Canada’s newest hospitals are electronic ‘ecosystems’

Hospital or ecosystem? With all of the modern networking and integration going into new hospital builds across Canada, the comparison has never been more appropriate. At the Niagara Health System (NHS) St. Catharines site, a state-of-the-art acute care facility that opened in March 2013, systems are so interconnected and wireless coverage is so pervasive, it’s hard to imagine delivering healthcare without it.

“It’s a living building,” says Jeff Wilson, NHS regional manager, ICT technical support. “We have the capacity to run a small city in here.”

From day one, the network was built with the future in mind. The goal was to achieve 100 percent coverage throughout the building, which spans nearly one million square feet. From the high-grade cabling and underlying network infrastructure provided by Hewlett-Packard (HP), to the wireless access points supplied by Cisco, to the distributed antenna system supplied by InnerWireless – a first for Canadian hospitals – every nook and cranny is covered, even the elevators and basement.

“Our networking and connectivity is like a utility; we can’t live without it now,” says Wilson. “It’s not a nice-to-have; it’s a must-have … As we move forward, it really is becoming the Internet of Things, so connectivity has to be seamless.”

Just as living and non-living things are interconnected in an ecosystem, the robust wireless infrastructure at NHS is enabling people and hospital equipment to interact in new ways. Nurse badges are equipped with wayfinding capability, making it easier to locate nurses and communicate with them using nurse-call consoles and cellphones as opposed to loud PA system announcements.

The porter and housekeeping systems operate in a similar fashion, sending automated alerts to the nearest porter when a patient needs to be moved, for example, and then automatically update the system to show the request was answered and someone is on their way. Even the Philips telemetry system, another implementation first for Canada, is sending vital patient information through the network to Cisco wireless phones so clinicians can access it wherever they happen to be.

Some of the functionality was in place on opening day, some is evolving as the hospital gets comfortable in its new ‘city-like’ environment, which includes building automation to control lights, heating and cooling.

Women’s College Hospital in Toronto is another Canadian facility capitalizing on a new build to deliver futuristic services. With phase two of its “Hospital of the Future” slated to open this fall, the hospital is embracing a ground-breaking ambulatory care approach, meaning surgeries, diagnostic procedures and treatments do not require overnight hospitalization. Instead, patients can be released within 18 hours to recover in the comfort of their own homes.

Designed to be an easily accessible hub of programs and services, Women’s College Hospital now runs like a “beautiful ecosystem,” says director of IT Brendan Kwolek.

“We have a number of renowned clinicians at Women’s College Hospital who’ve been encouraging us and pushing us to get to this point and now we’re finally here,” says Kwolek. “We’re evolving their vision which is a completely electronic record, with integration into all clinical systems and access to live data.”

Phase one of the new building was completed in 2013. Similar to the NHS experience in Niagara, automation hinges on robust, pervasive wireless coverage and a modern high-speed network. Women’s College Hospital chose a brand new HP wired and wireless network that includes intrusion detection and monitoring capabilities. Using the HP Intelligent Management Centre, IT staff can pinpoint gaps in coverage on live radio maps, making it easier to troubleshoot problems and provide proactive assistance.

“It’s great technology to have in your back pocket so you can actively monitor coverage,” says Kwolek.

Part of what makes Women’s College Hospital unique is its focus on ambulatory care. Because documentation and prescribing takes place in an exam room setting, every room must be “computerized and ready to go, and have documentation at the physician’s or care provider’s fingertips,” explains Kwolek.

Prior to moving into the new building, the hospital had a “mish-mash” of systems from a number of providers, and paper documentation was still in place. To support its forward-thinking ambulatory care approach, the hospital chose the Epic electronic patient record, joining only a handful of other Canadian implementations.

“Behind the scenes, there’s an emphasis on how tightly our computer systems need to be tailored to our workflows to support ambulatory care,” says Kwolek.

“We had a good opportunity to work closely with Epic to implement what we feel is a very solid, very efficient system that will allow us to do a lot of unique things in the future.”

Right now the hospital is live with Epic’s Registration, Scheduling and Ambulatory modules. New features include the ability to auto-determine the ‘next best available time’ when scheduling appointments, and to automatically prioritize people according to wait times and urgency. Epic also integrates with other hospital systems, such as the radiology information system, so that reports are automatically fed to the patient record, including a link to view and manipulate images where appropriate.

Wireless device integration is another advanced strategy in place at Women’s College Hospital. Glucose monitors and mobile ECG carts are wirelessly connected to the core hospital information system so that results are automatically transmitted and read. Later this year, the Philips telemetry system will also be implemented.

