Smart Hospital

Evi Setianingsih.,S.Kep.,Ns

Konsen Jurusan : Magister Manajemen Rumah Sakit

Sekolah Tinggi Ilmu Ekonomi Cirebon

 Outline

The Road to Digitizing Healthcare

What is a Smart Hospital?

Toward a Smart Hospital

 Health &
Health Information
Lets take a look at
these pictures...
Smart Manufacturing
Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
Smart Banking
Healthcare (On TV)
Healthcare (Reality)
(At an undisclosed
hospital)
Why Healthcare Isnt (Yet) Smart?
 Life-or-Death
Difficult to automate human decisions
Nature of business
Many & varied stakeholders
Evolving standards of care
Fragmented, poorly-coordinated systems
Large, ever-growing & changing body
of knowledge
High volume, low resources, little time
But...Are We That Different?

Banking

Input Process Output

Transfer

Location A Location B
Value-Add
- Security
- Convenience
- Customer Service
11
But...Are We That Different?

Manufacturing

Input Process Output

Raw Materials Assembling Finished

Goods

Value-Add
- Innovation
- Design
- QC
But...Are We That Different?

Health care

Input Process Output

Sick Patient Patient Care Well Patient

Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information
Standardizing Healthcare
 Large variations & contextual dependence

Input Process Output

Patient Decision- Biological

Presentation Making Responses
Digitizing Healthcare
Why Adopting Health IT?
To go paperless To computerize
the hospital

To Have
To become a
EHRs
Digital Hospital
Some Smart Quotes
Dont implement technology just for
technologys sake.
Dont make use of excellent technology.
Make excellent use of technology.
(Tangwongsan, Supachai. Personal communication, 2005.)

Health care IT is not a panacea for all that ails

medicine. (Hersh, 2004)
 Being Smart #1:
Stop Your
Drooling Reflex!!
 Being Smart #2:
Focus on Information &
Process Improvement,
Not Tech
Smart Hospital
Smart Hospital
Digital
Paperless Hospital?
 Outline

The Road to Digitizing Healthcare

What is a Smart Hospital?

Toward a Smart Hospital

24
Microsoft Health Future Vision
Connecting People to a Healthy Future With
Personalized Care Kaiser Permanente
What Clinicians Want?
To treat & to
care for their
patients to their
best abilities,
given limited
time & resources
High Quality Care

Safe
Timely
Effective
Patient-Centered
Efficient
Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
Information is Everywhere in Healthcare
30
Information in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010
Sep 15;304(11):1227-8.
Components of Health Systems
WHO (2009)
WHO Health System Framework
WHO (2009)
 Being Smart in Healthcare

Safe
Drug allergies
Medication Reconciliation
Timely

Complete information at point of care

Effective
Better clinical decision-making
Efficient
Faster care
Time & cost savings
Reducing unnecessary tests
Equitable
Access to providers & knowledge
Patient-Centered
Empowerment & better self-care
 Patient Safety
To Err is Human (IOM, 2000)
reported that:
44,000 to 98,000 people die in
U.S. hospitals each year as a result
of preventable medical mistakes
Mistakes cost U.S. hospitals $17 billion to
$29 billion yearly
Individual errors are not the main problem
Faulty systems, processes, and other
conditions lead to preventable errors
 Summary of These Reports

Humans are not perfect and are bound

to make errors
Highlight problems in U.S. health care
system that systematically contributes
to medical errors and poor quality
Recommends reform
Health IT plays a role in improving
patient safety
To Err is Human 1: Attention
To Err is Human 2: Memory
 To Err is Human 3: Cognition

Cognitive Errors - Example: Decoy Pricing

 # of
The Economist Purchase Options People

Economist.com subscription $59 16

Print subscription $125 0
Print & web subscription $125 84

# of
The Economist Purchase Options People

Economist.com subscription $59 68

Print & web subscription $125 32 Ariely (2008)
What If This Happens in Healthcare?
 It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005; Croskerry, 2013)
Cognitive Biases in Healthcare
Everyone makes mistakes. But our reliance on
cognitive processes prone to bias makes
treatment errors more likely than we think
Common Errors
 Medication Errors
Drug Allergies
Drug Interactions
Ineffective or inappropriate treatment
Redundant orders
Failure to follow clinical practice guidelines
 Being Smart #3:
To Err is Human
 Clinical Decision Making
PATIENT

Perception
CLINICIAN

Attention

Long Term Memory External Memory

Working
Memory
Knowledge Data Knowledge Data

Inference

DECISION
Elson, Faughnan & Connelly (1997)
Reducing Errors through Alerts & Reminders
Example of Alerts & Reminders
 Why We Need ICT
in Healthcare?

#1: Because information is

everywhere in healthcare
 Why We Need ICT
in Healthcare?

#2: Because healthcare is

error-prone and technology
can help
Fragmented Healthcare
http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
 Why We Need ICT
in Healthcare?

