A Student's Adventure at HIMSS 2018
March 21, 2018
It is said that Las Vegas is a city like no other. If this is true, then Las Vegas is the perfect location for HIMSS18 – a healthcare conference like no other. Organized by the Healthcare Information and Management Systems Society (HIMSS), HIMSS18 brought together world-class education, cutting edge products and solutions, and unique networking opportunities to solve the biggest health information and technology challenges [1 ]. I had been warned many times in the lead up to the event that the scale of the exhibit floor was incredible and that I’d be blown away by the number of attendees, but none of the warnings prepared me. Truthfully, I could have stayed for an entire extra week and still have been finding new pieces to explore and learn from.
My experience began on Saturday March 3, earlier than most HIMSS attendees. I had the opportunity to work with the Intelligent Health Association, supporting a demonstration on the Internet of Healthcare Things™ (IoHT) in the Intelligent Health Pavilion (IHP) [2]. This demonstration was co-created by Mackenzie Innovation Institute (Mi²) and Hamilton Health Sciences. On the day of my arrival, construction of the show floor was in full swing, with most of the walls for the pavilion already up. Security for the hall was tight, requiring exhibitor badges for entrance and most of the staff inside sporting hard hats and steel toes. Over the weekend, work was continuous and the only change Monday morning brought was a notable uptick in the crowd size entering Sands Expo Convention Center.
The hard work and effort of exhibitors and staff truly transformed what were seemingly empty halls to a show-ready exhibition in the blink of an eye. By Monday evening, the grand opening of the floor was underway. There was a live DJ and activity buzzing across the lower level of the exhibit floor. The spectrum of attendees became quite apparent, as some tables were occupied by suit-and-tie professionals working away on their laptops, while simultaneously a dance circle formed in front of the DJ booth, with dancers enjoying the sounds of throwbacks like Kris Kross.
Taking this array of energies and pushing forward to the 10th hour of my workday, I was grateful to be invited to my first ever business dinner with the Mi² and Mackenzie Health teams. The group ranged from Canadian hospital leadership to industry sales reps, all abuzz from the contagious excitement the conference offered. Over a plentiful dinner menu that did not disappoint, I was able to connect with other guests on both healthcare innovations and career perspectives. Undoubtedly, I left the evening with plenty to digest.
By Tuesday morning, everyone was back in professional form and the crowds entering Sands can only be described as massive. Everyone was full of anxious excitement. Arguably my busiest day of the conference, the morning was spent ensuring actors were comfortable with demonstration logistics in the IHP, while the afternoon was spent coordinating a mini conference on the Internet of Healthcare Things™, also held in the IHP. Somewhere in there I managed to join a Philips booth tour, but lunch got lost along the way. Luckily, during the Canadian Reception at HIMSS, I had the opportunity to catch up with familiar faces and grab a few appetizers to tide me over before round two of my introduction to business dinners later that evening. While it was clear these dinners were not events a student would typically attend, I was grateful for the invitation and the warm welcome from both my colleagues and the company representatives.
Wednesday and Thursday of the conference were a rinse and repeat situation. With my organizational responsibilities easing up, I was able to explore the show floor a bit more. Between scheduled meetings with vendors, lunches to share experiences and ad hoc introductions at interesting booths, by Thursday I felt like I was getting the hang of things. I was on a mission, having been challenged by my supervisor, Dr. Aviv Gladman, to find a game changing product. Exploring exhibits, I was both intrigued and amused by the change in approach when company reps learned about my affiliation with a hospital. Everyone is much more eager to share their vision and to continue a conversation when they realize your role inside a healthcare organization. As a student, this was an amazing position to leverage as it allowed me to gather plenty of insightful information. The collection of business cards and white papers will keep my learning going for weeks to come, I’m sure.
Wrap up for the exhibit floor took place Thursday at 4pm, and if I thought construction went quickly, tear-down happened in a flash. Within half an hour, what used to be a crowded floor of booths and showrooms was disappearing, carpets being rolled up and most exhibits already deserted. By Friday morning when I returned to take some photos, the floor was a ghost town and even the crowd attending sessions had significantly diminished.
It was hard to believe that something I had looked forward to and planned for months in advance was coming to an end – gone just as quickly as it had arrived. I was lucky to be catching the red-eye home Friday night, which left some time to explore the city and collect various souvenirs along the way. Though, without a doubt, the experiences I had throughout this whirlwind week were the most valuable souvenir I left Las Vegas with.
