The Smart Hospital November 10, 2015

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Christian Alexander
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1 November 10, 2015

3 Introduction Achieving Smart Hospital status or designation is a high priority, long term goal for new as well as existing hospitals. Naturally, recently completed facilities enjoy a substantial head start and will show the way for their older, peer institutions. However, existing hospitals may also attain a reasonable level of compliance through the purchase and installation of advanced technologies ranging from hard-wired and wireless networks to web-based systems run on personal telephones and hand held devices. Manufacturers will soon conclude that the market for upgrading existing hospitals will be larger than the one for new facilities, and they will quickly reconfigure systems to fill the void for apparatus capable for retrofitting older facilities. Consequently, the question at hand is two-fold; how to plan and design new facilities having maximum flexibility to incorporate future advances in technologies, but also to find ways to retrofit existing hospitals to become Smart Hospitals, for the least possible capital cost for new infrastructure and innovative technologies. Page 3

Elements of a Smart Hospital From the viewpoint of planning and design there are three principal physical elements that comprise a Smart Hospital: 1.

4 Elements of a Smart Hospital From the viewpoint of planning and design there are three principal physical elements that comprise a Smart Hospital: 1. habitable spaces such as waiting areas, examination rooms, inpatient care bedrooms, interventional rooms and surgeries, 2. the infrastructure of engineering systems, including medical gases, electrical capacity and distribution, as well as heating, ventilation and air conditioning systems (HVAC), and 3. the informational technology architecture or backbone, like secure hard-wired connectivity, wireless intercommunication (Wi-Fi) and cloud based storage for easily retrievable data. These three components provide the capacity to support new operational systems to improve patient care, as well as the capacity to implement improvements to existing facilities as each becomes necessary or highly desirable in the future. The fourth critical component consists of the Operational Systems themselves, which may run the gamut from patient registration, billing and communications systems, through electronic medical patient records, building information systems and controls, as well as more exotic advances such as robotic carts for the delivery of linens, supplies and medications (in operation at the new El Camino Hospital of Mountain View, California, a most-wired hospital within Silicon Valley). Habitable Spaces : The preeminent goal for the Smart Hospital is to provide the spaces, systems and resources within which staff may minister to patients and patients are empowered to participate actively in their recovery, personal care and well-being. Evidence of a Smart Hospital may begin at a lobby kiosk where an arriving visitor may be guided to his Page 4

destination, and an outpatient may register, make clinic appointments, receive messages from care givers, examine his/her electronic medical record and make any necessary copayments for clinic visits

and medical devices placed within the home.

Waiting areas can also be wired so that patients and visitors may make better use of their time for relaxing programming of choice and/or educational programs about home care and healthier life

5 destination, and an outpatient may register, make clinic appointments, receive messages from care givers, examine his/her electronic medical record and make any necessary copayments for clinic visits or medications through a secure information network capable of accessing all hospital systems and departments and extending outward through web-based health care applications to patient telephones and medical devices placed within the home. (The new Ambulatory Care Center for the Stanford University Health System in Emeryville, California features such kiosks on every floor and clinic entrance). Waiting areas can also be wired so that patients and visitors may make better use of their time for relaxing programming of choice and/or educational programs about home care and healthier life styles. Patients may also tap into Wi-Fi networks and the Internet on their own portable computers or smart phones. Exam and consultation rooms are outfitted with a large, wall mounted screen to be shared by patient, family and care giver for immediate access to the Patient Electronic Medical Record, recent diagnostic tests, explanations about impending procedures and/or educational materials for aftercare. (The new Kaiser Permanente Medical Office Building at Mission Bay, in San Francisco, California will open with such large television monitors in every exam and consultation room). The most wired area of the hospital, requiring the greatest band width and capacity is the Imaging Service, within which exists a plethora of diagnostic data to be stored, interpreted and communicated to primary care physicians and specialists (perhaps located miles away), nursing staff and patients, whether at the hospital or home. Operating theaters are the most complex spaces within a hospital, and each should be designed and planned as a plug and play element, having the capacity to be taken out of service for repairs or modifications without affecting adjacent operating rooms or the interventional suite as a whole. As an example, the new El Camino Hospital, has the capacity to independently and selectively disconnect all engineering systems within an individual operating theater, including medical gases, electric power, HVAC and informational technology. Once repairs are completed the room can be reconnected to all pertinent systems and returned to operation. Within the state of the art, Interventional Platform at the Memorial Sloan-Kettering Medical Center in New York City, all data gathered during every Operating Room procedure is observed, live for educational purposes, and all films and images obtained during procedures are recorded for subsequent research activities, compliance with procedural standards, careful examination for abnormalities, evaluation of the efficacy and efficiency for a given procedure and/or the subsequent recovery of the patient. Page 5

Engineering Systems and Information Technology Infrastructure : New hospital facilities must maximize the value of every investment for infrastructural capacity in order to ascertain the selection of

Though a litany of such systems could be developed herein, it is not as important for purposes of a White Paper as is a discussion of potential approaches to ensure the ability for existing hospitals

The initial steps to determine if an existing hospital can support Smart Technologies and how best to upgrade the hospital consist of an exhaustive, detailed evaluation of current patient care

integrated into a new informational architecture sufficiently robust to integrate an Electronic Medical Record, as well as technologies already in wide use by peer hospitals.

6 Engineering Systems and Information Technology Infrastructure : New hospital facilities must maximize the value of every investment for infrastructural capacity in order to ascertain the selection of state of the art systems throughout the hospital, especially those exhibiting the greatest resiliency for change and capacity to confront unknown future needs. Though a litany of such systems could be developed herein, it is not as important for purposes of a White Paper as is a discussion of potential approaches to ensure the ability for existing hospitals to successfully incorporate Smart Hospital aspects and systems. The initial steps to determine if an existing hospital can support Smart Technologies and how best to upgrade the hospital consist of an exhaustive, detailed evaluation of current patient care technologies, beginning with the telephone system, nurse call, monitoring equipment and existing technologies to determine their current state of obsolescence as well as their ability to be integrated into a new informational architecture sufficiently robust to integrate an Electronic Medical Record, as well as technologies already in wide use by peer hospitals. A subsequent step is to evaluate the physical obsolescence of the hospital itself, as to its capacity to deliver a high standard of patient care, ascertain compliance with basic building codes and ensure patient and staff safety, as required by evaluation agencies such as the International Joint Commission for Hospital Accreditation. Once a facility is deemed to be reasonably compliant for years or decades to come, only then should the facility be evaluated in detail to accommodate and integrate informational systems improvements necessary for consideration as a Smart Hospital. Subsequently the two major aspects of cost and feasibility may be reconciled through development of a long range master plan for capital investments for informational a technology and infrastructure improvements leading to the status and designation as a Smart Hospital. Page 6

WHERE ARE HEALTHCARE ORGANIZATIONS INVESTING?

HEALTHCARE FINANCING INSIGHTS REPORT ON AHA TRENDS AND 2017 HEALTHCARE OUTLOOK AHA STRATEGIC PRIORITIES: 2017-2020 WHERE ARE HEALTHCARE ORGANIZATIONS INVESTING? UPCOMING TRENDS WHAT, WHY, HOW? 46% of hospitals