Almost everyone agrees that advanced clinical and information technologies offer unprecedented promise to enable healthcare solutions. But right now, many hospitals are grappling with how to optimize technology and the financial investment it requires. This article discusses the top technology issues hospitals will face in the next five years. While the response to these considerations must be tailored to each individual hospital's goals and vision, there are issues that apply to all situations.

One general comment to begin with: To implement these strategies takes a lot of effort at the enterprise level. Where do you get the expertise? Don't forget your in-house experts: department directors, clinical managers, nurses, and support staff. Associations offer conferences profiling case studies that focus on these initiatives. In addition, consultants offer expertise developed through an iterative process of implementing numerous projects.

Evolving budget

High tech translates into high dollars. As technologies integrate with other systems, the resulting bundles are pricier since the scope has expanded; even though per unit costs may have dropped. In fact, technology is evolving so quickly, it's almost impossible to determine if a new development just around the corner will supersede this year's latest and greatest advancement. What's more, the Institute of Medicine (IOM) has established such a broad spectrum of initiatives, how can a hospital determine what its technology budget should be?

Here are some guidelines for developing a capital equipment strategy:

  • Prioritize resources (both people and money);

  • Align to your institution's core values and major initiatives (e.g., reducing medical errors);

  • Coordinate with annual capital management programs; and

  • Coordinate with major capital projects (new facilities).

If reducing medical errors has been defined as an initiative for your hospital, then a best-in-class positive patient identification technology that helps mitigate human error, such as RFID, would align with that initiative. Safety and code-required improvements receive top priority. Initiatives such as going wireless and/or paperless may follow close behind. Recent reports of electromagnetic interference suggest a tailored test plan for compatibility for your hospital is in order.

When evaluating your capital strategies, consider the synergy you can achieve by coordinating your major capital projects with your annual capital management programs. The advantages of volume purchasing, for example, can be gained by grouping your replacement and new equipment schedule as one order.

Prioritizing purchases

Once a strategy has been developed, the next step is to identify parameters for prioritizing what to buy. Associations such as the Healthcare Information and Management Systems Society (HIMSS) provide the benefit of a collective knowledge base. In response to a recent survey by this organization, chief information officers listed their organizations' top IT priorities for the next two years to be:

  • Implement technology to reduce medical errors/promote patient safety;

  • Replace/upgrade/implement inpatient clinical information systems;

  • Implement an electronic medical record (EMR) or components of an EMR;

  • Connect IT at hospital with remote environments (e.g., the physician's office);

  • Integrate systems in a multi-vendor environment; and

  • Address business continuity/disaster recovery.

Of these priorities, business continuity has received the most press of late. It's a diverse and critical initiative, so seeking the expertise of a consultant is common. A key component to address with your consultant is having a robust data center-the sole backup for your entire health system.

Historically, hospital data centers have grown from telephone switch rooms that never included the features common to modern data center designs. Today's hospital data centers have rigid requirements for power and cooling, as well as physical/electronic security and safeguards against extreme weather conditions.

Typically the data center is not manned during normal operations because it is fully automated. This being the case, it can be located on or off campus. Many hospitals locate their data centers in a basement. Who wants to lose above ground revenue-generating space to data backup? Often the required power and cooling is added, but flood aversion is sometimes forgotten. Flooding has damaged millions of dollars worth of electronic systems and years' worth of research results and patient records.

Some suggestions regarding your data center:

Sink the slab. To create the necessary clear space below the computer floor, sink the slab instead of raising the floor. This creates a seamless entry into the data center with no change in floor height and, therefore, no need for ramps.

Create a floor pan. Line the perimeter along the floor with a water-resistant baseboard or built-up concrete berm.

Put in french drains. Install french drains at doorway locations as a protection from water damage.

Avoid ceiling penetrations. Avoiding penetrations through the ceilings directly over your data center will help keep water leaks on the above floors from running down through cracks.

Avoid water pipes. If possible, don't pipe water through the space; at least include drip pans with water sensors below any pipes carrying water.

Integration

In today's technologically advanced hospitals, clinical systems must talk to IT systems. As systems become more and more interrelated, communication among all systems is crucial. Here are some integration goals:

  • Automatic data collection;

  • Information for decision support;

  • Plug and play technology (interoperability); and

  • Video streaming on the network - video over IP.

