As the general population continues to age and healthcare workers are tasked to do more with fewer resources, healthcare facilities will need to embrace technology and its capabilities to realize success in patient care and financial efficiencies. Humber River Hospital was looking to deliver enhanced care in a larger facility with more beds on the same budget—and found numerous technology solutions that are getting noticed.
One of Canada’s largest community acute care hospitals, Humber River Hospital opened in Toronto in 2015. In 2016, the Intelligent Health Association recognized it as North America’s first digital hospital, stating “patient care has been reimagined with mission-critical goals depending on technology for delivering enhancements.”
The hospital is large with over 700 beds and about 300-400 emergency patients per day being treated. It serves patients who speak in about 70 different languages.
Humber River Hospital’s vision is to work together to deliver innovative and compassionate healthcare in the community. When building the healthcare facility, the Humber River Hospital team considered the challenges it was trying to solve and its vision. The facility was designed around the following pillars:
Lean: It was critical to create a facility that could accommodate the number and types of people it serves and staff who can be as efficient as possible when treating them. From the moment an occupant enters the healthcare facility, they are greeted with a multilingual wayfinding kiosk to direct them through the hospital.
Green: Energy-saving systems are used throughout the facility to cut down on costs while creating a comforting and comfortable facility, like the use of electrochromic glass by View, outside air and an intelligent lighting design and control system.
Digital: Cutting-edge technology helps in the success of the first two pillars, in addition to tools that save lives and help staff do its job better, like handheld devices to monitor and interact with patients and a robot supply delivery system.
Digital Hospital Uses Technology to Drive Action
Although all three items have gained Humber River Hospital a lot of positive attention, the digital component was unique when it was developed.
“We wrote our specifications for this building in 2009, so some of these [technologies] were very new concepts,” explains Barbara Collins, president and CEO of Humber River Hospital. “There were engineers, architects, people like that who said, ‘There’s no way it will ever happen. You can’t get these systems to talk to one another. Staff won’t use the system. Doctors won’t use the system.’ That, in fact, hasn’t been the case.”
She describes how this is achieved by breaking down the digital focus into four components:
1. Digital information.
Information is readily available, simultaneously contributing to collaboration and knowledge sharing. It’s all actionable—it contributes to workflow, automation and better decision making. All systems are able to communicate with each other. Whether it’s a piece of diagnostic equipment, bioengineering, the medical robots in the building, there’s an opportunity for integrating communication.
2. Mobile and connected.
Providers and patients access and create relevant information anytime and anywhere. They can collaborate with each other conveniently and instantly. We need to have devices for them to do that on. Systems connect with people to drive performance, quality and safety.
3. Be mission-critical.
All systems have to be operational 100% of the time. Information has to be available for at least seven years, and people using this automation have to be able to deliver care 100% of the time.
Systems have to work together to deliver a more effective business outcome. Systems must allow for the exchange of information to drive action and inform people.
“We use technology to drive action through interoperability, which has allowed us to use closed-loop communication systems to implement analytics and to begin to use artificial intelligence in our processes,” Collins says.
The new technology “wasn’t toys for toys sake,” Collins says of how they decided what would be used at Humber River Hospital. Any digital tools put in had to:
Make the staff’s jobs easier
Decrease the amount of time staff spent walking the floor
Drive action through its use for workflow automation and better decision making
Improve communication among staff
“Where you can make a work process easier or prevent a communication error, people will use the device if you give them the right device, a reason to use it and education around it,” explains Collins, about adoption and use of the tools.
Technology Puts Focus on Patient Care
Throughout the building, technology is implemented in ways that benefit both the staff and patients. Some of the technologies used include glass to control energy use, a command center to better monitor and respond to needs, robots to deliver supplies, handheld devices for staff and an integrated bedside terminal.
Throughout much of the building, electrochromic glass is used and linked to the building’s digital system. Depending on factors like the time of day, seasonality or amount of sunshine hitting the glass, it will automatically darken or lighten based on a schedule. Additionally, a patient can use their integrated bedside terminal to change the amount of light coming through the window into their room.
The electrochromic glass has saved energy through controlling heat loss and gain, which is part of what’s made the building more energy efficient. “It’s paid dividends like you wouldn’t believe,” Collins says of the material.
The Humber River Hospital Command Centre opened in November 2017 as a data-driven mission control of the hospital, monitoring and managing the patients and facility itself. Together in a 4,500-square-foot space, key decision makers monitor data points to communicate with staff and respond to and prevent issues from occurring in the facility and with the patients.
