Commissioning Groups in England, will create demand for increasingly integrated
views which will grow as all healthcare organisations seek to manage the operation, reporting and communication
of complex flows seamlessly. Centralising this information, in a Clinical Coordination Centre, may become the gold
standard in handling this complexity.
The “Hospital Without Walls” for the 21st Century
Page 4 ©Hospedia Ltd 2014 November 2014
Presenting the information required by a Clinical Coordination Centre, in meaningful ways, requires not only the
software solutions that can provide that information but also hardware that can display it clearly and accessibly.
That hardware goes beyond the “mission control” style set-up of the CCC, and extends to the wards, the community
teams and other associated healthcare providers. Whether it takes the form of high-end display screens or mobile
devices, the right hardware can make the information available where it’s needed, when it’s needed, and should not
be forgotten in discussions that tend to focus on software needs.
Considering Patient Experience
From the patient’s point of view, the number of separate departments, consultants and even organisations involved
in their care can be overwhelming. The authors of the Future Hospital envisage a system whereby patients are not
“discharged”, but that care is seamless both in and out of hospital.
While the gold standard of a shared patient record may be attainable in the future, the immediate concern of
providers should be to ensure that useful data is already being shared. If not the entire patient record, at least basic
information in patient care and treatment supporting patient flow should be accessible to all applicable services -
which patients are attending, where, and the basic information required to complete each patient’s care.
The intention of the hospital without walls is to create a healthcare environment where patients are able to move
throughout their journey feeling like everyone they come into contact with is fully informed about their care plan,
their needs and their issues. Only through integration, information sharing and communication can this be achieved.
Electronic Patient Records and Patient Administration Systems
Although the UK is not the only country in the world currently struggling to achieve success in consistently and
completely sharing patient records effectively with all stakeholders, this failure is a big concern to the authors of
the Future Hospitals report and NHS in general. Finding a way to improve this situation must be a priority. PAS and
EPR systems have long been the cornerstone of information within the hospital, and as an embedded part of the
healthcare system, this is likely to remain the case for the foreseeable future.
However, delivering an integrated EPR system that meets the need of the hospital is a significant financial and
operational investment, with full benefits often not realised for years. While the EPR system is an essential part
of the modern hospital the question is whether or not these single systems can deliver the level of flexibility and
openness that the hospital without walls model demands when managing complex patient flows, and therefore
demonstrate their value beyond the purely financial, or whether they can be integrated with other solutions to a level
that creates a unified view of patient care across the whole healthcare economy.
The “Hospital Without Walls” for the 21st Century
Page 5 ©Hospedia Ltd 2014 November 2014
The Software, The Backbone
Underpinning the concepts of the hospital without walls
and the Clinical Coordination Centre is the need for powerful
software solutions; solutions that have been fundamentally
designed for the level of integration required to support the
needs of the future hospital.
The Clinical Coordination Centre concept presents challenges
for software developers used to dealing with relatively static
patient groups inside a single organisation, with a need to
progress to presenting complex data sets in meaningful ways.
The value is in useful, usable information, presented in such
a way as to avoid information overload. Whatever the answer
is, it is unlikely to be as simplistic as a series of dials on a
dashboard, as traditional models have employed.
Delivering IT systems which support a seamless view of patient
care will require close cooperation between system providers
in ways not yet envisaged, but which are likely to push the
existing models of healthcare integration beyond the current
limitations of HL7. There’s no single, out-of-the-box solution that
can meet all of the needs of the future hospital, and the ability
to share snapshots of capacity and demand, escalation alerts,
and patient focused information will require software providers
to develop new ways of working with each other, to the benefit
of the users and the patients.
Existing software that has been designed to be seamlessly
integrated into the healthcare space, such as ExtraMed Patient
Flow Management, is known as third generation software.
Unlike previous iterations of development, where required
features and modules are added onto existing systems,
in third generation software the development starts again
from the beginning. Instead of modules developed in silos
to meet individual needs, the overall system is considered,
developed and future-proofed. The platform is re-engineered
to be efficient, using the same logic across all elements to
allow future expansion to occur without the need for each
section of the system to be updated independently. This
style of redeveloping healthcare systems for the future will
become increasingly important, with requirements changing
and increasing rapidly as we move towards the “without walls”
model.
