Canada asking HIMSS Analytics for improvements
TORONTO – It’s widely agreed that the HIMSS Analytics EMR Adoption Model is important – it rates hospitals on a scale of zero to seven, with seven signifying that a facility is totally computerized and uses paperless charting. But Canadian CIOs and IT directors have been clamouring lately for changes to the U.S.-centric HIMSS methodology, arguing that it needs refining and more applicability to Canada.
“It’s great that we have it, and we eagerly await the number we’re given each year,” commented Lydia Lee, president of COACH: Canada’s Health Informatics Association, and vice president and CIO of the University Health Network in Toronto. “It shows us how well we’re doing, and if other hospitals are getting higher numbers, we can watch what they’re doing and learn from them.”
However, Lee and COACH’s chief executive officer, Don Newsham, have been hearing from members of the healthcare IT community that the HIMSS Analytics methodology should be fine-tuned for Canada.
“In the Ontario context, where most hospitals are independent organizations, the number is meaningful,” said Lee. “But in most other parts of the country, where healthcare is organized into regions, it doesn’t work. The regions are trying to integrate hospitals with long-term care and home care and physicians, and the HIMSS Analytics framework doesn’t account for this.”
She explained that if one hospital in a healthcare region is given a high number, it doesn’t mean the whole region is functioning with a great deal of computerization. “Many of the regions would like to be measuring system-wide performance,” said Lee.
Other facets of the HIMSS Analytics Adoption Model are also being questioned. Indeed, so much discussion erupted earlier this year about the HIMSS Analytics methodology – a good deal of it at the eHealth 2011 conference that was held in Toronto, in May – that COACH convened a think-tank this summer to discuss the issues.
The think-tank session included COACH executives and members, representatives from HIMSS Analytics, leaders of Canada Health Infoway, and other players in Canadian healthcare IT. Out of the meeting, COACH produced a White Paper with its own critique, as well as recommendations and for the HIMSS Analytics model in Canada. The White Paper is to be disseminated in November.
In addition to measuring and including region-wide initiatives – to better account for Canadian health authorities – those at the COACH confab are urging HIMSS to widen the scope of their methods in other ways. “HIMSS measures adoption, for the most part, in one way – by looking at the functionality of a system in a hospital,” said Newsham. “We think they, and indeed any adoption model, should be looking at three areas – functionality, breadth of use, and outcomes – for patients and healthcare users.”
He explained that it takes more than having a CPOE or medication management system in place to make an impact. You should also be measuring how many providers are using the system and how many patients are benefiting from it.
“It’s great to have a great clinical system implemented, but if it doesn’t make a difference to patients, it doesn’t really matter,” said Newsham.
That’s why HIMSS should be tracking how extensively a system is used, he said, and how it affects the health of patients.
Lee acknowledged that it’s challenging to measure outcomes and to correlate them to the presence of an IT system. But she said there are broad measures that can be tracked and included in the equation – including mortality and morbidity rates, patient satisfaction and clinician satisfaction.
“This can all be done,” she said. “You can measure outcomes.”
She noted that HIMSS Analytics was also asked to start tracking the uptake of clinical systems in organizations outside of hospitals – including doctors’ offices. She said there is extensive activity already under way in Canada to measure usage in physician clinics, especially in provinces like Ontario, British Columbia, Alberta and Nova Scotia.
One initiative that COACH will be pursuing on its own is to act as an aggregator of knowledge and information about that usage and uptake of EMR systems across the country. Said Lee: “At the eHealth conference, we had people from Alberta, who were devising measurements for clinical system usage in doctors’ offices, saying to others from Nova Scotia, ‘we didn’t realize you were doing this too.’”
COACH intends to bridge this gap by showing who is working on what, and how far they have gotten. “There’s no sense in re-inventing the wheel,” said Newsham. “It’s far better to share experiences and know-how.”
In order to be eligible for the HIMSS Analytics EMR Adoption Model, a hospital must first participate in the organization’s annual IT study, which involves filling out forms with a great deal of detailed information. The data goes back to HIMSS, which then determines the ranking of a hospital – essentially, the number it is assigned on the 0-7 scale.
“Our members are saying they’d like to see how the number is worked out,” said Lee. “That would give them more information about where and how to improve in the future.”
However, HIMSS Analytics is reluctant to outline its methodology and how it crunches the numbers. “They are a private company, and their methodology is proprietary,” commented Lee. “If too much information is given away, its competitors will start using it.”
