By Renee Diiulio
GE Healthcare, Waukesha, Wis, is hoping to usher in the next revolution in the delivery of medical care—that of the anticipated Internet of Things (IoT), aka the Industrial Internet, where technology helps to not only organize and analyze the past, but where machines work together to predict and improve the future. Through machine-to-machine communication (M2M communication, sometimes also referred to as device-to-device or D2D communication), the human middleman is replaced as a data carrier. The information, now far more accurate, is transmitted (securely, of course) to a larger software system, where the forecasting capabilities developed for trending and analysis are translated into physical actions that can help to improve both individual and enterprise-wide performance.“Five nines of availability (99.999 percent) translates to six seconds of downtime each week, while seven nines (99.99999 percent) is the equivalent of 0.07 seconds of downtime per week,” writes GE Software’s Nikil Chauhan in a recent white paper, “Modernizing Machine-to-Machine Interactions.”1 “While these numbers are generally acceptable in an ERP [enterprise-resource planning] system, the industrial world requires much more stringent service levels.” Healthcare, where devices play a large role and downtime can have direct and indirect impacts on patient care, is part of this industrial world and one of the markets the company has targeted.
In fact, GE has launched the initiative in all of the industries it serves with the overall goal to achieve no unscheduled downtime across every one of those industries. For healthcare operations management, or HOM, this means reducing waste via a “stairway of value.” And the first step, according to Fran Dirksmeier, general manager of Global Asset Management for GE Healthcare, is the reduction, or elimination, of downtime.
This phase encompasses the work of clinical engineering and includes specific tools developed by the company to help optimize assets. By including status checks within the machine chatter, devices can be truly monitored remotely, and all maintenance becomes preventive with a resource that knows how to maximize device performance. Physical elements are replaced before they can malfunction; technology upgrades are made remotely and automatically; capital planning stays proactive based on relevant metrics; compliance criteria is met; even location management is incorporated to bring the IoT into real time—and into the clinical setting.
These same principles are then applied to take the next steps, which address patient safety (with improvements targeting specific areas, such as hand washing) and length of stay. “We want to be able to manage patients throughout their entire stay to provide a frictionless patient experience,” Dirksmeier says.
Reducing Wait, Reducing Waste
Frictionless means reducing wait times throughout the entire stay and requires improved efficiency on the part of the healthcare provider. But with a view of the big picture and a reliable forecast for demand, resources can be better used and productivity maximized, with a resulting positive impact, ideally, on outcomes and revenue. “Many hospitals run between 60 and 70 percent capacity, but they feel full, so they need help using their capacity more productively,” Dirksmeier says.
Effective and available equipment plays a key role in this area, and clinical engineering departments are more often charged not only with monitoring and maintaining equipment performance but also with managing, or at least contributing to, related high-level responsibilities, such as capital planning, acquisitions, and enterprise-wide networking. Many accomplish these tasks using their computerized maintenance management software (CMMS). GE aims to offer more.
In late December, the company launched iCenter, online asset maintenance and management software redesigned to help facilities optimize their assets, fixed or mobile. Data and reports cover day-to-day workflow as well as high-level analytics. Users can access data—in real time—regarding an individual device’s history or PM status, or they can create a benchmarking report to show how they compare to their peers in utilization.
Incorporation of the company’s AgileTrac technology expands the capabilities even further. A foundational technology and analytics solution, the software utilizes a real-time location system (RTLS) to track the physical whereabouts of assets, as well as patients and staff members. Using various RTLS types (including Wi-Fi, RFID, and infrared), the system can pinpoint the exact room in which a device, such as an IV pump, is located, and can also alert the biomed or clinician that the only remaining clean pump is in storeroom 4A.
If not connected to a network, the devices transmit through installed sensors, which technology has made smaller, more efficient, and more powerful, enabling “brilliant machines.” GE defines brilliant machines as devices that autonomously connect to the Industrial Internet, execute native or cloud-based machine apps, analyze collected data, and react to changes in that data.1
To connect these machines together and allow them to talk to one another—and make use of the IoT—GE has developed Predix, a platform that will work across all of its businesses as well as integrate with outside systems, though some development could be required. In 2014, GE will launch the Predix Technology Third-Party Partner/Developer program so other vendors and developers can integrate the platform into their own solutions and eliminate development steps for users.
“For us to solve enterprise-wide, large-scale problems, we have to be able to incorporate data from all types of systems. It can’t be just our own equipment. For an analytics-type of solution to drive productivity, it has to be able to fuse lots of different data sources together to make a nonlinear decision,” Dirksmeier says.
Once able to do this, the possibilities for decision-making and action are endless, according to GE. For instance, an oximeter could communicate directly with the ventilator, which could then adjust the oxygen delivery accordingly—without the intervention of a clinician.
Taking the scenario outside of a facility, GE depicts an ambulance speeding to the hospital. As it rushes along, it could communicate with traffic lights to increase the speed and safety of transport, transmit patient data (such as vital signs) to the hospital, and receive information from the patient’s electronic healthcare record (EHR) so testing and treatment could be started before the patient arrives in the hospital’s emergency department (ED).1
In another scenario, data collected from patient sensors could be used not only to monitor the individual patient and improve care, but it could also be used (stripped of patient identifiers) by researchers studying specific diseases or epidemiological trends. In fact, a current university research project is doing just that, collecting patient data using advanced, sensor-based devices to employ in a hierarchy that includes self care, physician monitoring, research studies, and epidemiological trending.1
Today, facilities are using the technology to improve performance in all areas of operations. Summerville Medical Center, Charleston, SC, employed GE’s RTLS technology to track clinician room entry and exit against the use of soap or sanitizer dispensers, and improved hand-washing policy compliance from 52% to 81% throughout the entire facility. The program has since been rolled out to the rest of the institution.
Aventura Medical Center, Aventura, Fla, implemented real-time patient flow and visibility, which resulted in a reduction of ED wait times by 68%, or 12,000 hours over 9 months. In addition, Aventura reduced discharge times by 3,000 hours over the same period.
RTLS programs at Virtua, NJ, enabled the average wait time for delivery of “ASAP” equipment to decrease from 202 minutes to 12 and for “routine” equipment to fall from 184 minutes to 14. Average ED-to-inpatient bed wait times also improved, decreasing from 16.2 hours to 2, and the organization saved an estimated $1.2 million. The technology is now being implemented in one-fourth of its hospitals.
GE believes that by implementing such technologies and connecting them through Predix, across industries, that the potential for improvement is infinite. Things will get done and done well, without the need for manual intervention, freeing people up to do other things and ushering in the Internet of Things. 24×7
Renee Diiulio is a contributing writer for 24×7. For more information, contact editorial director John Bethune at [email protected].