Visit to Himss16 in Vegas

Just returned for Himss16 and a lot of experiences and new contacts richer. What a week and what a town Las Vegas are. 

Our purpose of visiting Himss16 was to engage in dialogue with vendors that have equipment and IT software solutions that will help New OUH achieve the goals that are set for the construction project. At the moment in the construction project, we are focusing on two major areas within equipment and IT. They are:

1. The future patient room and Operation room and new equipment in those premises
2. Clinical logistics, service logistics and booking including the ambitious use of a RTLS platform (se paper for more information).

Our focus area was therefore not typical clinical systems like electronic healthcare records and other clinical systems like PACS. We needed to broaden our horizon and learn from the frontrunners of our field - Himss16 was essential in achieving that goal.

New Odense University Hospital will engage in Call for Vendors in 2016/17 and forward until the new building/hospital is ready for use in 2022. The visit to Himss16 was designed to inspire our project team and create knowledge for further dialogue and/or create input to requirements for further purchase.

We were looking for innovative solutions that can change and/or effect the care delivered within the hospital. It could be vendors that have products like:

• New digital beds
• Healthcare Robots
• RFID based systems
• Supply chain management systems
• Unit dose medication robots
• New ways of accessing EHR data
• New mobile equipment as radiology equipment
• New ways (apps maybe) of using our RTLS platform – beyond just finding equipment and clinicians
• IT systems within the clinical logistics, service logistics and booking area and solutions that connects the three.

We got a lot of help form  Invest in Denmark and ended with 15 booked meetings and a lot of informal ones as well. We will use our new inspiration in our enterprise architecture work and hopefully be ready to meet you all again - at least when we make the big call for software and digital solutions for the New Hospital.

Thank you Rebecca and Michael from Invest in Denmark - you were great.

I even got to speak at the following events:

• Invest in Denmark, Foreign ministry round table session with American vendors (50 participants)
• Nordic delegation on “New Technologies for data collection and usage” (150 participant from the Nordic countries)
• Belgium delegation, keynote speak on “Have we forgot the enterprise? Health IT is also about logistics” (60 participants

Digital wayfinding can be challenging

Orientation Strategy and specific navigation solutions will have a clear digital element in hospitals now and in the future. Digital technologies will be more mobile and able to handle larger amounts of data so that the hospital users ( patients, relatives and employees, etc. ) will increasingly benefit from solutions that can support a personal, contextual, secure and clear way of navigation.

The following conceptual elements can be a help for hospitals that want a way-finding strategy and concrete solutions afterwards.

Principles of digital find your way systems in hospitals

The following principles will guide the preparation of the actual digital navigation solutions.

1. Digital way-finding information must be easily accessible and offered on multiple platforms and they must be overlapping.
2. Digital way-finding information has to be context-sensitive, for example, be based on the current location as well as for example the time of day.
3. Digital way-finding information must be specific to the individual, for example, be based on the actual booking and show the way there.
4. Digital way-finding information must be offered to both external (patients / relatives / suppliers) and internal personnel (employees).
5. Digital way-finding information should complement analogue information (signs, letters, colours, landmarks, entry numbers, addresses, etc.) as a single coherent system.
6. Digital way-finding solutions must exploit the existing (if any) Real Time Location System (RTLS)
7. Digital way-finding systems should support the trip To the hospital (home-> Hospital/parking-> entrance->destination) but also support the trip home (destination->Exit-> Hospital/parking-> home).
8. Digital way-finding systems must import map data from central systems such as Facility management’s operating system. Imports must be automatic and for example serve as a subscription (master-slave).
9. Data should in whole or in subsets be exhibited to third party suppliers. This could be addresses, entrances, parking lots, playgrounds, sections etc.
10. Digital solutions must be based on business requirements and wishes materialized in the way finding strategy and clinical concepts on the hospital.
11. Digital signage must be coupled with clinical and administrative data, in order to offer a relevant way-finding information. For example: Digital signage at the local level coupled with clinical booking / scheduling system, so content on the door screens outside each room reflects the actual planned treatments or signage in conference rooms / auditoriums reflect agreements in meeting room booking system.
12. Data on the use of the way-finding solutions(eg type of searches and where they occur) must be accessible, so it is possible to continuously analyze and optimize the composition and signage information based on real-time usage patterns.

Three geographic levels of way finding

Navigation on the hospital should be able to guide the patient from a remote location (eg. Home) through to the hospital. Upon arrival, systemss) recommend the most appropriate parking area in relation to the recommended input on the New OUH, and thus the location of the department, the patient must visit. Intern in New OUH's building stock to be offered a clear, timely and contextual navigation assistance to all staff and visitors / patients.

Digital way-finding information can thus be divided into three geographic levels.

These are:
1. From the remote location (or home) to the hospital
Patients, relatives, business etc must be helped to find their way between a remote location and forward to hospital. This could also be navigation for internal transport between different hospitals within a organizational unit.

