An integration vision starts with an integration dream—one where all electronic devices within a healthcare facility have the capability to seamlessly communicate as needed to meet any function desired. Integration allows for application to gain efficiencies and cost savings, make better use of existing separated systems and, most importantly, provide a better product to patients.

In the past, low-voltage systems largely worked independently. Databases were complete for individual applications, but had little if any interface with each other. For example, an HVAC or power-monitoring system would communicate between other HVAC or power-monitor components via a central computer and graphical user interface. The nurse-call system, for instance, would include its own infrared locating system to locate staff, but would not be integrated to locate equipment or patients via an equipment or patient database.

Currently, major opportunities exist for integration in facilities today via either building or clinical systems. The ultimate dream is the integration of the building to the clinical systems.

Building integration

The left side of the figure above shows the desired integration in today's healthcare facilities on the building side. Finding a common platform by which all building systems can communicate is the first step toward achieving the benefits afforded by building integration.

For example, if the power utility requests all major commercial and industrial facilities to shed energy consumption on peak usage days, a program may be developed that reduces lighting and HVAC power consumption in certain areas at the push of a button. At the same time, an alarmed event could be sent out to all maintenance pagers notifying them that this reduction took place. Wouldn't it be great if all the electrical and mechanical graphical user interfaces had the same format?

One important note: As the benefits of accessing integrated building systems from off-site via the Internet become more common place, the security of the connection should be reviewed by IT staff.

Clinical integration

The right side of the figure shows the desired integration in today's healthcare facilities on the clinical side. Many facilities currently use an integration engine to integrate multiple databases within a hospital. Databases may include the patient information system, electronic medical records, lab, radiology, and billing to name a few.

A typical integration application might result in populating the nurse call system from the patient registration database when a name is assigned to a room. Typically nurse call systems may download this patient information from other databases when they are HL7 compliant. When a locating system (RFID) is employed, it is to the owner's benefit to install one system that can “talk” to any other database interested in “listening.” In addition to locating nurses, for example, other departments may be interested in locating patients, staff, beds, or other mobile equipment.

Integrating building and clinical systems

Two concepts that illustrate the potential of integrating building and clinical systems applications may be coined “Repair to Care” or “Lean to Green,” which are also illustrated in the figure.

Repair to Care is the integration of alarm or event management from the building system to the clinical system. For example, a patient care temperature-control malfunction is communicated directly to the nursing staff. Armed with this knowledge, the nursing staff may manage patient room assignments differently for new patient admissions until the issue is resolved. After the issue is resolved, the nursing staff is notified about the repair. As a result of this communication, patients are provided the appropriate care by a nursing staff that is informed and proactive.

In another example, a database field in the patient admissions software asks whether the patient wants a warmer or cooler environment. With this information, the temperature control is automatically adjusted in the room assigned to that patient so that it meets their comfort level.

A third example illustrates the integration of the RFID system where information is gained from a common equipment database. Two groups may be interested in the same information for different purposes. Clinical personnel are interested in knowing where equipment is located for their use, whereas maintenance personnel may be interested in locating the equipment to do preventive maintenance like replacing a battery.

In a Lean to Green concept example, significant energy savings through lighting or HVAC controls can be realized when they are set based on clinical schedules. Lighting and HVAC set-back controls are typically based on a static schedule set with manual overrides. This may be a reasonable solution for predictable office building occupancies, but what if the surgery schedule was integrated to the BMS or the lighting control system? Integrating the control system with the dynamic patient care schedule would enable more efficient control over these two large energy users, which in turn might result in significant energy savings.

Integration contractor

Similar to the process of selecting specific talent for hospital IT staff, selecting a competent integration contractor is critical. Typically the integration ideas identified and programmed which today may seem groundbreaking will most likely seem typical or elementary in only five years. The applications for integration are certain to increase with time, and finding an integration contractor upon whom you can depend to continually apply your vision is critical. Some criteria to consider when selecting a contractor include:

  • experience (this area may be the most difficult to find since integration contracting is relatively new)

  • general knowledge

  • the ability to work with the existing facility IT staff

Open-ended integration programming communicated between the integration contractor and the IT Staff is critical for future flexibility. The commonality of data centers in healthcare facilities is a true testament to the growth and diversity of the IT staff to support servers and applications. The integration of clinical and building systems will add applications, and the boundaries between the IT and the facilities group in healthcare facilities will blur as a result.

The integration of functions within the building and clinical systems applications continues to progress in each individual area. Integrating the building and clinical system for green cost savings and seamless event management is the next frontier. Developing an “integration dream,” selecting an integration design team, and identifying an integration contractor are the first steps to success. HD

Timothy Koch, PE, is an Engineering Project Manager for HDR, Inc., in Omaha, Nebraska.

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