I feel humbled to have been invited and grateful to have been involved in HIMSS18, as well as steadfast in my passion for this field. As was repeated to me by peer hospitals and vendors alike, the leadership and vision at Mi² is outstanding. I am proud to be part of such an exceptional organization.
Liane is a McMaster University Student in her fourth year of Electrical and Biomedical Engineering, with Co-op option. She has been part of the Mi² team since May 2017.
Detecting and Preventing Privacy Breaches: Privacy Auditing Innovation Project
January 8, 2018
Innovation Procurement – The Journey Continues
The Challenge
Every healthcare organization is regulated under strict legislation designed to protect the privacy and confidentiality of personal health information (PHI). A common cause of breaches is unauthorized access to PHI in electronic medical records (e.g. snooping). While open access promotes integrated, accessible, cost-effective and patient-centered care, it may also pose a threat to privacy unless safeguards are put in place to monitor, detect and even prevent this behavior.
In a complex and dynamic hospital environment, thousands of employees have access to PHI for hundreds of thousands of patient charts spanning across dozens of discrete information systems. As a result, monitoring every single access point can be a challenging undertaking – particularly since Privacy resources tend to be limited across most hospitals. The Privacy Officer manually reviews the audit log data from applicable systems using rules and logic to visually identify suspected breaches. Given the high volume of transactions, it is not feasible to audit all transactions across all systems with this manual approach.
Mackenzie Health has partnered with the Mackenzie Innovation Institute (Mi²) to develop an innovative procurement approach to address this challenge – Privacy Auditing Innovation (PAIP) Project.
Limitations of a Traditional Procurement
Traditional procurement models lack the flexibility that is needed to attract and inspire innovative solutions to complex problems. A traditional procurement typically involves the following stages:
This traditional approach often limits vendors to propose solutions that already exist in the market which are built with pre-defined set of technical specifications. Vendors are also limited to only one opportunity to submit a proposal, based on their assumptions and understanding of the procuring organization’s needs and have little opportunity for clarification. Likewise, organizations are then limited by their own understanding of one proposal from a given vendor, and may end up with a less-optimized solution.
An Outcome Based Specification Approach to Procurement
Unlike the traditional procurement approach, an innovation procurement process enables the hospital to describe the problem that needs to be solved and specify the expected outcomes of the solution, without the constraints of defined technical specifications. “Outcome Based Specifications” describe the desired functions, performance and benefits of the solution, rather than the technical specifications that determine how the solution should achieve those outcomes. This less prescriptive approach to procurement opens up numerous opportunities for vendors to produce creative and relevant solutions that can be scaled beyond a hospital setting.
Innovation Procurement through the Competitive Dialogue Process
Innovation procurement allows for a more flexible process that encourages open dialogue between the hospital and vendors. This in turn provides invaluable opportunities for all parties to establish a mutual understanding of the desired outcomes and potential solutions, clarify any assumptions, and ultimately generate solutions that meet (or exceed) expectations. This overall process is depicted in the diagram below:
In collaboration with Mi2, Michael Garron Hospital and Markham Stouffville Hospital, Mackenzie Health recently led multiple rounds of Competitive Dialogue sessions with short-listed vendors for the Privacy Auditing Innovation Procurement (PAIP) Project. The project team identified a preferred vendor through this process and successfully kicked off the six-month pilot project in October 2017. This pilot phase is expected to involve additional opportunities for innovation through iterative cycles of enhancement with the preferred vendor. This phase will also provide an opportunity for Mackenzie Health and key partners to evaluate the ability of the solution to meet the outcome-based Specifications identified at the very beginning of the project and determine whether to proceed with a long-term contract with the preferred vendor. Due to the flexible and agile approach taken with this procurement process, the project and senior leadership teams have been able to effectively manage challenges along the way.
What’s Next?
Mi2 is continuing to build capacity for adopting innovation procurement methodologies to develop and bring new solutions to market. Part of Mi²’s mandate is to act as a source for implementation and evaluation of disruptive innovations by sharing our growing knowledge and expertise in innovation-based procurement. Mi² has already engaged in opportunities to showcase knowledge at conferences and industry events and looks forward to sharing our experiences with other organizations. Mi² is currently evaluating numerous opportunities for new projects that can benefit from using innovation-based procurement models. Looking ahead, Mi2 is thrilled to be working with Mackenzie Health and its partner organizations on the next phase of this exciting initiative.
HealthAchieve 2017 was a blast!
