Humber River Hospital in northwest Toronto has been dubbed North America’s first fully digital hospital due to its adoption of smart digital technology systems throughout its operations. When the new 656-bed hospital opened in October 2015, the facility was constructed with technologies to enhance the patient experience, such as integrated bedside terminals with touch screens to give patients control over their environment, including lighting and ambient temperature.
Smart technologies also were implemented at Humber River to improve operations, such as the use of robotic systems to sort medication, automated guided vehicles for delivering meals and supplies to patient floors and a fully automated laboratory system that turns around lab results within one hour and automatically updates the patient chart. Staff throughout the hospital wear real-time locating devices, as do patients undergoing surgery so that their whereabouts and status can be known in real-time by staff and family members. The use of this technology has created, essentially, a paperless, seamless, connected experience for patients, staff and clinicians, according to the hospital’s senior leaders.
The hospital’s digital journey continues as Humber River is currently building a digitally advanced, hospital-wide command center that is set to open this month. While air traffic control-style command centers are frequently used in other industries, the use of command centers are just now starting to take off in patient care delivery organizations. Baltimore-based Johns Hopkins Hospital launched a hospital control center in early 2016 that was designed, built and implemented together with GE Healthcare Partners, the analytics consulting arm of U.K.-based GE Healthcare. Humber River also is working with GE Healthcare Partners on the development of its command center.
When it opens, the 4,500-square-foot command center at Humber River will use complex algorithms, predictive analytics and advanced engineering to target improved clinical, operational and patient outcomes, Peter Bak, Humber River Hospital CIO, says. The new command center will leverage the hospital’s digital infrastructure to make progress on its journey toward becoming a high reliability organization, he says.
Humber River is one of Canada’s largest acute care hospitals, serving an area of more than 850,000 people in the northwest greater Toronto area. Currently, the hospital cares for 130,000 emergency patients, far more than anticipated when the doors of the new hospital opened two years ago. Medical bed occupancy already averages 99 percent, and volume is increasing rapidly, leaving little room to grow. In fact, with no action, Humber River anticipates it will have a bed capacity shortfall of 45 to 50 medicine beds by 2021.
Barb Collins, Humber River Hospital president and CEO, describes the challenges of operating in a very high occupancy environment: admitted patients in the ER wait to be moved into a bed on an inpatient floor, patients on the floors wait to be transported for an imaging exam, and patients cleared for discharge wait for numerous tasks to be organized and completed before they can leave. “These are the realities that patients in many acute care hospitals face, and that drive you to want to do things differently; the command center is our way to try to change that environment,” Collins says.
When the new hospital opened two years ago, Humber River’s senior executive leaders focused on four key areas to enhance the hospital’s digital capabilities. “We asked, what is a digital hospital? We say it’s one that has electronic information where people are mobile and connected; their patients are empowered and the systems are automated,” Bak says.
He continues, “Each solution that Humber River has implemented has been driven by very clear reasons. In some cases, there is a financial benefit, and in other cases, it is predominantly a quality and safety benefit.”
While some hospitals focus on implementing one-off technology projects, Humber River’s senior executive leaders had their sights set on an enterprise-wide digital strategy that supports patient care and efficient workflow throughout the hospital. “Our motivation is we have to deliver excellent patient care to far more patients than before, in a much bigger space and do that with essentially the same budget,” Bak says.
According to Bak, the operating cost for the technology is about 3.5 percent of the hospital’s operating budget. “That is a low number when you look at other industries and it is the same as many of our hospital colleagues who are nowhere close to being as digital as us,” he contends.
An Analytics-Driven Command Center
Humber River’s digital journey will reach a new milestone with the opening of its analytics-driven command center. With a strategic initiative to become a high reliability hospital, Humber River’s leadership recognized the need for more visibility into the day-to-day activities in the hospital.
The heart of the command center will be the “Wall of Analytics” that processes real-time data from multiple source systems across the hospital. Using 16 advanced and predictive analytics developed by GE Healthcare Partners, 15 to 20 staff co-located in the command center will have real-time visibility and insight to take action on everything from delayed patient care activity to unbalanced physician and staff workload to unusual situations that may correlate to increased risk of patient harm, Bak says.
This information will enable real-time decision support so staff can prioritize patient care activities, expedite discharges and make short-term staffing decisions, which will mitigate potential bottlenecks before they occur. Congestion in the emergency department and patient flow bottlenecks occur every day in hospitals, yet the biggest challenge is that operational leaders don’t have real-time, hospital-wide visibility into these problems, Bak says.
“Right now, the functional decision makers typically sit in departments around the facility and they are not connected; they don’t see the holistic picture of what’s going on. What the command center will do is concentrate these decision makers in a single space, equip them with real-time information and empower them to take action to improve performance. We’re going to be monitoring a lot of patient care activity that’s going on across the hospital and putting that information in a meaningful way in front of people that are already tasked with organizing activity in the facility, like our bed management team and our environmental services managers.
“The other piece of what we’re doing, and perhaps the most important piece, is all the process re-engineering and procedures we are building around the command center analytics,” Bak says. “When the analytics are telling staff in the command center there is a problem, they need to know what to do about that problem.”
Plans for the Humber River command center include adding new analytic capabilities over time. The current implementation is focused on patient flow and the logistics of delivering care, the next phase will focus on monitoring patient progress through clinical pathways, intervening to assist when potential issues are identified and reducing the occurrences of “never events.”
Peter Bak
Following that, Humber River intends to focus additional new capability on the continuum of care. The command center will provide an opportunity for the hospital to link to patients at home through wearable technology or a phone call, enabling clinicians to know if a patient is having a problem managing their care at home, Bak says. Rather than waiting until a patient’s condition deteriorates and they need to visit the ER, the command center would notice a change in the patient’s condition early on, communicate with community providers, have them check on the patient, bring the patient back for an elective clinic appointment, and in the process, help the patient to manage at home longer and avoid an ER visit.
Bak notes that this kind of digital transformation, which not only introduces new technology but also substantially changes the way care is being delivered, requires the commitment and support of senior executive leaders, right up to the Board.
“This starts with a very clear vision, and a commitment from the top. Once you’ve clarified your vision, then you can start working your way through the execution of it. Although a lot it is workflow re-engineering, adopting new software and tying them together, you still need clarity in what you’re doing. If you don’t have clarity, then you’ll bumble around,” Bak says.
With the accelerating changes occurring in healthcare, Bak contends that digital transformation is the foundation for care transformation efforts. “You really have to look at the future of your organization and what’s happening in healthcare, generally. We know that many organizations are under a lot of pressure to serve a growing population and an increasingly elderly population, and you have to do it well and with less dollars available; it’s a fundamental challenge in healthcare around the world. What we’re doing at Humber River is breaking new ground and really addressing that problem,” he says.
