At the 650-bed Humber River Hospital in Toronto, Ontario, CIO Peter Bak has been leading an initiative that has already shown important results in terms of leveraging a variety of technologies in order to enhance clinician and staff effectiveness and improve patient outcomes. The building of a new replacement facility that consolidated what had been three separate campuses with aging legacy facilities, led to both opportunities and challenges, in terms of how the healthcare professionals at Humber River might move forward in the context of overall digital transformation. After a vendor selection process, Bak and his colleagues ended up choosing to partner with the Toronto-based vendor ThoughtWire, in order to build the kind of “app-oriented platform” that Bak was looking for in order to maximize the efficiency of physical resources and to optimize the efficiency of the physical activity of clinical and non-clinical staff in the new facility.
Bak spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding Humber River Hospital’s experience so far on this digital transformation journey. Below are excerpts from that interview.
What was the situation that caused you and your colleagues to need a solution in this area?
Humber River Hospital was three separate campuses, and they were separate hospitals that amalgamated. The government runs and owns hospitals here. So these hospitals were amalgamated, and the buildings they were in were very old, dating from the 1940s. And we service an area of Toronto with about 850,000 residents, with a significant population growth happening. These facilities were simply not capable of handling the growth. So the executive team agreed that we needed more beds and a new facility, and we got funded for that, and transformed into a new single facility with 650 beds.
When did your new facility open?
It opened middle of October 2015, so, almost a year and a half ago. And it was a 12-year journey from the start to opening the doors. Our senior executives were looking at the opportunity, in building a new hospital, to lead the way; instead of following old models of care, how would we do things differently?
So there were two elements to this—a design element that was different, and a digital opportunity. And the whole world is going digital, but the question was, what should that mean? I was brought in as a consultant in 2009 to start the process of asking, what is a digital hospital? So, why? What are you trying to improve or do? And this is really all about business efficiency, quality, and safety. So as with any organization or industry continually looking to do better, the motivation for going digital was to leverage technology to do better. And that’s a pretty obvious statement, but interestingly, not everyone feels that way.
What did this quest look like on a practical level?
Part of looking at how we might be a bigger, better, or different hospital—we shifted from semi-private rooms and wards, which was and is the norm in Canada, to single-patient rooms. So right there, that increases your footprint and your physical space pretty dramatically. The second thing was, we want to also move from a model where you walk in through a central door into the hospital and fan out through various areas. We said, no, let’s follow an airport model, where you go to specific terminals or concourses. So we ended up with a different design from what we typically see in hospitals. And then the third element was energy: hospitals are inherently energy hogs. And community hospitals are typically very high consumers of energy. We looked at this and said, we want to be a more energy-efficient building, because that saves money. So these were some key drivers to try to save energy consumption while working in a hospital that would be physically much larger. And by the way, our ministry doesn’t have unlimited funds, and we won’t get a bigger budget just for becoming physically larger. So how do you deliver equal or better care, energy-efficiently? So we looked to technology to assist us in that. So that was a big driver when we were looking for technology.
So, how did you develop a strategy for this?
I would say that with any transformation strategy in any industry, there’s a fairly well-understood process for doing that—you need to understand what your pain points are, and what problems you need to solve. It’s a fundamental strategy, because if you look at change management, which is a key element here, many people fail around the change management piece. And the thing is that you need to change for the better, not just for the sake of change, or change will be rejected. So we went through a whole “voice of the customer” exercise. We really asked people, on a day-to-day basis, what is the most frustrating and painful stuff for you? And there’s a general theme that emerges that I think you’ll find in most hospitals, and it’s really rooted in the use of paper, and the inefficiency of using fax and paper, and all that. So it’s a good exercise. So we walked through that whole process, including participating in current-state/future-state analysis and gap analysis. We did all of that, and what came out of that was that there was a lot of technology available; the trick was to make it all work together. The key was interoperability, not just integration. Integration connects two pieces together, but doesn’t change anything. So we were looking at interoperability workflows.
And we said, how do we connect all these technologies together to create interoperability workflows? And we said, OK, we’re doing this work in 2010 and our doors will open in 2015, and technology will have advanced already by then. So you need to plan for that. So what we were looking for was a platform that would give us evolutionary capability. And the way we articulated this—and I’m a systems architect—in the world of banking, insurance, and retail, these kinds of platforms exist and have been in place for years. So we went out and said, good, we want a platform that abstracts all of our systems. And people leapt to the idea of abstracting all of our clinical systems.
