by Mark S. Valenti, President and CEO, The Sextant Group

Technology in Healthcare
From place-based to technology-based, the nature of healthcare delivery is changing rapidly. Across the US, our architectural, healthcare and medical education clients from Harvard Medical School to The Cleveland Clinic continue to transcend the boundaries of space and time. Telemedicine, telehealth, mHealth, e-health, wearable devices—what does the healing journey ahead look like for 24/7-connected patients? And as healthcare becomes more data-driven, how do we better train physicians of the future? A coordinated integrated communications technology environment is mission-critical to contemporary healthcare.

If you’ve ever sent your doctor data from your Fitbit or another wearable device, you are at the center of the technology revolution that is transforming the way we manage our health and wellbeing. Three key factors are driving the evolution of on demand healthcare:

    1. A maturing technology environment with ubiquitous high performance connectivity using fixed and mobile devices
  1. A regulatory environment in the US that requires electronic health records be integrated with digital information from all medical devices for heightened patient care and safety
  2. An emerging population of healthcare customers who are connected 24/7 and are patients with no patience for the old paradigm

The Back Story
At The Sextant Group, one of our very first projects was with the Allegheny Health Network. Back in 1995, we connected multiple operating rooms in Allegheny General Hospital in Pittsburgh with multiple classrooms at Hahnemann University School of Medicine in Philadelphia. Moving high resolution digital video across the state using leading edge video codecs from Optivision and a cutting-edge network technology called Asynchronous Transfer Mode (or ATM) was a one-of-a-kind project that Fore Systems, the pioneer of ATM, used as a case study for many years. At the time, it was the largest ATM-based network built to date. About the same time, we were working for the Medical College of Ohio on the “Classrooms of the Future” project (COTF, as we called it). While you might think it was about learning space, the project was really about creating a digital, network-based learning environment for medical education. Many of the concepts we developed for the COTF have become fundamental to the work we have done over the past two decades and integral to the development of a blending learning delivery model.

Photo provided courtesy of NBBJ

Integrated Communications Technologies
One of the core principles we’ve come to hold is that integrated communications require vastly different spaces and technologies. Consider these scenarios:

    • A verbal consultation between a doctor sitting at his or her desk and a patient sitting on a sofa. Perhaps the doctor is on an iPad at a restaurant or in a call center. Is the patient’s privacy protected? Is there sufficient screen resolution to review medical images?
  • A patient in a dedicated telehealth exam room at an inpatient or outpatient clinic. Does the room have sufficient lighting, color-temperature, physical space, and camera angles to remotely diagnose something as detailed as a skin condition or to evaluate a patient’s gait? Is there space for an in-room assistant? What if this is a booth at a Walgreen’s?
  • A surgeon performing robotic surgery from a remote location. The patient end-point is an OR with very stringent requirements for life-safety, infection control, and so on. The remote doctor needs a dedicated facility with flawless bandwidth, image resolution, limited distractions, and 100% uptime.

The US National Library of Medicine and National Institutes of Health define telehealth as the remote delivery of health care to a patient through technology. As the act of remotely monitoring patients gains major momentum, telehealth opportunities are growing rapidly. Telemedicine refers to remote clinical services, while telehealth can refer to remote non-clinical services like medical education, faculty and staff meetings, in addition to clinical services. Telehealth providers are popping up in high volume on the Internet offering immediate online access to physicians groups and hospitals.

Today’s healthcare environment focuses on reimbursement and efficiency. Institutions need to be lean on staff and turn over patients quickly while continuing to offer outstanding care. Although telemedicine is an operable word, the latest trend in healthcare is known as “population health.” This refers to the preventative or holistic care of humans before they become patients. So the terms telehealth and virtual care are slowly replacing the old terminology. Essentially, the goal of telehealth is connecting the patient with the right specialist to improve outcomes and lower costs.

Electronic Health Records/Health Information Technology/Meaningful Use
In today’s environment, the Affordable Care Act mandates electronic health records. An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

As patient data has digitized, most medical equipment and devices need to be connected to the network. There is a resulting demand for systems integration in a way that that did not exist previously. In the next generation healthcare environment, for example, a patient may pre-register at a hospital and reserve an empty room online. The patient is then notified on his or her mobile device and then he or she stops by the registration desk to confirm the room. This requires a process and system of the nurse being notified via his or her mobile device (and /or electronic signage) that a room is reserved for “x” patient at “x” time. This requires integration of systems and communication pathways during the design of the facility.

