Barely four months into 2020 and the world has gone topsy-turvy with the sudden outbreak of COVID-19. The ASEAN healthcare system has been pushed to its limits. Hospitals in countries such as Thailand and the Philippines are straining at the seams to treat those afflicted. In Indonesia, the Asian Games athletes village has been turned into emergency hospital to cope with the rising number of coronavirus cases. Closer at home, the Ministry of Health had advised local doctors to stop or defer accepting non-resident foreign patients.
As the number of cases soar within the region, what measures should hospitals adopt in the fight against the fast-spreading contagion? It’s a complex business building hospitals, even more so with setting up an emergency infectious disease hospital within a short time period. At the core is four elements: human, processes, equipment and space; and the holistic interplay between them. The facility has to be properly fitted-out with the requisite analysis, monitoring, control and emergency response capabilities to treat infected cases and handle public emergencies.
Empowering the human
The human element underpins any hospital operations. The extensiveness and agility of collaboration among various specialist divisions should be considered. Integration of data, network, and building technologies into a centralised command platform would enhance seamless facility-wide co-ordination involving different units, departments and their corresponding supplies.
Communication is key. In today’s fluid environment, it’s important to keep emergency communications lines open to facilitate multi-party dialogue, information dissemination and decision-making.
Technology and artificial intelligence (AI) would greatly improve medical workers’ efficiency and effectiveness. Medical teams could leverage information technology to enhance the accuracy and speed of their diagnostic capabilities. AI could also help medical teams in risk management, where the technology could analyse threat types, threat severity and the likelihood of occurrence and integrates the insights with the hospital’s assets and resources to determine the risk levels.
Digitalisation of processes and optimising workflows are crucial steps to improving institutional response to emergency situations. Insights gained from digitalisation (which enables efficient analysis of the volume of data amassed) and workflow optimisation (such as early warning and control management) could be re-channeled into the healthcare system and adopted as best practices.
Smart technology could help to lighten the arduous process of contact tracing and monitoring in the region. Automated alerts could be set up that bypass the need for a manual contact center. Human intervention would only be needed for onsite verification of those whom need to be quarantined.
The use of AI technology would speed up the screening process. An infrared body temperature screening instrument is able to quickly detect people with a fever within a fast-moving crowd for initial disease screening. This is useful in reducing staff pressure, improving efficiency and accuracy, minimising direct contact and avoiding transmission. Once fever is detected in a patient, the system could be synced with security video surveillance to achieve location tracking. Through advanced algorithm, people who had been in close contact with affected patients could be tracked and alerted of their risk level. Real-time data could be used to analyse the developmental trends of similar cases and to determine if the cases are homologous.
Hospitals in ASEAN and all around the world would also benefit from integrated solutions that provide comprehensive situational awareness on operational aspects. An example could be bed capacity optimisation: Given that hospitals are operating at close to capacity, we could leverage smart technology for automated discharge. The system could identify when a patient is suitable for discharge — by using inputs on vital signs from the patient’s monitors to verify his/her well-being
against specific parameters. The discharge could then be confirmed via a healthcare professional. Subsequent follow up could be done via SMS over a 30-day monitoring period to determine the patient’s health status, and to ascertain if there’s a need for readmission or deployment of doorstep consultation.
Data analytics could be harnessed to better manage hospital workflows. Data analysis could also provide insights on personnel movements, including medical staff, within the compound. Real-time analysis on the operational status of each hospital sub-system is critical in ensuring the smooth-running of the medical facility.
Equipment and resources overview
Having a comprehensive overview of hospital resources is equally important. An integrated platform on the status of people, processes, equipment and space enables visual trend analysis and predictive management based on real-time and historical data.
The practice of good hygiene within the healthcare facility continues to be strategic in containing outbreaks. The latest estimates (March 19) by the World Health Organization showed that only half of countries around the world have a national infection prevention and control programme and WASH (water, sanitation and hygiene) standards in all healthcare facilities. To address this issue, smart washrooms solution, which tracks usage and replenishment of consumables and monitors air quality, could be implemented in hospitals in this region.
An integrated command center is necessary to ensure round-the-clock monitoring of negative pressure wards in infectious disease hospitals. Air pressure in these special rooms is lower than that of ambient air to prevent the release of contaminated air. The pressure difference between the public corridor, the corridor for medical personnel and the buffer area has to be maintained at a certain reading. The command center is essential in monitoring the negative pressure for these wards and nursing calls to protect the medical workers from unnecessary contact.
Good space management
The significance of good space management must be emphasised. Proper time and space management such as, route planning for quarantine areas and processes, is important to ensuring public safety in hospitals. Hospital waste management could benefit from smart technology. Intelligent logistics robots could be deployed to handle and process medical waste, thus reducing exposure and risk of transmission to humans. For manual work that is still necessary, spatial movements could be controlled through route designation for transporting clean and contaminated items, thereby avoiding a crossover.
A “three-zones-two-channels” layout is recommended for more effective containment of infectious diseases. The "three zones" refer to clean zones, semi-contamination zones, and contamination zones. The air between the zones should flow unidirectionally from the clean zone to the semi-contaminated zone to the contaminated zone, in accordance to varied pressure levels. The "two channels" refers to the routes for medical personnel and patients. A buffer room should be set up between the corridor for medical personnel and patients’ ward to ensure a separation of movement between medical personnel and patients. There should be a special double-layered window between the ward and the corridor for medical personnel. The windows on either side cannot be opened at the same time, which effectively prevents transmission.
Riding out the pandemic
In the face of the prolonged pandemic, technology can play a greater role alongside healthcare workers to care for patients. For instance, robots can help take vital signs, deliver medicine, disinfect the facility and entertain quarantined patients. Internet of Things (IoT) could monitor the daily temperatures of high-risk patients on quarantine via their mobile devices and upload the data to the cloud for analysis. This allows more data to be collected efficiently and reduce cross-infection with the patients.
The accelerated spread of COVID-19 has exposed structural problems in the global and regional healthcare system. The crisis demonstrates the importance of the ability to scale capacity quickly in response to the outbreak. Putting the right built technology to work to speed the building of healthcare facilities within ASEAN, and to connect all four elements of human, processes, equipment and space, will help address capacity issues in the region, going forward.
The writer is Vice President Asia Pacific &Managing Director Growth Markets, Johnson Controls.