14 May 2018 at 04:30 NEWSPAPER SECTION: ASIA FOCUS | WRITER: TANYATORN TONGWARANAN Dr Nina Kao demonstrates the infotainment offerings available in a room at Yuanlin Christian Hospital, part of the Changhua Christian Hospital (CCH) group in Taiwan. Smart healthcare requires a lot of factors to come together to deliver the best results to patients. For hospital operators, that includes smart building design where infrastructure and medical devices are interconnected with real-time data collection, cloud computing and big-data analysis. This dream of building a smart hospital has become a reality in Changhua, Taiwan's smallest and most populous county, a three-hour drive from Taipei with a population of 1.3 million. Because emergency care and medical resources in the area were scarce, Dr Kwo-Whei Lee decided to establish Yuanlin Christian Hospital (YCH) as the 11th branch of Changhua Christian Hospital (CCH) with the primary focus on comprehensive medical care through innovative and advanced technology. "The healthcare industry is a free market and we continuously need to compete with each other. We need to be efficient so that we can survive and make revenue. Different hospitals need to develop their own strategies," Dr Lee told Asia Focus recently during the Smart City Brands media tour hosted by the Taiwan External Trade Development Council. "Proper building design and spatial planning have proved to contribute to patients' healing journey, lower infection rates and reduce the length of hospital stays, while being able to generate higher efficiency in medical procedures and reduce energy consumption," he said. Images from a scan of a patient’s eye can be relayed to remote locations via the MiiS telemedicine application. For more than 120 years, CCH has been the prime health provider to people in central Taiwan with 11 hospital branches and 3,700 beds in Taichung, Changhua, Nantou and Yunlin counties. The group employs 8,000 staff. Over the past 15 years at CCH, Dr Lee has carefully observed the strengths and weaknesses in the medical system. The limitations he saw led him to believe there was a better way forward. With this in mind, he established YCH in 2015 as a small but highly sophisticated hospital with a full array of smart features and interconnected infrastructure to increase efficiency of medical operations, reduce energy consumption and enhance patients' experience. "We conceptualised the idea here as I wanted to overcome the issues at our current hospitals. I know the problems very well and know exactly where to change and what to improve," he said. Through smart spatial planning and data management, the hospital is able to increase efficiency and reduce costs and waiting times for patients, keeping them satisfied. "The idea is to develop a smart, resource-efficient and environmentally friendly hospital with comprehensive medical care and patientcentric services," Dr Lee said. “Proper building design and spatial planning has proven to contribute to patients’ healing journey, lower infection rates and reduce the length of hospital stays” — DR KWO-WHEI LEE, CEO, Yuanlin Christian Hospital "Patients want personalised medical information and precise diagnosis and demand prompt and 24/7 services. From the perspective of a healthcare service provider, we must provide according to what they need." Currently, YCH has 400 beds and full-scale medical facilities including major surgery, all-dimensional examination, obstetrics and gynaecology, major trauma, cardiovascular, paediatric emergency, 29 medical specialties and an air ambulance helipad. Because Taiwan has a vibrant information communication and technology industry, hospital managers can also collaborate with local technology companies without having to venture overseas. GREEN & PATIENT-CENTRIC The focus on patients begins with providing them with digital tools to input information about themselves to the hospital information system (HIS) without the need for human intervention, reducing the hassle of long waits and queues. A patient only needs his or her national health insurance card to initiate a primary check-up at a self-service kiosk, which measures vital signs and automatically prepares and labels test-tubes for further tests. "This shortens patients' waiting time and allows zero human errors," Dr Lee said. "With 2,500 to 3,000 outpatients per day, there has to be a system that engages the patients with medical service that is quick and precise." The inpatient experience is also a pleasant one. A touch-screen bedside infotainment system provides hospital information, diagnosis results and treatment options as well as entertainment options, so patients can learn about their conditions while being entertained. The hospital also places a significant emphasis on infection control through spatial design and technology. The intensive care unit (ICU), for instance, is designed with an overhanging cantilevered system in which none of the medical equipment touches the floor. Rooms are also curtain-free with electrically operated switchable glass compartments, reducing the risk of bacteria growing on the curtain. "We place the highest standard on infection control and we aim to minimise any possible risks of bacterial growth and viruses," said Dr Lee. The routes used to transport contaminated objects and sterile objects are also clearly separated, which eliminates any possibility of contaminating surgical tools. In the dentistry clinic, for instance, an overhead automated light-rail transport system transfers contaminated dental instruments to the cleaning and sterilising room. In the operating room there is Orber, a medical transport robot that can carry up to 150 kilogrammes of contaminated surgical materials to the cleaning room. "This can reduce the chances of work injury during the process of transport, and can avoid the risk of cross-infection when the transport is carried out by the staff," he said. The hospital also offers a long-distance consultation system through a robot. For example, it can evaluate whether a patient with acute stroke needs to be injected with rt-PA, a protein involved in the breakdown of blood clots. Another feature that sets YCH apart from many smart hospital designs is its energy management system (EMS). Real-time detection of outdoor environmental conditions helps determine appropriate indoor lighting, air-conditioning and energy requirements within each room. "We purposely designed the green building and smart energy control system to reduce energy consumption," Dr Lee said, adding that the visualisation dashboard and a control system can automatically adjust the output of the facilities to meet only the actual energy required. "Air-conditioning for operating rooms that are not being used, for instance, will not be turned on." In addition, the building is built with sun-blocking, and low-carbon construction materials with a heat recovery pump system, solar water-heating system, ice-storage air-conditioning system and rainwater recycling system to further reduce energy use. ATTRACTIVE INVESTMENT According to Dr Lee, the initial capital investment for the hospital was NT$4 billion (US$134 million) which is five or six times higher than for a traditional hospital of a similar size. This reflected the high commitment to research and development (R&D) and technology. "However, the turnover is much quicker than for a traditional hospital with revenue growing about 8-10 times faster compared to a traditional hospital," he said. He sees Southeast Asia as a great place to apply a similar model, giving its thriving economies, rising demand for healthcare and the low number of physicians. Making the hospital system more efficient has become crucial. There has been some interest among hospitals in the region, he said. "Hospital operators from Thailand, the Philippines, Malaysia, Laos and Myanmar are interested in our smart hospital system, and want to collaborate with us. "This will be good for them as they will not have to spend a lot of time and resources to go through trial and error building up a smart system. They can jump right away to the same level as ours." Dr Lee's plan for YCH over the next few years is to continue to deepen the technology and ICT system and ensure the highest information security for the patients. "We don't focus solely on the expansion of hospital size or number of beds," he said. That's good news for businesses that supply smart hospitals too. "Implementing digital platforms in hospital systems will help drive 20% growth in the medical computing market," said Vivi Yen, business development manager at Advantech Co Ltd, one of the key technology suppliers for YCH. "Digitisation will increase the efficiency of overall hospital operations and reduce manual tasks for physicians and nurses." Ms Yen said Advantech was currently working on similar installations in Southeast Asia including Singapore, Malaysia, Thailand and Vietnam. The top challenges for emerging markets, she pointed out, include infrastructure, transmission capability, software and system integration. The key is to collaborate with the right local partners and understand their requirements, as priorities and levels of technological advancement in each country are different, she added.