Though Indian healthcare providers are introducing a slew of measures to enhance efficiency and optimise their resources for best outcomes, they have a long way to traverse before metamorphosing into truly smart hospitals. By Lakshmipriya Nair
Patient-centricity is slowly gaining prominence in Indian healthcare and has led to the emergence of a new concept called ‘smart hospitals’. But, how is it defined? Succinctly put, it is about creating streamlined, optimised healing environments for best outcomes.
“Smart hospitals are those that effectively and efficiently use and leverage technology and data to ensure high quality medical care which is sensitive, proactive, consistent, repeatable and sustainable,” says Anil V Pillai, Director of Terragni Consulting, a healthcare management firm. Explaining the concept further, he states, “The fundamental tenet of being a ‘smart’ hospital is that it has to cover four essential dimensions. It has to be: patient experience focused, employee focused, organisation focused, and innovation focused.”
Pillai elaborates on the smart hospital concept:
- All its clinical, data and technology systems are integrated seamlessly
- The hospital has invested in technology and maintains these technologies to ensure that three key challenges of patient care are met:
- Alleviate patient and care-giver anxiety
- Ensure patients play a participatory role in their own healthcare
- Connectivity, information and data flow between hospital medical systems, patients, care givers, medical, nursing teams are seamless.
Talking about the benefits offered by a ‘smart hospital’, Barun Pal Chowdhury, Director – Design Build, Shapoorji Pallonji informs, “Smart hospital can lead to higher efficiency of doctors and other support staff. Additionally, security and patient safety gets more prominence while building high level of patient satisfaction. This will bring transparency, reliability and efficiency in the growing healthcare industry.”
Dapper and dynamic designing
So, how do we go about designing a smart hospital? Well, the key is to design set ups that are dynamic and engaging, combining architecture and technology. Thus, while creating smart hospital spaces, the design should enable hospital environments to be interactive as it would aid the hospital staff to do a superior job, more swiftly. The infrastructure should cater to the individualised needs of patients and amplify the opportunities to expand treatment options. They must also have a distinct focus on connectivity, communication, and access to information to enhance the quality and safety of patient care, reduce inefficiencies and ensure improved management and administration within the hospital.
As Dr Satish Prasad Rath, Chief Innovation Manager, Healthcare Research, Xerox Innovation Group (XIG) underlines, “Hospitals are now turning into health preserving entities and are teaming up with a network of interdisciplinary teams to maintain the health of a community. Investment will be needed in upgrading infrastructure to new age patient centric health record systems. The hospitals need to co-create this new era of medicine in participation with patients, technology firms, medical devices firms and pharmaceuticals.
Chowdhury explains, “To have a complete ‘smart hospital’, the infrastructure and technology has to support each other. An integrated system is the requirement of the day. Systems need to ‘talk’ to each other and share information. An intelligent healthcare infrastructure builds efficiency across an organisation.” He further informs, “The most important criterion of a smart hospital is seamless and paperless communication between various departments, personnel and communication devices. This translates into high level of infrastructure and technological support.”
Thus, a smart hospital should be characterised by:
Avant-garde technology
The last decade has witnessed a burgeoning romance between IT and healthcare. The marvels of IT are fast revolutionising healthcare delivery. Dr Rath opines that gone are the days when healthcare was reactive and confined to hospital-centered episodes. He says, “Nowadays, with technological advances, we can understand an individual’s personalised profile by analysing his pedigree, his social profile, his genomic profile, his past medical encounters from electronic medical records (EMR) and his quantified self view from his personal health record (PHR).”
“The healthcare industry is increasingly reliant on technology for the delivery of services to patients which has led to an increasing amount of intelligence within hospitals,” claims Subhasish Gupta, Country Manager – India & SAARC at Allied Telesis, a company providing networking infrastructure and interoperable network solutions. “The network has become a critical factor in the landscape of patient care. Quality care and affordable healthcare services can only be delivered profitably by utilising digital technology connected by a secure and reliable IP network,” emphasises Gupta.
Agreeing with this view, Chowdhury states, “Systems integration and systems design are the critical elements in designing a smart hospital. Various departments, such as the nurse call station, the radiology dept, the pathology labs, the scanning centres, etc., have to be seamlessly integrated keeping in mind the workflow of the clinicians so that they can work more efficiently. Elements such as mobile devices, smart boards, and wireless protocols have to be incorporated. Network connection is also something which is vital in this kind of design. Flexibility of IT infrastructure has to be kept in mind so as to accommodate and adapt to technology advancement.”
