I have just come back from a pretty amazing two day meeting.  The Centre for Social Impact ( led by Peter Shergold) and Cisco got together with 60 senior Australian beauracrats and brought innovation experts from around the world to talk about how to innovate in the delivery of public sector policy.

Sounds like it could have been boring...but it was anything but.  When you have innovation leaders like John Kao ( re Innovation Nation), Jonty Olliff-Cooper (DAMOS) and Beth Noveck (White Deputy Chief Technology Officer for Open Government) all talking about how to transform goverment through open engagement with citzens it was a "mind shifting" two days.

How does this relate to Digital Healthcare design. The link came first in John Kao's discusion around the use of design thinking.  Quoting Wikipedia:

"Design thinking is a process for practical, creative resolution of problems or issues that looks for an improved future result. It is the essential ability to combine empathy, creativity and rationality to meet user needs and drive business success. Unlike analytical thinking, design thinking is a creative process based around the "building up" of ideas."

What became clear in the discusisons (and presentations) that followed was that this concept of design thinking has been central in the delivery of successful public sector innovations (and public sector innovation is what designing new hospitals is all about).  The innovations we heard about were driven by the public sector deeply engaging with the citizens, empowering them with the ability to gather together and exchange/build ideas.  Finally it engaged the public sector management in a way that created empathy and understanding.   Yes there were lots of web 2.0 tools and innovative ways to drive engagement and feedback, but the issue was not the technology, the issue was creating the opportunities to listen in a way that creates understanding.

This struck me as the challenge that we have in front of of us.  We are all comming to the task of how to better deliver healthcare with great personal passion, but the issue we face is can we put aside our individual passions and listen to those in the system, providers and users, so we can really uderstand their needs.

A difficult challenge, but one with great practical rewards.

For those interested in exploring this field I thought I would do a bit of a summary of the key sites active in this area.  There are few activities dedicated to the application of health IT in healthcare design, however, the X3 Summit is a major conference in the US on the subject.  On the event website at www.x3summit.com  you can see  the program for this year's conference (Duke University May 5-7) and past programs.  It gives you a good idea of what is happening in this field.

While there is not a single site dedicated to issues around Digital Healthcare Design (if I am wrong please leave a comment on the blog...I would love to know the details)  there is a large amount of acitivity around healthcare design issues in general.  One of  the leading Australian centres active in this area is CHAA (Centre for Health Assets Australia). Associate Professor Jane Carthey is Director of the Centre and it is part of the Built Enviroment Faculty at the UNSW. They are responsible for producing the Health Facility Guidelines.  This is the publication that we want to supplement with a set of Health IT guidelines.  You can find CHAA at www.fbe.unsw.edu.au/chaa/.

Internationally, the major site is probably from the Health Design Technology Institute, which was supported by the Robert Wood Johnson Foundation in the US.  This group has a focus on evidense based design and has some fantastic papers on the subject that can be downloaded from their site (see www.healthdesign.org ).  All this is an important foundation to the work for developing the focus on Digital Healthcare Design in Australia.

Some other intesting sites are

• Centre for Health Systems Design
• Informed Design
• www.facilitiesnet.com/healthcarefacilities
• Picker Institute
• Healthcare Design Magazine
• Healthcare Building Ideas Magazine
• Academy of Architecture for Health
• Health Environments Research and Design Journal
• Healthcare Design Conference

I will get back to you soon with some details about an event we are organising in Australia on digital healthcare design, looking at how to design a digital hospital for 2020

Best regards

Brendan

It has been a while since I have been blogging.  The transition to Cisco (from the CEO position at HISA) temporarily diverted my attention away from blogging,  but I am now back.

Taking up the position at Cisco has opened my eyes to what is a bit of a missing link in the delivery of healthcare in Australia. 

Australia has over $20 Billion in hospitals currently in the planning, design and construction phases.  However, even with this enormous financial investment, there are no guidelines or even guiding principles for how information technology can be best included in these designs.

There is a big need for a multidisciplinary group that brings together architects, designers, engineers, IT professionals, healthcare providers and consumers to look at the interface between design and information technology. The objective is to bring these groups together and to drive innovation in healthcare delivery.  

If you are interested in this field, then join up to he Digital Hospital Design Group on The Health Hub ( see http://www.thehealthhub.org.au/pg/groups/3304/digital-healthcare-design/ ) and help us build this group and bring some guidance to the health facilities and systems that are going to deliver care to Australian communities over the 20 years.

This is an important task.  I hope it is going to take us all out of our comfort zone, with conversations involving a broad range of professionals and health consumers who have previously not had an opportunity to interact.

It is an experiment, but then the exciting parts of life, personal or professional usually are.

I hope to see you at the HUB.

If you want to send me a message to talk about involvement just click on the message function in the drop down menu and we can talk. 

See you in the Digital Healthcare Design Group.

Best regards

Brendan

Well ……….. it seems there’s no such thing as free speech around health IT …………….I’m sure you’d agree that this article makes interesting reading

http://www.smh.com.au/national/health-department-accused-of-censorship-20091127-jwwm.html

I’d have thought that all Cerner and NSW Health needed to do was to point to the reams of published, or at least public, examples of successes and business benefits that have been delivered by Cerner products – not quite sure why they would seek to censor or not respond ? Any thoughts ?

Victoria’s HealthSMART program has now been running for in excess of 5 years …..a number of wins have been had with implementations successfully undertaken in the PAS and financial spaces. Ask any clinician however ………… and all they care about  is having better tools with which to manage their patients and collect relevant  data related to their services.

We still do not have wins ……….or even visible implementations …….at key sites in the clinical space. More worryingly – we have very little indication to the broader clinical community, as to what is happening in this space, and what is and isn’t in scope – clinicians are left to wonder …………….and be cynical about the likely chances of success.

