Sunnybrook Health Sciences Centre targets improvements in patient care and wait times with mobile point-of-care solutions and other digital technologies.

As a 1,200-bed teaching hospital, tertiary care facility, and regional trauma centre, Sunnybrook Health Sciences Centre is one of Canada’s premier health institutions. It’s also a leader in using digital information to improve Canadians’ access to high-quality, cost-efficient healthcare services. Building on a foundation of wireless networking and Intel® technologies, Sunnybrook is deploying mobile point-of-care and other solutions that enhance clinical decision making, patient care, provider productivity, and system efficiency.

Improve Quality of Care

Sunnybrook’s goal is to become the safest hospital in Canada. Mobile access to patient information can help clinicians reduce errors and improve quality of care.

Reduce Wait Time.

  With 50–100 surgeries daily, managing patient flow is a logistical challenge that can produce delays and inefficient use of resources.  

Increase efficiencies. 

At Sunnybrook’s cancer clinic, which sees more than 200,000 patients per year, paper-based requisitioning and scheduling produce delays for patients and headaches for staff.

The solution –

• Provide information where it’s needed – at the point of care. Sunnybrook supports its healthcare professionals with electronic medical records, a 100 percent wireless environment, and a choice of mobile devices so that clinicians can get accurate, up-to-date information when and where they need it.
• To empower patients with health information, the centre has created an outward-facing patient portal and is on the forefront of efforts to create continuity of care records.
• Automate patient tracking.  Leveraging its wireless infrastructure, Sunnybrook is piloting the use of real-time location-based services to manage patient flow and utilize resources more effectively.
• Streamline scheduling.  Sunnybrook’s cancer centre is piloting an electronic order requisitioning application that enhances patient satisfaction and efficiencies and can be securely accessed from outside the centre.

Assessing the Situation

From tiny newborns to aging veterans, Sunnybrook Health Sciences Centre touches the lives of hundreds of thousands of Canadians each year.   Affiliated with the University of Toronto, Sunnybrook not only delivers direct care, but also trains more than 2,600 students annually and is home to scientists who conducted more than $80 million of research last year.  The centre’s research and practices influence care throughout the province of Ontario, across Canada, and internationally.

Sunnybrook’s leaders are clear about the importance of information technology in addressing healthcare’s challenges. “Our vision is to transform healthcare and make healthcare better for patients everywhere,” said Sunnybrook CIO Sam Marafioti. “Digital health strategies are one of our most important strategic levers for meeting the needs of our key stakeholders—patients, providers, and government. By demonstrating the benefits of information technologies, we can play a significant role in the healthcare system and benefit the entire region.” 

Marafioti will be the first to tell you that technology in and of itself doesn’t solve healthcare challenges. “Digital health initiatives have to be undertaken as part of a cultural transformation,” he said. “At the end of the day, you’re implementing healthcare projects, not IT projects.  If the project doesn’t have a clinical champion and user buy-in, and it’s not supported by the appropriate workflow analysis, it won’t work. But when IT is aligned with clinical priorities and an understanding of where the organization wants to go, it can be an important enabler.”

Delivering the Solution –

Improving Information Access

Sunnybrook has deployed electronic medical records across its enterprise, so enabling ubiquitous access to those records—and to other clinical information—is a necessity. “Providing secure access to information anywhere in the hospital and anywhere in the world is an important priority for clinical care,” said Sunnybrook’s IT director Oliver Tsai. “Once you’ve got that digital information, you want to use it every way you can to improve the patient’s care and also reduce workload stress on clinicians.”

Sunnybrook’s use of mobile information access starts with Intel technologies and a universal and secure wireless network from Bell Canada and Symbol Technologies. The centre’s wireless infrastructure—which includes more than 300 access points at three campuses—provides secure, audit-based access to electronic medical records and supports advanced capabilities such as wireless VoIP communications and real-time location services.

Using the network, physicians can instantly and securely access digital information from virtually anywhere in the hospital, as well as from clinics, classrooms, and offices. “We’ve got so many teaching physicians and consulting specialists who want to be able to check on their patients from their offices r classrooms, so we provide mobility across the entire enterprise,” said Tsai.  “There’s no chasing after the paper chart, and clinicians love the flexibility of being able to sit down with patients and look at their information together.  Mobile point-of-care solutions are an important way to return time to practitioners and improve quality of care and patient safety.” 

