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

HP Digital HospitalSt. Olav’s Hospital experience

Alfons BuxóSpain Presales Director

Current issues facing hospitals todayConvergence of several factors and challenges

Growing demand InnovationCost increase

•New diseases•Chronic diseaseincreasing•Skilled workforce needs•Hospital technology silos•Clinical Productivity•Process complexity•Resource optimization•Knowledge sharing•Technology alignment to business/clinical priorities•Labor shortages

•Aging population•Immigration•Universal benefits

•Improve Diagnostic capability •Targeted treatment•Manage pace of innovation •e.g for chronic disease management,•Best practice adoption

•Diagnostics and treatments•IT greater embracement•Technological complexity raise•Patient safety and quality of care•Care continuity•Clinical communication•Patient Satisfaction•POC information access•Clinical traceability

Speed innovation to transform health

Improve quality of careMitigate risks

Improve operational efficiencies

Clinical Productivity challengesExamples• 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

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

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

The infrastructure silos in hospitals today

Nurse Call Phone Systems (PBX)TelephonesDECT/Pager

Door OpenerIntercomCCTVAGV (Robot)

LightBlindsHeatingFacility Control

Mobile ward round

Wireless LAN

WiFi

Client PC

Hospital Applications

Paper

Medical Devices

EPR PACS HIS LAB EHC

RFID

Patient TV

Everything over IP – IP Everywhere

IP Convergence through a resilient, protected network Enabling the transmission of vital information

Patient terminal

LAN/WLAN

IP converterESPA 4.4.4

MDA/PDA

PC Mobile phones(SMS)

IP wirelessphones

OPC, SMTP, SMNP

I/O signalconverter

HP Digital Pen

Patient monitoringmedical equipment

WiFi tagsFacilitycontrol

EPRPACSLaboratory Etc.

Nurses’portal

GSM

Nurse call

PagerIP phones

What constitutes the Digital HospitalPatient 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 & CommunicationInfrastructure

•Patient bedsideinteractive services &communications

•Digital signage

Collaboration•Telehealth video & conferencing solutions (Web, audio, video, IM, presence)

HP Digital Hospital Solutions framework

Converged Network, upgrade & security servicesWired & Wireless

Voice, Data, Video

IP Telephony, PBX replacement

Presence, Instant Messaging, Unified Messaging

Workflow Management / integration

Directory integration

RFID enabledlocation

& trackingservices

•Hospital messaging &alerts•Mobile nurse call•Medical team assembly•Hospital orderly•Order entry & results alerts

•Asset tracking•Patient & staff safety•Temperature monitoring

•Electronic whiteboard•Medical equipment interconnect

•Integration with hospital applications- EPR / CIS / HIS- Lab IS- …

(Man

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ent,

QoS

, Use

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min

)

The Digital Hospital Journey

• Converged IP network for voice, data and video

• Messaging & alerts• Patients & Assets

tracking with RFID

• Enhance integration of applications and services

• Seamless communications & alerts

• Align applications with business processes

Physical integration

Logical integration

Ecosystemintegration

• Patient bedside terminal/portal

• Patient monitoring

• Reinvention and redesign of care processes

• Organizational virtualization

• Ecosystem partners integration

Inefficient manualprocesses

Technology enabled efficient processes

•Better quality of care

•Reduced number of errors

•Improved productivity and decreased cost

St Olavs hospitalExperience

St Olavs Challenges & VisionBuilding a state-of-the art hospital to deliver patient centric services

• Hospital was too costly to operate, with annual rising costs

• Decision to build a patient centric new hospital that will provide outstanding quality of care

• Opportunity to integrate clinical and teaching/research areas

• From one large structure to 11 separate centres

• Exploiting ICT to deliver information to the right persons at the right time at the point of care

• Located in Trondheim - Norway’s largest hospital

• Premises: Main Acute Services Unit (75%) & University Hospital (25%)

• Managed by the Regional Health Authority of Mid-Norway

• 950 beds• 8,000 Staff (+1,250 students) • 413,000 patient treatments per year• Provides services & specialties for

other hospitals in the region

St Olavs’ hospitalAdvanced logistics choices

Automatic Guided Vehicles (transportation robots )Pneumatic tube systems

Clothes management

through RFID chips and

cabinets

Automatic waste handling

The new St. Olavs’ hospitalA 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)

Creating the Digital Hospital Assets – division of labour

Nurse request wheelchair.

LBS selects the nearest one.

Transporter dispatch chair to the nurse.

Real time location and tracking

Asset Management

Equipment Maintenance

Temperature Monitoring

Workflow & Resource

Management

Patient & Staff Safety

Reduce costs Improve operational efficiencies Increase patient safety

Track…current and

historical location of medical devices and people, from a Web

interface

Alert…automated alerting and

notification (pump leaving a protected zone, overdue for

maintenance, requiring delivery, etc.)

Manage…the utilization of equipment, control the workflow and

utilize location data for operational

analysis

Integrate…location and status information to existing

hospital applications (e.g asset mgmt, EMR, etc.)

