Systems Approach and Systems Engineering Applied to Health Care | Johns Hopkins

Alan D. Ravitz, Adam Sapirstein, Julius C. Pham, and PeterA. Doyle, “Systems Approach and Systems Engineering Applied to Health Care: Improving Patient Safety and Health Care Delivery” JOHNS HOPKINS APL TECHNICAL DIGEST, VOLUME 31, NUMBER 4 (2013) [Biomedicine at APL]

Systems Approach and Systems Engineering Applied to Health Care: Improving Patient Safety and Health Care Delivery - 31_04-Ravitz.pdf; 

Despite the introduction of technology in medicine, challenges related to patient safety and quality health care delivery still abound. The economic and personal costs associated with these challenges are enormous. To address these challenges, APL, Johns Hopkins Medicine, and the Whiting School of Engineering’s Systems Institute have teamed to couple systems engineering principles and best practices with clinical expertise to develop innovative approaches to the socio-technical dynamics involved in health care.
This work focuses on understanding the interactions among people (clinicians, patients, families, and other stakeholders), processes (institutional, regulatory, professional ethics, etc.), and technology (medical devices and instrumentation)in the health care domain to formulate a systems approach to innovations that lead to improved patient outcomes. APL and Johns Hopkins Medicine are collaborating on improvements at the device level, specifically medication infusion pumps that represent significant patient safety challenges, as well as at the unit level in the intensive care unit.

Health care in the United States is a complex enterprise that involves much personal and emotional cost, as well as financial cost. Even if you are indifferent to the number of lives adversely affected by preventable errors, one illness, injury, or loss is too many if that affected life is yours or the life of someone close to you. The work Johns Hopkins has undertaken since 2010 has taken a systems approach to health care by focusing on the ICU—an area of health care delivery characterized by a high degree of technology
reliance, grave clinical situations, intense anxiety, and significant costs.

Beyond the initial requirements elicitation and conceptual development APL and AI have completed, much more work is needed in terms of characterizing needs and require-ments of the patient, family, and the hospital team. Greater progress and results could be achieved with additional workshops with broad cross-sections of participants including those from the social sciences, hospitality, and other disciplines traditionally not involved in health care idea-storming discussions.

Working Group Best Practices Ranking

 The collective outcome of the requirements elicitation activities proved formative for engineers and clinicians alike in terms of highlighting the challenges and opportunities to improve patient safety in the ICU. Several themes emerged from these requirements, including:

• Systems integration—clinicians strongly expressed a desire to see devices and systems more tightly integrated into the larger health IT enterprise.
• Information presentation, prioritization, and communication—nurses, doctors, and patients and families all expressed frustration over the nature of how information is presented and communicated. 

• Today’s clinical information systems force clinicians to access numerous disparate systems located physically in the patient’s room, as well as extended ICU and hospital enterprise systems. Further, today’s clinical information systems present.

Notional architecture concept for an Integrated
ICU.

The new paradigm inserts an “open middleware” layer that does not currently exist intoday’s operational health care settings. The use of open middleware effectively lowers the barrier to accessing information within existing and future technologies in the ICU, thus making possible information integration in support of clinical situational awareness, automated linical decision support, and analytics. Further, the open middleware supports rapid development of data-driven innovations in areas such as technology, clinical protocol, and patient and family involvement in their own health care.