Like ICT architects, their more well-established colleagues in the building industry can sometimes push for change without too much thought about business process impact.
CIOs are learning to watch out for new buildings going up without adequate thought or budget for WiFi.
At another level, the digital hospital buildings that have gone up without waiting rooms or medical records storage areas highlight another set of issues altogether. On paper, it all sounds so simple. Let’s build a paperless hospital, the architect says, and the design team get to work.
At no point, it seems, does anyone think to bring in a team of people who actually understand hospital process and who can ask the question, “How is this actually going to work?”
Is there such a thing as paperless?
A few years ago, I was in a meeting with some state representatives who were building what they thought would be Australia’s first digital hospital. One of my team who had a background as a health information manager asked them if they thought the hospital would be truly paperless.
Yes, they replied, there would be no paper anywhere.
Then my team member asked about the specialist staff who would be moving to this new hospital from the old building a mile or two away. Did the specialists have personal assistants or secretaries now, she asked.
Again, the answer was yes.
You can see where this is going – many of the specialists who were moving to the supposedly paperless hospital had secretaries or assistants who were currently typing up all sorts of correspondence, and scanning in referral letters from GPs and so on. But it appeared no one on the state’s building team really understood that at all.
As a result, there was no plan to deal with this existing mound of paper. It was just an assumption that the new hospital, which would be opening with new systems, would make this paper irrelevant.
Also, there can be an underlying assumption that a hospital is a closed system – that it doesn’t take in data (and paper) from people outside its walls – be they patients, GPs, specialists, or anyone else from the wide pool of a hospital’s contacts.
Really there is no excuse for not understanding all that. Anyone who overlooks this doesn’t understand the health system at all.
And yet it continues to happen. We are still seeing new hospitals being built all around the country without adequate input from people who really understand the flow of data through the hospital system.
You can generally trust the infrastructure people to know a bit about cabling, server rooms, and data centre requirements. But, in my experience, you can’t trust that they understand the application side, or, more importantly, how it all hangs together from a process point of view.
I suspect part of this is around the way buildings are delivered – level by level. If you look at the average building project plan, that’s how the work is generally broken down.
From an ICT perspective, that’s not a particularly effective approach. You really need to understand the whole picture, and you certainly don’t deploy by floors…
New technology can be hard to predict
In fairness to planners, it can also be pretty difficult to predict where technology is going.
Only five or six years ago, it seemed like a really good idea to plan for the deployment of drop-down computer terminals that could be used as a combination patient entertainment centre and clinical workstation. Macquarie University Hospital was one of the first to do this in Australia.
I don’t think anyone could have predicted back then how quickly bring-your-own-device technology, such as iPads, would take off. We have all seen how airlines have been rapidly dumping the in-flight back-of-seat screens, at least for short-haul, once they realised people were bringing their own devices on board.
Nowadays the percentage of patients who need an entertainment device would be much smaller than when that hospital made its plans.
In fact the whole issue of where to put technology is still unresolved as far as I’m concerned. We’ve tried computers on wheels (or COWs) but in many hospitals they end up being put out to pasture, and/or the batteries constantly run out and various other problems.
Additionally, in many of the older sites there just isn’t the room for fixed terminals in sufficient volume, so you find the registrars competing with the nurses to get access to a computer to do their discharge summary.
I don’t think anybody has got it totally right yet. One of the best approaches I have seen recently has been the new building at Sydney Adventist, where there is a terminal placed just outside every patient room. But of course this is a private hospital and not every public facility would have the budget to achieve a similar thing.