Our design team working on the new inpatient tower for the Boston Children’s Hospital Waltham Campus visited the Microsoft Technology Center, also called the NERD (New England Research Development) Center, with Boston Children’s Hospital clinical and IT staff.
BCH is interested in the future of healthcare communication and IT as part of their planning for the future of their campuses. Several people from Payette joined their team in learning from Microsoft what innovations are on the near horizon and that we can expect will be integrated into our new buildings.
Healthcare in a hospital environment currently relies on a hodgepodge system of familiar low-tech devices: phone, nurse call systems, intercom, little colored flags at doors and more sophisticated medical equipment: monitors that track vitals, monitors that track patient flow, medical equipment alarmed to indicate a change in condition, even lights that indicate when the noise decibel level exceeds recommended quiet environment. The goal of keeping staff and patients connected, knowledgeable and aware is a huge challenge. The amount of useful information available is staggering and the amount of questions to be answered even more so.
Our hospitals have grown in square feet while staff size has decreased and the remaining staff has become more specialized. It is a challenge to keep a clinical team connected to one another grows. The massive network of information, communication and check list items can overwhelm a person. Evidence of alarm fatigue in nursing (their ability to hear and respond to so many devices competing for attention) is growing. The environment is currently sending out a lot of data but there is little coordination and analysis readily available to staff. Utilization of technology in basic communication is rudimentary in many places relying on decades-old nurse call systems limited to the nursing unit and staff.
The advent of electronic medical records (EMR) has helped but not completely solved communication issues. The cost intensive-transition process has left many institutions with a basic but still cumbersome charting system that has not easily integrated a myriad of desirable sources of information such as patient input and all the medical equipment readings. A patient’s record is the key to quality diagnosis, safe administration of medications and troubleshooting of future risks. Where will we see the improvements?
Patient-to-clinician communication is also transforming. The medical world has always put tremendous emphasis on face-to-face contact, along with hearing, touch, smell and taste as the way a physician can diagnose problems. There are so many challenges to expanding this one type of relationship between clinician and patient to address accessibility, cost and language differences. Everyone cannot wait for a doctor’s office visit nor is it necessary for many issues. Other means of communication can support the patient/physician relationship.
How can new technology help? The ultimate goal is to find a single technology platform that is simple and easy to use for staff to access EMR, patient information and also be used for staff/patient interface as a method for patient care. Ideal communication systems are user friendly for doctors, clinical staff, support staff and patients and their families. In healthcare the customers of these IT systems include everyone that walks through the hospital door from the grandmother with pneumonia to the acclaimed pulmonologist consulting on her case. Ideally, a new platform will help drive down costs and increase safety. Microsoft has developed a range of tools that they believe can transform the environment and they are enthusiastically promoting their solutions to our clients. Many of these tools are familiar but they have been modified to the healthcare world. The tools are provided across a range of platforms and integrate technology from diverse sources. The goal is to save time and money and increase safety and health outcomes.
A few examples of what we saw at Microsoft’s Healthcare “Center of Excellence”:
- Large size tablets (85”) that are essentially a gigantic version of the Surface Hub that uses touch screen controls and interfaces with all other communication tools. These tablets access the web, internal resources (including the EMR and virtual communication) makes this a great idea for accessing information in team meetings.
- “Live” computer translation of languages around the globe. This is still in development but immediate high-quality translation is so important to delivering care that if accomplished, it will be a great boon to emergency rooms.
- The future will be in wearables, such as watches or bands that allow hands-free communication
- Log in through biometrics (amazingly fast retinal or facial scans)
- Repurposing of X-Box Kinect to become a way of conducting a virtual checkup or consultation (“Hospital @ Home”)
- Software that analyzes body posture and facial expressions Bedside communication, interaction with medical record and teleconferencing – all accessed from a tablet used by the staff
- Low-cost patient tablets that provide entertainment communication as well as offering the ability to connect with your own medical record.
- Development of wearable technology (similar to the Apple watch) that allows hands-free and immediate communication.
- Tablets that can be used for patient room signage with precautions, indications for cleaning, etc.
- Checklists for room cleaning that require an alcohol wipe of a tablet before you can close out of the program.
Healthcare has always existed in an information rich world that feasts on data. The challenge is to provide methods for analysis and a means to access this data through custom queries. We saw Microsoft offering solutions that married simple communication needs with management of big data and packaged for all the end user needs. These options for patient, clinician, families and researchers will soon be available through Microsoft and other vendors. It is our task as architects to imagine how this will change the built environment.