fredag den 23. oktober 2009

Hospitals of the Futurè

An important part of the Danish Prime Ministers future plans deal with the construction of a number of bright, new so-called Super Hospitals. When he addressed the Danish Parliament on his opening speech first Tuesday in October, the amount of 40-50 Billion Dkr (9 – 10 B US $) was mentioned.

In Denmark the Regions are responsible for hospitals, but they have no tax income of their own, so they are completely depending on the Government allocation of funds. So the 5 regions are looking to negotiations with the Government, and as it looks they are treated rather differently; the regions that have been most eager to close down small and inefficient hospitals stand to gain the most.

In any case the question any Dane should put to his regional politicians, now up for re-election in November, is how they see the future of the hospitals. If this is not discussed, I fear the entire discussion will be around the brick-and-mortar investment, and not about the rethinking of the entire health structure as I feel is highly needed – not least in light of the demographic changes we can foresee, including the lack of doctors, nurses, more elderly, more chronic diseases etc.

So where can we find the inspiration needed before these new super tankers are cast in iron?
Normally you would look to US:
But US has its own problems and has a highly different tradition than Northern European health systems, where this is an integral part of our welfare system, hence mainly paid for by the tax budgets. (Try to see the notices from the US Commission on the Future of Health Care from 2008: )

There are sources and best-of-breed examples out there that can easily by reached; the web page for DesignIT has a very interesting article of hospitals of the future.
One of the cases that DesignIT describes is the Il Camino Hospital (Silicon Valley, Ca):

Il Camino Hospital is a completely wireless hospital that is well on its way to becoming paper and film free. The hospital estimates that the new system has saved them 120,000 dollars a year in medical costs and 300,000 dollars a year in avoidable errors.
The hospital’s wireless technology includes:
· Voice-activated communicators: Nurses and doctors use a small voice-controlled, hands-free device that they wear around the neck to communicate with each other. The device is made by Silicon Valley start-up Vocera Communications Inc.
· Biometric supply cabinets: A device that enables authorised personnel to open doors or cupboards for medicine and other medical items by reading a thumbprint.
· Automated laboratory system: Laboratory tests go through various ‘stations’ that together make up an automated production line. Staff calls it ‘race track’. Automisation is made by
· Beckman Coulter Inc.
· Tablet PCs and handhelds: Doctors test small, tablet computers and handhelds devices. In time, these will replace the clipboard. These devices are manufactured by Hewlett-Packard Corp.
But this system would appear to be particularly exposed to terror attack or technical failure – unfortunately key considerations in the future. How will medical staff cope if the system goes down? Will they be able to treat patients? While innovative, this hospital must also be fool proof. Otherwise technology will control people rather than vice versa.”

But we don't need to go to US to find fine examples of forward oriented hospitals: In Glasgow, for instance the Homeopathic Hospital has an interesting, holistic approach that could very well be part of the design principles for Hospitals for next several decades.

In Taiwan, the Chiang Gung memorial hospital with 8.800 beds has a very advanced deployment of RFID for controlling logistics, likewise an important part of the future High Tech Hospital, where the focus is on accountability, quality, saving human resources for the health and care oriented tasks.
Asia seems to be really pushing the uptake of new technology when they plan for future hospitals;
See for instance these award winners Asian hospitals: . Not so surprisingly, there is a number of Singapore, Taiwan, Philippine references, but China and India is beginning to appear on this list as well.
Construction of hospitals is indeed a hot topic in these mega-countries.

In Sweden, Karolinska Sjukhuset, already a leading Nordic hospital in many specialties, is constructing a new site where the use of microelectronics and Gene technology is being deployed at a World record level. See for instance this description on their use of ICT.
Hospital trends in Europe can be found here: .
Since 2006 IBM has been running a Health Competency/Innovation center for the Latin speaking countries out of Barcelona. The center benefits from cooperation with the Hospital of Barcelona, one of Spain's most modern hospitals.

Each of the hospitals awarded in US, in Asia, being recognized as World leaders, contribute to the picture of the Hospitals of the Future, yet no hospital alone seems to have it all.
Given the pressure from the Climate debate and the mentioned adverse demographics plus not least the current financial crisis, new aspects has to come into the design principles.
And of course IT is going to play a major role. (See this New Scientist Article)

But in line with IBM's recent announcement of the Smart Planet initiative, I recommend that we look at the entire value chain of 'Health' – and not only look at the Hospital and the IT infrastructure: It has to be regarded as it is: A system of systems.
A Hospital is but one (important) station en route from disease to cure, but it doesn’t solve the long range development in human habits: from eating and drinking to travelling and social interaction.

The brick-and-mortar thinking should be replaced by thinking intelligent buildings:
imbedded control of material, light, control of electricity, water, sewage..

Around the hospitals we have a huge logistic task: transporting patients in and out, particularly in light of many more ambulant treatments, but also emergency systems, evacuation plans, logistics for delivery of goods, linen, visitors etc.

And we have the internal communication and collaboration between all the different stakeholders, doctors and nurses,, including admin, records management, knowledge management – and, not to forget: Electronic Patient Records that can be exchanged, distributed and disseminated with full compliance for data protection.

Another subsystem is the flow in and out of highly advanced diagnostic systems, surgery, remote collaboration, robotics. The advanced RFID plus asset management can take care of hospital beds, instruments, (patients), all sorts of critical material.

The final major sub-system is of course the entire process of a patient's engagement, not least how the out-patient services are provided, how collaboration can be obtained between hospitak satff and primary care, between patient and local government social services, including telemedicine and a holistic treatment of cronic patients in their own home, something we have been engaged in in far too many 'pilot projects' – now it is the time to deliver.

Or as Obama has put it: It's time to Change. This is understandable if you look at the status reports from 2008. So we Northern European spoiled citizens must cross our fingers that his medical plan for US comes true, because that would create yet a stronger, global drive to real forward thinking hospitals in the future.

Ingen kommentarer: