Smart technology is a major topic for hospitals today, and it’s all about gathering, sharing, and using information with the lofty aspirations of improving care while also cutting costs. The emphasis is on functional interoperability of medical devices and hospital systems to create a fully interconnected medical institution where data are seamlessly linked between and among devices and systems, particularly electronic health records (EHRs). But the question remains, is it worth the investment in the end?
A Smart Hospital Is…
“An intelligent hospital is really based on a combination of existing technologies that are designed, set up, and integrated to share data back and forth, and ultimately to provide an enhanced level of clinical information, to enable diagnosis, to monitor treatment, and to provide metrics to see how your hospital is performing,” says Paul Frisch, Ph.D., chief of biomedical physics and engineering at Memorial Sloan Kettering Cancer Center in New York. “It’s a convolution of a lot of things that have existed piecemeal for some while, and the use of new evolving technologies that are adding a layer of information on top about things that we couldn’t measure before.”
One of the medical institutions that got an early start on smart hospital technology is the Veterans Administration (VA), according to Keith Salzman, M.D., who has experience with both the U.S. Department of Defense (DoD) and the VA, and is now the chief medical information officer for IBM’s U.S. Federal Healthcare Practice, which addresses the technology needs of American public-sector health institutions. “In 2004, I started working with informatics at Madigan Army Medical Center in Tacoma, Washington. We had received a National Defense Authorization Act grant to demonstrate interoperability between the DoD and VA health care in terms of sharing both data and documents,” he says. It was a big undertaking because DoD and VA health care delivery systems have patient populations that are equivalent to the size of Kaiser Permanente—one of the biggest health care delivery organizations in the country.
The VA health information technology systems, collectively known as the Veterans Health Information Systems and Technology Architecture, or ViSTA, were implemented over a two-decade period. Its systems included EHRs, a picture-archiving and communication system for radiological imaging, bar-code medication administration, and laboratory electronic data interoperability. “Interoperability wasn’t the focus nationally at the time, so it was leading edge,” says Salzman. While the DoD-VA exchange project progressed, Salzman also worked on similar solutions within the Army Medical Department and the military health system.
As one of the earliest adopters of smart technology, the VA paved the way for other institutions, both large and small, Salzman says. “It’s kind of how transformation occurs. The early adopters are important because they mature the solution so that other people can move forward with something that works, rather than having to start from scratch.”
Today, the level of smart technology varies widely among hospitals. The technology typically evolves over time, as it did at Fisher-Titus Medical Center in Norwalk, Ohio. “In 2009, we finished a strategic planning initiative, including discussions about what our major goals were from an IT perspective,” describes John Britton, vice president of information services at Fisher-Titus. “We realized we were way too fragmented: we had a lot of different places that clinicians had to put information and no one real source of truth, if you will.”
So, Fisher-Titus partnered with an electronic medical record provider that could deliver a single back-end system: software that would provide one access point where clinicians could securely input and obtain pertinent patient information when and where they needed it (Figures 3 and 4). “We believe that if we have to log into more than one system, it’s too many,” Britton explains. Today, the 99-bed acute-care hospital has a comprehensive electronic patient health record system that caregivers can easily access securely, in real time, at any time, and from anywhere and, in 2013, added an interactive patient portal from which patients can view their health records online. “Any one of these technologies itself is not unique, but having them all in one place and having them completely integrated is,” Britton says. “We actually host hospitals around the world due to the interest of having all of this technology in use in one place.”
Simple Tech, Good Results
One smart-hospital technology that is widely used across medical facilities and has shown clear advantages is the radio-frequency identification (RFID) transmitter, which is applied to equipment so hospitals can keep track of what they have and where it is. This saves time because staff members don’t have to scramble to find items, such as mobile pumps and wheelchairs, that could be almost anywhere in the building. Some hospitals are also adding RFID transmitters to patient wristbands and staff ID tags so that they can track where everyone is and where they’ve been. If a patient is found to have an infectious disease, for instance, medical staff can quickly backtrack and single out everyone who has been in close contact with that patient.
