Please can you give a brief introduction to wearable technology?
Bob Zemke: Wearables is very much an emerging trend and healthcare is leading this effort. Consumer technology, such as the FitBit, Jawbone, and others, are going to merge with medical devices that are already being used in hospitals today.
In wearables, the analysis is around what value can be gained by real-time telemetry information being sent from a patient into a system for constant monitoring and evaluation. Or can we collect this information and then use it to have better evidence for analysis and for trends such as diabetes management?
Another example would be post-discharge, how much movement are we even seeing from a patient with maybe a cardiac issue, or mobility osteopathic-related issue.
So really it’s about how can we leverage technology now to give us more insight into either how the patient’s body is performing or the actual activities of the patient and provide that back to the clinician.
How has wearable technology advanced over recent years?
Bob Zemke: Well, there are two sides this: one is what I consider the medical devices. When we were monitoring patients ten years ago inside hospitals, everything required wires so mobility was very limited.
At first, medical manufacturers started to create telemetry systems that could be worn so that patients could move around the hospital. Post-surgery, the faster we can have a patient start to move around, usually the quicker they start to heal.
I know when my father had knee replacement surgery he was envisioning being able to lay on the couch for the summer to recover. He was rather shocked when the physician said, no, you’ll be in physical therapy the day after.
Now we’re starting to see almost the consumerization of technology. I think in the next couple of years this is going to lead to smaller, lighter devices that are going to be easier for clinicians to deploy.
Also we have the adoption of high speed internet at home and on our smart phones. A lot of the wearables are using Bluetooth and they feed back to the smartphone and the smartphone will then relay that data back to either your primary physician or back to the hospital.
What impact do you think wearables will have on healthcare in 2015?
Bob Zemke: The first thing I see is there’s a real goal of trying to shape the behavior of patients and encourage positive reinforcement or negative reinforcement.
We’re seeing greater adoption of wearables that are feeding back to your general practitioner. This means there is a greater focus on the trends. Also, I’ve noticed for myself, and others, there becomes no lying to yourself about your own fitness routine or dietary habits.
The consumer device shows how active you are all the time, so it provides consistent reinforcement.
I think in the next few years we’re going to see increased adoption of wearables that try to keep us motivated, this should hopefully lead to people making better choices and not just in preparation for the scheduled visits we have with our physicians.
How will wearable technology in healthcare change the doctor-patient relationship?
Bob Zemke: In the past we’ve asked patients to provide paper-based surveys recording their own information. That hasn’t always been an accurate assessment of what’s really taking place.
I think the technology is going to allow less effort from the patient to be providing accurate information back to their clinician for assessment.
How important is data analytics in healthcare?
Bob Zemke: Extremely important and from a few different angles. When we talk about analytics, depending on what your role is in the hospital you tend to have a very different definition.
So we can talk in terms of big data and mega-trends, such as what we’re seeing globally or nationally at the hospital in terms of the types of patients coming in, what type of care is required and so forth.
We can also get into the more raw data and I know Mark has done a lot with this, in terms of understanding how information is flowing inside of the hospital network what type of applications are being used more than others, what’s the performance of them.
There’s always that question when you roll something out has there been adequate training? Well if there’s a high adoption level and you can see that with analytics then you know you’ve been successful.
Low adoption could indicate a training issue or it could be the application needs to be rewritten to be more accommodating to the clinician.
Mark Taglietti: The ICT Directorate at UCLH manages and delivers services across a large estate and technically complex environment – six hospital sites in central London. This is the reason why I am interested in technical analytics. Having access to real-time and historical data on how the technical estate is performing, ensures that we are both an informed provider of services whilst also being intelligent customers and buyers of services.
Analytics are vital at the technical layer because they enable the team to understand how the environment is performing, and therefore allow us to be proactive in the way in which we deliver services. We know, for example, how systems are operating, how we are utilizing capacity and where pressure points are; we can then use this data to make informed tactical and strategic decisions.
In this regard I view analytical platforms as vitally important components of the armoury that we can use to improve service delivery and quality, and derive value to the organisation. This is why I have been on a mission to develop, in conjunction with a range of supplier partners, including Extreme Networks, an integrated analytical toolset that provides a holistic view of how the technical estate is performing, both at the end-user technology layer, such as end user computing devices, but also the network and applications layer.
It is important to note that we are focusing purely on the technical aspects of analytics at this stage.
Please can you outline the data analytics program UCLH is working on using Extreme Network’s data analysis tool?
Mark Taglietti: From an ICT perspective, we started this journey in middle 2013 and focused purely on end-user technology analytics, i.e. what is occurring from the user perspective through intelligence gathered from the desktop or laptop computer. It is important to note that this is not about monitoring usage, but rather understanding, reporting and responding to how the computer is interoperating and functioning – both locally and across the network.