Finally, Canadian IT professionals in smaller hospitals across Canada have noted that it takes a good deal of time and effort each year to provide HIMSS Analytics with the data they ask for. “It’s not so bad for large organizations like the UHN,” commented Lee. “But the smaller hospitals are having trouble with it.”
These organizations are asking for accommodations to be made for them in the future, something COACH would like to see happen. For its part, HIMSS Analytics said it is willing to create a Canadian advisory committee as a way of providing more information to Canadian hospitals, and to keep closer tabs on the concerns of participants.
Upopolis now benefits children at Holland Bloorview rehab hospital
Upopolis.com, the first secure social networking site specifically designed for kids in hospital, launched at Toronto’s Holland Bloorview Kids Rehabilitation Hospital in September.
Holland Bloorview is the eighth facility and first children’s rehab hospital in Canada to be connected since the site was introduced at McMaster Children’s Hospital, in Hamilton, Ont., in 2007. For young children, and teens in particular, being in hospital and disconnected from their world, causes stress and anxiety.
Created by the non-profit Kids’ Health Link Foundation (KHL) and powered by TELUS, Upopolis offers the best features of social networking for young patients. Upopolis provides personal profiles, secure mail, instant chat, discussion boards, personal blogs, e-books, surveys, polls, newsfeeds and links to age-appropriate games.
What makes it unique – and special to kids in hospital – are features such as classroom and homework links, kid-friendly health and wellness information, and connecting children to share their medical condition and experiences.
Sheila Jarvis, president and CEO of Holland Bloorview, explained that the “average stay here is 61 days, and in some cases longer. For a young person, that can feel like a lifetime and can lead to feelings of loneliness, isolation and stress. Upopolis allows kids to stay connected to their friends and families, which is extremely important for their healing.”
Paul Lepage, senior vice-president, TELUS Health Solutions, said this shows the best of what the private and public sectors can do. “At TELUS, we give where we live. We’re helping make the future a little friendlier. That’s our motto.”
Sheridan Nurseries also partnered with KHL to bring Upopolis to Holland Bloorview, help with its initial implementation and to continue the program development for all connected hospitals across Canada.
Privacy, security and trust are fundamental to Upopolis’ design. “Each institution can customize Upopolis according to its own security preferences and cultural protocols,” said Basile Papaevangelou, KHLF founder and chair. “Upopolis is monitored to make sure there is no bullying, no inappropriate content or behaviour, and no access to unsafe sites such as diet sites that promote eating disorders.”
With Upopolis, patients can:
• Communicate/connect through instant chat and stay up-to-date with school work through a homework function connecting to teachers for assignments.
• Share their experiences, thoughts, opinions and photos on blogs and engage with others on discussion boards.
• Learn about their medical condition from kid-friendly medical content and what to expect about tests and procedures they will experience.
• Have fun with games, customize their profiles with different themes and colours, and find new online friends in the Upopolis community across Canada.
Jessica Greenwood, 13, and Lexie Zadorozniak, 12, are two in-patients who were on hand to demonstrate how they use Upopolis. Jessica said it helps her by talking to others: “I’ve made friends all over Canada, and I can still access it when I become an outpatient.”
Lexie’s mother is very impressed at how completely open the kids are with each other. “There’s no embarrassment when they discuss medical issues and what they’re going through; things that kids who are not experiencing medical care would find gross.”
But Upopolis isn’t just for kids. Parents can keep in touch with their children when visits are not possible, and they’re reassured that the kids connecting online have some sense of normalcy. Medical content written in plain language helps them understand their children’s condition and be better equipped to handle potentially difficult conversations. (McMaster Children’s Hospital created the site’s core medical library, and each hospital can supplement it with content specific to its culture and patient base.)
Child life specialists are given expanded resources to use as therapeutic tools or to provide fun and interactive distractions for patients during treatment. Feedback from the kids and specialists fuels continuous product improvement. The new version, V.1.6, is bilingual, and includes a calendar and group chat feature.
The online support network was inspired by the in-patient experiences of two teenaged friends, Christina Papaevangelou and Katy McDonald. In 2002, Christina was admitted to McMaster Children’s Hospital with a life-threatening illness, and not long after, Katy was diagnosed with cancer. Since Katy was hospitalized for a long period of time, she was feeling disconnected from friends, family and keeping up with schoolwork. Christina recovered, but Katy did not. Inspired by their friendship and common experiences, Christina began to explore ways to help kids in hospital stay connected to their outside world.
