Alfons Buxó. Director de Prevenda HP. Barcelona.

1. HP Digital Hospital
St. Olav’s Hospital experience
Alfons Buxó
Spain Presales Director
© 2008 Hewlett-Packard Dev elopment Company, L.P.
The inf ormation contained herein is subject to change without notice

2. Current issues facing hospitals today
Convergence of several factors and challenges
Growing demand Cost increase Innovation
• Aging population • New diseases • Diagnostics and treatments
• Immigration • Chronic disease • IT greater embracement
• Universal benefits increasing • Technological complexity
• Skilled workforce needs raise
• Improve Diagnostic • Hospital technology silos • Patient safety and quality of
capability • Clinical Productivity
care
• Targeted treatment • Care continuity
• Process complexity
• Manage pace of • Clinical communication
• Resource optimization
innovation • Patient Satisfaction
• Knowledge sharing
• e.g for chronic disease • POC information access
• Technology alignment to
management,
business/clinical priorities • Clinical traceability
• Best practice adoption
• Labor shortages
Improve
Speed innovation to Improve operational quality of care
transform health efficiencies
Mitigate risks

3. Clinical Productivity challenges
Examples
• Doctors: Seeking data and information
− To and from meetings, rounds and
demonstrations (Radiology, Pathology, Labs)
− To see the next patient
− Professional tasks are done sitting or
standing at a work-place
• Nurses: Seeking data, information,
persons or assets
− To and from patients in general
− Responding to nurse-calls
− Rounds
− Checking and reporting med-tech. devices
− Messaging and transporting paper-based information
− Seeking for, and transporting assets
• Productivity: Healthcare lagging behind other industries

4. How ICT can help
• Medical staff
− Manual processes automation
− Digitization process / analog systems
− Improve the capture and dissemination of clinical information
− Facilitate mobility and location of personnel and health
equipment
− Integration of Clinical and Business Applications
− Exchange and distribution of data, images and clinical information
(i.e. e-salud initiatives)
• Patient
− Ensure that the required information is at the right time and
place
− Enable personalized and remote attention through
collaborative tools (Telehealth, remote diagnostic, remote
assistance, etc. ..)
− Facilitate the monitoring of chronic and infectious diseases
− Dissemination of health information (prevention campaigns,
vaccinations, etc. ..)
− Empower the individual to manage their own health

5. What is a Digital Hospital?
− Relies on technology as an integral &
fundamental part of its business strategy
− Enables the organization to leverage its
potential for delivering higher-quality
patient centric care, in increasingly
efficient ways through the use of
technology & process redesign.
− Builds on an Enterprise Architecture that
goes beyond advanced clinical systems &
includes technology integration to create a
pervasive, real-time health information
environment

6. The infrastructure silos
in hospitals today
Nurse Call Patient TV Door Phone Mobile ward round
Opener Systems
Intercom (PBX)
CCTV Telephones Paper
AGV DECT/Pager
(Robot)
Medical Devices RFID
Wireless LAN
WiFi
Client PC
Hospital
Applications
Light
Blinds
Heating
Facility
Control
EPR PACS HIS LAB EHC

7. IP Convergence through a resilient, protected
network
Enabling the transmission of vital information
Patient terminal IP phones IP wireless MDA/ PC Mobile Pager Nurses’
phones PDA phones portal
(SMS)
GSM
OPC, SMTP, SMNP LAN/WLAN
EPR
PACS
Laboratory
IP converter I/O signal Etc.
ESPA 4.4.4 converter
Nurse call Patient monitoring Facility HP WiFi tags
medical equipment control Digital Pen
Everything over IP – IP Everywhere

8. What constitutes the Digital Hospital
Patient Bedside Terminal & Portal
Messaging & Alerts
• Nurse call
• Medical team assembly
• Hospital orderly
• Event driven alerts
Location &
Identification Services
• WiFi
• Passive RFID
Device Integration
• Patient monitoring
• Infusion pumps
Integration
Platform
Network & Communication
Infrastructure