To facilitate its highly connected and integrated approach, each new exam room is equipped with a 24-inch monitor, allowing clinicians to easily work without the need to scroll or page back and forth. Beyond that, each area of the hospital is free to use whichever device makes sense. Some areas are standardizing on Microsoft Surface 3 tablets, while others are incorporating Rubbermaid wallmounts or workstations on wheels.

“The advantage of having a new, modern infrastructure is we’re not limited by the technology we’ve got in-house,” says Kwolek. “We can pick a cart, a wireless tablet, a handheld, just about anything, and not have to worry about additional infrastructure investment … This is the way we do business now. It’s not the paper world anymore,” he says.

Earlier this year, McGill University Health Centre (MUHC) opened the doors to its 43-acre super hospital, spanning five city blocks in Montreal. Not surprisingly, a robust fibre optic network and WiFi mobility strategy are key enablers as the facility aims to be one of the most innovative academic health centres in North America.

After four years of construction and a $2.355-billion investment, the site is among the most advanced in Canada, though some solutions are still in the process of being rolled out. The high-level goal is to identify the most important functions carried out each day and ensure clinicians are equipped with applications and devices to support their workflow, says Dr. Jeffrey Barkun, professor of surgery and chief clinical officer for technology transition at MUHC.

“For a workflow related to completing rounds in a group, we’ll have a huge LCD screen. If it’s something that has to do with putting a note at bedside, which we do not have yet, we’re aiming for tablets. And if it’s to do with looking at results on the move, that’s where we have our WiFi mobility platform and the form factor we’ve targeted is cellphone,” explains Dr. Barkun.

Every patient room at the new Glen site is a single room and that means a lot more walking and more dependence on two-way communication. Wall-to-wall WiFi coverage is necessary, says Dr. Barkun, to support the hospital’s Bring Your Own Device (BYOD) strategy. To facilitate communication between care teams, in-house developers created two applications designed for smartphones. One provides quick and easy access to essential parts of the in-patient records housed in the organization’s Oacis information system through a visual display, and the other pre-populates up to 80 percent of daily notes by capturing information from tagged text messages.

One development having the most impact on how clinicians work in the new environment is a new electronic card system. Each member of the hospital staff has a card which serves as their unique identifier. The card opens doors and provides access to on-demand printing services, a functionality Dr. Barkun didn’t expect to be as popular as it is.

“The few times you want to print something, you just bring your card, swipe it in front of a printer and no matter where you are in the hospital, what you’ve sent to the print queue will come out,” he explains.

Moving forward, the cards are expected to provide garage access and will also be used to log into new thin client terminals spread strategically throughout the hospital, with the ability to maintain context between sessions. Right now, only generic logins are provided for the thin clients, which can be confusing at times.

“Not everything was optimal from the word go but we expected some of this,” says Dr. Barkun, noting that electronic medication reconciliation and point-of-care recognition are among the software applications slated for implementation later this year and early next year.

Core to every hospital of the future is the patient experience. Inpatient rooms at the new MUHC site are unlike anything Dr. Barkun has experienced previously. And the same is true at NHS and Women’s College Hospital where both Wilson and Kwolek remain focused on making the patient experience even more seamless.

In St. Catharines, Wilson is considering adding a meal ordering feature to the patient bedside terminals, which already provide television and Internet access. He’d also like to provide patients with access to their clinical records, either from a mobile device or at bedside, as well as provide visitors with patient tracking capabilities similar to the information currently displayed on large monitors in day surgery wait rooms.

In downtown Toronto, Women’s College Hospital is openly promoting its patient-accessible wireless network and plans to add more patient-specific capabilities in the future. One area under consideration is the whole aspect of proactive care management, says Kwolek, where patients could be prompted to book routine exams or tests according to their specific health condition.

“We’ve learned through consumerization that patients want more access to their information and they want to be more active in their healthcare,” he says.

Another technology under consideration at both NHS and Women’s College Hospital is wider use of beacons – also known as micro-location sensors or Bluetooth Low Energy devices – both for asset tracking and a means to deliver personalized, predictive services to patients. Kwolek’s vision is to use the technology to deliver relevant patient information to mobile devices, whether that’s access to medical records or information related to a current visit. “Maybe I’m guiding patients to information based on where they are in the hospital,” he explains. “If you’re in Endocrinology, do you want to see information about diabetes? It really presents an exciting opportunity.”

“We need to look at innovating beyond the four walls,” adds NHS’s Wilson. “How do we enable cloud technology? How do we involve patients in their own records? How do we connect the community? We’ve done the groundwork but we still have a lot more to do.”