These technology advances in mobile and network capabilities have changed the consumers’ expectations of what is available and desirable. High demand consumers who have grown up with access to a smartphone or other mobile device, the “always connected generation,” now have digital health tools at their fingertips. This consumer-driven push for health data digitization and ownership is ushering healthcare into the digital world. How do we better prepare physicians of the future for the digital era? The patients who are now managing their wellbeing via their smart devices are ready. Are the facilities and technology systems ready? How long until the hospital spaces and systems and services are ready?

Patients with No Patience
Given the national trend to build fewer brick and mortar inpatient facilities, more ambulatory facilities, and more of a “care everywhere” concept of bringing care to the patient through technology, the 24/7 Connected Patient concept is born. The 24/7-Connected Patient concept encompasses everything from virtual care devices, wearables, communication with providers, the clinical equipment during a hospital stay, telecare when confined to the hospital, patient entertainment and education, and the patient’s need to be on the Internet from his or her bed and communicating with the outside world. Add to that the need for the connected provider, the connected environment and the necessary infrastructure to support it all. The patient’s journey of being “connected” to their provider from preventative care and onward through each phase of the healthcare continuum includes the eventual hospital discharge and follow up care, at which point the cycle repeats. As health providers turn to electronic communications, the delivery of health care is transforming.

Photo provided courtesy of NBBJ

The Digital Doctor and iPatient
Will physicians of the future need to be experts in technology? In a healthcare world now infused with digital data, will the always-connected iPatient and physician who is now an expert in web cams and big data meet-up in a world of virtual reality? Certainly, medical schools around the country are incorporating virtual simulation technology and other cutting edge technologies into their healthcare training and education. At The University of Nebraska Medical Center, ranked by U.S. News & World Report as one of the top schools in the country for healthcare training, the UNMC Kearney Division enriches its students in a state-of-the-art facility that enhances modern health education.

UNMC and UNK students receive rigorous hands-on experience in ultra-realistic simulation labs. In these fully operative facilities, students develop and test their skills using high-fidelity interactive patient simulators in a risk-free environment. Adjacent to each lab is an audiovisual control room with a mirrored window in which an instructor controls and monitors the simulation. Wireless microphones, ceiling microphones, and in-ear monitoring systems enable communication between instructors and students. Simulations can also be recorded for later review utilizing specialized medical software and pan-tilt-zoom cameras.

On the clinical education and training of healthcare professionals, at places like the Cleveland Clinic, currently regarded as one of the top four hospitals in the US by U.S. News and World Report, technology is certainly forefront in immersive training. In the Education Institute’s Center for Multidisciplinary Simulation, physicians, nurses and allied healthcare providers engage in high-fidelity team-based sessions to learn specific clinical skills or practice new technical skills through the use of state-of-the-art task simulators. Innovative simulation labs, including a high-fidelity Operating Room simulator and several reconfigurable Procedure Situation Rooms, allow surgical teams to practice their technical skills in an interactive, ultra-realistic yet highly controlled (and risk-free) learning environments.

Convergence with a Vengeance
As we look to the immediate future, it’s clear there is an increasing demand for a thoughtful, organized, and systematic approach to the development of integrated communications and automation technology in the healthcare environment. As the Internet of Things will re-design our daily lives and the environment around us, the healthcare world will magnify that many times over. Smart, connected devices, fast, secure, and ubiquitous networks, and a new generation of healthcare providers and customers will shape a healthcare market far different from the current state-of-the-art. Stand-alone systems will eventually cease to exist, as the real value will lie in connectedness – connected devices, connected systems, and connected people. That is convergence with a vengeance, re-shaping the healthcare marketplace for the betterment of all of us.

About the author
President and CEO of The Sextant Group, Mark S. Valenti CTS is an international thought leader in Information, Communications and Automation Technologies (ICAT). He was the opening keynote for the 2017 Smart Building Conference in Amsterdam in February and the featured presenter at the 2017 AV/IT Leadership Summit in San Diego in March. 

Top photo provided courtesy of Eskenazi Health