Patient entertainment and education access systems, also called “patient portals” or “interactive patient entertainment solutions,” are transforming the hospital patient experience and optimizing health care delivery.
They are being used to integrate support services and clinical information systems to increase operational efficiencies and reduce patient wait times as well as to give patients access to on-demand entertainment, educational programming, Web content and communications tools such as e-mail and video teleconferencing.
As the patient entertainment and education access system becomes a base-level expectation for the hospital environment, organizations must examine how this technology will impact their planning for renovation and new construction projects and information technology strategic master planning.
The transformation
The fundamental building blocks of patient entertainment and education access technology are not new to the hospital environment of care. Traditional television programming coupled with varying degrees of on-demand content have been available to health care inpatients for decades.
However, recent advances in high-speed data networks, Internet protocol (IP) networking, technology convergence, Web-based applications and multimedia content have transformed the television into a low-cost portal connecting patients with the world. Additionally, the continued maturation of Internet-based services has greatly improved the methods of accessing and delivering entertainment and education to the bedside and virtually any other location in the health care enterprise.
Current methods of providing patient entertainment and education access technologies vary in the way patients access the content and the means by which the content is broadcast to each television, but most systems include several core components. Patients generally use a remote control, keyboard or touch screen to navigate a series of menus containing content options. Once a patient has selected a program, head-end servers send the selected content to the appropriate television.
Each vendor’s patient entertainment and education access system varies in appearance, but most generally include a bedside remote control, such as a pillow speaker, a wireless keyboard and mouse with controls; a control box attached to a television monitor that interfaces with the cable television system or IP network; a coaxial or unshielded twisted pair (UTP) network connection to the transmission equipment located in a nearby communications room; and centralized head-end equipment located in the facility’s main distribution frame or data center.
Until recently, patient entertainment and education access systems normally resided on legacy broadband coaxial CATV distribution networks. However, because of newer IP-based technologies and the demand for the delivery of rich and robust media content, it is important to leverage the existing infrastructure while concurrently designing a new infrastructure to handle the convergence of video, voice and data. This is why UTP is becoming the new infrastructure standard of choice.
Through such an infrastructure backbone, a variety of services and content are available to patients and staff, including the following:
- On-demand movies similar to those found in hotels are available as pay-per-view or as an expanded channel selection in hospitals.
- On-demand educational content is becoming one of the most important aspects of education and entertainment. For instance, prescriptive health education can be provided to patients to help educate them in the treatment of their disease.
- Video games can help occupy patients and visitors during periods of inactivity, helping to decrease the perceived length of stay.
- Web access offers patients the ability to communicate in real time with their physicians, friends and families.
- Integrating food services information into the media content allows patients the opportunity to view menu selections tailored to their prescribed diets, to make their selections and to schedule their meal times.
For the hospital staff, these systems can provide point-of-care services with access to software applications such as electronic medical records and patient schedules and, in the future, other electronic resources yet to be defined.
Impacts to the facility
Space and infrastructure requirements play a big role in the planned deployment of a patient education and entertainment system. These requirements range from the form factors of the various system components to electrical power requirements, low-voltage cabling requirements and space for back-end devices, just to name a few. The ability to meet these requirements varies radically from project to project and significantly depends on whether the project is new construction or an upgrade to an existing facility.
• Deploying in new construction. The key to deployment of a patient education and entertainment system in new construction is consensus planning.
The coordination begins with departmental programming. This focuses on collecting input from anyone who has a stake in the project. This usually includes administrators, clinical staff, physicians, support services managers and anyone else who will be affected by the new system. This process includes early meetings intended to review the critical features and impacts of the new system.
The imperative at this stage of the project is to introduce staff to the capabilities of the technology and get them thinking about potential impacts on their departments. Many tools, such as “blue sky visioning” sessions, focus groups and surveys, can be used to guide this process .
Programming culminates in a conceptual narrative describing the various functions and features desired by the staff (usually based on staff surveys), maintenance procedures with any warranty requirements and the graphical interface. This functional basis of design will be the foundation for preliminary infrastructure design and serve as the first draft for a request for proposal.