“Christina and I established Kids’ Health Links Foundation to make a difference in the lives of hospitalized children,” Christina’s father, Mr. Papaevangelou, said. “My dream would see it become international.”
Upopolis is a software-as-a-service (SaaS) solution hosted by TELUS, which partnered with Kids’ Health Links Foundation. TELUS’s in kind and cash investment, in excess of $1 million, covered initial specifications system architecture, delivering hardware and software and services for hosting, upgrades and improvements and funds to under-resourced hospitals to hire Child Life Specialists. TELUS will continue to provide site expansion, managed web hosting, application support and maintenance services over the course of the partnership.
Upopolis now connects kids at BC Children’s Hospital, IWK Health Centre (Halifax), Sick Kids, Ste. Justine (Montreal), Lutherwood (Waterloo, Ont.), Children’s Hospital of Eastern Ontario, and McMaster Children’s Hospital. More information is available at www.kidshealthlinks.org/
Telepharmacy increases pharmacist availability in small hospitals
In March 2010, West Haldimand General Hospital, a 23-bed facility with active emergency and day-surgery services in Hagersville, Ont., was looking for ways to include their hospital pharmacy in their outcome-based improvement programs.
Doing so was a challenge, as the hospital also faced a common and persistent constraint: The cost of a full-time equivalent (FTE) pharmacist was hard to justify on the basis of the low medication volumes.
West Haldimand initially entered into agreements with West Lincoln Memorial Hospital, a 50-bed hospital located sixty kilometers away in Grimsby, to share the services of a pharmacist/manager, who spent two days per week (0.4 FTE) at West Haldimand and three days per week (0.6 FTE) at West Lincoln.
Pharmacy technicians and nursing at West Haldimand performed the necessary quality checks when the pharmacist was unavailable. However, it was recognized that this temporary solution ran counter to trends in the healthcare industry, with pharmacy practice becoming more visible and pharmacists increasingly viewed as key contributors to medication management.
Concurrent to this trend, Accreditation Canada also started to look for evidence of pharmacist participation in outcome-based improvement programs and adverse drug reaction (ADR) risk mitigation planning.
Faced with overwhelming evidence that the status quo was unacceptable in the face of these pressures, West Haldimand management directed their new Pharmacy Manager to find ways to institute medication order review during prime daylight hours and arrange on-call services so that the organization had 24/7 access to a pharmacist.
Additionally, although not a requirement, hospital management preferred that the project be completed in eight months to avoid being in the middle of a workflow change-over during an upcoming Accreditation Canada visit.
Progress toward instituting a clinical pharmacy model was reprioritized to occur at a later date.
Of the two project objectives, after-hours coverage was less critical because dispensing during these hours was minimal and, if planned well, could be staged during prime hours. Therefore, solving the prime-hour FTE pharmacist oversight was the first order of business.
That project resolved into two medication workflow issues. First was the lack of planned, systematic medication order (prospective) review. Second, and equally important, was consistent, programmatic verification of the actual fill before delivery.
It was fairly obvious that the key was to find and deploy workflow solutions that would reduce cycle times and increase the pharmacist’s availability. Likewise, it was obvious that any solution would be information technology-based, since such technology is the only solution with claims of ‘doing more with less’ or at least ‘doing more with the same.’ What technology, and at what price?
Assisted by a team from North West Telepharmacy Solutions of Winnipeg, West Haldimand chose the Pharm-Q Electronic Supervision (ES) solution from Envision Telepharmacy of Alpine, Tex.
This state-of-the-art, web-based electronic supervision and medication order management (MOM) solution allows the authorized hospital pharmacist to review orders from any web-browser, located anywhere. It also provides anywhere/anytime high-definition electronic imaging of completed and filled orders, enabling the pharmacist to verify a fill before delivery to the floor, dispensing machine or patient.
A simplified end-to-end process begins with the nurse scanning an order sheet into the Pharm-Q ES system, at which time it shows up in the pharmacist’s queue as a line item waiting review. The pharmacist opens and reviews an order sheet, and either releases it for fulfillment or puts it on hold while waiting for additional information. Once a medication order is filled, the pharmacy technician arranges the medication on a specially designed, high-definition camera station, and takes a series of pictures which are electronically attached to the order sheet image, and are then sent for pharmacist verification. After the pharmacist verifies the fill, the order is ready to be delivered. The whole process occurs while the nurse, pharmacist and technician are in different areas of the hospital and in most cases while the pharmacist is remotely located.