Melding-sentral

Patient

Send and receive messages

Custommenus

and predefined messages

Personnel FireTeam

Predefined acknowledge alternatives

Replay and forward(auto and manual)

On-touchduty or assault calls

Hospital Communication System

• IP Phone messaging • Nurse Call• Medical team assembly• Hospital Orderly• Building Alerts

AGVLifts Notifications Clinical Applications

Hospital Comm. System

Creating the Digital HospitalNursecall – 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.

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.

Creating the Digital HospitalMonitoring – Locating nearest nurse

A biomedical device generates an alarm.

System locates closest nurse and instruct her to evaluate patient’s condition.

Benefits for Nurses – St Olav’s hospital

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

“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

Business Technology-In-ActionDigital Hospital Solution at St. Olavs

Operational Tools

IP TelephonyFixed/wireless

NetworkInfrastructure

Digital dictationPatient Alarm

Appl. .Data

NTNUAppl. .

DataSt Olavs

Patient terminal

Peripherals

Cabling

Public Network

Secure LogonCertificates

TV distribution/VideoAudio

Medical DigitalAssistant (Ipaq)

Meta Catalog

Alarm and tracking

Messages application

Excerpts from IDC Case Study (Sept 2006)

… a groundbreaking project … … St. Olavs Hospital has been

tagged the most modern hospital in Europe and probably

among the world’s leading healthcare technology initiative and is now fully operational …

… St. Olavs Hospital should be considered the world’s

benchmark in terms of tactical and strategic usage of

technology in life and death scenarios for the better of their

customers, the patients …

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

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

Conclusion

Conclusion

• 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

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

Backup

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

Healthcare Providers Business Challenges

Speed innovation to transform health

Improve quality of careMitigate risks

Lower costs/Improve operational efficiencies

•Hospital technology silos•Clinical Productivity•Process complexity•Resource optimization•Knowledge sharing•Technology alignment to business/clinical priorities•Cost containment•Labor shortages

•Improve Diagnostic capability •Targeted treatment•Manage pace of innovation •e.g for chronic disease management,•Best practice adoption

•Patient safety and quality of care•Care continuity•Clinical communication•Patient Satisfaction•POC information access•Clinical traceability

¿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

IDC Healthcare IT Maturity Model

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

Improved patient care andefficiencies through bettercommunications, collaboration,information flow

Built on

• a converged, resilient, securedand adaptive network infrastructure,

• Unified IP based communications, alerts

Enabling • incremental solutions and

integration to improve healthcare processes efficiencies, quality of care

The Digital Hospital

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

InformationIntegration

Across devices, instruments,applications

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.

Application integration layers

Clinical & Admin Information SystemsApplications views

Processes components

Integration layer (Middleware)

SW infrastructure (network, virtualization, …)

Hardware infrastructure (cabling, processors, disks…)

Legacy applications (departmental)

Technologicalarchitecture

Applicationarchitecture

By specialty, processes,(patient files, prescriptions, …)

Blood bank

ClinicalChemistry

Medical applications & instruments integration

CTG, ECG, etc.

Software Discrete data Waveform (real time)

Endoscope, Microscope,Remote Lab Instruments,FAG, OCT, etc.

Infusion Pumps, CTG, ECG, Blood Pressure Monitors, etc.

DICOMHL7

ASTMNon Standard

Integrations

Examination Observation Observation/Monitoring

IMATIS Application Platform and Middleware

Presentations

Clients devices

Sources of data and information

Applications

HP and Imatis information integrationsolution

Benefits• Connecting different

communication and medical devices as well as applications

• IMATIS portal sends data to the right communication device

• Transaction processing with real-time control and storable sets of rules provides necessary security

• Instant real-time event driven information delivery

IMATIS portal

Adapters, Gateways, Drivers

IMATIS SOA Platform - Middleware

Functional View & solutions benefits examples

Example: Asset tracking at St Vincent’s hospital improve productivity and time with patients- Active RFID solution to track assets - Automated inventory management and alerts- Integration to order fulfillment system

Benefits

- Improved equipment availability - 20% cost reduction in rental costs and lost equipment

- Improved service unit staff productivity -20% increase in nurse time with patients

Costs savings

Patient services (QoC)

Productivity

•Reduce purchase of new equipment•Reduce rental costs•Staff efficiency

•Reduced safety incidents•Reduced wait times•Increased staff time with patients

•Increased patient throughput•Increased capacity of critical departments (OR/ER)•Increased staff productivity•Reduce staff time spent on manual searching, logging and monitoring procedures

Real time location and tracking solutions

Asset Equipment Temperature Patient & Workflow & Management Maintenance Monitoring Staff Safety Resource

Management

Patient Terminal

• 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

• Access for clinicians to the hospital information system via smart card

Patient services

Productivity

• 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,

bringing greater patient safety and convenience

• Community outreach for specialty counseling and resources between facilities

• Community outreach for specialty counseling and resources between facilities

• Foreign language patients assistance• Staff development – Training, Peer to

Peer interaction, Mentoring and best practices

Video conferencing and high resolution images sharing

Costs savings

Patient services (QoC)

- Large US orthopaedics specialty practices with 19 offices, six surgery centres- Adopted UC real-time video collaboration to relieve physicians attending training and compliance meetings travel burden- In nine months, the system saved 100 hours of physician travel time, meaning more time for patient care

• 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 (*)

Costs savings

Patient services (QoC)

Productivity

Presence, Instant Messaging

• Large NHS Healthcare trust employing 7,000 people over 8 hospitals improved employee collaboration using a UC solution providing IM, VoIP, video and web conferencing. • Benefits reported include enhanced patient care through improved collaboration, significant time savings through presence, and much reduced email traffic.