9. HP Digital Hospital Solutions
framework
•Integration •Electronic •Hospital •Patient •Digital Collaboration •Asset
with hospital whiteboard messaging &alerts bedside signage •Telehealth tracking
applications •Medical •Mobile nurse call interactive video & •Patient &
- EPR / CIS / equipment •Medical team services & conferencing staff safety
assembly
HIS interconnect communicati solutions •Temperature
•Hospital orderly
- Lab IS ons (Web, audio, monitoring
•Order entry &
-… results alerts video, IM,
presence)
Workflow Management / integration
(Management, QoS, User
RFID enabled
location
Presence, Instant Messaging, Unified Messaging & tracking
Directory
integration services
IP Telephony, PBX replacement
Converged Network, upgrade & security services
Admin)
Wired & Wireless
Voice, Data, Video

10. The Digital Hospital Journey
Inefficient Technology
• Enhance integration of
manual enabled efficient
applications and services
processes processes
• Seamless communications
& alerts
• Patient bedside
terminal/portal • Align applications with •Better quality of
business processes care
• Patient monitoring
• Messaging & alerts
• Patients & Assets •Reduced
tracking with RFID number of errors
• Converged IP
network for voice,
•Improved
data and video
productivity and
• Reinvention and • Organizational
decreased cost
redesign of care virtualization
processes • Ecosystem partners
integration
Physical Logical Ecosystem
integration integration integration

11. St Olavs hospital
Experience

12. St Olavs Challenges & Vision
Building a state-of-the art hospital to deliver patient centric services
• Hospital was too costly to operate, with • Located in Trondheim - Norway’s
largest hospital
annual rising costs
• Premises: Main Acute Services Unit
• Decision to build a patient centric new (75%) & University Hospital (25%)
hospital that will provide outstanding • Managed by the Regional Health
quality of care Authority of Mid-Norway
• 950 beds
• Opportunity to integrate clinical and
• 8,000 Staff (+1,250 students)
teaching/research areas • 413,000 patient treatments per year
• From one large structure to 11 • Provides services & specialties for
separate centres other hospitals in the region
• Exploiting ICT to deliver information to
the right persons at the right time at
the point of care

13. St Olavs’ hospital
Advanced logistics choices
Pneumatic tube systems Automatic Guided Vehicles (transportation robots )
Clothes management
through RFID chips and
cabinets
Automatic waste handling

14. The new St. Olavs’ hospital
A state of the art, patient centric hospital
IP over all – all over IP : A single, converged IP
network for voice, data and video
• Secure, scaleable, resilient and responsive,
99.999%
• Campus wide Wireless LAN in 11 buildings,
inside/outside, Voice over WLAN
• Seamless communications through 1400 IP
phones messaging
• Nurse call for 350 beds, 50 Nurse Stations
• Emergency calls management from handhelds or
patient signal system
• Hospital Orderly – transport ordering, dispatching
• Building alerts (30 technical systems integrated)
• Patient terminal – Entertainment, integration with
building control, access to clinical systems
•HP Ipaq PDA’s (500)

15. Creating the Digital Hospital
Assets – division of labour
Nurse request
wheelchair.
LBS selects the
nearest one.
Transporter
dispatch chair
to the nurse.

16. Real time location and tracking
Reduce costs Improve operational efficiencies Increase patient safety
Workflow &
Asset Equipment Temperature Patient &
Resource
Management Maintenance Monitoring Staff Safety
Management
Track Alert Manage Integrate
…current and …automated alerting and …the utilization of …location and status
historical location of notification (pump leaving a equipment, control information to existing
medical devices and protected zone, overdue for the workflow and hospital applications (e.g
people, from a Web maintenance, requiring utilize location data asset mgmt, EMR, etc.)
interface delivery, etc.) for operational
analysis

17. Hospital Communication System
Send and receive
Replay and forward messages
(auto and manual)
• IP Phone messaging
• Nurse Call
• Medical team assembly Custom
menus
• Hospital Orderly Hospital and predefined
• Building Alerts Comm. messages
Melding-
Predefined System
sentral
acknowledge
alternatives On-touch
duty or assault calls
Lifts AGV Team Personnel Fire Patient Notifications
Clinical Applications

18. Creating the Digital Hospital
Nursecall – Emergency Response
2 patients
initiates
nursecall.
Each patient’s
primary nurse
receives
request via IP
phone.
1 patient
requires
emergency care
and initiates
emergency
team assembly.
System locates
closest care
provider for
each of the
team role and
directs them to
the patient.