2. From the hospital premises to parking and entrance
When patients, families, external suppliers etc. arrives at the hospital, they are offered navigation to the area that are closest to their destination. For patients, this information may be retrieved in a clinical booking system, while external transport will have to navigate to the goods reception.

From the entrance to the local destination.
Patients, families, employees, etc. should be able to get navigation aid within the hospital, which are contextual and based on the relative position between their current position and their destination.

Client Equipment usually found in way finding suites across the hospital

Way-finding stands
Larger stands with touch screens for interactive use, for example in a vestibule.

Digital signs
Smaller screens for digital signage for either use in hallways vertical or horizontal signs or possibly as elevator sign

Digital information screens
Larger screens for use as info screens for use in waiting rooms, receptions and other places where patients and relatives are present.

Way-finding  Apps
Way finding apps on the smart phone could focus on the parking area, entrances or guiding to final destination.

Digital door signs
Small door signs with text on room number and booking info as relevant clinician or type of room.

Digital signs in terrain
Larger signs in the terrain that can show info on contextual directions, overview maps and general information.

Whent to Australia to learn about POSIWID

I have just returned from Sidney for the first Australasian Enterprise Architecture Conference, where I was invited to speak. I had some concerns on the long journey, but I must say that the program, the level of the speakers and the nice people I met – just made up for it a 1000 times. I was blown away and the only regret that I have was, that I did not speak to more people or the conference were a little longer.

I would like to quote the Chair Darryl Carr when he writes:

High-quality speakers
Our international and local keynotes did not disappoint. Whether it was Tom Graves and his insightful view of Big Picture Enterprise Architecture, Craig Martin's take on the design of businesses in the age of Digital Disruption, or IASA's President Paul Preiss with his incredibly passionate view of the future of the architecture discipline, attendees were treated to an amazing amount of information and experience.
 
Here are just some of the comments from attendees:
•    Superb!
•    Fresh and insightful approach to the development of the architecture profession.
•    Very high level of speakers.
•    Great real world stories.
•    Thought provoking and challenging the current paradigm.

Sometimes you are truly surprised. For me it happens not that often. Last week it did several times. Thank you all for making my trip worth to remember. 

Ohh yeas POSIWID: (The) Purpose Of the System Is [expressed in] what It Does. 

It is generally not a good idea - but in my line of work it is often the case. I will explore the theme later this week because in the healthcare sector we tend to do that a lot.

Effective logistics is the new battleground for a quality healthcare system - Read my new article

The Danish government decided in 2008 to spend 10 billion Euros on 16 new hospital construction projects. In Odense, the budget is totally 1.3 billion Euros and will be approximately 220.000 m2. The hospital will be ready in 2022.

TOGAF as a framework has been used in order to secure a coherent and semi-automated logistics system, where:

• clinical logistics
• service logistics
• planning/scheduling

(the logistics complex) are the central elements. The project has identified those three areas as interdependent and most important, leaving out systems like electronic health records (EHR).

It has been crucial for the project that clinicians do not interact with the service logistics system, but instead focus on their clinical workflow through interaction only with the clinical systems at the hospital. A real time location system (RTLS) has been acquired, so it is possible to track mobile equipment, beds, trolleys, patients and personnel. Based on the exact position of equipment or personnel/patients, tasks can be created or registration made automatically in the surrounding application.

The new logistics solution will help the hospital cope with fewer beds, be more efficient and increase quality overall. TOGAF has proven itself as a reliable framework in order to map the business architecture of the future and select and design appropriate information system architecture and technology architecture.

Download my article on the subject

New Concept for the Digital Hospital – English version

Today an empty field of 78 hectares in the 3 largest city in Denmark. In seven years a new University Hospital (Nyt OUH) complete with 714 beds and 52 operation rooms of various types. A major building and development project regarding clinical processes, organization, IT and technology is underway. TOGAF, as a framework, is the driving force of this planning process and will ensure a coherent and up to date IT architecture when the hospital is finished in 7 years.

The hospital will collaborate with the University of Southern Denmark in order to bridge the gap between research and clinical treatment. As part of the major building project, the Region of Southern Denmark and the project organization will work on describing, analyzing, acquiring and implementing IT and technological solutions that will redefine the healthcare delivered, support the clinical vision and make day to day clinical practice operate in the new building. We call it “The Digital Hospital”

The digital solutions that are the building blocks of the digital hospital must accommodate the opportunity to support the best possible patient treatment, as well as support new working procedures and processes. To further a desired progression towards New OUH, the visions must necessarily affect the hospital's core business - patient treatment - by making the digital field unique.

When dealing with IT everybody in the organization have an opinion on how to do it, how to implement and what to buy.  Therefore, it is easy to miss the strategic and analytical perspective and focus on day to day deliverables and small adjustments according to the user needs. Not that they are insignificant – on the contrary, but they are minor adjustments that will only lead to small changes in the business or processes and probably not deliver a strategic significant change. IT planning, enterprise architecture etc will get you there. However, it is more challenging, and some will argue more time consuming. In a big organization like ours, it is the only way to go.