November 2, 2017
The Mackenzie Innovation Insitute (Mi²) is proud to participate in the Ontario Hospital Association’s HealthAchieve Conference and Exhibition which will take place at the Metro Convention Centre in Toronto from November 6 to November 7, 2017. As part of Mackenzie Health’s journey to the Smart Hospital and in line with the hospital’s vision to create a world-class health experience, Mi2 will showcase the concept of the Internet of Healthcare Things (IoHT) and share the role it is playing in delivering healthcare services in an increasingly connected world.
Mackenzie Innovation Institute and its industry partners will be located in the Intelligent Health Pavilion.
IoHT Demonstration Wall Experience
As part of the Intelligent Health Pavilion at HealthAchieve 2017, Mackenzie Innovation Institute (Mi2), an entity afflilated with Mackenzie Health, has collaborated with its vendor partners to showcase a demonstration highlighting different aspects of the Internet of Healthcare Things (IoHT). IoHT facilitates the seamless interaction between people, processes and technology working together to deliver a world-class healthcare experience.Partners involved with this collaboration include leading organizations such as Cisco, CleanSlate UV, Compugen, Hill-Rom, Philips and Sodexo.
Keynote Presentation: “Putting the “H” in IoHT”
On Tuesday November 7 at 9:30am, our Chief Medical Information Officer, Dr. Aviv Gladman will be presenting in the Leadership Theatre of the Intelligent Health Pavilion about Putting the ‘H’ in IoHT. From cloud computing to embedded systems to intelligent workflow automation, the footprint of the Internet of Things is expanding rapidly in healthcare. This session will explore how concepts in IoT are being applied in healthcare to build the Internet of Healthcare Things.
IoHT Panel Discussion
The Mackenzie Innovation Institute is pleased to host a conversation on The Internet of Healthcare Things (IoHT). Dr. Gladman, Chief Medical Information Officer and Critical Care Physician at Mackenzie Health will lead a discussion on the role IoHT is playing in shaping the future of healthcare delivery. Panel members from leading organizations including Cisco, CleanSlate UV, Compugen, Hill-Rom, Philips and Sodexo will share their perspectives on the opportunities and challenges in moving towards an IoHT enabled world.
Dedicated Mi² and Partner Booths
Also located in the Intelligent Health Pavillion, Mi² and its industry partners will have dedicated booths representing their organization. We invite all guests to visit the Mi² team as part of the visit and also encourage you to learn more about the partners we collaborated with for developing this experience.
We invite you to visit the Mackenzie Innovation Institute and our partners at the Intelligent Health Pavilion to explore the concept of IoHT and begin our Journey to the Smart Hospital.
Trail blazing “smart” hospital support services
September 7, 2016
The future of non-clinical hospital support services will largely be defined by technological solutions. Mackenzie Innovation Institute (Mi2), and Sodexo Canada are now partnering in an exciting new technology-development project at Mackenzie Health that promises to help shape what that future will look like.
Sodexo has been Mackenzie Health’s provider for comprehensive support service since 2008. Today, we provide a full array of services, including: call centre services, patient and retail food, environmental services, patient transport, bio med and physical plant maintenance, central equipment distribution, security and ground keeping. From our perspective as a service provider to healthcare facilities across North America and beyond, what sets Mackenzie Health apart is its determination to use the power of “disruptive” technologies to take patient care to new levels of excellence.
The hospital’s recently established Mackenzie Innovation Institute (Mi2) dedicates significant resources to achieving its vision of going beyond digital to becoming a truly “smart” hospital. Among these is the hospital’s world-class, first-in-Canada Innovation Unit designed to be an incubator of new ideas and approaches. This 34-bed acute care medical unit is a living laboratory at the point of care with a mandate to solve everyday challenges facing healthcare providers and patients.
Our new partnership is aimed at radically advancing how the IT systems that manage delivery of non-clinical support services at Mackenzie Health interface with each other. Sodexo is working closely with the hospital to develop and evaluate IT system innovations that will further automate and streamline how service directives are issued to our support staff. The result will be services that are more efficiently delivered and highly personalized to the needs of patients.
The first phase will involve improving how our existing service IT systems communicate with each other and interface with the hospital’s electronic medical record to enable “smart” patient scheduling. The goal is to get as close as possible to “one-touch point” service fulfillment for clinicians. Achieving this interconnectivity is no small feat when you consider that, at Mackenzie Health, we use 28 different technologies to deliver 26 individual support services.