19. Creating the Digital Hospital
Information push – Lab Test
Orders blood
test using PDA.
Nearest
qualified
technician draw
sample.
Sample sent to
lab via tubes.
Lab process
samples.
Results are
pushed to
Doctor’s PDA.

20. Creating the Digital Hospital
Monitoring – Locating nearest nurse
A biomedical
device
generates an
alarm.
System locates
closest nurse
and instruct her
to evaluate
patient’s
condition.

21. Benefits for Nurses – St Olav’s hospital
“I now have greater freedom to
deliver on the core services and
more time to spend with my
patients, which I used to spend
filling out forms, making endless
phone calls, chasing relevant patient
information and test results, or just
tracking down people.”
Aud Olsen, Head Nurse, St Olav’s
hospital
Productivity
Walking distances significantly reduced
− Old facility 5.3 km = 1 hour 7 minutes of a 7 hour shift
− New facility 3.5 km = 45 minutes of a 7 hour shift – 23
minutes per day released for patient care

22. Business Technology-In-Action
Digital Hospital Solution at St. Olavs
Excerpts from IDC Case Study
(Sept 2006)
… a groundbreaking project …
Patient … St. Olavs Hospital has been
Audio /Video
Patient Alarm terminal TV distribution
Digital
dictation IP Telephony tagged the most modern
Peripherals Fixed/wirel
ess hospital in Europe and probably
Alarm and tracking among the world’s leading
healthcare technology initiative
Meta Catalog
and is now fully operational …
Messages
application … St. Olavs Hospital should be
considered the world’s
Secure Logon Medical Digital
Assistant (Ipaq) benchmark in terms of tactical
Certificates
Appl. .
Public and strategic usage of
. Network
Operational
Tools
Data
Appl. Data
NTNU
technology in life and death
Network St Olavs scenarios for the better of their
Cabling Infrastructure
customers, the patients …

23. Experienced Results at St. Olavs
• Treated more patients in 2007
than 2006 with smaller budget
• Improved patient care with
better access to data
• Patient stays are shorter, less
inpatients
-20% in Neurology centre, 5.9d
=> 4.7d
• Staff productivity increased
through better collaboration
• Reduction in yearly workload in
2006/2007

24. Conclusion
© 2008 Hewlett-Packard Dev elopment Company, L.P.
The inf ormation contained herein is subject to change without notice

25. Conclusion
HP and its partners can help healthcare providers increase
efficiencies, optimize resources et improve quality of care by
integrating IT, medical devices, and applications within the digital
hospital. HP brings industry leading track records in
• Partners management
• Delivery capacity
• Commitments
• Design, project management, complex
solutions integration
• Costs and risks reduction
• State of the art technologies
• Availability and security of information
access, anywhere, anytime

26. Backup

27. Agenda
• The Digital Hospital – vision, solutions framework
• Functional view, solution benefits
• St Olav’s hospital experience
• Cost Benefits analysis

28. Healthcare Providers Business
Challenges
Speed innovation to Lower costs/Improve Improve
transform health operational quality of care
efficiencies Mitigate risks
• Improve Diagnostic • Hospital technology silos • Patient safety and quality
capability of care
• Clinical Productivity
• Targeted treatment • Care continuity
• Process complexity
• Manage pace of • Clinical communication
• Resource optimization
innovation
• Patient Satisfaction
• Knowledge sharing
• e.g for chronic disease
• POC information access
management, • Technology alignment to
business/clinical priorities • Clinical traceability
• Best practice adoption
• Cost containment
• Labor shortages

