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The secret of fully integrated healthcare at Maexima Medisch Centrum

Donald Wade
1 July, 2006  

Donald Wade
Freelance Journalist

Paul Rieter is a man with a vision. A vision of how things  should be. And with responsibility for €80 million of hospital spending, and 28 years experience in the same institution, he’s entitled to one. Rieter is the CIO and chief of medical technology at one of the top clinical training facilities in the Netherlands: Máxima Medisch Centrum. He envisages a single, open-standard, converged platform for all hospital communications, data networking, clinical information and the automation of medical equipment. This, he says, will enable the hospital to achieve the gold standard of healthcare – to empower the right individuals to take the right action based on the right information at the right time, wherever they are in the hospital.

It’s a vision that fundamentally depends on the unifying  properties of the now ubiquitous Internet Protocol (IP) – a  technology that has come under some criticism when applied to mission-critical areas. So how can Rieter be confident in his vision? And what has convinced others to endorse it? The answer is that he has delivered a rock-solid foundation for his project, backed by a sound business case and best-of-breed technology.

Convergence: a single infrastructure for a single vision
With a background in clinical information and medical  equipment, Rieter is well placed to assess whether new IP  technologies can live up to the critical demands of a large,  bustling, medical centre. He sees the convergence that IP  offers as a key enabler for meeting Máxima’s long-term  objectives: “With healthcare inflation at an all-time high,  competition growing between medical institutions and the  average age of the population in countries throughout Europe rising, the pressure is on centres like Máxima to do more with less – and technology plays a vital role in this.

“It’s all about aligning Information and Communications  Technology (ICT) to the business. In the future, it is  inevitable that there will be a higher patient-to-nurse  ratio. It’s also true that the cost of drugs and therapies  will continue to rise. So it’s only logical that we should look to technology as an enabler for better healthcare. Prices are coming down, the functionality and reliability continues to improve, and it has the ability to extend to every part of the organisation. It can, and should, be used to reduce the workload on staff, to enable them to work more efficiently and to empower them to provide better patient care.”

More integrated healthcare
Máxima was established in 2002 through the merger of two  hospitals: St Joseph in Veldhoven and Eindhoven’s  Diaconessenhuis. With 865 patient beds and 3,400 employees, the organisation doesn’t just provide sophisticated facilities for highly specialised medical and nursing training; it also delivers advanced medical care to the community. But as Dutch healthcare is liberalised, patients are able to choose where they receive treatment, and so Máxima must compete with other healthcare centres.

Consequently, Máxima faces many similar challenges to those of the private sector. For instance, Máxima has to  continually improve customer service for an increasingly  savvy consumer, and achieve operational efficiency while  delivering leading-edge services. When it comes to  healthcare, meeting these challenges means joining up  people, processes and information to create services truly  focused on the patient.

For Rieter, the critical component of ensuring success is to  first understand how the organisation communicates and how  technology can support and enhance that process: “The move  to IP telephony has been critical. Not only does a  converged, single network lower the cost of voice  communications, particularly for intersite communication,  but it enables closer integration with data applications.  This has many benefits. For instance, through Nortel’s  Unified Messaging system, we are able to provide staff with  comprehensive access to vital emails, faxes and voicemail  services through any touchtone phone, desktop PC email  client, web-enabled PC or mobile email device. As a result,  information travels more quickly throughout the organisation and it is less likely a communication is missed.”

Risk and reliability
However, it wasn’t possible to switch immediately to a  converged environment. With staff confidence in the  performance and reliability of the phone system paramount, it was important to Rieter that the organisation evolved gradually towards a pure IP platform for telephony. This meant selecting an equipment vendor that could ensure an incremental migration path from its analogue PBX.

It was also key that the solution was open standards- based  and actively targeted at interoperability in a multivendor environment. In a critical industry such as healthcare, the underlying IP-based communications platform must seamlessly integrate with legacy applications from a range of different sources – including paging and a variety of alarm systems ranging from fire to blood bank alarms.

As the hospital wanted to build a platform for the future,  the communications system also had to be able to cater for  new technologies. File sharing and video conferencing, for  instance, could enable greater collaboration across  departments, supporting new state-of-the-art techniques such as remote diagnosis and mobile access to test results.

The system also had to be robust and offer proven  performance enhancing features such as quality of service  (QoS) and bandwidth control. “It was imperative that I could maintain the same high-standard user experience. Add to this the need for interoperability, open standards and a gradual migration path to pure IP and you can see we had quite a comprehensive list of requirements. Nortel technology could meet all of these criteria, and that is the basis on which I selected to work with them,” says Rieter.

Communication on the move
Rieter’s plan for IP telephony hasn’t stopped at the wired  network. In a busy working environment, where staff such as  doctors and nurses are perpetually on the move, huge  efficiency gains can be realised if IP telephony can travel  with them, wirelessly.