Many hospitals have reported success with RFID, particularly for monetary benefit. For example, the 1,100-bed Addenbrook’s Hospital in Cambridge, United Kingdom, has added tags to thousands of pieces of equipment and “more than doubled its asset-utilization rate, thereby reducing the need for excess rentals and purchases, as well as the amount of time employees previously spent searching for missing items” . The 58-bed Texas Health Harris Methodist Hospital Alliance in Fort Worth added tags to patients, staff, and equipment, and noted US$65,000 per month in savings from rental fees alone .
Researchers are beginning to perform some wider-ranging cost-benefit analyses. In a 2010 article in Health Affairs, researchers analyzed four of the VA’s integrated ViSTA systems and “conservatively” estimated more than US$3 billion in benefits, over and above investments in the systems, just through 2007 . In a West Health Institute report of smart technology implementation throughout the United States , the authors predicted US$36 billion in annual savings from the widespread adoption of functional medical device interoperability, which encompasses data exchange among devices and data repositories, such as EHRs.
When it comes to medical care, of course, costs aren’t the only potential benefit. As an illustration, the benefits of RFIDs extend into the quality of patient care, Frisch says. “Like many other hospitals, we at Memorial Sloan Kettering use real-time location systems to help us monitor our supplies as well as our workflow. We can see how long a patient has been in a specific location, we can trigger informational alerts when a patient has been alone too long or when medical care is not being delivered quickly enough, and we can track staff to see what their responses are.”
Complex Conditions, Multipart Solutions
The use of RFID to track supplies, equipment, patients, and staff is a relatively simple addition to a hospital, especially when compared with the technologies required to help orchestrate the care of patients with complex health conditions.
Nowhere is that more evident than in intensive care units, where thousands of data points can be generated per patient per second, leaving care professionals to sort through the mass of changing physiological data, identify the often nuanced variables that are critical to patient care, and then act on them. This is why an increasing number of products are being rolled out to collect and analyze data from multiple pieces of equipment and other sources so that care professionals can have manageable and relevant information to help guide patient treatment.
IBM, for instance, has developed InfoSphere Streams, an advanced streaming-analytics computing platform that takes in a collection of high-volume data from multiple real-time sources before analyzing it. Emory University Hospital is using the technology along with software from Excel Medical Electronics to design a research application for its ICU to catch early signs of trouble before they become life-threatening problems. Likewise, the University of Ontario Institute of Technology has begun using IBM’s big-data platform to decipher the hundreds of unique pieces of information coming from sensors and other equipment monitoring premature babies to spot potential issues, such as sepsis, early on when they are more easily corrected.
A major advantage of these and other technologies will be in allowing attending care staff to filter out extraneous information, including the all-too-frequent trivial “alerts” that current monitoring equipment can trigger, says Salzman. “There’s a lot of data that’s being collected and a lot of it is noise, but if you can begin detecting the things that matter, and bring the number of alerts down to a reasonable and meaningful level, then you can intervene before problems get serious and patients start to crash from their physiologic status.”
That is a goal of Moberg Research, an Ambler, Pennsylvania, company that develops integrated neural monitoring technology, including its Smart Neuro ICU. Moberg Research unveiled the ICU during the National Institute of Standards and Technologies 2014 Smart America Challenge in June.
The Smart Neuro ICU is designed to improve care for patients with brain injuries by creating an integrated data architecture in the ICU. This environment will allow the application of data generated by two large trials under way in the United States and Europe. The two trials are collecting a very comprehensive data set—genetics, imaging, prior head injury, and other information—on approximately 8,000 head-injured patients over the next two years. The idea is to set up working ICUs that become laboratories for testing concepts in brain-injury care generated by these and other trials, explains Dick Moberg, founder of Moberg Research.