The system flexibility and responsiveness we are striving for will free physicians and nurses to spend significantly more time caring for their patients and less time dealing with service requests. Under the envisioned “smart” system, a single directive entered into the hospital’s electronic medical record by a physician or nurse will automatically trigger all of the support services needed. Each automated service request will be time stamped, scheduled and immediately directed to the appropriate support staff via mobile devices.
In the future, service chain reactions emanating from a single clinician “touch point” will occur hundreds or even thousands of times a day, creating new possibilities for a truly exceptional patient care experience. This exciting initiative will establish new healthcare industry standards that can be shared with other hospitals by Mackenzie Health to further contribute to healthier communities. Sodexo is extremely proud to be part of this ground breaking project to push back the boundaries of what is possible. The lessons we learn hold the promise of benefiting healthcare facilities across North America and around the world.
Detecting and Preventing Privacy Breaches: From Logging and Auditing to Smart Preventing
June 2, 2016
Mi² is proud to be working with Mackenzie Health in procuring an innovative health record privacy solution that is truly proactive in detecting and preventing any unauthorized access to sensitive data, while supporting real-time access to shared patient records.
The ideal solution will:
- Proactively prevent any potential data privacy breaches and unauthorized access to patient information systems
- Minimize the amount of resources needed to address unauthorized access to systems
- Work seamlessly with existing patient record management and patient care initiatives
- Adaptable with the ability to be improved over time (i.e. reducing false-positive results)
Why are we doing this?
Mackenzie Health is re-imagining their patient-care delivery model and is committed to following a connected health strategy that leverages the power of digital communications and the Internet of Healthcare Things (IoHT). Mackenzie Health, is the proud recipient of HTX REACH funding which enables the opportunity to evaluate, procure, and implement medical technologies that address high-priority health system problems.
For healthcare providers everywhere, data privacy and security issues are high up on the agenda. Mackenzie Health is committed to taking a proactive approach in protecting private and confidential information and is looking for a partner that shares this vision and can help implement a reliable solution.
This is an excellent opportunity for vendors, as it is expected that the innovation solution brought to life at Mackenzie Health will draw great interest in the healthcare community at large.
Existing Partnerships
To realize Mackenzie Health’s vision around data breach prevention, they have partnered with a number of key partners:
Bid Information
You can learn more about the bidding process for this project by visiting here.
Innovation Procurement Process
Possible solutions will be discussed confidentially in the dialogue phase of the procurement process with short listed bidders.
Vendor Information Sessions
To find out more information about this exciting opportunity, Mackenzie Health will be hosting Vendor Information Sessions on:
- June 2, 2016 from 3pm to 5pm
- June 8, 2016 from 2pm to 4pm
To participate and for more information, please contact
Yvonne Geverink
(905) 883-1212 ext. 7130
The Digital Health Moment
July 15, 2015
In 2002, Proctor & Gamble coined the term First Moment of Truth (FMOT) to describe the 3-7 seconds after a shopper first encounters a product on a store shelf; a transient moment in which a product can be sold by appealing to the shopper’s “senses, values and emotions.” The Second Moment of Truth occurs each time the purchaser uses the product, because every positive usage experience increases brand loyalty and enhances future sales. In 2011, Google introduced the business world to the Zero Moment of Truth (ZMOT), arguing that the widespread availability of internet searching had shifted the transient moment of sale to the precise moment when a shopper “has a need, intent or question they want answered online.” (Google, 2011). The concept reflects the fact that most of us no longer go into stores to make decisions about purchases. We search the internet, “educate” ourselves with reviews, then find the store that sells the product we want at the price that we want. We make our decisions to buy products based on what we read online at the moment that we have the need. In that digital moment, a company has only a fraction of a second online to sell us on their product. And it only takes one bad review or comment by one user that appears high enough on our search results for us to bother reading it, to turn us away from that product. These digital moments, which briefly digitally connect a business with a potential customer, represent transient opportunities to improve product sales, or transient risk to worsen them.
The Internet of Things has augmented the transient opportunity of the digital moment even further. Gartner describes the business moment as a “transient, customer moment that organizations can exploit dynamically based on the interconnection of many things.” In the value stream process of the business moment, business opportunities can be extended beyond the initial sale by capitalizing on the digital moment of engagement with the consumer.
Gartner uses this theory to explain how a paint sale can generate a sale for laundry detergent and other household products utilizing internet of things devices in a home (Gartner, 2015).
Thanks for the marketing lesson, but what does this have to do with healthcare?
