EmailLong term plans sometimes fall short of their full potential not because of failures in their implementation, but because the specifications did not take account of how changes in technology can present new opportunities.
The directors of St Olav Hospital in Trondheim, Norway, had this in mind when they laid plans for complete rebuild early in the decade. Its spokesperson Arve-Olav Sulumsmo says they looked into the middle of the next decade and did not pretend to see all of the details.
"It was clear from the beginning that the IT systems would have to be functional in 2005 but still modern in 2014. We took a step back from the immediate needs and asked what we needed to stay up to date as technology changes."
It embarked on a two stage rebuilding, the first of which was completed in 2006 and the second of which is due to begin soon and run until 2010, with additional work extending to 2014.
The IT investment, totalling about £50m for each phase (and about 6% of the total), has been included in the capital rather than operating budget as it is regarded as part of the building and does not include clinical applications. The specification focused on functions, about 2,500 of them, rather than specific technology, although it did include a requirement that Cisco provide the network infrastructure. This was because the medical school attached to the hospital, which accounts for quarter of the capacity, was already standardised on the company's technology.
The network has a bandwidth of about 10Mbps for most of the terminals and a massive 40Gb at the main switches, placing it on a scale similar to the network for internet traffic in and out of Norway. It provides the scope for heavy demands on the picture archiving system and a high definition TV feed in and out of operating theatres, and Solumsmo says it has the capacity to handle new developments in magnetic resonance imaging.
The installation has also included the provision of IP telephony, with about 2,500 handsets to accompany the PCs.
HP was brought in as the other main supplier, providing about 2,500 PCs, all the servers, the security architecture and quality control of all points in the system.
Although the hospital did not have it in mind at the beginning, the project has led to a development in line with the 'digital hospital' concept fostered by HP, which has provided the IT hardware and accounted for two-thirds of the contract value. It involves the provision and infrastructure and its integration, owned by the vendor, with specialist applications and management systems around the hospital.
"Medical technology and ICT are starting to merge," Sulumsmo says. "I don't think you can have advanced medical equipment without a computer."
Moving into a new building, however well equipped, provides challenges.
"One of the challenges was that we had an existing hospital with existing systems, and when we moved half of the hospital to the new buildings the clinical systems would have to keep running on old and new hardware.
"The hospital had to find out what applications were running and what was needed to take them to the new network. We started with about 300 applications but had a goal to reduce it to about 100 so we had fewer to test on the hardware. In practice we got it down to about 150, but this has now gone up to 200."
Sulumsmo says the transition has not been smooth in all areas. While the new infrastructure has provided potential benefits, it has proved difficult to get many staff to take adantage of them.
"We did a lot of work on the processes but it was inadequate. Many of the hospital staff basically thought that they could move to the new locations and keep working as before.
"But when you go from two computers on a hospital ward to everybody having access, and to everybody having a telephone on their desk or in their pocket, it has a profound effect on the daily work. It was more than people anticipated, and it took time for some to learn how to use a PC or the new phones.
"We had to justify taking a lot of people out of work to do the training, and had to do it in an operational environment. It was difficult but necesssary, and we should have done more of it."
St Olav's is better placed than most Norwegian hospitals for the integration of clinical systems. It provides the main site for mid-Norway, the only region where all the hospitals have standardised their systems, and where the network has provided the technical capacity for all eight to work from a server in Trondheim.
Solumsmo says this provides advantages when the patient is happy for details to be shared, but the country's consent laws mean it is impossible for clinicians to get access when a patient is unconscious - which is when the situation is most likely to be urgent.
The next phase of the building will involve the provision of another 2,500 PCs and telephones, with an expansion in the number of wireless access points from 500 to over 1,000. Beyond that the hospital is still working on its requirements.
"We have opened a four month window when a team will go through the design and see what upgrades are needed," Solumsmo says. "We know we want to upgrade the nurse call system, and get more information onto the MIMIC panel on thePCs so we can see more of what is going on. For example, we might integrate the reporting system.
"There's also scope for integrating PDAs with the IP telephony system."
;