The first Smart Neuro ICU will be at University Hospital Zürich in Switzerland. “To do this, we had to have a hospital that’s building a new ICU or that was willing to sort of start from scratch in their information architecture, we had to have the funding, and we had to have a champion at the hospital. And it turns out that all three of those came together in Zürich before they did in the U.S.,” Moberg says.
“At this point, we already have one room at University Hospital Zürich that is our prototype, so the system connects to a lot of other pieces of equipment, takes the data in and highly time synchronizes it, and then displays it at the bedside in a monitor,” he describes. As that prototype continues evolving and includes data from more devices, the hospital is proceeding with plans to add more Smart Neuro ICU rooms. In addition, the hospital is partnering with the University of Zürich to add data-visualization software, and with IBM Innovation Center in Zurich to incorporate streaming analytics capabilities. On the U.S. front, Moberg Research is well into talks with several American hospitals and, with recent funding from the DoD, should have Smart Neuro ICUs in the United States soon.
This project has two other major objectives, Moberg says. One is to work with various other partners who are creating apps that will plug new and well-vetted research findings, as well as new guidelines for treating or managing patients, into the data-analysis capabilities of the Smart Neuro ICU. Moberg explains, “This will open up a pathway to bring innovation into the field, to save time and create efficiencies, and to give patients better outcomes.”
The other objective is to provide data-driven answers to questions of whether smart technology pays off. In brain injury, the potential is certainly there. “The estimate for direct and indirect costs for traumatic brain injury patients is US$76 billion a year in the United States, so it’s a tremendous cost,” Moberg says. “A little bit better outcomes would quickly realize quite a significant cost reduction.”
Reports like the one from West Health forecast cost decreases, and while their arguments are sound, predictions only go so far, Moberg says. “We need to create these integrated environments where we can deploy new technology and findings from clinical trials to find out whether the technology is helping and whether the outcomes are getting better.”
Yardstick of the Future
Costs will always loom in the background, but improvement in patient outcomes is the measure by which smart medical technology will be weighed, especially by physicians and others who provide medical care and those who are on the receiving end.
That means some changes are in order, according to Salzman. Hospitals today use a payment model in which they are reimbursed based on the number of services provided, but that doesn’t take outcomes into consideration. Payment reform has to accompany the technology transition so that the emphasis is shifted from a fee-for-service model to an outcomes model, he says. The former encourages hospitals to provide as many services as possible themselves and not to accept data from another provider because they don’t receive any payment for that. “That has to be reformed so that hospitals are paid for performance or outcomes. As we move toward that, then we start changing the reward paradigm,” he says.
In an outcomes model, information becomes the currency of health care, smart technology becomes the norm, and the performance of the health care industry is lifted, Salzman asserts. Some providers are already inching toward an outcomes model. He specifically noted insurance giant Aetna, which is “implementing transformational principles and shifting from a fee-for-service model to an outcomes model,” he says, noting that the company has demonstrated improvements in patient benefit as well as cost reductions for health care delivery when an outcomes model is employed. “In the big picture, that’s where things are headed, but getting there is going to be kind of stop and start as you get levels of adoption along the way.”
Exactly how smart technologies—those that enable the gathering, sharing, and use of medical information—will impact costs and patient outcomes will remain an unanswered question for a while longer, Frisch asserts. “It’s still very early in the process, and, especially in terms of outcomes, it will be some time before we have the long-term data that will show whether these systems are validated.”
In the meantime, smart technology can and should be added to hospitals, Britton says. “The value truly comes in enhancing the quality of our patient care. We can save lives with this technology, and it’s hard to put numbers on that benefit.”
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- C. M. Byrne, L. M. Mercincavage, E. C. Pan, A. G. Vincent, D. S. Johnston, and B. Middleton, “The value from investments in health information technology at the U.S. Department of Veterans Affairs,” Health Affairs, vol. 29, no. 4, pp. 629–638, Apr. 2010.
- West Health Institute. (2013, Mar.). The value of medical device interoperability: Improving patient care with more than $30 billion in annual health care savings. [Online].