In Connected Care Part One, we looked at a macro view of Connected Healthcare—across institutions, homes, researchers, manufacturing, administrative and government organizations.
Now let’s zoom in to the place which most people associate with healthcare—the hospital.
The modern hospital is generally a physical maze to the staff and visitors. It is also a digital maze of non-standard technologies, legacy software applications, and devices of all kinds—wireless and wired.
In the connected healthcare world, we often talk of interoperability, but don’t often see it. We see multiple frequencies, multiple devices, some of which are collecting data on the equipment’s condition, and some extremely smart devices collecting data about the dispensing of treatment and status of patients. Most of us, at some time, have experienced the plethora of these new and old technologies that have come to be part of the patient and care giver experience.
Of late, Real-time Locating Systems (RTLS) has been making an entree in the hospital environment. The concept is simple—medical equipment is expensive, and hospitals usually buy more than they seem to need, since when you need it—you must have it. Lives are to be saved, patients are to be transported, tests are to be done, and so what is the big deal about buying extra? Busy staff are unlikely to return these assets once they use them—they are off to the next ringing bell.
Early projects with RTLS were useful, have ROI, but are bland. Wheel chairs, pumps, monitors, etc. are tagged and then located. But early RTLS projects introduced yet another layer of technology to the mass of devices already in use, with more training on yet another technology, another procedure.
People, Patients and Things...
The reality is, although these projects might be interesting, there has not been too much growth in the “tracking things in the hospital business.” Not that the projects don’t have value, but these project have to compete for investment dollars along with many other expenses. When you can buy a new MRI or latest equipment for a cutting edge procedure, or optimize the scheduling to increase the numbers of available beds producing increased revenue, that is more likely where the money will go.
RTLS, as envisioned in the past, just doesn’t touch the foundation of where the action is in the hospital.
We used to have a ‘tracking vision’ on how RTLS could work in the hospital with patients and things (see Figure 1).
Figure 1: ChainLink RTLS vision 2005
However, what if we could leverage the concept on a much larger scale? What if we could leverage the standard wireless network to not only track but also monitor everything—events, people, staff, patients and assets—not just the ‘stuff in the room’ but the room itself, in order to optimize the entire operation, improve patient care, increase revenue and save money?
That is what several health institutions are beginning to do. In Part One I talked about the Intelligent InSites partners’ event. Here is the most significant facet of this particular community’s contribution to the Connected Healthcare universe.
Although they call it RTLS, I think what is being built is much more (see Figure 2).
In this scenario, all the operations, work, status, capacity, and needed services can be seen. Unlike many of the RTLS systems we have seen so far, which only focus on a discrete set of assets, this interoperable platform connects the planning, monitoring, and execution of the entire operations. Not only do we know where people and things are, we know about the environment itself. The example in Figure 2 is excellent, since Ms. Smith is occupied caring for a patient. We know about her and the activities she is engaged in. Another nurse can respond to the next ringing bell!
Capacity management, room or facility availability, schedules, etc. can be supported. For example, for testing or surgical procedures, the better I can process the patients, the quicker they get treated, the more people I can treat, and the more money the hospital makes. For seamless execution, the staff, patient, supplies, equipment, multiple rooms, and more, have to be coordinated at every point in the process.
So, what we are really talking about is coordinated care.1Certainly in this setting, it means something very different than outside the facility—here we are meshing the patients’ needs and orchestrating the environment.
In supply chain we started small, scheduling work centers within a factory—bringing people, equipment, supplies and the product together to the ‘point of use’ or ‘point of consumption.’ Over time the optimizing principles were expanded out to the line, then the facility, then across the whole global chain. Surely a principle such as this can be applied here. Instead of discrete offices with individual scheduling staff checking on room status and staffing, and working on one discrete event at a time, let the software create the schedule. (Waiting patients can often wait days for notification of a date for surgery and even critical condition patients can wait days for a slot. Yet often the rooms can be empty.) Schedulers can then add the human ‘touch’ working with staff to understand the needs and priorities and to assure that, in a dynamic hospital environment, changing circumstances are reflected in the systems, and everyone is communicated with as scheduling changes. This is just one example of how coordinated care in the hospital setting can work.
Hospitals are an ‘event driven’ business model, vs. the production model (i.e. building a standard set of products or services), where each patient and their needs is unique. Every day, at every hour, the configuration of care is special. So, though there are comparative models of great gains in effectiveness in other industries, healthcare will look different. It is a massive effort to make changes in culture, technologies, and investments, but change has begun.
The U.S. spends $5,274 per capita on health care; Canada, $2,931; Great Britain, $2,160.2 And with a lower life expectancy than Britain and Canada, Americans should be asking, “Where is the money going—how is it spent?” We do have the latest gadgets, but that does not seem to be the issue, as it turns out. For example, the US spends six times as much as Britain, Germany, Canada, and Japan on administrative costs! And the cost of supplies can be ten to twenty percent higher!3 Surely, administration costs are not what patients and tax payers want to underwrite. And the cost to operate a hospital is a ‘constant,’ though ‘revenues’ may fluctuate a great deal from day to day.
Applying methods that attack the non value adds, the sub optimized and idle capacity, and reduce the expense of purchasing excess equipment, can take us a long way in reducing cost, and at the same time improve patient experience (and save lives!)
1Coordinated care, usually means Primary Care and the administrative processes of that care
3We’ll come back to Supply Chain in Healthcare in the later articles.
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