Traditional thinking about digital transformation tries to introduce digital capability into the existing way we deliver health services with the objective of improving what we currently do. This approach inevitably constrains our thinking and limits the opportunity for transformation. The advent of COVID-19 has shown that there is now a need - and an opportunity - to deliver care differently, creating an inflection point in the way digital design and capabilities can enable care.
Providers and
receivers of care have had to embrace change at pace and in this upheaval lies
the opportunity to reimagine and shape the future not just digitally but in
creating a completely new strategy. This shifts the opportunity from digital
transformation to smarter, user-centred design. The concept of a smarter
hospital focuses not just on the building but its role within an integrated
care system. The smarter hospital focuses on the lives of its people - those
working in it, receiving care or visiting - the processes that run within the
organisation, and its impact on the community and the environment in which it
operates. The smarter hospital will need to operate with infection control
principles at its heart in order to manage patients who test positive for
COVID-19 alongside the rest of the service.
The challenges of a
novel virus and disease have created a closer link between research and care
delivery, offering us the prospect of every patient being in a trial and
turning our hospitals into real world learning environments. Now there is an
opportunity to think afresh about the role that our hospitals can play, enabled
by digital capability. This is about the hospital at the heart of a local
health and care ecosystem as part of a coordinated approach to clinical
services, not simply about the estates. These services will often be expected
to serve different populations (local, regional and perhaps tertiary) within
and beyond the four walls of the hospital. This paper proposes a vision of a
Smarter Hospital, based on user centred design. The hospital is re imagined
through the lens of patient pathways and clinician workflows, and where digital
options differ for each population using the service, and the processes and
buildings are designed with this intent.
The foundation for
the vision is a paperless service, enabled by clinical, care-giver and
patient-facing technologies including high levels of digital workflow
integration with electronic health records (EHR) and patient administration
systems. This foundation includes the pervasive use of data: informing patient
care; enabling patient flow optimisation; maximising building operation; and
ensuring effective resource utilisation.
The core of the
Smarter Hospital is flexible and modular, including digital technology,
interoperability, data fluidity and a secure, open digital platform to nurture
innovation as technology emerges. For example, developments in voice activated
notation might allow a reduction in the time spent writing electronic records,
potentially breaking down some of the physical and communication barriers
between patients and clinicians. We know that using an EHR takes up a lot of
the clinician’s working day; one US study states that it amounts to about 50%
of a clinician’s time.1 Such digital innovation alone has implications for
consultation room design, the acoustic design of the building (air conditioning,
acoustic damping) and building power requirements. The advent of COVID-19 has
heralded an age of e-mail, text, telephone and video consultation becoming
mainstream alternatives to physical outpatient services. Consultations can be
provided away from hospital buildings providing an opportunity for clinical
staff to work remotely. The application of user-centred design principles
combined with current and emergent digital technologies can revolutionise the
relationship between the patient, the care giver, the Smarter Hospital and the
service. This can be described through the lens of these different
relationships, and impact upon four core design
components: –
Patients and families – Community – Workforce – Environment
The
four design components of a Smarter Hospital
Patients
and families: Making the patient and their family a part of the team
Co-designing care
pathways with patients will drive greater visibility and control; adopting
user-based design principles to enable groups of patients or “personas” to
articulate their particular needs and preferences will enable a streamlined
pathway. Key to this is creating a frictionless interface between the patient
and the service. It builds on the principle of giving more visibility and
control to patients, not only of their care, but in the co-designing of
services.
The interaction with patients and families
should strive to be digital first but also allow for more traditional routes.
Having a digital front door of the hospital powered by a virtual assistant
could allow for the automation of booking, cancelling and rebooking of
appointments as well as other common queries such as enquiries about letters
and appointment details.
The increase in
remote consultations allows patients to interact with healthcare professionals
from home or from a local community resource, such as a library or health
centre. Many of the standard clinical assessments could be digitalised and
carried out before the appointment or admission. All this creates capacity and
more time for longer interpersonal interactions in those circumstances or
stages when this is more important.
When patients
unavoidably need to attend the hospital, their journey could be enhanced by way
finding technology. Imagine a journey concierge app allowing you to book your
appointment with a pre reserved parking spot, having your smart phone auto route
to that parking space, and augmented reality providing way finding support to
navigate within the building to the correct consultation room.
A patient portal could
give the patient access to a summary of their records, discharge notes,
correspondence, and possibly a transcript or recording of their consultation.
This portal could be used for patient education material in multi-media format.
Medical records could include patient-generated text such as preferences,
patient reported outcome measures and therapeutic goals. This has significant
implications for how we evaluate consultations.
An ongoing
relationship with the patient can be facilitated through digital access.
Interaction need no longer be limited to the time the patient is physically in
the hospital. This relationship creates the possibility of community monitoring
using the IoT (internet of things), devices in the home, or wearables, to track
at-risk individuals. The delivery of individualised and preference-specific
content could allow for a rich economy of disease management tools to emerge.
