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Hospital of the future

Hospital of the future

Forget clipboard charts, groaning files and moaning patients.

You'd struggle to find anyone who doesn't agree that the idea of an electronically enabled health system would be a giant leap forward for healthcare in the Australia of today and tomorrow. Anyone with a background in technology who has spent any time in a hospital in recent years will be immediately struck by the jarring lack of integrated systems.

What? It will take a fortnight for my doctor to receive the results of these scans? In 2010? . . . Madness.

So it would be fair to say that working as a chief information officer in the healthcare sector has all the hallmarks of a thoroughly frustrating gig.

The failure of successive governments to make any real headway on a national e-health strategy has left many hospitals working in the technology dark ages.

There's room after room filled with groaning files recording details about patients who have long since left the area, and have long since forgotten they ever had to have that saucepan ¬surgically removed from their head.

Getting systems in place to link all of the information together is a logistical nightmare, and one that needs to be approached if individual e-health records are going to be meaningfully complete.

Step forward Geoff Harders, chief information officer at the new Macquarie University Hospital (MUH) in Sydney's north – who has a background that encompasses the design and implementation of all the ICT systems and infrastructure at St Vincent's Hospital in Melbourne and a CV that includes CIO work for six ¬Victorian government health services.

He has a wealth of ideas about how the technology-driven hospital of the future should look, and at MUH he is in a position to put those ideas into practice.

Freshly opened in June of this year and co-located with the Australian School of Advanced Medicine, MUH is Australia's first and only private hospital situated on a university campus. It has, at the centre of its ethos, a commitment to delivering what it calls a "positive patient experience and superior clinical outcomes through the best available care and the latest technologies".

Getting it right from scratch

Speaking to MIS after the hospital has been operating for only a short while, Harders is understandably enthused about the great opportunity he sees for creating a hospital unencumbered by creaking old technology.

All patients will have an electronic record at the hospital, for starters, and the institution promises to use the best available medical technology, and provide the best in wireless networking, RFID (radio ferequency identification) and VoIP (voice over internet protocol) communications.

"The advantage that we had is that we didn't have to start off with an existing facility," Harders says.

"So therefore all of the ¬legacy systems you would normally have to deal with weren't an issue. Since we were starting from scratch we were able to do what we wanted right from the beginning. So from that perspective there was always the vision that we wanted to be technologically advanced and to push the envelope in relation to the holy grail of electronic medical records."

Harders joined Macquarie University Hospital in March, and says his job description was to get it open and operating and to then drive the vision going forward.

However, even for a newly opened facility, Harders faces the challenge of numerous systems across different parts of the ¬hospital that don't fit naturally together. He says an initial ¬challenge in getting the facility up and running has been kicking off a program to simplify its systems.

He says the hospital's underpinning systems will be moved on to a common platform, with common databases running right across the hospital.

That way the interaction between different parts of the network will happen at a systematic level rather than doctors and consultants having to worry about managing the software.

The most visible sign that MUH is more technologically advanced than other hospitals is the presence of bedside patient "cockpits", which are becoming the focus point for patients' care in the facility.

The hospital has installed 150 of the units, which are made by Siemens Enterprise Communications.

They are described by Siemens as ¬"integrated bedside entertainment terminals", as they let patients make phone calls, watch free-to-air and pay TV and movies, and also listen to the radio, surf the web and play games.

Bedside units reveal data

They also serve as information centres for patients, and allow them to retain a little more control of their hospital stay.

They can access key clinical and administrative data and make daily meal choices online. Patients can also browse hospital information services, learn more about their medical condition, and find tips about how to improve their health.

"Being able to access videos about their particular disease and how to deal with it will be a big help for some patients," ¬Harders says.

"Often people are in hospital and are confronted by a new disease or problem and just have no idea what it means. They are worried that their life is going to end, whereas in reality it is a problem that can be dealt with effectively."

Aside from making a hospital stay more bearable, the advancing technology is changing the way those caring for the patients are able to work.

When a clinician arrives at the bedside, they are able to turn the patient entertainment system into a clinical workstation through an access card and system log-in.

Doctors and nursing staff can use the system to access data about the patient's prior treatment and condition.

During patient consultations, a range of diagnostic images or laboratory data, for example, can be retrieved and easily compared with previous results.

The cockpit is also designed to provide patients with greater safeguards against incorrect doses of medication through patient-error and drug-error checking processes offering accuracy and precision.

When the nurse comes in to give the patient a dose, it will have a precise and reliable record of date and time of what they have already received and what treatment has occurred.

"Because of this, all of a sudden you have a much closer nexus between cause and effect," Harders says.

"At the minute, the medical chart at the end of the bed is really the tyranny.

"If the chart is not there when someone needs it they have to remember details, take notes on something else and then remember to update the chart when it is back again.

"In the electronic system the chart is virtual and can be viewed at multiple places, so there is not the conflict about chart availability that currently exists in most hospitals."

Presently the records are held within the hospital and are updated with any records that a patient brings with them. However, Harders says he hopes the recently commenced ¬issuance of national healthcare identifier numbers will usher in changes that will see complete records able to be shared between hospitals electronically.

Harders says that the technology revolution at the hospital has engendered such change that a substantial amount of training among staff has been required to ensure they are comfortable working in a new way.

He says doctors are already using the systems to look up all of their patients' details, charts and overnight events, in order to be prepared before they start their rounds.

Other hospitals want it too

"That way they can spend more quality time with the patients that need more time than others, and be more efficient and effective in delivering patient care," Harders says.

The information chief says he has already been contacted by a number of his CIO peers in the medical sector, keen to pick his brains about how the hospital's technology is being set up, and how it is performing in action.

He says he is always happy to talk about how things are going, and have candid conversations about the challenges he faces, as he seeks to push through much more systems integration and many more improved business intelligence systems.

"Part of our aim is to become an exemplar of what can be achieved if you are brave enough to start down the journey," Harders says.

"You can become much more effective, much more efficient and actually deliver better and safer patient care."

NBN would have an impact

Harders says the investments are paying off. "We have made ¬substantial investments in technology generally – both in more traditional IT and also in how they interface with other ¬systems," he says. "For example, in our intensive care and cardiac care units all of the machines are feeding directly into our clinical ¬systems.

"We are getting a much clearer picture of what is happening with a patient over time, what interventions have occurred and what the results have been."

The medical sector was one that was specifically referenced when plans for the federal government's national broadband network were first released in early 2009.

Harders says that while the hospital itself is well equipped with its own infrastructure, better national networks would be a boon for more technically advanced hospitals and other medical facilities.

He says a national high-speed network would help in reticulating medical images to other parts of Australia or the world, and would leave the medical community better equipped to share health records as they become available electronically.

"It would certainly be very helpful to have a national broadband network – you can never have too much bandwidth, ¬especially in a hospital," Harders says.

"The options available are substantial. We have numerous neurosurgeons as part of our staff here. If they had the capability, through the NBN, of taking medical images like CT scans and MRIs from the Northern Territory or country Queensland they could provide expert opinions remotely. It'd make a big difference." MIS Australia

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