Sunnybrook offers clinicians a choice of Intel technology-based mobile and stationary platforms. “We intentionally did not standardize on any one modality,” Tsai said. “We have COWs [computers on wheels] with small PCs, and are looking to put wireless tablets on the COWs so that clinicians can take a less intrusive system into the patient’s room. It’s also commonplace for practitioners to use wireless laptops and even handheld computers to access medical records and other information. These devices give you so much power, and you can share with the patient right at the bedside.”

According to Tsai, Intel client technologies deliver the reliability and performance Sunnybrook’s clinicians need for viewing and manipulating digital images, graphing care trends, collaborating with  colleagues, and performing statistical analysis for quality assurance. “Intel’s mobile technologies are especially valuable to us, since they support the standards we use to ensure the security of the traffic going across the network,” he noted.

Streamlining Surgery Logistics

Real-time location services (RTLS) offer a variety of ways to address efficiency bottlenecks and derive additional value from investments in wireless infrastructure.  One of Sunnybrook’s initial RTLS applications targets the workflow challenges of managing its busy operating rooms, where 20,000 patients undergo surgery in a given year.  It’s a classic workflow process as patients move through the different stages of preparation, pre-op, surgery, post-op recovery, and returning to their rooms.

“To deliver the best care and maximize access to the healthcare system, you need to have staff, beds, materials, and other resources—and the patient—in the right place at the right time,” Marafioti  explained. “The challenge in a facility the size of Sunnybrook is knowing exactly where a patient is.  Providing this information represents big workflow and efficiency opportunities that can save time and money.”

Sunnybrook is piloting a location-aware patient tracking solution in which surgery patients are assigned an active radio frequency identification (RFID) tag before they leave their rooms for the operation.  Using wireless technologies from GlobeStar Systems and Ekahau that are designed to run with Intel® Core™2 Duo processor-based mobile computers, surgery staff can monitor patient location and keep the process flowing smoothly.

Sunnybrook also gains valuable data that can help optimize overall efficiency.  “Without actual data, you can’t make effective changes,” Tsai said.  “Location-based technologies can give us insight into why equipment ends up where it does or why people go where they go. These insights will be very helpful in managing operations and optimizing our work processes to enhance efficiency and ultimately reduce wait times.”

Reducing Stress and Inefficiency with Automated Scheduling

Sunnybrook is also moving to automate order requisition processes. A pilot program is underway at its cancer centre, which handles more than 200,000 visits annually and is one of the busiest in North America.

In a typical visit, the physician will schedule a number of tests and procedures for the patient, such as having blood drawn, receiving chemo or radiotherapy, getting imaged, and meeting with physicians, nurses, counselors, nutrition educators, and other clinicians. These orders are manually written and captured in a form known simply as “the pink sheet.”  Like most paper-based healthcare processes, this system is fraught with inflexibility and inefficiency. “When you’re dealing with hundreds of pink sheets every day, they can get lost or become illegible,” Tsai explained. “You have multiple staff who need to refer to them, and it’s difficult to add a procedure after the pink sheet is made up. There is potential for error and for delays in getting care—all because of the use of paper. So we asked, ‘Why can’t we improve the order requisition process to make this information securely available to whoever needs it from wherever they need it?’”

With the new system in place, orders can be adjusted as needed, and errors are reduced.  Patient visits proceed with less stress and fewer delays, and staff members don’t waste time tracking down pink sheets that are lost or in another staff member’s possession. Resources are scheduled and utilized more efficiently, leading to shorter wait times. And clinicians enjoy increased flexibility because they can access the order requisitioning system through mobile and desktop devices from across the Sunnybrook enterprise.

Strengthening the Patient Relationship

Clinicians aren’t the only people who benefit from convenient, secure access to healthcare information. “Today’s empowered patients expect more transparency and efficiency in their healthcare,” Marafioti said. Sunnybrook addresses that expectation with a patient portal that enables patients to access test results, request appointments, exchange secure messages with physicians, obtain prescription refills, and make data available to other healthcare providers.

“It’s a transformational initiative that extends our relationship as the patient’s trusted advisor,” Marafioti says. “It’s a big step toward opening the black box of healthcare and strengthening our relationship with our patients.”