The use of
gamification apps can enhance chronic disease management and the development of
patient experts, and virtual reality or augmented reality therapeutic options
can improve pain control. There is a small step from this to connecting
patients and families who have similar conditions or care pathways to create a
network of support and information around the hospital.
Workforce:
returning to the joy of care
Redesigning services
with the workforce, for the workforce, and including digital enablement of
streamlined care will be critical to enhancing job satisfaction—now more
important than ever for people who have cared through the COVID-19 crisis and
may be suffering from stress and burnout. Delivering digitally enabled care,
anchored in a new Smarter Hospital building, provides a unique opportunity to
attract staff to the hospital, and to offer services they would enjoy
delivering and of which they can be proud.
One of the most
stressful aspects of clinical practice can be when pressure of the procedural
workload gets in the way of patient care. Much of this workload could be
automated. Sifting through general information to find the essential updates
and navigating to find the most appropriate evidence-based treatment pathways
can be increasingly time-consuming. Augmenting access to the latest research
with artificial intelligence to provide decision support could reduce the
pressure of processing large bodies of current practice and guidelines.
There is an
opportunity to address unexplained variation between clinicians in a supportive
and educational way, providing a less stressful and a more rewarding way to deliver
care. The introduction of poorly designed EHR systems can be a significant
source of stress for many hospital staff. In one US study, 70% of doctors
reported stress related to health information technology. Streamlining EHR
implementation to enable the optimisation of passwords and authentication
technology, the provision of clinical adoption support, and using sentiment
analysis could help to embed user practices on IT systems. Having mature
bring-your-own-device (BYOD) strategies might help to normalise the experience
of hospital technology.
The environment
itself has a significant impact on wellbeing. A building designed with light
and green space helps promote a calmer and more relaxing environment for
everyone. Access to leisure facilities, and the provision of dedicated sleep
pods and rest rooms can all be important components of an effective working
environment. Other technology changes could include recruitment, induction and
training, talent deployment and improving the environment of the workplace.
There are significant opportunities to rethink scheduling and rostering
systems, using platforms designed to link staff to shifts in a more
controllable way. If applied to temporary and ‘bank’ staff, the provision of
flexible working conditions could go some way to address the recruitment and
retention challenges currently faced in some staff groups.
Community:
a seamless care journey
A Smarter Hospital
should contribute to a vibrant spirit of community participation beyond its
walls, supported by open and secure digital platforms. These platforms should
be harnessed as the basis for fostering health start-ups, device companies and
industry partnerships. These ecosystems can have a significant impact on local
employment and business development. The services of a Smarter Hospital will be
characterised by a highly porous, virtual border between the service within the
building and the community, in terms of the experience of the patient and care
giver.
This is likely to
involve a network of buildings serving different clinical needs, such as
community hospitals with diagnostic facilities and step-up or step-down beds.
The integration of services into place-based care programmes will be important,
ensuring links to population health management (prevention and wellness)
programmes. Diagnostics and interventions should be provided as close to the
patient as possible using the assets and resources in the primary care hubs.
Although novel contracting and workforce planning may be needed, leveraging
digital capability offers the opportunity for the community to enter the
building, and the hospital to be a part of the community. The connectivity of
5G could allow for more community monitoring and streamed mobile diagnostics.
The availability of any-time-any-device EHRs
are the foundation of such a way of working. Digital links to the community
provide more opportunity for local voluntary groups to be more closely
integrated into hospital services such as transport or befriending services.
Environmental:
the greenest hospitals in the world
Increasingly we all
need to play our part in minimising our environmental impact, and this applies
no less to hospitals. There are opportunities especially in newly built
premises to set a global example of sustainability excellence. The methodology
of digital twins is a powerful way of creating intelligent buildings which
exploit building sensors to monitor and capture environmental and asset
performance. This isn’t limited to sustainable heating and energy generation
solutions but extends to single-use plastics and the adoption of intelligent
preventative ‘fix before fail’ operating processes. Carbon neutral designs,
delivered using sustainable development standards, also embrace advances in
materials usage, land use, energy transport, water and wastewater management.
There may be
opportunity to join local energy networks that create heat exchange systems.
The provision of services via digital channels could act to lessen one of the
most significant environmental impacts of a hospital - by reducing the travel requirements
of its staff, patients and visitors, further enabled by electric-vehicle staff
transport systems and digital platforms for lift sharing.
The disruption of the
COVID-19 pandemic creates an inflection point in the delivery of healthcare.
There is an opportunity for user-led design to enable patients and healthcare
professionals to reshape care for the future, enabled by technology. The shift
to a patient and carer view, combined with the capabilities of technology,
creates possibilities to transcend the walls of the hospital, and for
healthcare to step up to its responsibilities in addressing environmental
impact. All this has been accelerated by a new virus and a new disease that has
forced us to look again. It would be a shame not to embrace the opportunity
this crisis has given us.
Credit: Mark
Davies, Chief Medical Officer ,IBM and Watson Health, Europe, Middle East and
Africa/ Medpoint Healthcare