Hospitals Beyond Four Walls

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In the mid-1900s, hospital facility managers dealt mainly with building maintenance, heating, electricity, water and sanitization. Times have changed dramatically as the facilities themselves evolve into high tech equipment.

As more and more Canadian hospitals develop electronic networks to store and share patient information with other health-care providers, there exists a myriad of Information and Communication Technologies to chip away at the already eroded health-care spending. Yet, for those hospitals caught in the rush to improve old facilities by implementing the rapidly advancing ICTs, the rewards are formidable.

A November 2001 report by the Ontario Hospital Association and the EHCR (Efficient Healthcare Consumer Response) found that through best practices and investing in new ICT, the total savings across Canada by improving supply chain management alone would amount to approximately $350 million per year.

“When designing a system, what is important to long term strategies is to define the care delivery environment and have better decision making tools,” spoke Miyo Yamashita, corporate privacy officer, University Health Network. The University Health Network serves a staff of 10,000 health-care workers while providing some sharing with the Faculty of Medicine at the University of Toronto, and utilizes Toronto labs.

“UHN’s Project 2003 has clinical decision support, resource management and scheduling, community integration, research informatics, two more business systems and a telecommunications strategy that relates back to how the hospital is physically changing to test its new device strategies-where the privacy comes in will impact community integration efforts, e-chart research, business systems and telecommunications.”

At NORTH Network, physicians at the northern sites are able to contact specialists at Toronto’s Sunnybrook Health Sciences Centre, gaining access to expert opinions at a major teaching hospital. As well, doctors and patients in Kirkland Lake and Cochrane can consult surgeons and specialists at Timmins and District Hospital, the most sophisticated treatment centre in Northern Ontario, to obtain teleconsultations that enable patients to avoid time-consuming, expensive and sometimes perilous trips.

With many facilities no longer being in just one physical location, multiple sites are now linked through ICTs to meet the needs of health-care providers, planners and patients. The Ontario government’s Smart Systems for Health, for example, is creating a personal health record with a virtual private network throughout Ontario to share information in a secured manner along with common business services.

Similar goals are behind Infoway Health, a Federal initiative of Health Canada. The 29 pilot projects that are currently underway include hospital networks with fully integrated medical devices, interactive diagnostics and online treatments, e-commerce and more.

At Beausejour Hospital in New Brunswick, the federally funded National Nephrology Telemedicine Project offers consultation, radiology, diagnosis, mentoring and distance education for the prevention of cervical cancer.

“We have a central registry with a recall system that links all the labs,” spoke Suzanne Robichaud, Telehealth Coordinator, Beausejour Hospital Corporation, Moncton, NB. “Those labs know which women are going and those who are not, will be reminded via a database…we are also developing an e-consult software for doctors at a distance.”

Brian Schmidt, COO of the BC Cancer Agency, believes information management and information systems are very much global capacities. ” By mid 2003 we will be virtually paperless within our organization… We send out a report on one of our fibre optic links. We determine the most cost-effective way to bundle various pieces of paper to a doctor electronically – we are working with the government of B.C. to distribute up to two million pieces of data per year,” says Schmidt.

The B.C.Cancer Agency’s most successful changes are in three main areas. One is the redesign of its system for radiation therapy treatment, through the automation of all the processes within the radiation departments.

The second area is in the movement towards the electronic health record. Physicians review their information through their transcription and essentially provide information to other physicians and nursing staff without really having to move a hard copy record along.

The third area is with respect to the community extranet management tool over the Internet to communicate all information to the agency’s community partners. “We wouldn’t be doing any of this if it wasn’t improving patient care or critical patient care needs,” added Schmidt.

As hospitals continue to find new ways to apply ICT, facility managers will face new challenges. Not only must they consider the current needs of the organization, but they must also plan for the future. A future where long distance robotic surgery, such as London Health Sciences Centre has clearly performed, or the Programmation regionale des services ambulatories (PRSA) program in Laval, Quebec that is transforming hospital care into ambulatory care with secure patient health records-all will place even greater challenges on facility managers. Hospital buildings are no longer just four walls, but a complex network of infrastructures that people depend on.