Marafioti and Tsai believe the portal saves time for physicians and leads to better care.  “Patients are already scouring the Internet for health information,” Tsai observed. “The more information we can provide as a trusted authority, the better. The portal empowers the patient and enables them to be more directly involved in their healthcare. It also provides answers to the most frequently asked questions, allowing physicians to concentrate on the patient’s unique needs.” 

In addition to the portal, Sunnybrook is leading efforts with regional and US healthcare experts to develop continuity of care records. “We live in a mobile society, and we may need healthcare wherever we travel,” said Marafioti. “We also need healthcare services from a growing number of specialists and in a greater variety of settings.  Patient portals and continuity of care records help people manage their health more effectively and share their health data with other healthcare providers.”

Robust Digital Foundation

Given Sunnybrook’s size and the complexity of its services, its digital environment faces huge demands. “We operate in an incredibly complex environment,” Marafioti said. “As a tertiary facility, teaching hospital, and regional trauma centre, we care for some of Canada’s sickest patients.  There’s a tremendous amount of coordination and collaboration that goes on as our clinicians work to do the best job for each patient. We support hundreds of special services, and we want each of them to have the best digital technologies to care for their patients, meet their workflow needs, and maximize their own productivity and satisfaction.” 

Sunnybrook meets those complex demands with Intel  technologies.  “Intel is the pillar.  Well over 90 percent of our enterprise architecture is Intel,” Tsai said. “The Intel® platform is robust, stable, and reliable.  It never fails, and we’ve been extremely pleased with the performance of the dual-core technology.”

Intel’s support for open standards is another plus. “It means we can give our end users the flexibility to choose products that meet their particular needs,” Tsai added. “We don’t have to force a single solution on them.” 

Intel’s architectural innovation helps Sunnybrook as it continues to deploy new digital technologies.  “Because of all the expansion we’re going through, real estate in the data centre is a significant concern,” Tsai said. “With the Intel dual-core server technologies, we can reclaim physical space.  Server virtualization allows us to reduce hardware costs and provision servers instantly, to add capacity to respond to the hospital’s needs.  That’s exciting.”  

According to Tsai, Sunnybrook views Intel as more than a technology vendor. “Intel is beyond a partner—it’s a force of nature in the industry,” he observed. “Intel provides true system-level leadership. Intel’s experience and expertise and its willingness to work with us in envisioning the future are exactly what healthcare needs.” 

Profile of Sunnybrook Health Sciences Centre

Tertiary care centre with 10,000 staff, physicians, volunteers, and studentsMore than 1,200 beds in serviceMore than 200 specialty servicesNearly 380,000 in-patient days and almost a half million clinic visits during the 2005/2006 fiscal yearStrategic programs in cancer, cardiac, musculoskeletal, neurosciences, perinatal and gynaecology, trauma and critical care, and aging and population health

Return on Investment

Through its innovation with digital technologies, Sunnybrook Health Sciences Centre continues its leadership in patient care and provides a robust model for the province and the nation. While specific benefits are being measured, Sunnybrook expects to:Optimize the care of individual patients while ensuring overall efficiencyReduce wait times due to improved workflow and better use of human and physical resourcesImprove patient outcomes by reducing medical errors and enhancing clinical decision makingIncrease patient satisfaction through a streamlined experience with less stress and shorter wait timesRaise job satisfaction for clinicians, researchers, and educators

Key Technologies Used by Sunnybrook

Intel® Core™2 Duo processor-based tablets, laptops, computers on wheels (COWs) and nurses’ workstations from a variety of vendorsDell servers powered by the Dual-Core Intel® Xeon® processorWireless networking technologies from Bell Canada and Symbol TechnologiesRFID-enabled location-aware technologies from Ekahau and GlobeStar Systems Integral AnswersServers based on the Dual-Core Intel® Xeon® processor give Sunnybrook a high-performance, highly available foundation for a variety of important healthcare applications.Their scalable, energy-efficient architecture, support for industry standards and built-in virtualization capabilities add flexibility and reduce costs in the data centre.Intel Core 2 Duo processors deliver outstanding responsiveness and reliability whether clinicians choose to access healthcare applications through wireless tablets, COWs, or nurses’ workstations.