What mission control will look like at the hospital of the future

In July, Toronto, Canada-based Humber River Hospital and GE Healthcare announced their collaboration to build one of the first hospital command centers of the future, designed to deliver better quality of patient care.

 The 4,500-square-foot center will feature GE Analytic Tiles using artificial intelligence, predictive analytics and thoughtful design to target improved clinical, operational and patient outcomes on the journey to becoming a high-reliability hospital.

The GE Tiles power Humber's quality command center with decision support tools drawing real-time data from multiple sources around the hospital. The system helps command center staff to expedite and synchronize patient care activity. This creates spaces for clinicians to practice great care. It works by identifying irregularities or potential issues before they become emergencies. Humber's command center will feature 16 distinct analytic tiles from GE. Over time, GE and Humber expect to expand the data model to include data from wearable technologies to care for patients outside the hospital.

Here, Managing Principal of GE Healthcare Partners Jeff Terry and President and CEO of Humber River Hospital Barb Collins discuss the project and how they see technology evolving.

Q: How is the hospital of the future different from a typical hospital today?

Jeff Terry: The hospital of the future seeks to deliver high quality efficient care; that goal doesn't change. However, new tools and methods are making it possible to achieve ever-higher performance in four areas:

• Serving the right patient in the right place, and that doesn't always mean at the hospital.
• Making it easier for patients to navigate and access the hospital.
• Making it easier for caregivers to provide care at the hospital.
• Becoming highly reliable.

Barb Collins: Given the cost of healthcare, we need to make care delivery safer and more reliable, and where possible automate processes so we are doing procedures in the most efficient and effective way.

JT: That doesn't mean robots will be practicing medicine. Clearly, delivering healthcare is a human activity, but we want caregivers to operate at the top of their license. That means if a machine can perform a function safer, faster and better, we should automate it and allow humans to focus on patient- and family-centered care.

Q: Barb, how are you already incorporating automation into the hospital's processes?

BC: There are several ways, but one of the most important concepts is that of interoperability — the ability of systems to exchange and make use of information; one example is with our nursing staff. In a traditional hospital, the nurse travels to a patient room with a blood pressure monitor and pulse oximeter to measure oxygen saturation and check the patient's temperature, heart rate and blood pressure. The nurse writes the results down on a piece of paper and at some point, takes the information back to the nursing station and inputs it into the patient's chart. Nurses, however, get interrupted often which can delay entry of results into the patient's chart.

In our hospital, we know through a real-time locating system which nurse has entered the patient room to check the patient's vitals. There is a fixed bedside monitor at the head of every bed, which once the patient's vitals are taken and checked by the nurse, automatically sends them to the patient's electronic chart. If there are abnormal results or abnormal cardiac monitoring results and a certain level of concern, other members of the team including the physician can automatically see the results.

To add to this, with real-time closed loop communications we can see whether the provider has accepted the results. If the provider gets busy or distracted and the necessary care isn't followed up on, our system will catch that and notify the right provider to assist as required. All of this is safer and faster, and prevents staff from having to perform manual steps.

JT: Humber River's design blends physical, technology and process design to make it easier for patients and caregivers. What Barb described is a hospital that has been designed for care … at the room level, department level and hospital level. And they've been internationally recognized for that design. The challenge to replicating that is it requires expertise in multiple disciplines.

Q: How does building the "hospital of the future" with a central technology hub impact care?

BC: Hospitals are busy places in which communicating issues is a key component of safe, high-quality care. Much like airplanes; airplanes travel around the world and their movements are recorded in black boxes; a data center tracks that and intervention occurs if required. We need that function for patients in the hospital and those in their homes. This is a whole new way of providing care by using data and digital technologies to help with early warning of changing patient conditions and of process breakdowns. When vulnerable patients return home and do not notice a problem until they are so sick they need to go to the emergency room, we wonder how that happened. If you monitor data, you can detect delayed or missed care activities and as well as deterioration in patient status before it becomes an issue. We are embarking on that with our command center.

Q: Is the command center and mission control like a central transfer center? How would that be different than what most hospitals are already doing?

JT: No — this mission control concept is different and goes way beyond transfers; the scope can include access, throughput, length of stay, quality, safety, staffing and even population health. For example, a command center can spot patients who've fallen off their pathway outside the hospital. That "backstop" capability just isn't there today for too many critical processes. With the hospital, command centers can prioritize and synchronize processes to reduce delays and defects.

There is a culture curve of course; caregivers don't want "big brother" looking over their shoulder. The key is to work with caregivers to design command center activity that amplifies and de-stresses the work of caregivers, not disrupts or second guesses it.

BC: Our hospital team understands the opportunities digital capabilities present for patient care. A number of our physicians and staff come to the table to help us plan technology that will improve patient care and care delivery process. They see technology and analytical data as a benefit. That's part of a cultural transformation and understanding that digital technology when properly applied improves patient care.

JT: All major hospitals and health systems in the future will have command centers and mission control. The capability is revolutionary. Johns Hopkins is the first hospital to implement the concept and we are working with hospitals around the world on similar projects. Provider organizations are starting to recognize if we are going to deliver highly reliable care and take advantage of our oceans of data, we need a central node to orchestrate a range of informatics and interventions.

Q: How will wearables and communication technology affect patients seeking care in the future?

BC: Wearable technologies are going to allow providers to send patients home sooner and avoid ER visits. In the next year, we will look to increasing the use of wearable devices for patients who return home but need to continue care. The command center can monitor their results remotely and, for a patient who requires help, we can intervene. For example, we could send a 65-year-old patient home with a respiratory and vital signs monitor. By tracking monitoring data through the command center we can be proactive if the patient is experiencing changes that could signal a problem. If mission control sees that the patient has a dangerous heart rhythm, we can intervene and get them to an elective clinic appointment or send home care to them. When our central command center opens later this year, we will already be underway with planning for this expanded functionality.

JT: Wearables are a real technology trend in the hospital and allow hospitals to extend their influence beyond their four walls.

Q: Is this concept something other hospitals could implement?

JT: The secret to Humber's success is a leadership that worked together for 10 years. They committed to a vision, adapted it over time, implemented a new hospital and continue to evolve.

In the end, several things here are special: the design of this hospital; it's use of cutting edge tools in lab and pharmacy; the data center and EMR. The command center is the next step. It builds on what came before.

BC: A bold vision needs to be a hospitalwide commitment. Our senior team and program and physician leaders committed 100 percent to our mission. You must have a committed team that's nimble enough to make changes quickly to benefit from technology changes. You must continue to build on a digital vision each and every day or quickly you will become yesterday's hospital.

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