* Survey conducted by Carestream Business Diagnostic Studies

• Contact specialists to rapidly respond to patient queries and react faster to medical emergencies•Location information can also help identify the closest and most suitably qualified person to respond.

Digital Signage in hospitals

• 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

• Touchscreen Directories and Wayfinding Systems−help patients navigate your facility, increasing on time arrival at appointment

• Patient Registration and Check-In Kiosks−self-service kiosks to fill out new patient profiles −Staff savings, while reducing wait times

Costs savings

Patient services

Productivity

Registration zoneSmart Technologies

Registration Area

While waiting, havea coffee or some gaming

Self Service Counter

Digital Signages

Wireless Network Technology

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

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

HP Digital Hospital Cost-benefits analysis case study

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

Cost/Benefit Analysis• Identification of business

objectives • Establish key facts – salaries,

time taken for tasks• Estimate process improvement

with solution• Calculate benefit in time saved• Convert time saved to financial

value using key facts• Assess impact on qualitative

measures.

• Measures:− Quantitative benefits

• Time saved• Cost reduction• Revenue enhancement

− Qualitative benefits• Patient satisfaction• Staff satisfaction

Can be applied pre- and post-implementation

Business Objectives - Examples

Driver Strategy

Increase operational efficiency:

Information available anywhere Asset trackingSingle network

Improve Patient Safety: Prescription Policy onlineMedical Team Assembly

Increase patient satisfaction: Enhance bedside facilities

Increase staff satisfaction Automate patient administration

50 9 March 2009

Impacts of the solution - examples

Strategies• Information available everywhere

• Find & locate personal equipment

• Unified and integrated network

• Specialised medical equipment alerts

• Provision of bed side services

• Automated administration processes

Converged Network and

VoIP

Wired, Wireless

Location Services

Patient terminal

Hospital alerts and

messaging

Secure integration of information and medical equipment

Necessary solution components

Implementation Plan

Phase 1

•100% IP backbone, VoIP; Wireless•60% Information intégration

•60% Hospital Alerts & Messaging•50% Patient Terminal•40% Information Integration•100% Location Services

•40% Hospital Alerts & Messaging•50% Patient Terminal

6 1812Time (months)

Content

Release 1

Release 2

Release 3

Development of the Roadmap

• Align opportunities• Identification of pre-

requisites • Definition of the project

phases• Identification of costs and

benefits by phase

Benefits and Costs

At current prices; 4 years illustrated

0

2000

4000

6000

8000

10000

Phase0

Phase1

Phase2

Phase3

Phase4

Phase5

Phase6

Phase7

Benefits

Total Costs

(K€)

Release of Benefits

Hospital Messaging

Information integration

Location Based Services

Patient Terminal

Total Benefits (M)

Costs

Net Benefits

0

0

0

0

0

(6.5)

(12.9)

Return on Investment = 28 months; Total Net Benefits (3 years) = 9.1M€

Phase = 6 months

Value released

4.2

10.8

1.0

2.0

18.0

(1.3)

16.7

2.1

5.4

0.5

1.0

9.0

(1.3)

1.4

2.1

5.4

0.5

1.0

9.0

(1.6)

(6.3)

1.0

3.2

0.5

1.0

5.7

(6.5)

(13.7)

0

0

0

0

0

(6.4)

(6.4)

Phase 0

Phase 4

Phase 3

Phase 1

Phase 2

2.1

5.4

0.5

1.0

9.0

(1.3)

9.1

Phase 5

Following Year 5

Digital hospital – workshop• Looks at the hospital from

− Business view− Functional view− Technical view− Implementation view

• Determines− Business drivers− Vision, goals and analysis criteria

• Defines the digital hospital strategy− Principles− Motivations − Implications

Result Management report & presentation incl.• Strategy and solution description• Business benefits and ROI• Investments and work packages

WhyBusiness view

Functional view

Technical view

Implementation view

Which

How

• With which products?• With whom?• When/where

(rollout, implementation)?

• Drivers, goals?• Content?• Criteria for

measurement?

• Data?• User?• Services?• Quality?

• Structured?• Planned?• Realised?

Partner selection• Cisco, Cardiac and• Xevit • Lincor• Nortel• ProCurve• Trident (Jaotech)• Ascom• Lifeline (Cloaverleaf)• JDM• Axis• J&K• Aeroscout• Philips• Nervecenter

• Create a roadmap of deals • Point solutions pave the

way to the total Cardiac solution.

ConclusionDigital Hospital Delivering Business Outcomes

• 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

Accelerate business growth:Speed innovation to transform health

Lower costs / increase efficiency:Improve operational efficiencies

Mitigate risks:Improve quality of care