This process is completed well in advance of the system installation. Thus, there will be aspects of the basis of design that require revision before actual installation. These revisions will result from advances in technology, changes in staff requirements and changes to the scope of the overall project.
With these high-level system requirements in hand, designers can begin to engineer support spaces and the cabled infrastructure to support the system. Readers with experience in the architectural and engineering design process know that the flexibility of the design steadily decreases as project time passes, eventually reaching a point where changes must stop.
For example, space planning is the first design element to reach the point of no return. Like all technology systems, patient education and entertainment solutions require space for head-end equipment such as racks, servers, service provider connections, modulators and satellite dishes as well as intermediate equipment throughout the facility such as splitters, patch panels or switches. Once space has been allocated, it is very difficult to acquire more. Therefore, designers must have an idea of how much space will be needed to support the system.
Given the speedy and unrelenting nature of technology development, two key factors in designing a patient education and entertainment system must guide any project plan. These are planning a design that is flexible and engineering an infrastructure that is reliable.
The design must be flexible so that the regular technology modifications during design are quick and simple. This includes cable and termination types, location of end devices or changes to system features. A reliable infrastructure must accommodate modifications to system components in the distant future so that the impact on operations as well as the building will be minimized.
• Deploying in existing facilities. Planning for deployment in an existing facility contrasts significantly with planning for new construction.
First, system selection will be affected by current spaces and infrastructure. For example, screen size may be limited by available wall space or weight restrictions on mounting hardware. Some solutions might include a bedside screen and interface mounted on a swivel arm. Such a system would require detailed coordination with many other bedside devices as well as confirmation of the availability of power and data outlet locations on the patient room headwall.
Regarding the existing cable plant, it is likely that most of the television locations are only cabled with coaxial cable, and many patient education and entertainment access systems are moving toward an IP-based solution requiring UTP. This means that it is necessary to review what systems are built for a coaxial infrastructure and to consider upgrading the cable plant in the existing facility. Should the system of choice require UTP, the resulting cable upgrade will require great planning and effort.
After weighing the impacts upon the operations and budget, a designer may decide to limit the system selection only to solutions that will operate across the existing infrastructure. It quickly becomes obvious that the process of planning a system deployment in an existing building faces extraordinary difficulty.
In a nutshell, the choice must be made between allowing current infrastructure to limit the system selection or allowing the system selection to drive a painful renovation of an existing facility. One way or another, the decision will impact the organization for years to come, so it must be made by consensus and with great caution.
Looking to the future
Moving further into the future, health care delivery will likely require video conferencing at the point of care. The delivery method will require a video presence between the caregiver and the patient or between the physician and the caregiver.
Individualized patient care will become personal and timely and will offer feedback and an overall improved patient experience. Video conferencing will provide the venue necessary to enhance treatment of a patient in a mobile care environment with accurate and up-to-date information.
Scheduling information will be shared with the patient, the clinical staff and the support staff, all in real time to maximize staff utilization and improve operational efficiencies.
Staff will be able to view and schedule procedures in advance and arrange adequate and timely transportation, resulting in reduced wait times, increased patient throughput and reduced operational costs. The patient and family will be able to see which procedures are scheduled throughout the day and which physician will be seeing them, order meals in advance, and schedule their entertainment and visiting hours around their care.
Electronic medical records will be implemented in all organizations having the responsibility of treating patients. A complex combination of integrated software applications, patient entertainment and education access will promote and enhance information exchange among health care organizations, primary caregivers, physician practices, and inpatient and outpatient centers.
Using the electronic medical record via the patient entertainment and education access will incorporate a new model of patient care. New services such as e-health, mobile care, remote delivery of care and remote diagnostics will be transparent.
Convergence of technology
The convergence of technology, infrastructure and integrated software applications provides new tools that will give power to the users.
The convergence and integration of these technologies can give patients additional control over their stays and can give staff the tools they need to help patients actively participate in their own care. n
Chris Miller, CPHIMS, is an information technology senior project manager at Sparling, a Seattle-based technology consulting firm. He can be reached at cmiller@sparling.com. Nate Larmore, CCNP, ICNC, MCSE, is an associate and information technology senior project manager at Sparling. He can be contacted at nlarmore@sparling.com.
This article first appeared in the July 2007 issue of HFM.
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