And there was also an energy efficiency component to this, correct?
Yes, definitely. We’re trying to drive down energy use and improve the efficiency of all of our systems, including building systems, robotics, and financial systems, among others. So we felt the platform had to abstract and integrate not only clinical systems, but also lighting systems, HVAC systems, call systems, nursing systems, everything. So we wanted a platform that could be universally available and help us to integrate these systems for efficacy. So we were looking for a platform that could abstract all these systems and also leverage these systems to integrate workflow.
And by the way, we’re moving into a modern web world, so everything has to be mobile. So we wanted an app-oriented platform. All of the tools you build are going to have to work on smartphones and behave like apps. So we went out to the market and were looking for solutions, and a number of candidates were presented to us.
And we looked at systems like Oracle and IBM, and a lot of those systems were generic and not healthcare-focused. Meanwhile, the healthcare-oriented systems we looked at weren’t integrated; they were focused on specific apps, and a lot of those apps were telephony-oriented. And even in 2010 and even still somewhat now though less so, the way that people connect and go mobile in healthcare is very telephony-oriented, with pagers and telephones, and also app-oriented. But there was this startup company in Toronto, that met all our criteria, named ThoughtWire. And we happened to know the founders, and they were healthcare people. And they had a platform that gave us the ability to abstract all these systems, gave us the opportunity to orchestrate all these systems, and they had a healthcare pedigree.
When did you sign the contract with ThoughtWire?
At the beginning of 2014; and we got everything working by May 2015, so, within a 10-to-12-month period.
Can you explain the core functionality involved in this platform?
Their core functionality is what we call our notification manager. Essentially what they’re doing is driving closed-loop communication. It’s alarms and alerts from a variety of different systems, but it’s connecting people and driving the workflow based on those alerts. For example, with our nurse assist workflow, when a patient hits a call bell, it messages a nurse’s mobile device. And the nurse has the ability to call back or video-conference call back to that patient. And there are variations on that capability. Each unit is a 32-bed unit; it is a very large space, and so for a nurse to roam from one room to another to respond to nurse calls, would consume a lot of time. And we did a lot of modeling on this. In the old buildings, the nurses were walking 5.6 kilometers in shift, and we modeled that if we didn’t change the paradigm, nurses would be walking 12 kilometers in a shift. And you could double the staff, but that’s not affordable. So one of the technologies involved is this nurse assist function. We had a 1-5 nurse-patient ratio in the old facility and in the new one, where the physical space is three times larger. So that’s one example of a benefit.
Could you share a couple of other examples?
Yes. We have a code-blue function and a code function. If somebody hits the code-blue function, it will notify the code-blue teams. And because we’re 1.8 million square feet, code-blue team members are notified, and if they don’t accept the call, it escalates to the second team; we have two. The other thing is that we notify the entire staff in the vicinity. So all of that is built into the ThoughtWire platform. So at the end of the day, it’s doing smart notification to ensure that the right people know what’s going on and have the right action to take, and that has supported increased efficiency.
What have the biggest lessons learned been so far, in all this?
A big lesson I have from all of this is that digital transformation such as the kind we’ve undertaken, adds value. It really does drive the opportunity for quality and safety. And that’s very important. The other thing is, people say, well, you’re a brand-new building, so you had the opportunity, but we’re legacy sites. And I say, no, at the end of the day, you can do this, because it’s Wi-Fi, software, and networks. So most of this really is very doable in existing sites.
And you did this in the context of change management and mapping your processes and needs, so that is very important, correct?
Yes, it’s very important. And I can only speak for Canadian hospitals, but we don’t always think things through in such a planned and strategic way.
Is there anything you’d like to add?
Yes, there’s a very important thing I’d like to add. Even after five-plus years, we feel ourselves still at the beginning of this journey, and we see a tremendous amount of opportunity to drive ourselves to a “highly responsible organization,” as it’s called. We want to improve outcomes as much as possible, efficiency as much as possible, and the patient experience as much as possible. And we can now leverage analytics to drive ever-improving efficiency and effectiveness. We’re about to reach the next layer, so that we can transform this hospital beyond anything we’ve done before. And that’s the key lesson learned: that once you achieve these base capabilities, you’ve prepared yourself to reach new levels of transformation. And that’s key; if you can’t put in the fundamentals, you’re stymied in terms of creating more fundamental change.