From a healthcare management informatics perspective – we remain  a long way from seeing the ways in which these clinical systems could or would support the improved provision of services to patients …………let alone actually being able to measure these benefits. I guess the key question is ……..how much longer will the sector need to wait ?...........as all the while,  clinical medicine increases in diversity and complexity,  and these tools to support the practice of that medicine fall further behind in relative terms.

Those of you who know me will recall that this is a favorite topic of mine ......... the question of what is a "bed" when talking patient care and hospitals … or more particularly ………. how do we define what a bed is ?

This is important to note for the development and use of operational IT systems that track usage and staffing of, and the need for, “beds” and also for those of us who develop computer or mathematical models of facilities and systems. Historically, blood has flowed – or at least many a nasty word said over “beds” - in the cut and thrust of hospital operations……….. so they are no trivial matter……………..and some would have us believe (with fair justification) that more of them is the answer to improved access to hospital care.  

Given some important realities however (see below), I think we need to explore a new concept for the 21^st century….can I submit to you for your consideration – the “patient treatment space” (the PTS) ……..as you know every new idea needs a new acronym J

The patient treatment spaces concept can encompass the same issues confronting “beds” – namely questions of – staffed (specialized vs generic) vs unstaffed; empty (transiently or temporarily) vs occupied ; gender specific or gender neutral; single room or multiple bed room; PPV vs normal; isolation vs non isolation; HDU vs ICU; ventilated vs non ventilated; physical bed vs trolley vs upright chair ……………..you get the idea……….

………whilst allowing for the fact that what is more important looking forward from  now with drivers to SD,  ambulatory and virtual care – that is the capacity of a “space” funded by an entity, to treat patients in a quality fashion whilst recouping expenditure ………… for example – if you run a GI service and the vast majority of your work happens to be endoscopy vs IP care …………… you are much more likely to be interested in available capacity to perform endoscopy (with the attendant implications) than access to vast numbers of IP beds

The work of Peter Pronovost 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61439-2/fulltext  is to be applauded.

Furthermore - we should certainly examine the ways that IT can support such simple aides-de-memoire and their implementation - in fact we must - as many healthcare workers will work off electronic work lists both now and in the future.

The "ticked off" part ?? - why has it taken our industry so long to do what others have being doing for decades (that's a PhD.......or a career...... not a blog entry :-) ) ........... one reason I would argue is (and I agree with Peter's 3 buckets idea) - that the 3rd bucket is neglected - health-mic is definitely focused on improving "the lot of the 3rd bucket" amongst its other roles.

I thought this was an interesting article for number of reasons.

http://arpa.allenpress.com/pdfserv/10.1043%2F1543-2165-133.4.601?bcsi_scan_455C35AC431ED0B8=Fsb3MH9X2bZWJ68iGk4fnw0AAADsXfAE&bcsi_scan_filename=10.1043%2F1543-2165-133.4.601

Delays in TAT in labs have an impact on system effectiveness and directly and adversely on patient care in some cases.  The paper also addresses the  issue of buy vs build in hospital information systems, an issue I have touched on in a previous AHR paper.

For those from an IS bent - in my current PhD research on technology ecosystems (Adomavicius et al) - I have identified an LIS as sitting in the same "technology layer" as a RIS and a PAS (all transactional systems)  - with the PAS as the focal technology

We recently chatted on our list serv re a "Virtual Hospital” or a “Virtual Healthcare system” - drawing analogies with the Virtual Physiological Human project and similar initiatives  - http://communications.nottingham.ac.uk/News/Article/Assembling-the-Virtual-Human.html

What I wrote at the time was: “So why not a virtual operational hospital (or a virtual operational health system) ...$$ are obviously one factor .......but is this something worth trying to drive as one activity of our research collaborative?  Consider the analogies with the complexities of health organizations of various kinds - their uniqueness (a-la  the personalized medicine concept) ...and the fact that many of us have already developed numerous models of parts of, or entire hospitals, or even broader health systems through various technological means. The end game can be a better understanding of the effects of localized interventions rippling through organizations or health systems facilitated  by interconnected tools and systems - which in turn can be linked to real time operational systems”

From where I sit I think we have a chance for a first ever international assault at this with links to Europe and the US – what are your thoughts ??

Last week the Department of Health and Aging released its report to support Australia's first National Primary Healthcare Strategy.  This is an important report to read for those interested in Consumer e-Health.  You can download a copy of the report from  http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc .

There are two important things to take home from this report.  The first is there is a clear recognition throughout the report that e-health technologies, including web based information sources, mobile computing systems and online health records are vital elements that need to be further developed to better engage consumers in better maintaining their health.  This is not only discussed in the chapter dedicated to e-health (Element 6 of the report), but also inferred throughout the report when delivering on the reports objectives are discussed.

The second important consumer e-health aspect to the report is that while there is a recognition of the need for these systems there is no real detail on what they would look like or how they would be delivered.  There is some discussion regarding access to a personal health record, but again little detail on the what or the how around it. 

To me, this further emphasises the need to rapidly develop the discussion around what are the required consumer e-health systems and how we could develop and deploy them.  Unlike the professional systems that are in the spotlight now, where the roll out is gated by large capital investments from the Federal and State governments, the implementation of consumer systems are going to be driven much more by open market developed applications and the implementation will only be gated by the cost and the value that they deliver to consumers.  This is a notoriously difficult genie to control once it is out of the bottle.

If we want to make sure that Australia's health consumers have access to the applications which will really improve their ability to manage their health then we need to work out  how to create the market conditions that foster these types of applications. 

Hopefully through the Health Beyond group on the Health Hub we can develop that sort of conversation.