29. ¿Cómo pueden ayudarnos las TIC?
• Personal Sanitario
− Automatización de procesos manuales
− Digitalización de procesos/sistemas analógicos
− Mejorar la captura y difusión de la información clínica
− Facilitar la movilidad y localización del personal y el equipamiento sanitario
− Integración con las Aplicaciones Clínicas y de Negocio
− Intercambio y distribución de datos, imágenes e información clínica mediante iniciativas de tipo e-
Salud
• Paciente
− Garantizar que la información requerida está en el momento y lugar adecuados
− Habilitar la atención personalizada y a distancia por medio de herramientas de colaboración
(Telemedicina, Telediagnóstico, Teleasistencia, etc..),
− Facilitar el seguimiento de enfermedades crónicas y contagiosas
− Difusión de información sanitaria (campañas de prevención, vacunas, etc..)
− Darle al individuo poder para administrar su propia salud

30. IDC Healthcare IT Maturity Model

31. Improved patient care and
efficiencies through better
communications, collaboration,
information flow
© 2008 Hewlett-Packard Dev elopment Company, L.P.
The inf ormation contained herein is subject to change without notice

32. The Digital Hospital
Built on
• a converged , resilient, secured
and adaptive network
infrastructure,
• Unified IP based communications,
alerts
Enabling
• incremental solutions and
integration to improve healthcare
processes efficiencies, quality of
care

33. Information
Integration
Across devices, instruments,
applications
© 2008 Hewlett-Packard Dev elopment Company, L.P.
The inf ormation contained herein is subject to change without notice

34. The need for integration
• A patient-centric healthcare service is increasing
the dependency on information integration, to
create complete and up-to-date Electronic
Patient Records
• EPR systems require integration at various
levels, with objectives
− To support the coordination, quality, and continuity of care
− To improve health information communication under the
control of the concerned patient
− To reduce accidents and redundancies
− To improve productivity
• HP and our partners offer a new approach to
integration, covering both applications, medical
instruments for examination and observation,
ICT devices and building control.

35. Application integration layers
Clinical & Admin Information Systems By specialty, processes,
Applications views (patient files, prescriptions, …)
Application
architecture Processes components Legacy applications
(departmental)
Integration layer (Middleware)
SW infrastructure
Technological
(network, virtualization, …)
architecture
Hardware infrastructure
(cabling, processors, disks…)

36. Medical applications & instruments
integration
Presentations
Blood bank
Clinical
Chemistry
Integrations
IMATIS Application Platform and Middleware
Examination Observation Observation/Monitoring
DICOM
HL7 Waveform (real time)
Software Discrete data
ASTM
Non Standard
CTG, ECG,
Endoscope, Microscope, etc.
Remote Lab Instruments,
FAG, OCT, etc.
Infusion Pumps, CTG, ECG,
Blood Pressure Monitors, etc.

37. HP and Imatis information integration
solution Clients devices
Benefits
• Connecting different
communication and
medical devices as well as IMATIS portal
applications
Applications
• IMATIS portal sends data
IMATIS SOA Platform - Middlew are
to the right communication
device
• Transaction processing
with real-time control and
storable sets of rules
provides necessary Adapters, Gateways, Drivers
security Sources of data and
information
• Instant real-time event
driven information delivery

38. Functional
View &
solutions
benefits
examples

39. Real time location and tracking
solutions
Asset Equipment Temperature Patient & Workflow &
Management Maintenance Monitoring Staff Safety Resource
Management
Example: Asset tracking at St Vincent’s Productivity Patient services
hospital improve productivity and time with (QoC)
patients
- Active RFID solution to track assets •Increased patient •Reduced safety
throughput incidents
- Automated inventory management and
•Increased capacity of •Reduced wait times
alerts
critical departments •Increased staff time
- Integration to order fulfillment system (OR/ER) with patients
Benefits •Increased staff
productivity Costs savings
- Improved equipment availability - 20% •Reduce staff time spent
cost reduction in rental costs and lost on manual searching,
equipment •Reduce purchase of
logging and monitoring
new equipment
- Improved service unit staff productivity - procedures
•Reduce rental costs
20% increase in nurse time with patients •Staff efficiency