Intelligence gathered has enabled a number of operational improvements to the design and use of the computer estate across the trust, and has proved pivotal in making strategic purchasing decisions, whilst enabling a range of ‘service improvement’ and sustainability initiatives.
Such was the success and benefits provided though end-user technology analytics that it seemed right to investigate and consider options around networking and application analytics.
Our physical networking architecture is based upon platforms manufactured by Extreme networks, which provides the data transmission layer for our client, server and application estate.
Early in 2014, I was invited to a demonstration of the Purview analytical platform developed by Extreme networks. This subsequently resulted in a high level executive and engineering briefing with the provider of our “end-user technology” analytics platform, provided by Nexthink, and the agreement for both organisations to develop and produce an integrated platform set.
This approach is both insightful and powerful as it demonstrates that customers and suppliers, who provide differing platforms, are able to innovate through collaboration to develop integrated platforms that subsequently improve service delivery, quality and value.
As an ICT professional in the healthcare industry, I believe that technology can and does make a difference in the delivery of patient care. If we are able to design, build and deliver robust, highly available, and scalable technology services that accommodate clinical services, then we have succeeded. The information that analytical platforms provides absolutely assists in this regard.
Bob Zemke: I think one of the other areas is that Mark touched on is patient care and safety, however, efficiency is also key. Hospitals that are cash-strapped need to be looking at managing their operations at a smarter level.
What you need is intelligence and understanding; you need evidence before you can make decisions. So that’s the new focus with analytics, it’s not about just upgrading because we think it’s time, or looking at capacity issues, rather, what is causing the capacity issues? And is there something that we can do to remediate them that’s more cost-effective than just initially going back to the board and asking, OK, well it’s obvious we need more bandwidth.
Mark Taglietti: A good example is with firewalls. Our firewalls work extremely hard due to the sheer amount of rules that are required to ensure service availability and security. Network bandwidth is not a problem, but high CPU utilization is. If and when the processors are running high, then service degradation can occur.
Through network and application analytics, we can see what is happening across our network, such as the top users of services, what systems they are using, and if required, we can dynamically enforce policies to reduce that burden across the network and ensure bandwidth is available to critical services.
I can foresee a future where technology functions of any organisation will simply be able to dial up capacity to meet demand as and when required. This ability to dynamically manage consumption is extremely exciting and in some instances already available through the use of ‘software defined networking’.
Another example of ‘end-user technology’ analytics at a fundamental level is demonstrated through a recent visit to a clinical area within the hospital. I came across a consultant who was trying to access a browser-based system and was frustrated with the time taken to login. It was taking in excess of 60 seconds to resolve the host name and produce the logon screen.
Following some very basic troubleshooting, it became apparent that the machine was connected to the wrong network and this was resulting in connectivity and performance problems. A subsequent query into the analytics platform identified a further 20 machines that were also incorrectly patched and no doubt suffering the same fate.
Engineers were immediately dispatched and within one hour, all machines were re-patched and the service was fully restored. This is one of many examples whereby the capability provided by analytical platforms can be beneficial in both incident management and the delivery of service improvement initiatives.
Network analytics is also useful in the area of sustainability, for example organisations that are trying to reduce carbon emissions can report on device power management and enforce policies to reduce consumption of power. In print management, we can report on usage statistics such as pages printed and quality or output. This can facilitate discussions around acceptable use and policies that could ultimately result in reduced cost and consumption.
Another key area of value is the ability to prove innocence, for example it is often the case that when performance issues occur, it is generally the network that is the first to be focused on and blamed. This is no longer the case with network and application analytics, as we can now see an immediate side-by-side view of network latency and performance, against server, application or client performance. This is extremely beneficial in ensuring resources are quickly and correctly diverted to the actual cause of a problem, and subsequently reduces the ‘recovery time objective’ window.
For me, it’s extremely exciting to be in this position and to be working with partners like Extreme Networks and Nexthink to innovate and improve the quality of services that ICT can provide through the use of technical data analytics.
Do you think the healthcare industry is ready for the technologies of today and tomorrow?
Bob Zemke: I think in some areas healthcare gets a bad reputation as being last to innovate. But what I think is more important is we're not bleeding edge.
In the last five years the clinical community has started to come to IT with ideas, asking whether we can try certain things out. I think it is a much more welcoming and collaborative industry now than when I started years ago.
So I believe some hospitals are ready and some hospitals may not be, there’s always challenges around budget, and staffing.
Mark Taglietti: There are a number of challenges in this regard, one is financial, the other is finding and retaining talent, and the third is developing a culture based around a strategic vision that supports innovation, passion and determination for continual improvement and change. If you have the right ingredients, then anything is possible.