About ExtraMed3
Designed to apply the significant benefits
of integrated systems to healthcare,
ExtraMed3 has been reengineered from its
roots in patient flow management, taking
into account user feedback, to create a
fully integrated system that can be adapted
and upgraded with ease. The Hospedia
Clinical Workflow Platform provides a robust
open API which gives IT departments the
ability to deeply integrate with existing
applications (or even build new Apps on an
existing platform).
The system provides a comprehensive
toolkit to manage patient care and the
patient journey, from pre-admission to
post-discharge. The benefits of ExtraMed3
extend beyond clinical efficiencies and
patient experience, with significant cost
savings validated by Deloitte, showing that
the system can deliver annual cost savings
of £4.3m through reducing length of stay,
clinical efficiencies worth £170k per annum,
and £840k worth of annual savings through
the prevention of hospital infections.
The “Hospital Without Walls” for the 21st Century
Page 6 ©Hospedia Ltd 2014 November 2014
In all areas of healthcare, software developers need to
recognise that data is expanding - not only is it coming in
from a wider variety of sources than ever before, it is also
being shared with and used by a wider group of stakeholders.
Multiple systems within a hospital, sources outside the hospital
walls, and stakeholders that work both in and out of the
physical hospital location, are all relying on up to date, shared
data. There is a significant need to need to understand the
different “personas” using the information available, and ensure
that information is presented appropriately no matter what the
audience. Although the definition of the data to be shared will
be determined by the organisations themselves, the method of
presentation is an area that software developers must address.
Information Governance (IG) and risk management are
two areas that software solutions must get right, to
ensure that enabling the sharing of information between
organisations achieves the goal of smooth and effective
patient handover without any compromise to confidentiality.
This is a considerable challenge. To begin the process of
integration, developers should engage with IG teams and
senior management, who can support quick progress in this
area by identifying data that could be shared without risking
confidentiality.
Unified Communications
Unify’s Unified Communications (UC)
solutions bring together voice, mobility,
Web collaboration, video, messaging, and
contact centre applications into a single,
purpose-built unified user experience.
These solutions empower today’s
anywhere healthcare workers with tools
to communicate and collaborate more
effectively. Combined Patient Flow and UC
solutions can support the Hospital Without
Walls by providing the user with information
about and access to a patient’s care team
in real time.
Supporting virtual board meetings with
widely dispersed teams, supporting direct
access to effective communication for ad-
hoc meetings about patient care (rather
than waiting for scheduled reviews) to
facilitate speedy decision making and
bringing teams together to deal with
operational issues in real time.
Unify, formerly Siemens Enterprise
Communications, has teamed with
Hospedia, to deliver the UK’s first UC
enabled point-of-care patient workflow
solution. The net result recovers lost time
and productivity that yields significant hard
and soft savings, and increases patient
satisfaction.
The “Hospital Without Walls” for the 21st Century
Page 7 ©Hospedia Ltd 2014 November 2014
Is it possible?
The goal of achieving the “Hospital Without Walls” is a noble one, with significant benefits to healthcare
organisations, staff and patients, bringing healthcare to the leading edge of technology and service. There are,
however, some significant hurdles to overcome, and the traditionally poor application of national IT projects in the
healthcare space will no doubt contribute to hesitancy from stakeholders.
The fundamental principles of this proposed model are integration and communication, and software services must
rise to the challenges of the evolving needs of the healthcare economy. Through 3rd generation software and
carefully thought-out development and integration, these challenges and needs can most certainly be met. The
crucial component at this early stage is the desire to make this work, the drive to see the NHS evolve into a world-
leading consumer of technology to support its activities.
The “Hospital Without Walls” for the 21st Century
Page 8 ©Hospedia Ltd 2014 November 2014
About Hospedia
Hospedia is the world’s leading provider of point of care systems in healthcare. Hospedia’s Patient Centred Care
Platform provides patient media, patient engagement and clinical workflow solutions that support hospitals, staff,
patients and visitors worldwide, through powerful software, hardware and integration capabilities. The Platform
delivers a range of services that make a real difference to patient care while providing clinical efficiencies and
substantial financial benefits.
If this white paper has been of interest, and you would like more information about how Hospedia solutions can
be implemented to support your hospital priorities, please contact our team of experts. Our team can work with
you to help build a business case for individual circumstances, formulate an implementation plan that works
around operational requirements and assess how to tailor the service to your specific needs.