The biggest impact on service levels and cycle time came from the switch from a paper to a paperless system, inherent with the use of a Medication Order Management (MOM) system.
While a paper-based system can be modified to provide remote medication order review by using fax technology, it is not recommended.
Additionally, the advantages of a remote telepharmacy service are only truly available when deployed along with a database-enabled MOM. Such solutions permit a remote pharmacist to see the order queue and status, meet the demands of fill verification when equipped with high resolution imaging, and meet all of the accreditation standards for pharmacy oversight.
The Pharm-Q ES solution was designed, installed and up-to-speed in eight months. The same pharmacist who previously commuted between two hospitals located sixty kilometers apart could now serve both pharmacies simultaneously during prime service hours.
Installing the remote telepharmacy solution, along with a MOM, provided the coverage and oversight needed for any time/anywhere supervision. A recent Accreditation Canada survey at West Haldimand highlighted the hospital’s innovative approach to achieving 24/7 pharmacist access using supportive technologies.
While the technology can reduce cycle times, improve scheduling and provide information for data-driven decisions, it still takes a pharmacist to do this work. Before installing any pharmacy workflow technology that promises improved efficiencies, hospitals also should determine whether there is capacity in the current pharmacist’s work day to take advantage of the improvements or whether there is additional budget to grow the pharmacist staff.
Otherwise, only part of the problem of meeting expectations of 24/7 medication review and verification by pharmacists is addressed. In this case electronic supervision provided enough improvement of the pharmacist’s time management that additional pharmacist staffing during prime hours was avoided.
What West Haldimand accomplished in less than eight months can be adapted by many small hospital pharmacies looking for ways to improve medication services within very limited budgets.
Likewise, in-house electronic supervision of technicians and nurses also lends itself to large metropolitan healthcare systems facing significant increases in demand for services and concurrent pressure to reduce costs. Applying information and communication technology solutions to these challenges is one of the few tools that can keep the promise to do more with the same.
For its part, Envision Telepharmacy, established in 2004, is a pioneer in developing services, tools and systems that provide electronic supervision and remote order processing through high-bandwidth, standards-based web technology, still imaging, and high resolution video. Enabling and realizing safe, quality patient care and pharmacist access through the use of compliant and cost-effective telepharmacy solutions is its mission. North West Telepharmacy Solutions is the exclusive software distributor of Envision’s Pharm-Q Medication Order Management (MOM) software in Canada.
David Millar is Pharmacy Manager at the West Haldimand General Hospital and West Lincoln Memorial Hospital. Emily Alexander, PharmD, is CEO, Envision Telepharmacy, in Alpine, Tex.
Hospitals of the future will have much in common with prisons, experts say
Hospitals of tomorrow will be more like jails of today. And for that trend, in Ontario and the Toronto area, especially, we can thank the yesterdays of the 2002-2003 SARS outbreak.
“SARS (severe acute respiratory syndrome), and then other infection control crises we have been through in the past five years, is probably influencing future hospital design right now more than anything else,” says Bruno Antidormi, the senior vice president and most experienced healthcare executive at EllisDon Corp., in Mississauga, Ontario, a major builder of Canadian hospitals and healthcare facilities with over 190 built in the past 20 years. Continues Antidormi: “Much of the hospital design and construction we are already doing is dominated by infection control and the isolation that control in turn demands.”
That trend toward ‘isolation’ is most obvious where many enter a hospital first, the emergency department.
“In future hospitals, you walk into Emergency and you say you’re sick and there will be a lot more rooms in the immediate area of the ER where you can immediately be put into a separate room and kept away from the rest of the hospital population,” says civil engineer Antidormi.
But the isolation imperative penetrates far deeper into the innards of the future hospital. Indeed right into the ductwork.
“Generally in new hospitals there will be more single rooms than before because of the need for better isolation,” says Antidormi. “But even the air systems are being designed with the things in mind like making the return air supply totally secure; maintaining ‘negative air pressure’ in isolation rooms (where air flows in and not out when the door opens); and putting better seals on the doors themselves. So in all these kinds of ways, hospitals of the future will be built more like we now build jails.”