Like the Moments of Truth, or Gartner’s business moments, a health moment exists as a transient opportunity to improve your health, or a transient risk to worsen it. Digital interactions aside, we experience these health moments many times each day. Should I have the french fries or the side salad? Should I exercise for 15 minutes or catch up on email? Should I take the stairs or the elevator? We consciously make a multitude of daily decisions that affect our health in some way, and there are many more opportunities that go unnoticed because we fail to recognize or act on them.
We live in a world of increasingly frequent digital moments of engagement that could be used to improve our health, or to improve how healthcare is delivered to us and how we experience it. The widespread availability of personal digital health products such as wireless blood pressure cuffs, cloud-based fitness trackers, and even internet-connected bathroom scales means that these digital health moments are becoming increasingly actionable. As healthcare providers and healthcare delivery organizations more fully embrace electronic health information systems, we will see increasing opportunities to create actionable digital health moments in healthcare delivery.
Capitalizing on digital health moments requires thinking outside the traditional healthcare delivery model. Tom Kaneshige gives the example of how a hospital’s television commercial can be used to reduce emergency department visits over time by identifying Twitter users that watched the commercial and targeting them with educational health promotions, capitalizing on the digital health moment that transiently existed when those higher risk individuals watched the commercial (Kaneshige, 2014).
The smart hospital operationalizes digital health moments by connecting patients, healthcare providers, health information systems and medical devices through the Internet of Healthcare Things, providing “just-in-time” information and intelligent healthcare process automation that create a personalized patient and provider experience. Consider the moment that you arrive at the hospital for a scheduled follow-up in the fracture clinic. Your hospital wayfinding app directs you to the closest empty parking spot. The clinic is instantly notified of your arrival, but they are running late, so why don’t you grab a coffee in one of several convenient locations (directions provided). You won’t need to register since you already used the online advanced check-in feature. The radiology department was also notified that you were in the building, and they have a cancellation, do you have time now to get that follow-up ultrasound schedule for next week? Don’t worry, the fracture clinic will automatically shift your appointment time to accommodate both. Come to think of it, you are due for routine bloodwork later this week before seeing your family doctor. Want it done in the hospital lab? By the time you have completed your appointments at the hospital, your family doctor’s office has received notification of the bloodwork results, and has posted a copy to your secure patient portal with comments from your doctor “Looks good, enjoy the rest of your day!” One digital health moment triggering multiple semi-autonomous “smart” processes, resulting in a number of opportunities to improve your health, and improve your healthcare delivery experience.
Going with the french fries? A quick view of your most recent cholesterol profile flashes on your smart watch, along with a reminder to book a follow-up appointment with your family doctor. Maybe I’ll have the salad instead.
Lecinski, H (Google, 2011). ZMOT: Winning the Zero Moment of Truth. Available at https://ssl.gstatic.com/think/docs/2011-winning-zmot-ebook_research-studies.pdf Accessed July 2015.
Lafley, AG (P&G, 2002). P&G 2002 Annual Report. Available at http://www.pg.com/annualreports/2002/pdf/pg_ar2002.pdf Accessed July 2015.
Kaneshige, T (Kaneshige, 2014). CMOs Must Capitalize on Digital Moments of Engagement. Available at http://www.cio.com/article/2848464/cmo-role/cmos-must-capitalize-on-digital-moments-of-engagement.html Accessed July 2015.
Reinventing Healthcare Wearables
June 18, 2015
February 2015 marked the official launch of our new uniforms for the Innovation Unit staff. As part of the first phase of this pilot project, nurses are now wearing purple and black uniforms, while Personal Care Assistants are identified by charcoal grey uniforms. Each uniform also features the role of the person wearing it (RN, RPN, PCA), as well as the Mackenzie Health logo.
With the new uniforms, we aim to make it easier for our patients to recognize the staff who are caring for them, therefore create a better care experience and increase their satisfaction. Research demonstrates that standard staff uniforms help reduce confusion among patients and healthcare providers, resulting in an increased perception of professionalism and improved patient experience. The feedback received to date from our staff also supports these findings.
This initiative builds on and complements the innovation and transformation initiatives already initiated at Mackenzie Health, such as the smart badges, smart beds or the AIDET communications tool. The uniforms are currently available for Innovation Unit staff only. The opportunity to expand this initiative across other units or at an organizational level is currently being explored.
If you have any questions regarding the new uniforms, please contact Madeline Logan-Johnbaptiste at 905-883-1212 ex. 7461.