40. Patient Terminal
Patient services
• gives patients more control whilst recovering,
enables them to communicate with external world
• Opportunity to carry training programs for
patients with long term condition
• TV, Video, Radio, Telephone via IP
• Internet/ E-mail / Access to hospital information
system
• Lights & blinds control
• Integrated Nurse call system (IP or analog)
• Console Games
• Patient Billing
Productivity
• Access for clinicians to the hospital information
system via smart card

41. Video conferencing and high resolution
images sharing
Patient services
(QoC)
• Highly accurate remote diagnosis and
knowledge-sharing with specialty
centers and other hospitals regionally
and globally
• Peer-to-Peer clinical discussions
• Shortened decision cycles
• High level patient case management, Costs savings
bringing greater patient safety and
convenience
• Community outreach for specialty - Large US orthopaedics specialty practices with
counseling and resources between 19 offices, six surgery centres
facilities - Adopted UC real-time video collaboration to
• Community outreach for specialty relieve physicians attending training and
counseling and resources between compliance meetings travel burden
facilities - In nine months, the system saved 100 hours of
physician travel time, meaning more time for
• Foreign language patients assistance patient care
• Staff development – Training, Peer to
Peer interaction, Mentoring and best
practices

42. Presence, Instant Messaging
Patient services Productivity
(QoC)
• Large NHS Healthcare trust • Contact specialists
employing 7,000 people over 8 to rapidly respond to
hospitals improved employee patient queries and
collaboration using a UC solution react faster to
providing IM, VoIP, video and web medical
conferencing. emergencies
• Benefits reported include
enhanced patient care through •Location
improved collaboration, significant information can also
time savings through presence, and help identify the
closest and most
much reduced email traffic.
suitably qualified
Costs savings person to respond.
• Dramatic improvements in quality and cost of care are possible by the introduction of
UC tools such as presence, IM, conferencing with PACS, to enable instant
communication between physicians as an integral part of the radiology workflow (*)
* Survey conducted by Carestream Business Diagnostic Studies

43. Digital Signage in hospitals
Patient services
• Digital Signage in Waiting Areas
−displays carrying a mix of news, health and
wellness information
−content tailored by department
−for private health providers, promote higher-
margin services
Productivity
• Touchscreen Directories and Wayfinding
Systems
−help patients navigate your facility, increasing on
time arrival at appointment
Costs savings
• Patient Registration and Check-In Kiosks
−self-service kiosks to fill out new patient profiles
−Staff savings, while reducing wait times

44. Registration zone
Smart Technologies
Registration Area Self Service Counter
Digital Signages
While waiting, have
a coffee or some gaming
Wireless Network
Technology

45. HP Digital Hospital Customers
• St Olav’s hospital, Trondheim, Norway
• Nye Ahus hospital, Oslo, Norway
• Asklepios, Bamberg, Hamburg Germany
• University Hospitals Leicester NHS Trust, United Kingdom
• Medish Spectrum Twente hospital, Netherlands
• Katharina Hospital, Netherlands
• University of Michigan Health System, MI USA
• University Health Network, Toronto Canada
• IMSS, Lagos de Moreno, Mexico

46. HP Digital Hospital
Cost-benefits analysis
case study
© 2008 Hewlett-Packard Dev elopment Company, L.P.
The inf ormation contained herein is subject to change without notice

47. Business Context
• New Hospital building planned in Northern France
• Opportunity to provide modern care based upon modern
hospital – equipment, facilities AND IT infrastructure
• Want to assess impact of many solutions together
• Model data set at 250 beds
Solution Components:
• Hospital Messaging
• Information Integration
• Location Based Services
• Patient Terminal
• IP Infrastructure

48. Cost/Benefit Analysis
• Identification of business • Measures:
objectives − Quantitative benefits
• Establish key facts – salaries, • Time saved
time taken for tasks • Cost reduction
• Revenue enhancement
• Estimate process improvement
with solution − Qualitative benefits
• Patient satisfaction
• Calculate benefit in time saved
• Staff satisfaction
• Convert time saved to financial
value using key facts
• Assess impact on qualitative
measures.
Can be applied pre- and post-
implementation