He further informs, “Some innovations such as tracking devices and smart boards can be important elements of a smart hospital. Patients can be tagged with tracking devices and these can also be synced with the electronic or ‘smart boards’ which can allow the caregivers as well as the relatives of the patient to know the whereabouts of the patient, e.g. when they are in the scanning centres or out of the OT, etc. Cloud support can also be incorporated in the design of a smart hospital. A patient’s records, lab reports, doctor’s notes can all be stored in the cloud so that no matter where the patient is, the attending doctor can call up the information at the tap of a button. This means that information is available ‘just-in-time’ when and where required!”
Looking at the growing potential for intelligent IT in healthcare, companies like Allied Telesis and Xerox are offering innovations aimed at making healthcare delivery simple yet effective.
Gupta highlights that Allied Telesis offers include intelligent wireless networks which enable clinicians to move among patients with a tablet-type technology for rapid access to all manner of information and IP telephony that enables staff to be contactable anywhere in the facility, rather than only at their desks.
He says, “Allied Telesis has a number of innovative technologies that deliver the performance, intelligence and security required within smart hospitals. We have couple of deployments in KPC Medical College, MGM University (Medical College and Hospital) and KIMS-Hubli. With our network security technology, the organisations can access operational data from the same place. Besides, security is enhanced as access to the network is limited to personnel with the appropriate rights. The organisations achieved high performance, security and greater network efficiency at a low cost. The solution greatly increased network efficiency.”
Dr Rath too highlights, “Xerox is working on analytics driven intelligent tools that will work for employee wellness, ICU admission prediction, post discharge readmission prevention and personalised care plans. These intelligent tools will empower existing hospitals to increase their services and care delivery without physically increasing their beds and take care of menace of chronic diseases through home monitoring.”
Blackberry sees a lot of potential in the healthcare sector as well. It is investing in NantHealth, a healthcare platform. In an interview with Express Computer, Annie Mathew, Director, Alliances and Business Development, BlackBerry says, “Technology and mobility will play a crucial role in revolutionising the healthcare system and propelling the next phase of growth in India.” (Read more at http://computer.financialexpress.com/interviews/blackberrys-prescription-for-success-in-healthcare/12604/)
Hospitals too are eagerly adopting new-age technology and integrating them into their infrastructure. For instance, Aster Medcity, a quaternary care hospital based in Kochi, was recently in the news for introducing a system called ‘Bill Buddy’. It helps to update patients regarding their treatment expenditures and on the spot payment. A hotline number is provided to each patient, bystander or relative, which can be used by them whenever they want to avail of this facility. The portable bill counter will then reach the patients room post which, the bill settlement and payment can be undertaken on the spot. This will eliminate the difficulty faced by the patients and bystanders of hunting for the right counter, waiting in long queues during payment.
Col Sunil Sharma, Head Physical Security Practise, Mahindra Special Services Group (MSSG) informs how the ‘Internet of Things’ have enabled healthcare set ups to amalgamate IP-addressable communications and medical devices, sensor systems, building systems, and hospital information systems like EMR with the aid of an enterprise service bus. It permits these distinct systems to exchange information with each other, and with patients, healthcare providers, and staff. This, in turn, has made it easier to deliver the right information and resources at the right time to the point of care and opened up new avenues for the emergence of healthcare processes that are smart, efficient and effective.
Stress on security and surveillance
Another predominant aspect while constructing a smart hospital is safety and security.
Sudhindra Holla, Country Manager, Axis Communications informs, “Security is a big concern for hospitals as it is accessible to the public. Healthcare industry is being attacked by unauthorised intruders, cyber criminals and others. This industry is facing challenges in protecting the privacy of their patients and securing their infrastructure. Therefore the industry should opt for integrated security solutions that will be easy to maintain. This will allow the management to monitor and address specific areas of concern.”
“The healthcare sector looks for surveillance solutions, which can give them a 360° view. Hence, the approach towards surveillance has changed from analog to digital surveillance. Health industry has also adopted this change. This has added benefits to the healthcare industry and also helps in remote monitoring and robust storage capabilities,” he states.
Col Sharma also says that the realisation of the need for a safe and secure environment in healthcare has gained ground, leading to change in perception towards safety and security.
“Healthcare providers understand the importance of patient and their relatives’ healthcare experience during the time of medical emergencies or services. However, the providers also understand the sensitivity of the healthcare environment and therefore focus more on prevention and fast resolution to ensure a safe and peaceful environment. This requires robust and optimal processes and constant periodic trainings of staff and review of processes and incidents to optimise processes. Top managements are seized by the importance of safety and security. Therefore, they are intimately involved in ensuring safety and security, infra upgrades, process optimisation and staff trainings to achieve and improve upon the patient healthcare experience,” he adds.