But the way they will be financed and run will be more like Ontario’s 407 highway that speeds traffic across the top of Toronto – a toll road.
“We’ll see more and more of a new hospital delivery model now being asked for by provincial health departments,” observes Antidormi. “Here in this province, for example, Infrastructure Ontario is putting hospitals out for tender, like it does for jails and court houses, in a P3 or ‘Public Private Partnership’ delivery model (EllisDon has done or is completing 20 such PPP projects since 2004). Or, often to describe this same scenario, we also hear the AFP acronym for ‘alternative finance procurement’.”
By any name, this new provincial government modus operandi means not only that the likes of EllisDon will design and construct the hospital, but will also look after it as a private “concession.”
“It’s just like the 407,” explains Antidormi. “A private concessionaire maintains the road, plows the snow, and collects the tolls. But it remains a thoroughfare for the general public use.”
Like complaints about a constantly traffic-jammed road, there’s been public outcry over jam up of patients who wait for months before getting the care they need or have asked for.
“I would say that is the other big influence, beside the need for isolation. Reducing delay is also very much driving hospital design now and for the foreseeable future,” says Antidormi. “There are simply not enough hospitals, so that when new ones are built or old ones are remodelled, we are changing the architecture to make it easier to streamline more patients through the hospital.”
Also to shorten caregivers’ sneaker time.
“It’s a challenge right now to make already very busy doctors more productive so that they can deliver more care to more patients. But we can use the hospital architecture to better arrange hospital facilities,” says Antidormi. “For instance, there is a lot more day surgery going on in hospitals these days. As a result, we are designing hospitals so that the day surgery is entrenched nearer the main surgical suites.”
That means, Antidormi further points out, the surgical instruments used in day surgery and the larger surgical carts used in the main suites are coming in the same direction from the same sterilization area. In turn, that gives the nurses and anesthesiologists, who often work in both day care and main surgeries, shorter travel times afoot.
Perhaps more importantly in future, demonstrating better flow of both patients and caregivers may well mean the provincial governments will give their architects freer rein in the hospital’s actual design.
“Even now with companies like EllisDon that have had a lot of experience building hospitals, we can now go out and hire our own architectural teams. Ones who really know how to read a compliance document,” says Antidormi. “If that document says, basically, we, the client want to streamline our operation, then our architects start going to town. They draw up a presentation of what the hospital might look like, and then begin holding what we call ‘design compliance meetings’. Then they evolve the final design from the results of those meetings.”
One possible result in the early going of those compliance meetings, Antidormi quickly adds, is that the client says flatly: “This isn’t going to work,” or “It does not meet our specifications.
“But that very process usually gets us eventually moving in the right direction,” says Antidormi.
Once a mutually agreed upon design emerges from the compliance meeting process, there is a final step.
“We put a number to it and say: Here is our design; and here is our price,” says Antidormi.
Doing the same thing but with different plans are usually at least two other competing teams of architects and builders. Often those architects are from firms specializing in healthcare design. For example, the international architectural company, Perkins Eastman, with offices in Toronto, has designed hospitals sited around the globe, ranging from the American Cancer Centre in Shanghai, China to the long-term care hospital, Bridgepoint Health, overlooking Toronto’s Don Valley Parkway.
“Usually it is the team with the best design and the lowest price,” says Antidormi, “who wins the job.”
Similar processes are determining who wins the job elsewhere in the country. On the west coast, Bird Construction Company is re-building the Kitimat General Hospital, the Richmond Hospital, and the Children’s & Women’s Health Centre in Vancouver. In Quebec, the McGill University Health Centre and the Centre hospitalier de l’Université de Montréal (CHUM), have both begun construction aimed at becoming state-of-the-art super hospitals.
But perhaps in its smaller way, the 280-bed Nanaimo Regional General Hospital on Vancouver Island knows best the challenges of overcoming yesteryear’s hospital design.
At the recent Healthcare Facilities Symposium & Expo in Chicago, Suzanne Fox, Nanaimo’s emergency department manager, outlined the reasons why so many hospitals, including her own, need to be re-built:
• insufficient or inadequate space to support
• poor physical design to enable those functions
• restricted access and patient flow through
• lack of up-to-date information technology in support of care delivery.
Nanaimo’s striking new and large Psychiatric Emergency Services wing is also a future indicator, as EllisDon’s Antidormi optimistically sees it.