Achieving these goals is not easy. Integration crosses all department borders and requires multidisciplinary cooperation and prioritization. One department may view integration as a low priority for itself when it is a high priority for the enterprise. This can result in delay and compromised quality.

Systems integration and process redesign must go hand-in-hand. A successful roll-out strategy should encompass ample staff training and flexible adoption rates among departments. The demand for information access has hit OR integration. Clinicians want to view the OR from any computer, anywhere. The development of video streaming makes this possible. But don't overlook the impact on network capacity!

Changing infrastructure

As hospitals move into the high-tech world, they require less space to store paper records but increased infrastructure to support technology. Even that infrastructure is changing. The move to wireless is one example; systems that only a year ago were always hardwired are now evolving into wireless. At present most hospitals have limited wireless capability, but they do understand the need to manage the proverbial three-year cycle of technology change.

The most popular scheme is the “wireless utility,” a single wireless infrastructure that is now replacing many independent wireless antenna systems. It is designed to support mobile computing, RFID, asset tracking, cell phones, medical telemetry, two-way radio, and other wireless communication devices. This type of point-of-care data capture utility is usually nonobtrusive and not easily visible within the environment. Another advantage of the wireless utility: transitioning to the next generation of equipment can be done from within the technology room as opposed to replacing radio equipment in the hall every fifty feet.

As technology advances, the footprint within hospitals for technology continues to grow. Telecommunication closets are now “technology rooms.” Data centers are moving offsite because they needn't be in high-cost clinical settings. Indeed, today's data centers support multiple facilities within a health system. And wide area networks allow campuses to share redundant information systems in line with their consolidation and disaster plans.

Phones that now communicate with an internet communication protocol are called Voice Over Intranet Protocol, or simply “voice over IP.” This means there is only one type of cable required for both voice and computer communication. As a result, phones may move just like your laptop computer and get connected anywhere on the intranet. In fact telephone service providers foresee the campus telephone switch disappearing altogether.

Video and imaging systems are jumping on the IP bandwagon as well. Ultimately, the streaming of “video-IP” (video over IP) will make it easier to view the world. The infrastructure we use will change. Networks will be very robust, and the opportunity for capturing clinical video and performing eMonitoring will transform data capture.

For the large enterprise, multiscreen videoconferencing will become commonplace. The new systems are as easy to operate as dialing a phone.

Planning for changing technology

Technology is moving at such a rapid pace it's difficult for healthcare systems to plan ahead-especially for technologies that aren't yet available. But if future technologies are not considered, a new facility will be outdated before its doors open. Here are some steps to ensure that this doesn't happen:

Make room for technology. Be sure you plan technology rooms, not closets, with space for expansion, additional power, and the ability to cool. HVAC is a must for these rooms, so begin counting BTUs. The adjoining rooms should be designed as “soft” spaces that can be easily altered to accommodate future expansion.

Consider leasing equipment. There can be value in leasing rather than owning fast-changing equipment. Writing corporate agreements with vendors can help with non-obsolescence. Going with the “mega-vendor” may help interoperability and avoid problems commonly associated with proprietary systems. Leasing also can reduce your capital outlay by moving the expense into operations.

Design adaptable facilities. Often there is not enough money in the capital bucket to buy all equipment at once, so it is purchased over the long term. It is wise to install needed conduit, electrical boxes, and equipment support backing now for equipment you intend to buy later. This minimizes design changes and construction costs for future implementation.

Summary

Adapting to technology is fast becoming the priority-one topic in the healthcare industry. While the topic is complex and the list of technologies seems endless, it is important to be proactive in navigating through key technology issues. The considerations we've discussed for proper budgeting, equipment selection, effective integration, and interoperability should help you on your technology planning journey. HD

Steven Juett, PE, is the Director of Clinical Systems Planning at RTKL Healthcare Technologies. He can be reached at

sjuett@rtkl.com.

For more information about RTKL Healthcare Technologies, visit http://www.rtkl.com/services/healthcare_technologies.asp

Healthcare Design 2010 July;10(7):31-34