#3: Because access to high-

quality patient information
should improve care
 Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
Documented Values of Health IT
 Guideline adherence
Better documentation
Practitioner decision making or
process of care
Medication safety
Patient surveillance &
monitoring
Patient education/reminder
 Being Smart #4:
Link IT Values to
Quality (Including Safety)
Health IT
 Use of information and communications
technology (ICT) in health & healthcare
settings

Source: The Health Resources and Services Administration, Department of

Health and Human Service, USA
Slide adapted from: Dr. Boonchai Kijsanayotin
 eHealth
Use of information and communications
technology (ICT) for health; Including
Treating patients
Conducting research
Educating the health workforce
Tracking diseases
Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)
2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin
eHealth & Health IT
eHealth Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
Health IT: Whats in a Word?
Health Goal

Information Value-Add

Technology Tools
Various Forms of Health IT
Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)

Electronic
Health
Records Picture Archiving and

(EHRs) Communication System

(PACS)
Health IT Beyond Hospitals
 Health Information
Exchange (HIE)

m-Health

Personal Health Records

(PHRs)
Biosurveillance
Telemedicine &
Telehealth

Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, 60Inc.
Health IT for Medication Safety
 Administration
Ordering Transcription Dispensing

Automatic Electronic
CPOE
Medication Medication
Dispensing Administration
Records (e-
MAR)
Barcoded
Medication Barcoded
Dispensing Medication
Administration
61
Health Information Exchange
 Government

Hospital A Hospital B

Clinic C
Lab Patient at Home
62
My Life-Long Dream...
Achieving Health Information Exchange (HIE)
WHO & ITU
 Standards: Why?
The Large N Interfaces Problem
N = 2, Interface = 1

N = 3, Interface = 3

N = 5, Interface = 10

# Interfaces = N(N-1)/2

N = 100, Interface = 4,950

Myths & Truths on Standards
 . . :Health

Data Standards Expo: From Reimbursement to Clinical Excellence;

2011 Aug 8-9; Bangkok, Thailand. Bangkok (Thailand): Mahidol
University, Faculty of Medicine Ramathibodi Hospital; 2011 Aug.
http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards
 Myths & Truths on Standards

Myths
We dont need standards
Standards are IT peoples jobs
We should exclude vendors from this
We need the same software to share data
We need to always adopt international
standards
We need to always use local standards
 Being Smart #5:
Go for Systems that Use
Standards, Not a Unified,
Conquer-the-World System
Image Source: http://www.denofgeek.com/movies/avengers/37236/why-loki-was-cut-from-avengers-age-of-ultron
 Outline

The Road to Digitizing Healthcare

What is a Smart Hospital?

Toward a Smart Hospital

A Smart Machine: DeepMind
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/
Smart Phones, Dumb People?
Image Source: amazon.com
Smart Hospital,
Dumb...?
Clinical Decision Support Systems
 CDSS as a replacement or supplement of
clinicians?
The demise of the Greek Oracle model (Miller & Masarie, 1990)
The Greek Oracle Model
Wrong Assumption

The Fundamental Theorem Model

Correct Assumption
Friedman (2009)
 Being Smart #6:
Dont Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.
 Unintended Consequences of Health IT

Some Risks of Clinical Decision Support Systems

Alert Fatigue
Unintended Consequences of Health IT
Workarounds
 Being Smart #7:
Health IT Also Have
Risks &
Unintended Consequences
Balanced Focus of Informatics
 Technology

People Process
 Being Smart #8:
Balance Your Focus
(People, Process, Technology)
 IT & Organizational Context
The current location

The tailwind The headwind

The past journey The direction

The destination
The speed

The sailor(s) & The sail

people on board The boat The sea
 Being Smart #9:
Know Your Context &
Align IT with that Context
 Vision, Mission & IT Strategies

900 200

Vision High Tech Vision High Touch

IT as The Sail
Carr (2004) Carr (2003)
4 Quadrants of Hospital IT

Strategic
 Business Health Information Exchange

Intelligence
 Personal Health Records

Customer Relationship Management

Clinical Decision Support Systems
Social
Computerized Physician Order Entry
Media
Administrative Clinical
Vendor-Managed Inventory Electronic Health Records
PACS
Enterprise Resource Planning
LIS
Admission-Discharge-Transfer
 Word
Master Patient Index
Processor
O
 Being Smart #10:
Identify Your
Strategic IT Assets
The Sailors
 People

Techno-
Process
logy
 The Sailors
900 200
42 32
(range 20-65) (range 20-57)
IT
HIS interaction

turn-over rate
The Special People
Ash et al. (2003)
The Special People
 Administrative CIO
Leadership Level Selects champions
Gains support
CEO Possesses vision
Provides top level Maintains a thick skin
support and vision CMIO
Interprets
Holds steadfast
Possesses vision
Connects with Maintains a thick skin
the staf Influences peers
Listens Supports the clinical support
staf
Champions Champions
Ash et al. (2003)
The Special People
 Clinical Leadership Curmudgeons
Level Skeptic who is
usually quite vocal
Champions in his or her disdain
Necessary of the system
Hold steadfast Provide feedback
Influence peers Furnish leadership
Understand Clinical advisory
other physicians
committees
Opinion leaders Solve problems
Provide a balanced Connect units
view
Influence peers
Ash et al. (2003)
The Special People
 Bridger/Support level Skills
Trainers & Possess clinical
backgrounds
support team
Gain skills on the
Necessary job
Provide help at Show patience,
the elbow tenacity, and
Make changes assertiveness
Provide training
Test the systems
Ash et al. (2003)
 Being Smart #11:
Manage Your
Special People Well
 A True Story of Failure to
Involve Users in Hospital IT
Implementation
 Being Smart #12:
Involve Users Early &
Intensively in Your Process
Gartner Hype Cycle
Rogers Diffusion of Innovations:
Adoption Curve

Rogers (2003)
 Success Factors of Hospital IT Adoption

Communications of project plans & progresses

Workflow considerations
Management support of IT projects
Common visions
Shared commitment
Multidisciplinary user involvement
Project management
Training
Innovativeness
Organizational learning
Theera-Ampornpunt (2009, 2011)
 Being Smart #13:
Work Smartly with
Smart People
 Summary
To become a smart hospital, you must
Know what is smart all about
Know how to use smart machines
together with smart people
Manage both of them smartly