Focus on IoT and End-to-End Patient Traceability: Key Priorities for Smart Hospital Development at Putuo District People's Hospital, Shanghai

This round of healthcare reform coincides with a new wave of information technology revolution, where technologies such as big data, artificial intelligence, and the Internet of Things are re-empowering traditional industries and injecting greater vitality. The integration of new technologies has not only transformed the industry’s infrastructure from the perspectives of technology and resource supply but also thoroughly reshaped the supply-and-demand dynamics of medical and health services in terms of business and operational models. As the core of the medical service system, hospitals are also undergoing a transformation driven by the development of “Smart Hospitals.”

In August 2019, the National Health Commission issued the “Notice on Printing and Distributing the Graded Evaluation Standard System for Hospital Smart Services (Trial)” (hereinafter referred to as the “Notice”), deciding to carry out the 2019 graded evaluation of hospital smart services in secondary-level and above hospitals that apply information systems to provide smart services. The Notice set forth clear requirements for the grading criteria and evaluation methods for smart hospitals, charting the course for the development of smart hospital construction and officially ushering in a new era of smart hospital development.

Smart hospital development encompasses multiple dimensions, including patient management, hospital operations, payers, and data regulation. To help hospitals identify the right direction for smart hospital initiatives, VCBeat (WeChat ID: vcbeat) interviewed Dr. Lv Zhongwei, President of Shanghai Putuo District People’s Hospital (Tongji University Affiliated Putuo People’s Hospital), one of the first batch of national pilot institutions selected by the National Health Commission for smart hospital development. He provided a detailed overview of the smart hospital construction process.

Currently, the more mature aspects of smart hospital construction mainly cover non-core medical processes such as appointment registration, payment, inquiry, and light consultation, while medical services and care oriented toward core medical processes remain scarce.

Putuo People's Hospital, Tongji University School of Medicine, and Shanghai Putuo District People's Hospital have affirmed since the inception of their smart hospital construction in September 2018 that such initiatives should serve three key stakeholders: medical staff, patients, and hospital management.

President Lu Zhongwei stated, “The development of smart hospitals is driven not only by policy and patient needs but also by the demands of medical and administrative staff for digital transformation. The transition to a smart hospital can provide patients with a convenient, efficient, and comfortable healthcare experience, thereby addressing the challenges of ‘difficulty and frustration in accessing medical care.’ Within hospitals, the demand for digital transformation among staff centers on an electronic medical record (EMR) system as the core, along with interoperability and mutual authentication across various systems.”

Having clarified the requirements for smart hospital development, Tongji University Affiliated Putuo People's Hospital and Shanghai Putuo District People's Hospital have primarily structured their strategic planning around three core dimensions: smart medical care, smart services, and smart management.

First is “Smart Healthcare” for medical professionals. Putuo People’s Hospital, Tongji University School of Medicine (also known as Shanghai Putuo District People’s Hospital), fully established a Level 5 Electronic Medical Record (EMR) system by the end of 2017. Centered on this EMR system, the hospital has continuously strengthened its information technology infrastructure, with a focus on achieving interoperability and mutual recognition among multiple systems, including the Hospital Information System (HIS), EMR, imaging, and laboratory information systems. The hospital has comprehensively deployed wireless networks and leveraged devices such as PDAs and mobile carts to build information systems supporting mobile ward rounds, nursing management, infusion management, Internet of Things (IoT) applications, material traceability, and medical record traceability.

In terms of core clinical workflows, Putuo People's Hospital Affiliated to Tongji University (Shanghai Putuo District People's Hospital) has leveraged artificial intelligence (AI) technologies to expand diverse applications of "AI + Healthcare." Specifically, the hospital is advancing intelligent recognition in its radiology department, encompassing medical image recognition, image segmentation, image registration, image fusion, and image reconstruction.

Implementing a pre-prescription review system to standardize medication practices among healthcare professionals, promptly prevent drug incompatibilities, and avoid adverse drug events; continuously improving digital information systems to drive medical and nursing workflows toward "paperless, intelligent, and efficient" operations.

Dean Lu Zhongwei stated, “The construction of smart hospitals has not only reduced the workload of medical staff but also accelerated diagnosis and treatment while enhancing precision. By improving diagnostic and therapeutic efficiency, it has also boosted the performance metrics of healthcare professionals, thereby motivating their work enthusiasm.”

Second is the “Smart Services” oriented toward patients. The hospital has deployed numerous all-in-one kiosks and self-service terminals in its outpatient and emergency departments, offering a range of services including self-registration, appointment scheduling, payment processing, report printing, and invoice printing. As a pioneer in Putuo District, the hospital implemented the “treatment-first, payment-later” medical model and was the first to deploy an outpatient and emergency consultation-room payment system as well as a bedside settlement system for ward nurses, thereby providing convenient services to patients. Leveraging the “Shanghai Putuo Health” WeChat official account as its foundation, the hospital offers a suite of convenient services such as mobile payment, appointment registration, scheduled consultations, information notifications, and report inquiries, making the patient experience more convenient and efficient while enhancing patients’ awareness and access to information.

At the outpatient hall of Putuo People’s Hospital, Tongji University (also known as Shanghai Putuo District People’s Hospital), TMI intelligent triage and guidance robots have been deployed to support triage and patient guidance services in the hospital’s outpatient/emergency departments and health examination center. Equipped with advanced natural language understanding and knowledge graph reasoning capabilities, the robots provide services including triage and guidance, indoor navigation, assistance with medical procedures, dissemination of hospital information, and promotion of medical knowledge.