Take the example of the traditional paging system. Sending a message often results in huge delays and hold times.  According to the results of a survey conducted by the  company Spectralink, nurses can spend as many as 900 hours per year paging doctors. Furthermore, they don’t get the peace of mind of knowing whether the doctor has received the message.

The same study also demonstrated that using wireless  handsets – the same Nortel 2200 series handsets now being deployed at Máxima – organisations can save as much as 80% of this time. “We wanted a single converged wireless device that acts as both bleeper and telephone handset,” comments  Rieter. “This type of equipment enables our doctors to call straight back, or an automatic delivery report can be generated to confirm that the message has arrived.

“Clearly, the user experience is just as important – if not  more important – on the wireless handsets as on the wired  network. These devices are the most likely point of contact  for a doctor in an emergency. Consequently, we need some way of assuring performance. While there is not yet an agreed standard for QoS over a Wireless Local Area Network (WLAN), we were able to obtain the necessary functionality from the Nortel solution. The combination of this and seamless handovers when users move between wireless access points were essential components in creating a system we could trust. In fact, a colleague of mine has run tests that  ompare our older cell phone system with the WLAN technology, and has proved that the new system not only has just as much redundancy, it’s actually more reliable.”

Remote access, remote action
With a good foundation in place, Máxima has lots of plans  for the future of the system and the converged  infrastructure as a whole.

Rieter comments: “I would like to speed up the process for  doctors obtaining test results. With a wireless device like  those we’re deploying, they can receive the results the  moment they are done, discuss them with a colleague in  another part of the building and, depending on the  circumstance, call the patient. One day, we may also be able to share high-definition images of MRI scans and X-rays so that a second opinion can be sought without the need to bring people physically together. These possibilities will enable more efficient working and increase the organisation’s responsiveness to patients’ needs, which in turn will improve care.”

Another possibility that Rieter is interested in pursuing is  “presence”, the ability to check the status and even the  location of an individual, such as a doctor, with IP-based  technology. “Using the presence awareness capability built  into IP messaging servers,” says Rieter, “medical  practitioners who are spread across a hospital campus – or  in different hospitals altogether in the case of Máxima –  can allow other users to see when they are connected to the  hospital network, and if they are available. In this way, if  their expertise is required, they can be contacted, saving  critical time and money.”

This ability to check the availability of particular individuals could also be extended to Máxima’s contact centre in the future. It too has been updated to a converged Nortel system in line with Rieter’s vision for a single infrastructure, and it is playing an increasingly important role in Máxima’s plans.

Contact for the 21st century
“One of the most demanding pressures of liberalisation in  Dutch healthcare is the need to maintain competitive  differentiation through excellent customer service,” says  Rieter. “Critical to this is modernising the way patients  and their insurance companies can interact with Máxima.”

Research carried out by Rieter’s team on the effectiveness  of customer interaction in the Máxima contact centre  revealed that it could take more than 20 minutes to be put  in contact with the right person. So when Rieter implemented Nortel’s contact centre solution, he was keen to utilise its skills-based routing capability to ensure calls are put straight through to the members of staff best suited to dealing with them. Combined with the presence capability, this will be an even more powerful proposition. However, in keeping with the measured approach to ICT at Máxima, Rieter is cautious at the moment, analysing how best to use the system and its management tools before they are implemented.

“The older patients are not quite as up to date as the  younger generation when it comes to utilising the latest  technology,” says Rieter. “We need to ensure that the  processes we put in place with the new system are  sympathetic to their requirements too, and offer them  genuine improvements. However, they aren’t far behind, and with young people very interested in, say, booking  appointments and filling out forms online, there is a great  opportunity for us to differentiate ourselves.”

Automation and patient care
The improvements that Máxima is hoping to make with the new infrastructure don’t stop there. Rieter also has plans for the integration of healthcare equipment into the converged network. As someone who has worked extensively with purpose-built, clinical and medical technology, he is well aware of the enormity of this step. However, he is also very confident due to careful planning.

Take the case of a heartbeat monitor, Rieter suggests. It  can be configured so that as soon as the patient’s heart  shows signs of stress the device sends an automatic alert  over the IP network. The central IP call server then issues  an alarm over the Wireless LAN to members of the crash team, providing details of the patient’s location and condition. Similarly, if the same piece of equipment experiences a fault, it can send specific details to the appropriate technical support staff, who can then rectify the problem straight away.

The key technology for this is an application gateway,  something Rieter has already invested in as a sign of  commitment to this area, “I see automation as pivotal to  enabling the cost-efficiencies that the modern healthcare  institution demands. I also see it as a fundamentally good  thing for patient care.

This kind of capability, I’m certain,” he concludes, “is the  future for better healthcare: right information, right person, right time.”