A Primer on the Internet of Healthcare Things (IOHT)
June 17, 2015
Sometime between 2008 and 2009 there were suddenly more devices, computers, and sensors connected to the internet than there were people in the world (Cisco, 2011). This network of devices, computers, and sensors is called the Internet of Things (IoT). And while personal computer usage has grown linearly over the past decade, the sensors, cars, refrigerators, TVs, wearables – i.e. the things – connected to the internet have grown exponentially. Cisco’s estimate that there will be 50 billion devices connected to the internet by 2020 is now considered by some to be conservative (Forbes, 2014).
But what is the value proposition of this $19 trillion dollar industry to healthcare?
Hospitals have traditionally been late adopters of technology and industrial concepts. The 1999 Institute of Medicine report, “To Err Is Human” highlighted the approximately 44,000 – 98,000 preventable deaths in the United States each year that were attributable to medical errors (IOM, 1999). That report, coupled with skyrocketing healthcare delivery costs, triggered a call-to-arms that led to the rise of the continuous quality improvement movement in healthcare over the subsequent decade. LEAN and Sig Sigma quality improvement principles are now being applied to hospital business, clinical, administrative, and design processes around the world (Sperl, 2013). This has engendered a drive towards standardization, closed loop delivery systems, and fully electronic records in order to reduce human error and improve efficiency and cost of care, to a large extent using either front-end or back-end clinical and business decision support. Despite that, fundamental problems remain in communicating critical information “just-in-time”, implementing quality improvement initiatives at the bedside, and creating sustainable change. Most importantly, medical errors still happen, every single day, at hospitals all over the world. That’s where the Internet of Healthcare Things comes in.
Consider this smart sprinkler controller, available online for a few hundred dollars (www.greeniq.co). Like other sprinkler controllers, the Smart Garden Hub connects to your existing in-ground sprinkler system and allows you to program how your lawn is watered using a timer and electrically triggered valves. Unlike conventional sprinkler controllers, the Smart Garden Hub is connected to the internet through your home wireless network. When the timer signals that it’s time to water the lawn, the Smart Garden Hub connects to the internet and obtains the local weather forecast for your area. Based on the rain forecast, temperature, and humidity outside, the Smart Garden Hub decides on its own whether to water the lawn, and for how long. So when it is raining, the sprinkler doesn’t water. When it’s cold and cloudy and there isn’t much evapotranspiration, it delivers less water. You can still make personal and seasonal adjustments. You can save about 50% of your water bill, spend less time taking care of your grass, and actually end up with a nicer looking lawn (author’s personal experience).
Cost savings, reduced work effort, improved outcomes, and better end-user experience, all enabled by allowing one device to exchange information with another through the internet of things. Creating sustainable, affordable, more effective, and safer healthcare is all about reducing cost and improving efficiency, outcomes, and patient experience. What we need is a Smart Garden Hub for healthcare.
The demand for internet of things solutions in healthcare is not new. Patient controlled anesthesia (PCA) infusion pumps are programmed by anesthesiologists for both continuous and bolus dosing of opiate and other pain medications after surgery. The patient gets the benefit of a continuous infusion of pain medication, and can press a button to control their own additional ‘as needed’ doses. Opiate pain medications can have strong side effects, such as decreasing blood pressure and heart rate, decreasing level of consciousness, and suppressing the drive to breathe. In 2006, the Anesthesia Patient Safety Foundation commented that “life threatening overdose cases are disturbingly common”, and recommended that PCA pumps should have “the ability to automatically terminate or reduce PCA (or PCEA) infusions when monitoring technology suggests the presence of opioid-induced respiratory depression.” (APFS, 2006) The concept, called an infusion safety interlock, was explored further at the Medical Device Plug-and-Play Interoperability Lab at Massachusetts General Hospital / Partners HealthCare/ CIMIT (MDPnP, 2012). By connecting a PCA pump, patient monitoring devices for blood pressure, oxygen saturation, respiratory rate, and end-tidal carbon dioxide, and the nurse call system, the pump can be designed to both automatically shut off and notify the ordering physician/responsible nurse when pre-determined conditions matching a potential narcotic overdose are reached. Unfortunately, after almost a decade, the concept has yet to penetrate the healthcare technology market, not because it isn’t technically feasible, but because of persistent issues around interoperability, privacy, and perceived risk.
In healthcare, device and system information exchange (ie. interoperability) has traditionally been accomplished using single-use software interfaces that enable a particular device or system to send information to another particular device or system, but not to any others. These interfaces are predominately unidirectional, meaning that an IV pump may be able to send information to the Electronic Medical Record (EMR), but be unable to receive any information in return. That works well for automatically collecting a patient’s vital signs into the EMR, but what if we want the vital signs machine to automatically increase the frequency of recording vital signs because laboratory results in the EMR are showing a severe electrolyte abnormality? Or back to the PCA infusion interlock example, how do I tell the pump to stop delivering opiates if information only goes in one direction?
