22 June 2021
Intra hospital interoperability moving to crisis point
A modern interoperable hospital setup featuring simultaneous management of multiple patients with multiple data points on many integrated and co-ordinated devices is emerging. It is one of the greatest new challenges for administrators seeking improved safety, efficiency and patient centricity.
Free Webinar: Beyond Nurse Call: platforms that transform workflow and communication in hospitals, Tuesday July 13th 11am AEST REGISTER HERE.
Most Australian hospitals, even relatively newly built ones, will feature a melange of non-integrated devices and reporting systems, and an array legacy alert systems, which aren’t well co-ordinated with any other systems or care team workflows.
These systems usually build up via the use of multiple vendors, either over time or even in new builds, which increases the complexity of anyone attempting to co-ordinate clinical teams and their interactions with patients.
As the number of systems proliferate – physiological monitors, ventilators, IV pumps, dialysis, EMR, nurse call and real-time care team location services, to name a few – each creating patient data for a particular aspect of a patient’s management, and each often having its own cascading alarm management protocol, the fatigue and confusion among a care team can start to expand rapidly.
EMR data provides a comprehensive view of the patient’s condition and status.
But, much of this data lacks situational relevance, and is not provided in a timely manner in the right context to the right people in a care team so it is actionable.
Most often, real-time patient data is only available on the original medical devices that are connected to the patient at the point of care. When these devices are not integrated to a co-ordinated patient data flow protocol, the alarm fatigue and confusion can end up detracting from the safety and efficiency of care teams.
Nearly all hospitals in Australia lie somewhere along the spectrum of this problem, many at the lower end where legacy and proliferation of new non-integrated systems are starting to create issues for care teams and their patients.
Surprisingly, because of the complexity of patient management workflows, the variance in how hospital management approaches the workflow in their hospital, and the difficulty in making the devices of a variety of vendors easily integrate, even new hospital builds are failing to address the problem adequately.
Many hospitals in Australia, old and new, are marching to a tipping point where the proliferation of systems without proper co-ordination and integration is starting to retard the overall ability of the care teams to deliver a good service. The situation in some cases can be so extreme as to threaten patient safety.
Beyond nurse call
A key issue for hospital administrators thinking through this problem is the concept of “nurse call”.
Nurse call is a term that had its origins in the 1800s when Florence Nightingale applied the system of bells for calling servants to hospital wards. Nightingale introduced beside handbells to be used by patients to alert nursing staff when they needed help.
The next major iteration of nurse call technology to bells was in larger hospitals which started using light and tone systems to differentiate patients and types of calls.
Two way audio was introduce in the 1980s. Around 2000 IP based systems were implemented allowing the nurse call system to integrate crudely with other core platforms such as EMRs and security systems, and today most modern hospitals build their IT infrastructure around wireless networks. In such networks “nurse call” remains a highly identifiable and often tightly defined component.
Today, partly as a result of increasingly outdated standards which were developed through the 80s in most countries to get some alignment of the basics in the systems, “nurse call” remains a well defined component that many hospitals must implement.
There exist many vendors offering a vast range of defined system components, often reflecting the basic specifications required by a local standards regime.
But the basic concepts of “nurse call” has now been surpassed by technologies which now provide hospitals with an ability, if desired and or specified, to integrate most patient based devices into a wireless co-ordinated intelligent communications platform for a care team.
But because of how standards and vendors have evolved, basic nurse call and adjacent products remain a major specification element of any new hospital set up where a replacement is required, while rarely does a hospital specify that a replacement system be able to integrate with most other patient based devices and alert systems in the set up to form a holistic and integrated communications platform for care teams (as they probably should).
While base nurse call functionality is always specified, rarely does that specification stretch into a more holistic hospital wide data and communications platform for the care team and patients.
You won’t even see such plans much in the strategic objectives of some of our major hospitals.
Nearly all hospitals upgrading nurse call will be constrained by the cost of replacement in the context of their funding regimes, and the regulatory need to only meet minimum standards requirements.
Most hospital administrators would love to plan over time to achieve the nirvana of simultaneous management of multiple patients with multiple data points, on many integrated and co-ordinated devices which talk intelligently to their care teams. But, such planning is so far a rare luxury within the confines of their funding model and other priorities.
Other than funding, some of the hurdles administrators face in moving to more efficient internal communication management platforms include:
- A vast array of vendors whose offerings and ability to widely integrate into broader hospital communication platforms are difficult to determine. There are lots of “nurse call” vendors, many of whom offer adjacent products and services, but understanding the overall ability to achieve integration with other vendor products is not often apparent.