49. Business Objectives - Examples
Driver Strategy
Increase operational Information available anywhere
efficiency: Asset tracking
Single network
Improve Patient Safety: Prescription Policy online
Medical Team Assembly
Increase patient satisfaction: Enhance bedside facilities
Increase staff satisfaction Automate patient administration

50. Impacts of the solution - examples
Necessary solution components
Converged Secure
Network and Hospital alerts integration of
VoIP Location Patient
and information
Services terminal
Wired, messaging and medical
Strategie Wireless equipment
s Information available everywhere
•
• Find & locate personal equipment
• Unified and integrated network
• Specialised medical equipment alerts
• Provision of bed side services
• Automated administration processes
50 9 March 2009

51. Implementation Plan
Development of the
Release 1
Roadmap
• Align opportunities
•100% IP backbone,
• Identification of pre- VoIP; Wireless
•60% Information Release 2
requisites intégration
•60% Hospital Alerts &
• Definition of the project Messaging
phases Content •50%Phase 1 Terminal
Patient
•40% Information Release 3
Integration
• Identification of costs and •100% Location
benefits by phase Services
•40% Hospital Alerts
& Messaging
•50% Patient
Terminal
Time (months) 6 12 18

52. Benefits and Costs
(K€)
10000
8000
6000
Benefits
4000 Total Costs
2000
0
Phase Phase Phase Phase Phase Phase Phase Phase
0 1 2 3 4 5 6 7
At current prices; 4 years illustrated

53. Release of Benefits
Phas Phas Phas Phas Phas Phas Following
Value released e0 e1 e2 e3 e4 e5 Year 5
0 0 1.0 2.1 2.1 2.1 4.2
Hospital Messaging
0 0 3.2 5.4 5.4 5.4 10.8
Information integration
0 0 0.5 0.5 0.5 0.5 1.0
Location Based Services
Patient Terminal 0 0 1.0 1.0 1.0 1.0 2.0
0 0 5.7 9.0 9.0 9.0 18.0
Total Benefits (M)
(6.4) (6.5) (6.5) (1.6) (1.3) (1.3) (1.3)
Costs
(6.4) (12.9) (13.7) (6.3) 1.4 9.1 16.7
Net Benefits
Phase = 6 months
Return on Investment = 28 months; Total Net Benefits (3 years) = 9.1M
€

54. Digital hospital – workshop
• Looks at the hospital from Business Why • Drivers, goals?
view • Content?
− Business view • Criteria for
− Functional view measurement?
− Technical view Functional • Data?
Whic
− Implementation view view h
• User?
• Services?
• Determines • Quality?
− Business drivers Technical • Structured?
How
− Vision, goals and analysis criteria view • Planned?
• Realised?
• Defines the digital hospital strategy
− Principles Implementation • With which products?
− Motivations view • With whom?
• When/where
− Implications (rollout, implementation)?
Result Management report & presentation incl.
• Strategy and solution description
• Business benefits and ROI
• Investments and work packages

55. Partner selection
• Cisco, Cardiac and • Create a roadmap of deals
• Xevit
• Lincor • Point solutions pave the
• Nortel way to the total Cardiac
• ProCurve solution.
• Trident (Jaotech)
• Ascom
• Lifeline (Cloaverleaf)
• JDM
• Axis
• J&K
• Aeroscout
• Philips
• Nervecenter

56. Conclusion
Digital Hospital Delivering Business Outcomes
Accelerate business growth: Lower costs / increase Mitigate risks:
Speed innovation to efficiency: Improve quality of
transform health Improve operational care
efficiencies
• Clinical information automatically captured and fed into elec
patient record
• Electronic decision support --- accelerating and improving
treatment decisions
• Interactions between patients and staff are radically
improved
• Changes in patient conditions can be communicated real
time enabling faster response
• Location-based services and WiFi tags helps staff locate
resources faster and manage assets better
• Bar coding and RFID technologies greatly improve
medication administration – one of the most error prone
care procedures
• Portable devices and wireless communication extend the
organizational boundary, leading to better, more efficient
care for chronic-condition patients
• Vast amounts of data can be captured for medical research,
speeding the creation of new treatments and healthcare
delivery options
• Happier Patients