“In healthcare, we seem to be on the road to where research in 20 years or so will have controlled most diseases, including cancer, but what keeps eluding us are the things that can go wrong with our brains,” says Antidormi. “Mostly mental disorders are not caused by a virus or by bacteria or by a gene mutation, things that can be cured. So you will see hospitals of the future with relatively large psychiatric and mental health departments as part of their make-up.”
EllisDon cut its teeth on future-style P3 hospitals with the design and build of the William Osler Health Centre, serving the northwestern suburbs of Toronto and nearby towns. These P3 hospitals often have 30 year maintenance contracts. For hospital concessionaires like EllisDon, this leads to higher quality in the original “design & build” of a hospital, argues Antidormi.
“We’re not saying we can make a hospital maintenance free, but we can make it very easy to maintain. So we do things like put in more durable surface areas or even more janitor sinks. We look at our design and say: Hey, if we put a sink over there, it means the janitor will have a shorter walk. Or if we put a sink nearer the front door it will be easier to clean the front door mats. And then we say: If we put a drain under those mats to let the snow melt that gets trekked in, we won’t have to clean those mats as often. And then we say: If we put heat tracing on the sidewalk in front of the front door, we won’t have to send a guy out there to shovel the snow every wintry day and there won’t be any snow trekked in.”
In that long run, though, it’s not so much the details of construction and it’s technologies that will most shape the nature of future hospitals. It is the technologies you can’t see very much of.
“The bricks and mortar of construction haven’t changed too much since the ancient Egyptians were using their bricks and mortar,” says Antidormi. “Oh yes, there have been some advances in the use of progressive materials such as metal sidings, glass panels, aluminum frames, and self-draining systems. But I would say it is the ICT, that is the information and communication technology, that will influence hospital design and function the most in future. That’s why EllisDon employs its own ICT staff consultants.”
To illustrate his case, Antidormi then runs through this not-so-far-off future ICT-rich scenario for an interviewer: “You, Andy Shaw, drive to the hospital for an X-ray and right at the beginning you swipe your card at the entrance booth of the hospital parking facility. That action immediately transmits the information to the hospital information system. So when you walk in the hospital front door you may be a little startled to see a hospital kiosk that lights up automatically and points your way to the X-ray Department. When you get to the Department you are greeted with: Oh hello, Mr. Shaw, we saw that you pulled into parking a few minutes ago, so we are ready for you. The doctor will see you in just a few minutes. And sure enough, in just a few minutes you are ushered into see the radiologist, whose first question is not: Are you Andy?, or any other identification queries. The doctor knows all that already.”
Antidormi paints another picture for a patient who is already in hospital and has just had an X-ray taken.
“You’re staying in hospital because there is something in the X-ray that should be seen and interpreted by a specialist at Mount Sinai Hospital in downtown Toronto. At your bedside, a physician shows you your X-ray that’s been sent to the specialist and the area of concern in it. And you see it on your own voice-controlled patient terminal that’s become a fully interactive terminal. So it lets you control the temperature in your room; turns off your lights when you want; or you can even pay your gas bill on it and feel more like you’re having a normal day in the process. That bedside terminal becomes the patient’s joystick.”
In a few places, including one in Canada, that future scenario is now.
“There are several hospitals in Europe that are fully digital and work like the one I just described,” says Antidormi. “And the first fully digital hospital in Canada is one we’ve built up in Sault Ste Marie, Ontario.”
Two much bigger EllisDon hospitals in the greater Toronto area – a Halton Health Services hospital in Oakville and the Humber River Regional Hospital – will join the all-digital ranks when completed in about four years.
But how to know further out what a hospital should look and function like in say 10 years, or 20 years?
“That’s hard to predict exactly, of course,” admits Antidormi. “So I think as a result you will see hospitals in future be modular.”
Not modular in the sense that walls of hospital rooms can be moved around, but in the sense that the ICT technology built into those walls will be able to service whatever purpose a room is put to. Even if it becomes the laundry room.
“When the laundry comes to a loading dock, it generates a message to the person-in-charge’s BlackBerry indicating that clean laundry is on its way upstairs,” says Antidormi. “And similarly everyone in the hospital, including all the nurses and even all the doctors will have some sort of personal device, whether it be a BlackBerry, or an iPhone, or a tablet of some kind. A hospital of the future will be built in a way that its people can generate and pass information to whomever wants it, wherever they are.”
A freedom that can’t be found in jail.
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