New hospital pioneers intelligent workflow using connected systems

Intelligent building design can improve how a hospital operates in new and significant ways. The newly constructed Oakville hospital, one of a trio of sites managed by Halton Health Services (HHS) in Ontario, was designed with a mega-network – a central brain – that interconnects all systems: clinical, environmental, security, communications, and more.

This will give the hospital an incredible amount of control over systems and devices, as with today’s technology, virtually any hospital device and service can be infused with intelligence to create novel solutions – including integrated alarms, smart beds and persistent computing.

Building the intelligence: After four years of construction, the building for the Oakville Hospital is now completed. HHS is preparing it for use by testing systems; patients and staff will occupy the building when it officially opens in December 2015.

“This is the most technologically advanced hospital that we’ve built in recent history – and we completed it two weeks ahead of schedule,” says Stephen Foster, Director of ICT Services at builder EllisDon Corp., adding that the company has more intelligent hospital projects in the works.

The Oakville Hospital has paved the way for future intelligent hospital construction in Ontario, as the government is now supporting interoperability between systems in their design, says Vert Rayner, Chief ICT Architect for Redevelopment at HHS.

“Historically, the network was not considered in scope and was excluded from the Ministry of Health’s funding envelope for new hospital builds. We persuaded the Ministry that the network itself is part of the building because it’s the brain that runs everything. So our network was included in the base funding, but we also invested $30 million in our internal IT plan for the technology that would run on it.”

The hospital is equipped with all the advanced systems needed to create a unified workflow, says Foster. “It has a complete Cisco medical-grade network, with a Cisco VOIP wireless solution throughout. There’s a real-time location tracking system (RTLS) that can track infant abduction, patient wandering, wireless duress, and equipment with three-meter accuracy. It has a visual signage solution with over 250 large monitors installed throughout the site to display hospital and visitor content. Staff members are equipped with Cisco 7925 wireless handheld devices that allow them to communicate with both systems and people.”

The technology that allows over 20 disparate systems to talk to each other intelligently is the enterprise service bus (ESB), which captures all the alerts and alarms generated by these systems, and shuttles them to the right destinations as defined by staff.

However, Rayner warns that ESB is a concept, and not an actual product yet, and that HHS had to select and cobble together several components to create its ESB. “We use best-in-class solutions for our HL7 interfaces and biomedical equipment integration.”

At the core is Connexall, an alarm management and event notification software platform, provided by Toronto-based GlobeStar Systems. With over 1,100 implementations globally, Connexall has helped these facilities improve communication, breaking down the silos that usually exist in hospitals – resulting in better and safer patient care. “A key feature of Connexall is that it’s vendor-neutral and device-agnostic and will work with and leverage virtually any system, so a hospital is not constrained in its choices,” says Yihan Zhang, VP of Engineering at Connexall.

“We take the data from many different systems, consolidate it, add business intelligence, and link the systems together to empower our single user interface.

When there’s a trigger, say a patient presses their nurse call button from the bed, Connexall acts based on the pre-programmed workflow decided by hospital staff: who it should alert, on what devices, how should it escalate, and so on.

“This applies to events or alarms from other hospital systems, such as building automation, infant abduction, etc.,” explains Zhang.

Connexall is completely customizable to a hospital’s needs and GlobeStar staff worked with the Oakville team to determine how to best utilize the Connexall platform in the new hospital. The options with Connexall are limitless and will continue to be so with the pioneering efforts of the Connexall R&D team.

Intelligent decision-making: Eliciting those decisions from staff and vendors was a massive undertaking, requiring multiple meetings with stakeholders from different hospital departments over the course of six months.

For example, in a legacy building, an infant abduction alarm typically goes to security systems and personnel. In an intelligent building, an all-points alarm could, in theory, be issued to every device and monitor instantaneously throughout the hospital.

All stakeholders need to be engaged to decide who the right parties are to receive alerts and how to handle them. To that end, Foster says a series of meetings were set up to get those decisions and configure systems to user requirements. The Connexall team met first with all of EllisDon’s vendors involved in the project.

“We first had to sort out what alarms and alerts were available to hospital staff from almost 20 systems, and we consolidated those into a list. Then we set up meetings with hospital staff in every functional unit to prioritize the ones that were important and how they wanted to handle them. Then we boiled those down to a manageable number so staff don’t suffer from alarm fatigue,” says Zhang.

