The new Royal Adelaide Hospital (RAH) opened in September. At a cost of $2.3 billion, it is one of the most expensive buildings in the world.
It is “without question” the most technologically advanced hospital in the country, says SA Health chief information officer and executive director of eHealth systems Bill Le Blanc.
The RAH is home to a huge robotic pharmacy distribution system (one of the biggest in Australia); more than 100 automated dispensing cabinets in patient wings to support the accurate and timely distribution of medicines; telehealth facilities for staff to consult with patients across the state, digital imaging technology which allows clinical images to be streamed live from operating theatres and procedural rooms for diagnostic andtraining purposes; and the largest automated microbiology system in the southern hemisphere.
The 800-bed facility will eventually provide care to an estimated 85,000 inpatients and 400,000 outpatients each year, is also the state’s only public hospital to roll out a digital instrument tracking system to manage its vast collection of medical equipment.
And complementing the new hospital’s world-leading care has been the state-wide deployment of the Enterprise Patient Administration System (EPAS), which replaces paper medical records to significantly reduce medication errors and improve patient safety.
[The EPAS formed the basis of Le Blanc’s CIO50 submission last year]
RAH is, as Le Blanc puts it: “truly a digital hospital of the future”, so impressive that the hospital had to urge members of the public not to use minor ailments as an excuse to get a look at the new facilities.
But there are haters too. As well as rolling out the RAH’s extensive technology programme, an investment well in excess of $130 million, Le Blanc has had to fend off savage condemnation of his team’s work from media-savvy, vocal critics.
“Technology is an easy target for them,” he says.
Every element of the RAH has been designed to improve the patient experience and health outcomes.
The building is full of natural light and artwork, has numerous courtyards and sky gardens while the 100 per cent single overnight patient rooms – each with views over the River Torrens create the best possible healing environment with greater levels of privacy, comfort and infection control.
The technology programme for the hospital, some four years in the making, has followed the same principles.
“The technologies enable better clinical outcomes, lower costs, and higher throughput. Every inpatient room is a single-bed room where technology enables many services to be brought to the patient – for example, mobile radiology units will x-ray the patient in their own room – rather than the patient having to be brought to the service,” says Le Blanc, who has been with SA Health for close to a decade.
“Having patients recover more quickly with shorter ‘Average Length of Stay’ means the health system can process a higher volume of patients without increasing bed numbers and with better clinical outcomes.”
A number of the technologies in place are world-leading, “over and above what is typically found in a modern hospital” Le Blanc says.
A fleet of 25 automated guided vehicles (AGV) move more than 1600 trolleys each day delivering food, linen, medication and surgical instruments throughout the facility, travelling discretely via 14 dedicated lifts and 27 lift lobbies.
Medication robots automate the dispensing of prescriptions, picking both imprest orders and outpatient prescriptions, and manage a centralised inventory. The technology significantly decreases dispensing errors; frees up the pharmacist’s time to focus on the quality and effectiveness of medicine use; and reduces the amount of inventory required and the amount of wastage from expired stock.
More than 100 automated dispensing cabinets in patient wings to support the accurate and timely distribution of medicines. Nurses input the patient-id and biometric authorisation via staff fingerprint.
The cabinet ejects a drawer containing only the medication and correct dosage prescribed for the patient, reducing the strain on nurses time to administer medication, as well as the amount of ‘lost’ medications.
A saturation of wireless access points means assets like wheelchairs, infusion pumps or barouches, fitted with imbedded chips, can be tracked in real time. The tracking of staff provides a safety capability, meaning security workers can be quickly dispatched to those in need of assistance.
People over technology
The roll-out of the new technologies, and the EPAS system has been a huge challenge not just for Le Blanc and his team, but hospital staff.
“Two simple words: digital disruption. Disrupting almost every area of business and clinical operations that were previously performed manually,” Le Blanc says. “The challenge of such significant change was compounded by people needing to make significant contributions to the project in addition to their ‘day jobs’. They’ve had to be simultaneously providing quality care in demanding circumstances at the old RAH.”
To ease them into the new ways of working, mock-up patient rooms and operating theatres were constructed to help staff conceptualise the changes to their physical environment. At the old Royal Adelaide Hospital, a skills centre was established where staff could familiarise themselves with new technology they would be using technology hands-on.
Technology has been explained and featured in internal newsletters, across social media and spoken about at ‘Grand Rounds’, the hospital term for a town hall meeting.
“The key thing is that it’s not about me, it’s about the role that technology plays in such a large and complex organisation, so I work with business leaders by regularly engaging with health network CEOs, our chief medical officer, clinical leaders and I have a team of account managers who engage with key stakeholders throughout the health system providing bi-directional advocacy,” Le Blanc says.
“I have learned that leading the technology function in a large complex organisation is much more about leading people than technology. Invariably technologists will be able to find a technology solution to a particular problem however the people management, cultural change, and business change management aspects are bigger issues for CIOs,” he adds.
Facing the critics
There is resistance to every change in an organisation. Le Blanc and his team – given the scale and breadth of the change they are bringing – have faced more criticism then most.
At times, it has cut deep. Last November Le Blanc and his team faced the wrath of medical unions and the scrutiny of the national media after a glitch caused an outage in the EPAS.
At last year’s CIO50 event Le Blanc brought a newspaper clipping with the headline ‘EPAS fails will be fatal’. He has appeared on talkback radio to defend the technology. In April this year the system was criticised by a coroner investigating the death of a patient.
The system has even become a political football. In November, South Australia’s Opposition Leader, Liberal Steven Marshall said his party would pull the plug on the roll-out if elected in March.
“Healthcare in any state attracts constant media scrutiny and is never far from the front page. The level of digital disruption in our business means technology is increasingly the subject of public attention,” Le Blanc says.
“In our business there are vocal critics of the changes we are making. There are websites dedicated to opposing it. Technology is an easy target for them. They are savvy users of conventional media, social media, and industrial bodies to keep their views front and centre.”
As CIO Le Blanc takes it on himself to defend his team’s work, putting himself up as media spokesperson.
“When this happens in our environment, my highly skilled and deeply committed staff feel they are being publicly attacked for the great work they are doing and it is important they see me at the forefront of defending the digital transformation program,” he says.
In time, the end results of the technologies that have been introduced, and the positive effect on patient outcomes will speak for itself.
“We have great people. Outstanding, dedicated people. However, like any group, they require leadership so that they are doing the right things. It’s trite, but true, that culture beats strategy, which is why I maintain a strong emphasis on culture. Supportive, collaborative, but accountable,” Le Blanc says.
“The key thing is that it’s not about me, it’s about the role that technology plays in such a large and complex organisation. The ability to take a business on a journey of transformational change, enabled by technology, I believe, is the most important skill that CIOs need today.”