1.2 Billion Euros for Technological Innovations in Danish Hospitals
Digitalization, centralization, and specialization are the three guidelines for a full-scale restructuring of the hospital landscape in the Danish province of Mid Jutland. Aarhus University Hospital is a prime example of these guidelines and is considered a role model far beyond the borders of Denmark. The Aarhus Hospital unites four former hospitals on one central hospital site. The hospital is scheduled to become fully operational this year.
Lars Ganzhorn Knudsen, Chief Consultant Development and Innovation, Aarhus University Hospital, is optimistic about the infrastructural planning of medical facilities in Denmark. He is enthusiastic about the trend-setting decisions of the government in Copenhagen. Denmark, with nearly 6 million inhabitants, can serve as a blueprint for other countries.
In an interview with RFID & Wireless IoT Global, Lars Ganzhorn Knudsen explains how the infrastructure in the medical sector in Denmark is being modernized.
University Hospital Aarhus: Facts and Figures
- 41 clinics on an area of more than 475,000 square meters – when completed in 2021
- 850 stationary hospital beds and 9,700 employees
- Over 920,000 ambulatory patient treatments annually
- Over 46,000 emergency treatments annually
- More than 82,500 surgical procedures annually
- Over 10,000 endoscopies per year
- Over 4,850 births annually
26 Hospitals Will Care for Nearly 6 Million Residents in the Future
The infrastructure program envisages the construction of seven completely new hospital complexes as greenfi eld projects. This includes the new Aarhus University Hospital. Nine clinics will be technologically upgraded and expanded as part of the structural program. No structural or technological changes will be made in 10 of these clinics. After completion of all measures such as new buildings, upgrades or conversions, the 5 regions in Denmark will have a total of 26 hospitals.
Overcapacity and Strained Costs
The population of Denmark aged 75 years or older will almost double from 7.8 percent of the population in 2017 to 14.4 percent in 2047. The incidence of type 2 diabetes will also increase by 95 percent by 2030. The Danish Ministry of Health also expects the number of COPD patients to increase by 45 percent reaching up to 254,000 in 2030. Overall, the prognoses show that the healthcare system and the distribution of medical facilities are not optimally adapted to the development of society. Overcapacities of hospitals, emergency rooms and hospital beds that have been accumulated over years are straining budgets and hampering the efficiency of patient care.
The Master Plan: Digitalization, Centralization, and Specialization
The master plan for the future development of the medical sector is based on the three guidelines, 'digitalization, centralization and specialization'. Medical facilities are to become more efficient as a result. The outcome: the number of hospitals, emergency rooms, and hospital beds will be reduced. Today, the average length of stay of a patient is already less than 4 days – a significant reduction compared to the recent past.
The number of ambulatory patients has increased by 50 percent between 2007 and 2020. The immense project involves an investment volume of six billion euros. 20 percent of the total investment volume is specifically reserved for the development and integration of new and innovative technologies in hospitals.
3,600 UHF RFID Readers in the World' s Largest RFID Clinic Complex
In the first construction phase of Aarhus University Hospital, 2,500 Zebra Technologies FX7500 UHF RFID readers were installed. Each reader is connected to 3 Zebra AN480 UHR RFID antennas. During the construction phase until 2019, the RFID infrastructure was continuously expanded. Today, around 3,600 readers are integrated in the entire building complex. "We assume that Aarhus University Hospital currently has the most powerful UHF RFID infrastructure in the world," states Lars Ganzhorn Knudsen. From the point of view of Knudsen, an innovation expert, the size of a hospital is an important factor for the effi ciency of an IoT solution. "Localization and object or personnel identification become more complicated the larger a clinic is. The advantages increase with the size of the clinic. Therefore, the ROI can only be achieved from a certain clinic size."
Over 20 RFID Applications Already Fully Integrated
Today, more than 35,000 objects are labeled with RFID tags. These include several thousand trolleys and mobile load carriers, boxes, mobile tools, hundreds of medical devices, and laboratory samples. The hospitals are currently running pilot tests regarding the tagging of employee ID cards. If successful this will be considered to be implemented for specific members. All uniforms are tagged with RFID, however, the possibility of using this in the hospital supply chain is to be implemented in the future.