In preparation for the opening of the Oakville Hospital, HHS conducted a pilot project at Georgetown, a legacy sister-site that was retro-fitted with Connexall to test the system. “Over the past year, we worked with Georgetown staff to determine the best way to set up and use alerts,” says Foster.

However, the Georgetown facility doesn’t have the RTLS and other advanced systems that will be operating at Oakville, says Rayner. To ensure the systems are tested thoroughly by Oakville’s staff, HHS has a robust operational readiness program in place. “We take people through and show them how the technology works. We have a few months where we can bring people on-site and train them so they can hit the ground running for Oakville’s official opening in December.”

Fine-tuning the system once it goes live is inevitable, but it will be easy to manage by Oakville’s internal staff, says Foster. “Staff may have asked for alarms or escalation times they find unhelpful once they’re actually in a live environment. The system is user-friendly and will allow them to make those changes on the fly as required.”

“Connexall provides an online portal to facilitate both system fixes and training,” says Zhang. “Connexall provides highly customized training services to help hospital staff use, administer, change and grow the system. We also offer ‘train the trainer’ sessions for nurse educators so they can teach new staff. We are here to help, every step of the way.”

The hospital of the future: Intelligent hospitals function at a much higher level of efficiency, says Rayner. “What distinguishes a new hospital from a legacy facility are the capabilities and workflow you can embed right into the design.”

For example, Oakville’s EHR system is designed for “Follow Me” computing, which reduces logging on and off repeatedly when clinical staff do their rounds.

“You get persistent computing sessions, so you can walk around from one device to another, tap your ID badge and your session is recalled. If you’re in a patient’s record, you’ll still be in it if you go to another device or computer. This is estimated to save doctors about 30 minutes a day.”

The nurse call system doesn’t just send an alert to a console, it sends an alert right to a nurse’s smartphone via Connexall, and they can speak directly to patients to find out what they need. An escalation sequence is in place if the call isn’t answered right away, says Rayner. “The alert goes first to the assigned nurse, then after two minutes, it goes to a buddy nurse, and after four minutes, it goes to all nurses in the unit. We developed those specs based on what frontline people told us worked best for them in practice.”

Intelligent buildings also make smart beds that can communicate with mobiles a reality, he says. “A Hill-Rom smart bed has about 30 different alarms that react to different forces: a patient exits, a bed railing is down, the angle of the bed is wrong, and so on. When a patient who shouldn’t be up gets out of the bed, it sends an alarm to the nurse’s smartphone.”

“Connexall is proud to have joined forces with EllisDon and partners to create a holistic solution with the Connexall platform for Oakville Hospital that will serve not only their current requirements, but future ones as well,” says Zhang.

In addition to boosting patient satisfaction, the visitor experience is also enhanced with way-finding signage on monitors.

Wandering patients are easily found by Oakville’s locating system, since they’re all equipped with RFID tags when they’re admitted to the hospital. “Our real-time locating system is part of our building’s wireless network.”

Use of RFID tags for people and equipment will grow in the future as more intelligent hospitals with RTLS are built, says Rayner. “You can introduce some big operational improvements both in terms of efficiency and patient care just by knowing where everything and everybody is all the time. If I had to pick one thing to invest in now to get a lot of mileage in the future, it would be locating systems.”

To improve patient safety, the hospital has already implemented positive patient safety identification (PPID), in which barcoded identification information is added to wristbands when patients are admitted. “Staff don’t have to re-key ID data, which reduces errors substantially. So all medication administration, lab collections and capture of vital signs in our EHR will be based on positive patient identification.”

Rayner believes hospital operations will change dramatically over the next 10 years as intelligent infrastructures become commonplace. “It’s the basis for all kinds of new workflows that we haven’t even dreamed of yet. What we achieve on opening day at Oakville is just the beginning of a deeper transformation.”

However, IT leaders at hospitals that are contemplating new construction need to perform their own due diligence to ensure they get the right infrastructure to grow in the future. “I got a lot of information at the Intelligent Hospital Pavilion at the HIMSS Conference, and from other organizations building new hospitals.

The great thing about hospitals is that they share information freely. Building a new hospital only happens once every 60 years for most organizations, and it’s very important that you talk to others who have been through it before,” says Rayner.