The Digital hospital as a concept for Nyt OUH was sketched out 3 years ago. The Digital concept where more of a method than an actual concept.  I decided therefore to write a new one, which clearly marked the road we are on and point us in the right direction. The Region have a set of architecture principles and I made sure that our Concept was aligned with those. You can always argue that a set of IT principles or the Concept is flawed and is not covering everything. It might be too superficial or to focused on detail. We will adjust our concept regular and make sure it provides us with the needed frame and direction for the future.

 

Link: Concept for The Digital Hospital
Link: Digital vision (Danish, english will be uploaded shortly)

The New Odense University hospital into a new phase

We are now officially in the new phase of our project. It is very interesting, and we are now going towards a more detailed level in the project. We are for example going to design and equip all the rooms of the new hospital. The standard rooms and the unique rooms as well. It is a very important period, that has been underway for some months  now. We started last Wednesday with our user involvement process and a kick meeting. During the next 6 months, we will arrange up to 150 user meetings, were the clinicians will guide us, give input and help us with the different rooms. In the end we have touched and discussed up to 1000 different rooms with the users and asked their opinion on the work processes in the room, the functions in the room, the layout, design, equipment, installations etc. In the end, we believe their input is crucial to our common success.

For the rest of the areas in IT and equipment planning, we work on the IT infrastructure of the hospital, the building related IT systems as BMS, redesign a brand new Concept for the Digital hospital, installing systems in our Mock up at Syddansk sundheds Innovation and most important creating a high end project team to work on solutions based on the Digital hospital concept. We use TOGAF and Business process management as our primarily methods, and will end within the year with very specific suggestions on what to buy, what to upgrade and what systems to close. In the IT management and planning we thereby also has to get more concrete on our work and suggested solutions. I very much look forward to the next period, and the team seems great and very diverse in their abilities. More of that later.

If you would like to take a tour of the new hospital, look at the small movie below. Everything is coming into focus, becoming clear and touchable. For a man like me that likes clear and present goals and concrete achievement the following year will be a ride of joy, excitement and big big challenges of course.

Enjoy - its in danish... sorry

Risk management in agile Projects

Sometimes something wonderful happens. A couple of weeks ago I went to Aalborg to evaluate 5 projects at the University. One of them was about risk management in agile projects. I read the thesis at home and one thing was perfectly clear. There are very little academic literature about the subject and therefore project teams usually takes on an approach designed for sequential project models as the waterfall method. So risk management is probably conducted in a manner that are designed for one methodology and used in a total different. The risk that risk management will go wrong are substantial, and therefore will the project overall be in jeopardy. The student who wrote the thesis did it in a very professional manner and it delivers new knowledge to the subject. I was impressed.

So lets start with the beginning and define risk as the literature does. the text below and the figure are from the thesis.

Wallace et al. defines a software risk as ”A condition that can pose a serious threat to the successful completion of an software development project” (Wallace et al. 2004)

Bannermann defines software project risk management as “A set of principles and practices aimed at identifying, analyzing and handling risk factors to improve the chances of achieving a successful project outcome and/or avoid project failure” (Bannermann 2008).

Acording to Boehm (1991) risk management consists og two steps with 3 substeps. The first is risk assessments and the second is risk control. The first is proactive while the second is reactive. How do we handle the risk once it occurs, so to speak.

http://file.scirp.org/Html/6-9900055%5Cd8a5c90b-f616-4af2-a9a2-bf98ab2fd15b.jpg

 Furthermore, a definition of agile projects are needed. The thesis uses this one.

”the continual readiness of an ISD method to rapidly or inherently create change, proactively or reactively embrace change, and learn from change while contributing to perceived customer value (economy, quality, and simplicity), through its collective components and relationships with its environment” (Conboy 2003).

The principles and activities in Scrum and agile methods are able to address a number of risks. Risk management is part of Scrum, as an implicit, simplistic and reactive mechanism that is unable to take care of all the risks associated with IT development.

Agile software development has many strengths that are required in today's development projects. This includes the close cooperation with the customer and flexibility that makes it possible to handle changes in requirements. However, agile methods also have weaknesses, because they don’t handle all the risks in modern system development projects. 

Risk management is part of Scrum, as a mechanism which is implicit in that it merely referred to as "obstacles "to be solved. At the same time the simplistic as it only involves the two steps "identify" and "solution" of obstacles . Not least is the reactive, as they often take care of risks when they become problems.

So it is all about handling and managing risk in a iterative and incremental project. Projects in Denmark that uses this method has been seen to crash rather heavy – probably because you do not know the end or your requirements before you start the project. That will make every manager have bad dreams and sometimes you end with nothing but the fact that all your resources are spent on great individual iterations but it have not amounted to the solution you had in mind. So because agile projects are more dynamic, iterative and incremental the require more management and of course risk management. It is therefore an even bigger surprise, that very few persons have found it relevant to study the field and develop a clear and relevant framework for risk management in agile projects. Well at least until a winter morning in the Northern Denmark.

The student developed a framework for risk management and identified where Agile projects handles risk in a embedded manner related to the methodology. Nice work I must say.