To create smart healthcare devices that interact with each other, we need to consider an alternative model for intraoperability.
The Building Blocks of the Internet of Healthcare Things
Imagine a medical device wrapped in a layer of connectivity. The connectivity layer controls information flow between the device and the outside world. The connectivity layer acts as a universal translator, converting the language the IV pump speaks into a standard language that can interface with other similarly connected devices. Most IV pumps already have a translator, called an HL7 interface, that standardizes the format of the information outputted by the pump. 
But it doesn’t allow the pump to be controlled, or to respond to events that may be important to the pump, such as the side effects that the drug it is delivering may be causing. In other words, it doesn’t make the pump ‘smart’. Many IV pumps also have security issues, often because of generic passwords that can provide ‘back-door’ entry-points for a hackers (Wired, 2015). So around the connectivity layer, we need to wrap a layer of security. The security layer ensures that any attempt by any other device to communicate with the IV pump is authentic (i.e. the request is verified as coming from another device and not a pretender), authorized (i.e. the requesting device has permission to communicate with the IV pump), and secure (i.e. no-one else is listening to the conversation between the device and the IV pump).
The next layer is the ambient intelligence layer. These are the rules that determine how the devices interact with each other, designed by experienced clinical staff based on how they would respond to similar clinical conditions. They can be very complex, and can utilize information from multiple other devices. In the PCA safety interlock example, the PCA pump may want information from the vitals machine (respiratory rate, end tidal carbon dioxide), from the electronic medical record (nursing assistant charting of decreased level of consciousness), and from the nurse call system (nobody has answered the PCA pump’s request for intervention within a 2 minute window) before making a decision to decrease or shut off the opiate infusion.
We can utilize the same conceptual framework to wrap not just medical devices, but also personal communications devices, clinical software applications, hospital clinical systems (e.g. Electronic Medical Record, drug dispensing system), and hospital building systems (e.g. security system, environmental controls). By utilizing a common framework, any smart device can ‘talk’ to any smart hospital system without the need to repeatedly build customized communications interfaces. 
When we allow these devices and systems to exchange information in order to intelligently automate workflow inside a hospital, we create an Internet of Healthcare Things. And with the right security and privacy measures in place, we don’t need to stop at the hospital’s physical walls.
Intelligent Workflow Automation
The Gartner Group predicts that the smart machine era will be the most disruptive in the history of Information Technology (Gartner, 2013). Nowhere will that be more evident than in home health and hospital-based healthcare. Hospitals, and particularly publically funded hospitals, have traditionally been repositories of aging equipment and infrastructure. As new technologies pervade the retail market, clinicians are becoming increasingly frustrated with the obsolete tools of their trade and are demanding immediate change. In areas where there is a sound business case, hospitals are leapfrogging technology, and purchasing systems with increasing capabilities for data exchange. Healthcare funding constraints, both in Canada and globally, demand massive efficiency gains to make healthcare more affordable without sacrificing quality. In addition, there is now simply too much discrete healthcare information for individual clinicians to manage without supportive technologies. Intelligent workflow automation improves hospital processes by managing all the mundane, non-value added tasks that clinicians and staff waste time doing every day. It makes is easier for doctors and nurses to focus on taking care of their patients, instead of filling out paperwork, trying to find things, and making unnecessary phone calls.
It can also make care safer. Patients in the Intensive Care Unit that are on life support are at increased risk for developing hospital acquired infections such as pneumonia. That risk can be significantly reduced by keeping the head-of-the-bed elevated at 45 degrees (CPSI, 2012). By combining location information (patient location = ‘ICU’), bed data (bed angle = ’< 30 degrees’), and ventilator data (ventilation mode = ‘pressure assist’), care providers can be automatically notified when a patient is at increased risk for hospital-acquired pneumonia. Additional information (nurse location = ‘in patient room’) can be used to suppress the notification in the case that a nurse has lowered the head of the bed in order to perform bedside care, such as toileting or bathing. This prevents alert fatigue, when staff ‘tune out’ to alarms because they happen frequently.