- A dearth of local implementations which would show the way for others. It’s hard to name one hospital in Australia which has co-ordinated most of its data flow and communications capabilities into an overall platform that is returning significantly in care team efficiency. This is not because some hospitals aren’t planning or trying. It’s mostly because it is only in the last few years that the technical capability has become viable, and the funding environment is still not aligned to this type of specification.
The ability to move towards a goal of multiple patients with multiple data points, on many integrated and co-ordinated devices which talk intelligently to care teams is still bleeding edge in some respects in Australia, but it is an achievable goal according to some of the major hospital communication platform vendors.
One major global vendor, Ascom, made the decision earlier this year to start marketing its more comprehensive nurse call suite, Telligence, and it’s hospital-wide communications platform solution locally in Australia because it felt that many Australian hospitals are moving to a tipping point on the issue.
As complexity starts to compound, some administrators are starting to think more seriously about the possibilities of more comprehensive integration of data services with care team planning and communication.
Until now, Ascom had only been selling its more basic nurse call solutions into the local market.
But according to Asia Pac head of marketing, Adam Jaffe, the Australian market has matured rapidly and increasingly the company is seeing instances where local hospitals can utilise the full communications suite of products on offer from the group, which have been available in larger overseas markets for some years now.
The new suite includes the Telligence patient response system, a vendor agnostic interoperable patient communications platform, which provides a single view and care team assignment engine for multiple device alerts and EMRs, and streamlines tasks such as patient rounding, admissions, discharge, housekeeping and bed scheduling.
The Telligence suite talks to third party vendors in the communications chain when needed, according to Ascom Product Manager ANZ Simon Squire. But, it also integrates with the Ascom Healthcare Platform, which is designed to integrate with any device, the core hospital information systems such as the EMR, and patient response systems (nurse call), and co-ordinate and analyse all the information for both care teams and administrators.
Squire said that the decision to market Telligence in Australia, along with the Ascom Healthcare Platform, is significant in that he believes there isn’t any system on the market that does everything that the Telligence platform does in one solution.
“Yes, you can get various different systems to send off different alerts: you might have the cardiac systems and the clinical devices being monitored by someone else and having that then integrate to another platform,” he said.
“But these are all usually very disparate systems. They might connect together at some point, but it’s lots of points of failure.
“We can take all of those feeds into our platform whether they are third party devices or not and manage it all: create alerts, create the events and report them, report end-to-end on what’s happening across all devices, when the alert raised, why, who attended, when they attended, how quickly and so on.
“All of this can be reported out on one platform rather than having to go to disparate platforms and get that information in dribs and drabs. Being able to get it all out of the one platform means that you have a complete picture end to end of an event.”
Jaffe believes that Ascom committing to selling and supporting its more sophisticated platform based offerings in Australia marks a turning point in the local market where the scale and sophistication of hospital investment is causing a lot of rethinking about how to achieve efficiency in an increasingly complex digital hospital environment.
“We are really beyond simple nurse call now,” he told Wild Health.
“These days the administrators are planning longer and thinking deeper about where they can create efficiency. Whether a new build or replacing older technology, integrated and vendor agnostic patient data management is becoming a focal point for a lot of forward thinking in the sector today.”
If you’re interested in this topic, Ascom is sponsoring a Free Webinar titled Beyond Nurse Call: platforms that transform workflow and communication in hospitals,
Tuesday July 13th11am AEST. REGISTER HERE.
- Kate Renzenbrink, Chief Nursing and Midwifery Information Officer, Bendigo Health
- Helen Sinott, Director of Nursing & Midwifery Informatics (CNMIO), Western Health
- Major Public Hospital CIO – TBC
- Simon Squire, Product Manager at Ascom
- The spectrum of situations a healthcare provider will find themselves in when considering upgrading: very old systems with little IP, wireless, through to complex modern large institutions with multiple vendor systems capable of talking to each other, but requiring design and co-ordination in the consideration process.
- The new hospital vs one with a spectrum of legacy systems to integrate with: case study.
- Australian nurse administrators working in Australian hospitals talking about the coal face problems of communication and workflow.
- The process of assessing your set up and whether you could or should upgrade and how.
- The upsides of successfully moving to an integrated workflow and communications platform environment.
- Q&A with expert speakers.