Third is “smart management” for hospitals. President Lv Zhongwei pointed out, “Smart hospital management is a refined endeavor. Currently, the hospital is applying data mining technologies to continuously advance refined cost accounting practices, enabling cost analysis by department, by disease type, and by medical procedure.”

Currently, Putuo People’s Hospital Affiliated to Tongji University (Shanghai Putuo District People’s Hospital) is leveraging smart technologies to optimize hospital management processes. This enables management information to be reflected in relevant administrative tasks more timely, comprehensively, and accurately. Management at all levels can promptly gain a comprehensive overview of operational dynamics. By fully expanding the application of the Office Automation (OA) system, administrators are kept abreast of operational status in real time, thereby advancing refined and informatized hospital management.

President Lü Zhongwei candidly acknowledged that Tongji University Affiliated Putuo People’s Hospital (Shanghai Putuo District People’s Hospital) also encountered challenges in the gradual advancement of its internet hospital construction.

First, regarding regional interconnectivity, President Lu Zhongwei believes that the development of smart hospitals should not be based solely on individual institutions, but rather on the integration of smart hospitals and regional healthcare systems. The smart medical service system needs to rely on a regional information platform to connect hospital electronic medical record (EMR) systems with residents’ electronic health record (EHR) systems, thereby achieving interconnectedness and sharing of medical and health data generated by hospitals, primary healthcare institutions, and patients at home within a defined region.

Achieve comprehensive interconnectivity, mutual recognition, and sharing of information among internal departments of medical institutions, with other medical institutions, with public health systems, and with primary care medical institutions, thereby ensuring effective integration of information systems.

Taking the coordination between hospitals and 120 emergency medical services as an example, smart emergency care requires effective interconnectivity and information exchange across multiple departments and institutions. This enables triage management of emergency patients prior to clinical consultation and advance preparation of interventions. It is essential to achieve data integration with pre-hospital emergency systems, allowing hospitals to prepare in advance for specialized emergency capabilities and protocols (e.g., for acute myocardial infarction and acute ischemic stroke). Furthermore, the system must support remote communication between ambulances and hospitals, enabling hospitals to access patient data collected in ambulances and dynamically provide recommendations for emergency care arrangements and preparation plans based on the patient’s condition.

In addition to regional interconnectivity, the mutual recognition of patients’ medication, treatment, laboratory tests, and imaging information still requires standardization, strengthening, and improvement in terms of information standards within the medical care process.

In addition, the funding for smart hospital construction, particularly the investment in secondary hospitals, represents a significant expenditure; thus, the development of smart hospitals cannot proceed without support from national and local governments.

Next, President Lü Zhongwei revealed that the smart hospital construction at Putuo People's Hospital, Tongji University School of Medicine (also known as Shanghai Putuo District People's Hospital) will focus on two key aspects.

1. Full-process patient traceability.Fully achieve interconnectivity of inpatient information within the hospital; establish integration between the hospital and regional emergency rescue platforms to enable real-time tracking of patient conditions; enhance the capability for cross-institutional information exchange and sharing among medical consortiums, comprehensively track changes in patient conditions, and provide timely recommendations for diagnosis, treatment, or referral. Track post-consultation patient outcomes and create electronic records through follow-ups; develop customized follow-up plans and content for different patients, offering personalized reminders including follow-up visits, medication adherence, and lifestyle guidance; support primary healthcare institutions in accessing relevant patient medical records through information systems.

End-to-end traceability for patients can facilitate the expansion of residents’ health needs from “medical care” to “health,” deliver high-quality clinical outcomes for patients, and better implement policies such as medical insurance cost containment and tiered diagnosis and treatment.

Second, the application of Internet of Things (IoT) technology in hospitals.The Internet of Things (IoT) refers to the connection of devices to networks via information-sensing equipment, following agreed-upon protocols, to enable information exchange and communication, thereby achieving intelligent identification, positioning, tracking, and monitoring.

The construction of hospital IoT can break the physical boundaries of hospitals, creating an efficient, convenient, and personalized experience throughout the entire process.

The main areas for the future promotion of IoT technology in hospitals include three aspects:

Real-Time Location Tracking of Medical Equipment and Personnel. In the process of medical service delivery, real-time localization of medical personnel, patients, and medical equipment can significantly optimize workflows, enhance the quality of hospital services and management standards, facilitate the monitoring and management of special-needs patients, and enable timely response to emergencies.

Provide patients with indoor positioning and navigation services related to their personal diagnosis and treatment activities, enabling them to query the locations of relevant clinical departments and real-time patient queue status for medical consultations via mobile devices.

Next is intelligent medical monitoring and mobile vital signs monitoring. By leveraging Internet of Things (IoT) technology, various physiological indicators such as body temperature, blood pressure, and pulse are collected via sensing devices to enable real-time monitoring of the health status of individuals under care. This approach is not constrained by time or location, thereby providing convenience to patients while helping to alleviate the shortage of medical resources.

Finally, it also includes medical device management.Equip medical devices used in hospitals (such as surgical packs and implants) with tags to store relevant information. Medical personnel can read from or write to these tags using handheld readers/writers and communicate via the Internet of Things (IoT) to access or input management data, thereby enabling device localization, tracking, regulatory oversight, and usage analysis.

From the smart hospital initiatives at Putuo People’s Hospital, Tongji University School of Medicine, and Shanghai Putuo District People’s Hospital, we can observe that a decentralized healthcare service system is gradually being implemented, with the physical boundaries of hospitals increasingly dissolving. In the future, patients will benefit from more convenient and precise medical services; smart hospitals will alleviate repetitive tasks for healthcare professionals, allowing them to refocus on core clinical value; and hospital management will become more efficient and intelligent, continuously driving innovation in healthcare delivery.