The power of simplicity - a way of looking at Requirements

Based on the clinical concepts of the New University Hospital and decisions about design and architecture we can identify a range of functional requirements that describe future processes, working methods etc on New University Hospital. Decisions for example that we build single person patient rooms single rooms or the establishment of cluster pharmacies will also require a wide range of requirements for future solutions.

From these functional requirements we then can identify a number of IT requirements that will make us able to solve or meet the functional requirements. These IT requirements can be assembled in IT solutions that solve one or usually more functional requirements. In other words, it reflects the clinical concepts and architecture and design requirements for future hospital - IT solutions ensure that these can be realized.

The following is an example where the kitchen and food logistics concept and the choice of making local floor kitchens around the hospital will cause the food to be transported from the central kitchen out to the floor kitchens. Here it is prepared and served on trays to patients. The Central kitchen staff therefore requires that they can monitor the food temperature from leaving the central kitchen to arrival in the floor kitchen. This is referred to as they want to monitor if the "temperature chain is broken." This can be solved in many ways, and one of them is to install censors in the crates which food is stored in. Data on temperature must be collected in an IT system, and to be given an alarm if the temperature rises to an agreed level and therefore the temperature chain is broken. Functional requirements from the central kitchen about securing healthy food that are always cold ends with an IT solution or an expansion of existing solution, so it is possible to continuously monitor the temperature of the food and give a warning if the temperature rises above a defined level.

The method is rather easy to understand, to communicate and it ensures that we always focuses on the business requirements and not start with IT. I guess a simple, understandable and effective method is always preferred in a busy schedule. It works for us at least.

Benefit Management may save us all!

I just read a thesis from the University of Aarhus, about harvesting value in IT projects. The students named the area as Benefit Management (profit realization), and is a highly relevant and general area that many organizations should prioritize. Particularly in the health sector.!

I've often wondered that in such a research-heavy and evidence-based system such as health care sector, how can you introduce New Technology, new processes around technology and new skills among staff, without knowing the evidence or just the effect on productivity or perhaps quality.?

Currently there are deployed  IT in the Danish health like in a pace not seen before. In Region Southern Denmark the regional project portfolio consist of more than 50 large and small projects, so spending millions and billions on a national level - and what do we get out of it? Well to put it bluntly we often don’t know!

Benefits management is defined in the book "Benefits Management – How to increase the business value of your IT projects" written by Ward, J. & Daniel, E. 2012 as:

“The process of organizing and managing such that the potential benefits arising from the use of IT are actually realized” (page 8)

Benefits Management is all about identifying and harvesting the value that a given project has the potential to realize. Currently projects are not initiated in Region of Southern Denmark without having drawn up a business case. But how will the projects be prioritized towards each other? And do we work adequately with identifying the value a given project may realize. Maybe – but probably not.

But when the system, technology or equipment is implemented, how is it ensured that the gains that were identified in the business case is realized. ? There may have been a tendency not to make this impact assessment, evaluation, or otherwise measure whether what you thought you got out of a project. Traditionally, the value collected are invisible deep within the operation of the organization. The point is that we often do not know what the value is and therefore we cannot harvest it.


I guess benefit management has two major objectives. One is on a macro project management level to harvest the value on a organizational level. It could be to increase the effectiveness with 2 pct. or to reduce adverse events. The other is on a local level, where the individual ward or department can identify their special benefits from the implementation and then try to work towards those when implementing the system. Done right it may help on the projects implementation success rate on a local scale, because the receiving users take responsibility on the implementation and the goals/benefits regarding it.

In my organization we have used the Himss IT value suite. In short it is a framework to identify the following:

•    How do we know Health IT works?
•    How does Health IT improve patient care?
•    Can others duplicate the type of value others have achieved?

The framework is suitable both on the managerial/organisational level but also on the local level, where a discussion with the headline “what is a successful implementation in our ward” the main issue.

Benefit management is and must be our focus otherwise we invest, implement, learn and reinvest in the dark. To know the impact is crucial also because only then are we able to share our experience and help others in their efforts.

It took two very talented, hard-working and well-prepared students to get my eyes to the problem again. (I gave them the grade 12 for the rest). They introduced me to the field on an academic and structured way. The road is paved with endless amounts of benefits and value of digitization - we all have an obligation to pursue these unyielding, and the courage to harvest them  in a proper and professional manner.

Ward and Daniel is a great book by the way – and I highly recommend it.

A full automated, double loop medication process in action – awesome expierence

In our project there is I clear line between the choice of less beds,  a fixed amount of m2 and an 8 pct efficiency increase, to new solutions that will help the hospital to operate in the new environment. The best is of course a solution, that will meet those requirements and increase the overall quality of the care delivered. IT has a tremendous role in that equation. So instead of talking about an increase in beds or m2, the discourse is and must be about new solutions because the constrains are fixed.

Last week I was in France – Annecy to visit a hospital that was build a couple of years ago. On the IT side the wards, patient rooms, EHR, RIS/PAS etc we were quite up to speed. They did not have anything revolutionary installed, and they to had a lot of patient terminals that no clinician used. But then I realised they did not have any big medicine rooms on the actual ward only a small area with acute medicine. So that intrigued me, because New OUH will be build that way.

We were then allowed to visit their pharmacy and there I got a huge surprise. Everything was automated, every drug was tracked and medicine was delivered to the ward automatically based on the data the doctor ordered in the EHR. For the first time a saw the whole process automated and it was a great success.

An Italian firm had delivered the robots (I guess they are better on healthcare robots than on trains) and the system seems to run smoothly.

Pill pick robot and unit dosed medicine

So

1. Robot that cuts medicine from the blister packs into one unit packets
2. Robot that counts the units to ensure they are all there
3. Robot that packs the units in separate bags withs barcodes and RFID
4. Robot that stores the units
5. EHR registers medicine prescribed and send data to pill pick robot
6. Pill Pick robot then picks the units and packs them for the individual patient and bind them together
7. The medicine is then shipped to the ward by a tube system

The above is not a futuristic vision – it is real and in operation in France. It will save m2, increase efficiency and tremendously decrease the amount of adverse events due to errors in the medication process. What’s there not to like for a future digital, “small” and efficient hospital.?