A world-first digital hospitals handbook published in Australia recommends reviewing the ICT knowledge of management and boards, engaging clinical change champions, and throwing out the rule book when it comes to ICT budget calculations for healthcare organisations planning to transition to digital technologies.

The new Standards Australia publication, developed as a handbook for private and public health systems, provides guidance on governance, business cases, systems architecture, staff training, risk management, change management and systems testing.

The Digital Hospitals Handbook applies a contemporary digital lens over the model of care and design of hospitals, according to Standards Australia CEO Dr Bronwyn Evans.

“The document effectively aligns with industry policy, addressing the importance of technology for the sector’s future. As the first of its kind in the world, it showcases Australia’s competitiveness and capacity for innovation,” Dr Evans said.

A Standards Australia technical committee composed of representatives from government, industry, academic and health organisations contributed to the production of the guidebook, which says that despite some examples of early adoption there is much disruption to come.

“It is still early days in the realisation of what might be termed a fully digital hospital. Certainly no site in Australia has implemented all available pragmatic digital technologies, for all disciplines, or is fully electronically engaged with consumers and all other parts of the health system,” the Digital Hospitals Handbook says.

For those hospitals seeking to digitally transform, the report recommends high-level leadership of the program, investment in change management and the early involvement of enterprise architects for what is an organisation-wide transformation.

“It is neither an IT project nor a building project, rather it is a business transformation program.”

The handbook’s recommendations include:

  • The program’s vision should be a realistic description of a successful outcome and chosen carefully to prevent it becoming a ‘political’ target or distraction.

  • The highest level of organisational governance – usually a board – should have final accountability for the program, while sponsorship is undertaken by the CEO who should be heavily committed both publicly and privately.

  • The composition of the board and executive should be reviewed to verify they can provide the necessary leadership and experience.

  • The enterprise architect and building architect need to collaborate. For a new digital hospital, engagement with enterprise architecture should commence no later than with architecture for the hospital building itself. For an existing hospital, the enterprise architect should be the first engagement.

  • Quality surveyors should no longer use percentage of construction cost or floor space-based calculations for ICT budget estimates for a digital hospital program.

  • Change management champions should be identified early in the communication process.

  • Clinicians of all types are the most important user category – key target benefits will be clinical, a key risk is clinical safety, and clinical workflows are the most impacted. Consideration should be given to creating permanent roles for chief clinical, medical and nursing information officers.

  • A digital hospital is a different organisation and the organisational structure, staff profile, operating costs, asset profile and risk profile should be reviewed.

  • Where the CIO does not currently report to the CEO this should be reviewed.

  • Training of end users should occur as close to go-live as possible to ensure maximum retention of the training.

  • The final testing of ICT systems should be in production environments, including mock go-lives, life-and-death scenarios and pull-the-cord-out situations.

  • The executive and managements need to sustain awareness of IM&ICT and related disciplines.

  • The memberships of the risk and audit or equivalent committee should be evaluated for the required skills, for example in data privacy and cybersecurity.

 

The committee made no recommendation when it came to going live with a staged or “big bang” approach, saying there had been successful examples of both.