Giving an insight on the offerings by his company, he says, “MSSG ensures that the technology component of physical security is open source and therefore future ready for integration in any smart hospital solution, as and when undertaken. MSSG IT Security services ensure data security by recommending adoption of best IT security practices to achieve patient and medical data security. The integrated services of physical security and IT security create a safe infrastructure environment for efficient and optimal medical services delivery.”
Breach Candy Hospital, Mumbai chose to opt for MSSG’s solutions. MSSG was given the role of planning, designing and implementing a risk mitigation strategy for fire safety and security within the existing set-up. The approach had to include the compliance and statutory requirements immediately and guarantee long term sustainability. N Santhanam, CEO, Breach Candy Hospital Trust informs, “It is approximately fours years since MSSG has been associated with us and there is a marked improvement in our physical security posture and fire safety. The focus has been on prevention rather than responding and MSSG team has duly supported us in the planning and implementation of the accepted plans.”
Thus, a proactive approach towards safety and security would indeed be an important step towards becoming a smart hospital.
Emphasis on energy efficiency
Energy efficiency is another aspect which would be crucial in the making of a smart hospital. Hence, many healthcare set-ups like Ruby Hall Clinic, Wanowrie in Pune and Kohinoor Hospital, Mumbai have opted to be ‘green hospitals’. Both are LEED certified hospitals for their measures in energy conservation. Kohinoor Hospital has a LEED Platinum Rating, the highest under LEED India Green Building Rating System. It endorses a whole-building approach to sustainability and has implemented an array of energy efficient measures to decrease energy consumption, lessen greenhouse gas emissions and enhance the quality of patient care.
Ruby Hall, Wanowarie has received a Gold rating by the IGBC focused on 42 specific actions in the areas of sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor air quality and innovation in design to get a gold rating. Reportedly, the hospital uses ecologically friendly building materials, energy efficient building envelope real time monitoring and control of energy and environment parameters, 100 per cent waste water treatment and re-use as well as 100 per cent rainwater harvesting and 100 per cent organic waste composting onsite.
Being smart would definitely include taking a leaf out these hospitals’ strategy and opting for similar tactics to become energy efficient.
A lot of innovations in several other spheres like lighting, modular operation theatres, space management and even CSSD can be implemented for optimal results. For instance, as Aditya Sinh Jhala, Director, Gourangaa Consulting a company offering CSSD and laundry solutions informs, “The idea of a centralised laundry can reduce operating costs at a very large scale for many hospital operators. The idea is to create a centralised plant that is not physically attached to any hospital but is a separate location and will have the capacity to serve large number of hospitals . It will be mutually advantageous for facilities to work together in creating such laundry plants to reduce their costs and increase efficiency.”
So, it is evident that the healthcare industry has woken up to the fact that it is time to discard outdated approaches towards healthcare delivery and adopt new-age ideas to improve and enhance healthcare delivery with optimal utilisation of the available resources.
Santhanam informs, “We have identified technology and technology infrastructure as the priority area to be addressed to establish seamless communication and access to information. In the first phase we have identified IT infra upgrade as the priority area. We have already initiated the process of upgradation and hope to be future ready by 2016. In parallel, we plan to integrate our services data to enable addressing of individual needs of patients by various platform independent of location i.e. in or out of hospital premises. Security of patient data is also of paramount importance and will be given due priority and investment.”
A long way to go
Thus, looking at the changing attitudes and the slew of measures being introduced, is it safe to deduce that the concept of ‘smart hospitals’ is fast growing in India? Are the Indian hospitals transfiguring into smart ones? Pillai doesn’t think so. He opines, “The focus is to approach being ‘smart’ with a rather disintegrated approach. There are hospitals that will put in smart panels in patient rooms, a kiosk here and a wi-fi there. The roll out of these technologies is rarely the outcome of a well thought strategic initiative. The ones that do so focus on driving operational efficiency and reducing costs. Patient experience due to the demand exceeds supply paradigm is at best seen as an aesthetic add on which enhances ‘marketability’ of the hospital and at worst given the short shrift. The other two dimensions of employee and innovation do not seem to figure currently in the larger scheme of things.”
He adds, “Indian healthcare has just commenced on its journey to be smart. To that extent, they all have some way to go yet. Having said that there are hospitals who have invested considerably in the path of being ‘smart’, examples like Fortis, Apollo come to mind.”
Chowdhury has a similar view to offer. He says, “The smart hospital concept is being adopted by some hospital chains but not in totality. The healthcare industry is progressing slowly but steadily.”
Yet, the concept has definitely taken root in the healthcare scenario and healthcare providers have been taking several steps to implement measures which would lead towards making them smart. The journey has begun. It is only a matter of time before reaching the destination.
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