From the ground up: Incorporating technology into the fabric of a new digital hospital
Like the light of Florence Nightingale’s lamp, digital hospitals are beginning to light the landscape of healthcare in the Information Age. As terms such as “smart hospital”, “hospital of the future” and “paperless hospital” become commonplace with every new hospital build, design needs to evolve to keep pace with this technological revolution.
But just what is a digital hospital? A digital hospital is defined as “a hospital that leverages comprehensive, pervasive IM & ICT to support clinical and administrative workflows, and safety and quality improvement; building fabric is designed or adapted to support the new workflows,” according to Standards Australia’s Digital Hospitals Handbook.
By way of illustration, the diagram below encapsulates the key ICT elements of a digital hospital, showing the complex arrangement of applications, infrastructure and end-user devices that a modern digital hospital needs to consider.
But why are digital hospitals required? What is the reason this multi-billion dollar industry exists?
Some of the results from Electronic Medication Record (EMR) implementations are astounding. Princess Alexandra hospital in Brisbane, Queensland, recently completed a HIMSS 6 EMR implementation and after a year of operation reported that medication errors dropped by 44 per cent, emergency readmissions within 28 days of discharge were 17 per cent less, drug costs per weighted activity unit were 14 per cent lower, hospital-acquired pressure injuries dropped by 56 per cent, healthcare associated infections lessened by 37 per cent, while the early identification of deteriorating patients increased by 59 per cent.
But perhaps the answer to this question comes not from looking at what digital hospitals have achieved to date, rather what the vision is for the future.
The Deloitte Centre for Health Solutions conducted a crowdsourcing simulation with 33 experts from across the globe with a specific charter to come up with specific use cases for the design of digital hospitals globally in 10 years. The group developed use cases in five categories:
- Redefined care delivery: Emerging features including centralised digital command centers to enable decision-making, continuous clinical monitoring, targeted treatments such as 3-D printing for surgeries, and the use of smaller, portable devices will help characterise acute care hospitals.
- Digital patient experience: Digital and artificial intelligence technologies can help enable on-demand interaction and seamless processes through a choice of devices to improve patient experience.
- Enhanced talent development: Robotic process automation and AI can allow caregivers to spend more time providing care and less time documenting it, as well as help enhance development and learning among caregivers.
- Operational efficiencies through technology: Digital supply chains, automation, robotics, and next-generation interoperability can drive operations management and back-office efficiencies.
- Healing and well-being designs: The well-being of patients and staff members – with an emphasis on the importance of environment and experience in healing – will likely be important in future hospital designs.
To realise this vision, hospitals designed and built today must not only consider today’s technology requirements but also meet the requirements of the next 20-30 years.
So what are some of the key ICT considerations in digital hospital building design?
Access to electronic information
Access to electronic information is going to be vital. There is little requirement for paper in a fully digital hospital however a huge requirement for access to clinical applications anywhere, anytime, anyhow. This will require computing devices in patient rooms, staff stations, reception desks, patient treatment areas, operating theatres as well as mobile device access through ubiquitous wireless networks. Staff, patients and visitors will all demand a level of integration with their mobile devices in the hospital both now and into the future as society becomes even more interconnected.
Put simply, we need somewhere to fit all the technology. Space will need to be considered for housing ICT equipment including Workstations on Wheels, and charging bays for batteries for mobile equipment and handsets. Wall space will become valuable real estate as articulated monitor arms for patient vital signs and large video displays for room and patient status are increasingly prevalent. Consulting rooms will become hubs for not only patient visits to specialists but also telehealth centres for virtual interaction with patients in remote areas.
Medication rooms may contain automated drug dispensing cabinets as part of closed loop medication management.
Autonomous guided vehicles/robots will be used to transport meals, linen, waste and medications throughout the hospital with space required for pickup and drop off points, charging bays, maintenance bays and corridors wide enough to cater for two way traffic.
Due to the increased computing requirements, ICT communications rooms and ICT Infrastructure spaces will need to be bigger to accommodate more network outlets, more network gear and more cabling.
Reliability engineering of power, cooling, cabling and security
With the increased reliance on electronic information in a digital hospital there needs to be a high level of redundancy for power and cooling. Access to electronic information is required 24/7 and any loss of access can result in patient treatment being compromised. It is critical that power requirements take into account computers that need to be on continuous UPS power and as such communications rooms are designed to avoid loss of service due to single point failure of equipment.
With the heavy dependence on computers, a higher level of physical security is required. Access to communications infrastructure including data centres, communications rooms and even data cabling needs to be physically secure from unauthorised access and tampering and monitored to allow breaches to be immediately detected.
Avoidance of interference
It’s important to avoid penetration of critical ICT infrastructure spaces by hydraulic, electrical and mechanical services. There are examples of modern hospitals with waste water pipes through data centres and communications spaces. Something that might be considered humorous until the day one bursts. Ensuring these penetrations are avoided is essential during building design to protect ICT infrastructure spaces from compromise.
MRI and other electromagnetic radiating equipment spaces should not be located adjacent to ICT communications infrastructure due to the effect electromagnetic interference can have on computer equipment.
Wireless devices such as security cameras and mobile antennas should not be located near the wireless access points that the wireless network requires to operate. It’s important to consider an uncongested wireless spectrum and a policy of clear air around the wireless access points so they can operate at peak efficiency.
It’s impossible to predict with any certainty what the future may hold but designs can ensure there is adequate spatial provision for future requirements. For example, allowing between 20 to 50 per cent spare capacity in cable trays, ICT communications rooms, rack spaces and network outlets ensures the digital hospital has room for growth.
Avoid the use of any proprietary ICT infrastructure. It’s easier to plug new technology into older infrastructure if it’s standards-based as opposed to something that’s proprietary and most likely needs to be replaced in the future. It’s important to select solutions and products that work with each other over a common interface and not “stand alone” or “all-in-one” solutions.
If there is one lesson that’s still valid from the days when the Egyptians were building pyramids, it’s that good planning and design avoids poor outcomes!
Rod Sprenger is Technology Lead for the upcoming Victorian Heart Hospital, which is being designed to be a world-leading, HIMSS Level 6 cardiac facility.
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This article was originally published by HealthCare IT News Australia