Imagine if the laboratory system was able to check automatically if a patient was on the correct antibiotic to treat their multi-drug resistant infection? What if a hospital’s elevators knew when clinical staff were rushing to manage a critical medical emergency on a different floor, and came to get them automatically? What if the hospital knew automatically when you arrived for your doctor’s appointment, and could fit you in for the MRI you were waiting for because there was a last minute cancellation? The possibilities are truly boundless, limited only by what we can conceive, and by what systems we have connected to the IOHT.
But good ideas don’t always translate into better care. At the Mackenzie Innovation Institute, we are exploring how the Internet of Healthcare Things can make healthcare smarter, safer, less costly, and a better experience for patients.
Evans D (Cisco, 2011). The Internet of Things: How the Next Evolution of the Internet Is Changing Everything. A Cisco IBSG White Paper. Available at: http://www.cisco.com/web/about/ac79/docs/innov/IoT_IBSG_0411FINAL.pdf Accessed May 2015.
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Welcome to DisruptEd
June 8, 2015
When I started medical school, the Dean told us that 50% of what we learn would eventually be proven wrong, and that we would forget the other 50%. What he didn’t say was that over the course of our careers, the practice of medicine would incrementally and fundamentally change because of technology, and particularly because of the internet and the internet of things.
Every innovation in healthcare is disruptive to someone. And until you understand how, your innovations will never fully succeed. Disruptive innovation is scary. It’s scary for hospital administrators because budgets become less predictable, job portfolios change rapidly, and the cost of change management can far and away exceed the cost of innovation. It’s scary for doctors and nurses because we are taught to work in certain ways, we get comfortable and efficient, and like all human beings, we naturally resist change. The internet of things has led to an explosion of products that have the potential to fundamentally change how doctors and nurses approach the delivery of healthcare, and how patients’ experience it.
Uber isn’t just a newcomer to the taxi industry, its business model has redefined what a taxi is, and in a few years there won’t be taxi companies, there will just be Uber and Uber-like ride-matching services. When people talk about the “Uberization of Healthcare”, they are mostly talking about Uber’s actual business model being applied in healthcare. A patient using an app to pick and choose the best individual healthcare delivery, care team, and therapies in a convenient and informed way. The ultimate in consumerized healthcare. But the Uberization of healthcare isn’t just about choice, it is about disruptive innovation. What Topol calls the “Creative Destruction of Medicine.” It’s about taking everything we think we know about delivering quality healthcare and throwing it out the window, rebuilding processes from the ground up and embedding and embracing disruptive innovations in health technology, best practices, and new service delivery models. And to healthcare delivery organizations and, perhaps more importantly, to healthcare providers that’s more than just scary, it’s heresy. So we look for reasons to say NO. “There is NO NEED for change”, “there is NO EVIDENCE to support change”, or more paternalistically, “We KNOW what our patients need.”
The healthcare technology industry is also culpable. Many healthcare products are built on loosely defined problem statements with insufficient clinician and patient involvement. We get dozens of pitches for products that solve problems we don’t actually have, or that only partially solve real problems. The Apple Watch effectively solves the problem of “I am too lazy to take my phone out of my pocket.” It doesn’t solve the problem of “I am in the middle of a sterile procedure and a nurse is calling me and I can’t answer the phone, and I am not wearing a watch because I am doing a sterile procedure.”
At the Mackenzie Innovation Institute, we believe in transforming healthcare through disruptive innovation; tearing processes apart to understand how to make them work better and rebuilding them with “innovation by design.” So we built an Innovation Unit at Mackenzie Richmond Hill Hospital, a living laboratory in an inpatient medical ward, where we can study workflow changes that result from disruptive innovation, not just from healthcare technology but also from clinical practice changes and alternative service delivery models. We are implementing next generation smart machine technology in a real healthcare environment, to better understand clinician and patient adoption, and clinical and financial return on investment.
We are also embracing the concept of the digital moment of health. Healthcare is made up of transient moments of opportunity to improve health, or transient risk to worsen patient outcome or experience. When these clinical moments occur through digital interactions, we call them digital moments of health. By capitalizing on the flow of information at the digital moment of health, we can create complex digital interactions that enrich patient experience, and improve patient safety and quality of care. When we link healthcare devices and systems together, we create an Internet of Healthcare Things with truly boundless opportunities.
In this blog space, we will explore innovations in health technology and service delivery from the perspectives of clinicians, healthcare executives, and the healthcare industry. We will challenge convention thinking, ignite debate, and unabashedly promote change. As Ted Levitt said, “Creativity is thinking up new things. Innovation is doing new things.” Let’s do something new in healthcare.
Game on.
