Future of healthcare: how can smart hospitals support healing?

Smart hospitals aren’t just more efficient. They can help people heal faster too.

Healthcare has been slow to capitalize on the opportunities that digital technology offers, be it generating new insights by combining data sources or automating building functions. This is partly because of the need to protect highly sensitive patient data, says WSP‘s Nolan Rome. “That was a barrier to healthcare being able to leverage technology in the same way as other sectors. Before there would have been a public network and a vendor network for all the public systems, the HVAC controls, the infotainment and patient wifi access, and all the secure data would be on a separate network. We’re becoming much more sophisticated around that — now in most cases, we can converge all of the systems onto a single platform, protected by software security. That’s unlocked so many opportunities. We are helping owners to integrate all of the systems that they already have, and use those to make their business more resilient, whether that’s around energy savings and sustainability, or to make nurses and doctors’ lives a little easier, or to make more informed decisions about how their business will operate five years from now.”

For many technologies, the business case wasn’t always easy to quantify, but that’s changing too. Integrating systems and harvesting their data allows owners to take a step back and examine whether or not investments are working as they should, says Rome. “When you’re making decisions about patient rooms that you’ll have for the next 30 years, what information do you need to decide whether an investment has been successful or to make improvements? We can measure how a patient infotainment system is used by clicks and time spent, to look at whether people are ordering food or looking at their patient data, or whether they’re just breezing right through that to get to the next movie. If they’re not, you can then look at why not. We can do that across the 250 or so systems installed across a hospital to build an umbrella strategy to understand if these systems are being used in the best way possible.”

Making physical changes to a hospital is disruptive and hard to reverse; technology allows constant, incremental updates in response to real-time conditions. “With software, you can play with it behind the scenes and test it before pushing it out,” says Rome. “There is still some cost, but it’s not like changing the built environment, where there’s infection risk, downtime and loss of revenue.”

Automated building systems and seamless information transfer don’t just make running hospitals easier. They also improve the experience for patients and their families. For example, providing them with better information before and during their visit can make it less stressful, says Simon Kydd at WSP. This could be delivered direct to their smartphone or tablet via an app. “The app would know what time you need to be there and it knows where you live, so it could tell you about different transport options and let you know what the traffic will be like at that time of day. If you decide to drive, a parking space can be made available. The app can show you what entrance to take, how you need to sign in and which waiting room to go to — all the wayfinding can be done on your device. And if your appointment is delayed for whatever reason, the app can reassure you that your car parking stay has been extended, so you don’t have to worry about getting a ticket.”

The applications of this technology in a clinical environment are potentially even more valuable — as when combined with RFID tags, for example. “If a physician or a caregiver with a radio frequency chip on their badge walks into the room, the system instantly knows they are there and their picture could pop up on the TV screen,” says Jason Schroer at HKS. “If patient wristbands also incorporated RFID tags, building systems could automatically set the lighting or temperature to suit their preferences. Hospital managers could look at a map of the facility and know exactly where everybody is, and you could do the same with medical supplies. Traditionally those systems were set up to just track where things are, but now we can use them to study how people are actually using the spaces and  make adjustments. As designers we’re interested in that technology because we can learn from it by observing behaviour. From a client’s perspective, it’s a way to manage their resources more effectively.

Rome, meanwhile has been working on a project in a children’s hospital, which shows another clinical application of responsive buildings. “We asked some clinical psychologists and paediatric nurses if it made a difference whether the nurse is in the room or not, and they said it definitely did. Children are much more apt to share how they’re feeling with their tablets and phones — those are their security blankets, that’s how they get their entertainment, that’s where they message their friends.” So they built a patient portal app where younger patients could adjust their room controls, but also record how they were feeling. “It gives nurses and doctors an indication of their overall wellness so that they can engage the patient at the right time, as opposed to just coming in on a set schedule to take their pulse and temperature. If they can see the patient is improving, they might wait for 30 minutes and spend that time helping another patient.”

Ultimately, designers hope to use smart technologies to create environments that promote faster healing. Wellness and biophilia have become major preoccupations in new buildings, and various studies have shown that views of nature, fresh air and daylight can improve outcomes, increase pain thresholds and shorten hospital stays — by as much as 20%. Smart buildings can supplement these effects or recreate them in internal spaces such as intensive care units. “It could be as simple as reducing the amount of noise in the room so people can sleep better, which speeds their recovery,” says Kydd. Nurse calls can be sent directly to handheld devices, rather than activating buzzers or lights that disturb other patients. “That device will tell the nurse to go to a particular patient and exactly what they require.”

As individual patient rooms have replaced long wards with high windows, some opportunities for daylight have inevitably been lost. Other types of room are sealed from the outside to control infection or protect specialist equipment. Tunable LED lighting can compensate by mimicking daylight patterns to calibrate the body’s internal clock. The same technology can also help staff working antisocial hours or very long shifts, says Schroer. “We can tune the lighting to mimic a better circadian cadence, and that could help to manage alertness and fatigue.” A study by HKS’ research arm CADRE found that nurses who could see daylight were able to maintain a higher cognitive level. “The next piece, which is harder to prove, is whether that then leads to fewer medical errors — logically, if you’re more alert and less fatigued, you’re less likely to make an error in patient care.”

This article appeared in The Possible issue 06, as part of a longer feature on the future of healthcare