“Because our systems all speak to each other and because we have the ability to use artificial intelligence and do the digital linking that we can, the command center allows us to track patient load, patient activity and changes in patient conditions automatically and digitally to help intervene or observe an issue,” Collins says.
A few months after the Command Centre opened, these types of improvements reflect the equivalent improvement in patient flow of opening 23 new beds.
Robotic supply delivery:
Robots travel the hospital hallways to deliver products and supplies, allowing staff more time with patients and less time traveling to get items. The robots are able to open doors and call the elevators. Collins explains that with the time staff can spend on patient care versus retrieving supplies, there’s almost a $3 million savings, which was factored into the business case to buy the robots.
Through the use of handheld devices that staff carry with them, they are able to connect with patients and their information. According to a study published in the Canadian Journal of Nursing Leadership, after the technology was implemented, the devices allowed nurses the ability to manage their time and prioritize alerts to the smartphone better.
Integrated bedside terminal:
Patient rooms feature a device to improve staff workflow and provide patients a way to customize their stay. The integrated beside terminals allow the nurse or physician to display vital signs and results. Patients can use the device to order meals, change the temperature in their room, raise or lower their bed, change the window shading or use the internet to play games or listen to the radio.
With technology being integrated into the patient experience and staff workflow, it’s creating a more calming experience, Collins notes.
“Patients are seeing a calmer environment where staff are more available to them,” she says. “There’s no scurrying up and down the hallways. If a patient wants to call their nurse, the nurse is carrying a handheld device and they can connect directly.”
How Technology Can be Used for Safe Medication Delivery
At Humber River Hospital, staff members are using technology to their advantage to reduce the change of human error as a result of communication.
“Where you can streamline and smooth communication, so much the better to prevent those errors from occurring,” notes Barbara Collins, president and CEO of Humber River Hospital.
Through the use of barcode medication administration and a closed-loop medication system, there are multiple check points to make sure the correct patient is receiving the correct medication at the prescribed time. Here’s how it works:
A physician orders the medication into the patient’s record through their own voice activation or typing it in.
The medication order is downloaded and the pharmacist receives a signal that there’s a new medication. They check it with the chart to make sure there are no conflicts to that medication.
Medications are loaded from the pharmacy into a robotic machine that recognizes from the order the drug it needs to select and package. It selects and packages it into an envelope and puts a barcode on it.
When a patients has drugs for a certain time, the information barcode for each of the drugs is hooked on a ring.
The nurse scans the patient’s barcode on their armband, which identifies it’s the correct patient. The nurse then scans the drug barcode, which identifies it’s the right drug or alarms if it’s not. Once the drug is administered, it’s automatically tracked in the patient chart.
This has cut down on medication inaccuracies. Medication error in Canada occurs 2.5 to 3.5% of the time, Collins notes. At Humber River Hospital through the use of the technology working together, the rate of error in 2018 was 0.007% on 3.3 million doses of medication.
How to Successfully Implement Technology into a Facility
According to the Canadian Institute for Health Information 2017 findings, 71% of the cost of a hospital stay includes staff salaries. Humber River Hospital’s use of technology was meant to help the staff be more efficient.
“If you can improve the efficiency level, you can have more staff at the same cost and provide better care,” Collins says.
More than 150 organizations—primarily hospitals and government agencies—have toured the facility since it opened. Although Humber River Hospital was built to accommodate the technology, many of the people visiting are looking to retrofit solutions into existing buildings. Nine hospitals in the U.S. have put in command centers since Humber River has opened, and they are all in current buildings, Collins notes.
For owners and managers looking to incorporate technology into their facility, Collins offers these tips:
Do a business case for the use of the technology. “There will be a payback,” she assures.
Implement it properly through education, support and commitment from senior leadership.
Know the return and payback, so you know how much you have to spend on the technology.
When Humber River Hospital has additional savings, it invests the money into additional care.
“For energy, we said we wanted to be 40% more energy efficient than any other hospital, have 100% fresh air, heated sidewalks to melt snow and heated main entrances, with floors heated in our main terrazzo floor,” Collins says. “We are actually 41.8% more energy efficient. As a result, we save $3.2 million a year in energy costs, so we turn that back into patient care.”
There must be buy-in for technology and patient care to be successful.
“You have to have a process where people believe in what they’re doing and what you as an organization are doing, and people are willing as leaders to lead the process,” Collins says. “You have to put resources behind it. You need to use that money to provide more care, more resources for staff and your positions so there’s a benefit to working very hard to make these things work.
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