Over 20 different assets have been tagged. All tracking information converges on one IoT platform. The platform is directly networked via interfaces with the clinical information system and a task management application.
Decentralized: Staff from all Stations Contribute Solution Proposals
The adoption of new RFID-based process optimizations was originally a top-down process, centrally controlled by the hospital management. Today, however, implementations also take place bottomup, without a preceding central planning phase. Employees from departments or functional units report directly to the hospital's tag lab, for example to track boxes in an area where frequently needed equipment is stored. This application is intended exclusively for a specific application.
"The bottom-up approach is clear evidence that hospital staff view RFID and IoT as a fundamentally available service – comparable to water, electricity and the IT network. That was the objective, but it took years for this perception to become firmly established. The investments in infrastructure were high. But now it pays off twice and three times as much. The infrastructure has a rock-solid performance. We have not seen any significant failures or need for follow-up work. Of course, one of the approximately 3,600 readers installed may have a defect. But the error rate is no greater than with other supply systems such as electricity, IT or water," reports Lars Ganzhorn Knudsen.
OR Management: +400 Tagged Case Carts
The most recent rollout in Aarhus is the optimization of the logistics process of sterile goods with tagged case carts. In the warehouse the information from the trolley tag is recorded and then married to the case cart via barcode with the individual IDs of all instruments. For very complex operations, up to seven of these surgical trolleys must be assembled. The virtual shopping cart of the software displays exactly which instrument is in which trolley.
"Only when such transparency is provided is the authority to act on the part of the employees. They can take action. For instance, they can adjust the operation plan on short notice," explains Lars Ganzhorn Knudsen. Moving the case carts to a transfer area automatically triggers a message in the task management system for the staff group responsible for transporting the trolleys between the individual departments and areas.
Since each employee badge is equipped with a UHF transponder, the system can display the task to the next employee in line. At the same time, the OR employee who ordered the instrument can view the current status at any time: In which area are the trolleys? Who has assembled the instruments? When are they in the OR transfer room? "Before the case carts were integrated into the RFID network, several telephone calls were necessary.
Today, these have been eliminated. This already affects the booking of instruments for scheduled operations. The 'Soduko Algorithm' developed by the IT team constantly updates the pool of available instruments. OR managers have real-time access to data and can book case carts for exact days and times.
Apply the RFID Tag and Immediately Identify the Object Digitally within the System
A part of the more than 350,000 tagged assets are all hospital beds and wheelchairs. In addition, there is a growing number of tagged mobile medical devices. An example during the Covid 19 pandemic shows how fl exibly the hospital can react to new situations and requirements. The university hospital was transformed from a general hospital to a "corona hospital" within a very short period of time. All scheduled but not vital operations were postponed, in order to free up capacities for the intensive medical care of Covid-19 patients.
Depending on the severity of the pandemic, 74 intensive care units are available in Aarhus. To ensure the availability of ventilators and to be able to locate all devices immediately, 132 devices were tagged with RFID labels within a weekend. The existing RFID infrastructure ensures the best possible availability and capacity utilization.
Anonymous Tracking of Employees during Logistical Tasks
For data privacy reasons, the University Hospital does not employ permanent employee tracking in the pilot phase. Not every employee is continuously visible during his/her working hours. As far as logistical processes are concerned, however, the employees are tracked. In the past, available employees had to be called by phone in order to assign them to transports on the premises or from one station to the next. Today, the transport order is specified in the task management system, so that all available logistics employees automatically receive this order digitally. The recording and visualization of employees is anonymous.
Mix-Ups Made Impossible: Each Patient Is Clearly Identifiable
Disposable patient wristbands are widely used in the international hospital landscape. In Aarhus, every patient receives a wristband with a printed barcode. This unambiguous identifi cation ensures, for example, that medication is correctly administered. If a doctor prescribes a drug, this information is entered into the clinical information system. A task is created in task management application. This triggers the compilation of the medication order by a commissioning robot in the hospital pharmacy. The drugs are sent by pneumatic tube to the appropriate ward.
A new task is created directly on the ward for the attending physician or the responsible nurse. To indicate this task as completed in the management system, the employee logs in, scans the barcode on the medication and then the barcode on the patient's wristband via smartphone. The correct delivery and administration of the medication is ensured and automatically documented.