What are Extreme Networks’ and UCLH’s plans for the future with regards to wearables and data analytics in healthcare?
Mark Taglietti: One of the things that Purview can do is interrogate application data information from across the network. Therefore, it could potentially have clinical system management applications and it may be possible to use for clinical data analytical purposes. However, this is yet to be considered, investigated, tested or confirmed in our environment.
Bob Zemke: One of the key areas we’ve been working on with our customers and in general is preparing for what we see as this tidal wave of devices. Devices and applications that just continue to grow.
We’ve been working with a lot of hospitals and making sure that the foundation layer of just IT service delivery is rock-solid, so that it can support the patients, and it can support the mobility demand that the clinical environment has.
Because once you have mobility capabilities inside of a hospital, you can really start to impact workflow, you can bring mobile communication platforms in, move away from beepers, and start innovating more with smartphones, tablets, and some of the others.
It’s the clinicians that can really start bringing this to us, to how can they make their job easier or more efficient. How can they add additional value? So we’re just trying to make sure hospitals are ready for that.
The other side is analytics. Analytics is going to allow us to start providing that more evidence-based approach to IT service delivery. In the future, Mark’s going to be able to start to say, here’s the trends we’re seeing for application usage.
They may notice that hardly any clinicians are using a certain application anymore and there are expensive maintenance costs associated with it. Or there’s a better system out there.
By giving him more insight into the work flow and what is the overall technical heartbeat inside the hospital, he will make better decision.
When I used to be in operations, sometimes you interviewed a few departments, and then you just kind of went with your gut on what was needed. This is really the first time that we can start to say I know exactly what’s taking place, and here’s why. Here’s the evidence as why we’ve prepared for a budget or we recommend a migration to a new platform or replacement of devices.
Mark Taglietti: You no longer need to be a technical operations manager or engineer to get a view of how your environment is running; moreover you do not necessarily need to work within the Information Technology field, you just need access to information that is pertinent and relevant to your job, and this is where analytics is of value.
Another good point that Bob mentioned was software compliance. If you are buying enterprise-wide applications that people are not consuming then change your purchasing strategy. Analytics can assist in this regard as it can inform on service consumption. Simply put if you are not using a platform why buy it.
What have been the main takeaways from this partnership?
Mark Taglietti: We have worked together for the benefit of the hospital, its patients and to drive innovation in healthcare. It is refreshing to have access to organizations that are agile and flexible in their approach and can work in an innovative and collaborate way; they can simply get things done. In Extreme Networks, for example, you have Bob Zemke, who works for a networking company, yet his knowledge in relation to the healthcare sector is phenomenal.
The knowledge of the healthcare market over at Nexthink is also extremely strong. So again, you engage with the right supplier partners who have the right product, the right level of passion and determination to succeed, innovate, and continually improve their service and value offer.
Bob Zemke: There’s so much improvement that could be done in what we call the short stroke. And that so often when they hear about national healthcare challenges and the like, it’s always a decade long or it’s going to be a two-decade process before we achieve the goal. And that’s where I think the failure happens. And why health systems get a black eye, the IT departments get a black eye because the complexity of thinking too far, too grand.
We’ve accomplished so much with UCLH in a short period of time, by just focusing on the basics. We started whittling away as we started to make improvements and when we made those improvements it freed up resources and time to start going after more strategic goals versus tactical keeping the lights on.
I think that’s so important that we almost need to simplify our goals, and work from there, and that will then free up the resources, the financing, to look at grander goals.
Mark Taglietti: There is a habit of over-complicating things. What we are talking about here, in my personal opinion, is actually fairly straightforward and represents a pragmatic approach. By having the right mind-set and engaging with the right people, it should not be hard and I am not finding it hard.
It has actually been a fun and interesting journey, because we’ve been given the leverage and the latitude to simply get on with it.
Where can readers find more information?
About Mark Taglietti and Bob Zemke
Mark is the Head of ICT Service Delivery and Vendor Management at University College London Hospitals NHS Foundation Trust (UCLH).
The first fifteen years of his career were spent in London working within the investment banking sector, followed by eleven years in Australian public healthcare, before returning to the UK and assuming senior ICT roles for the London Ambulance Service, and more recently University College London Hospitals NHS Foundation Trust (UCLH).
“I am working to support the trust in delivering a transformational ICT programme that will realise the benefits of innovation in technology, support mobile and digital services, and deliver a world class technical architecture to support clinical services that ultimately result in the improved delivery of patient care, patient services and patient experience.” M Taglietti.
Bob Zemke is Director of Healthcare Solutions at Extreme Networks. An IT professional with a broad span of experience in healthcare, Bob has over 14 years working both within hospital IT and as a consultant in next generation network design, deployment and management. He is co-author of a booked called WiFi Enabled Healthcare, available on Amazon.com.