UPMC reshapes the

nursing unit with

Overview
The need
UPMC sought to improve the workflow
efficiency in its nursing units to enhance
the quality of care, reduce costs/errors
and leverage its nursing resources more
effectively.
The solution
Supported by its innovative
partnership with IBM, UPMC developed
SmartRoom, a workflow optimization
system that leverages clinical intelli-
gence to guide nursing decisions and
activities.
What makes it smarter
As nurses address ad hoc challenges
on the fly, SmartRoom’s underlying clin-
ical algorithms automatically adapt the
prioritization of tasks, ensuring that
patients get the right treatment at the
right time—thus improving care and
reducing errors.
The result
“Our aim is to provide the right care, at
the right time, all the time. SmartRoom
is an example of how our partnership
with IBM is helping us meet that goal.”
—Tami Minnier, RN, chief quality officer,
UPMC
SmartRoom
A few years ago, the University of Pittsburgh Medical Center (UPMC)
and IBM decided to build on their shared vision of the future of
healthcare by forming a unique and far-reaching partnership aimed at
developing and commercializing new clinical solutions. One of
UPMC’s defining qualities as an organization is a pervasive entrepre-
neurial culture driven by an intense commitment to improving patient
care through clinical innovation. IBM’s partnership with UPMC taps
directly into this quality and demonstrates how a shared vision of
healthcare innovation can produce real results.
As the current national discussion around healthcare reform has shown,
the battle to improve healthcare delivery—to make it safer, more
efficient and more cost effective—has many fronts. One of the most
important is the inpatient nursing unit environment within hospitals,
which in many ways represents the backbone—the “front line”—of the
healthcare delivery system. As the point of most intensive contact
between caregivers and patients, nursing units are the scene of a con-
stant choreography of activities, the majority of which are routine and
predictable. Patients are monitored and tested, administered medica-
tions, and, if necessary, repositioned while in their beds to avoid
pressure ulcers—all in strict accordance with guidelines around timing,
frequency and dosage. That’s just a sampling.

Business benefits
● Reduction in time spent completing
documentation of nursing tasks
● Expected reduction in medical errors
● Additional time that nurses can use to
focus on compassionate caregiving
● Easier allocation of work among nurs-
ing unit staff
● Improved patient satisfaction
● More seamless hand off of patient
information between shifts
● Improved identification and tracking
of patient problems
● Helps to ensure timeliness of tasks
performed, such as turning patients at
risk of bed ulcers
● Nursing management has better data
on what time requirements are
needed on nursing units each and
every hour
Smarter healthcare: Leveraging intelligence to guide the nursing workflow
Instrumented
Interconnected
Intelligent
Mixing the routine and the unpredictable
Around this core framework of tasks, nursing staff are also required to
respond to ad hoc situations that routinely pull them away from their
more structured regimens. This may include consulting with attending
physicians, handling emergency situations, answering questions from
patients’ families and above all, providing compassionate care at the
patient’s bedside. It also includes the kind of critical thinking required
to spot and solve problems. On top of all this, nursing units need to
make a seamless handoff from one shift to the next to ensure not only
continuity of care, but also that clinical “red flags” are not missed in
the transition. For nursing staff, it’s a tall order that relies heavily on
memory, direct face-to-face communication and lots of walking.
Within this task mix, UPMC saw the opportunity to improve the qual-
ity of care and timeliness of completed tasks by structuring those parts
of the nursing unit workflow where practical and by providing nursing
staff with information support that enables them to focus less on
remembering their complex list of “to do’s” and—once they’re done—
easily recording them as completed at the point of care. Leveraging its
own clinical expertise and IT staff, UPMC designed and implemented
a workflow module known as SmartRoom, which uses interactive, in-
room screens to present nurses and nursing support personnel with a
prioritized sequence of tasks to be performed for a given patient (in
that patient’s room), as well as a prompted suggestion on which room
they need to go to next.
In-room sensing devices authenticate nursing staff and trigger the
retrieval and display of relevant patient information.
SmartRoom connects UPMC’s clinical knowledge base and best
practices in real time to nurses on the floor.
Algorithms developed by UPMC clinical staff control the prioritiza-
tion of nursing tasks, ensuring the right treatment at the right time.
2

Solution components
Software
● IBM WebSphere® Message Broker
● IBM WebSphere Application Server
Servers
● IBM BladeCenter® HS21
Services
● IBM Global Business Services®
● IBM Global Technology Services
IBM Business Partner
● Sonitor Technologies
“SmartRoom improves
the quality of care by
providing information
directly to the bedside—
where it’s needed most—
not to a computer in the
hallway or to a worksta-
tion at the nursing
desk.”
—David Sharbaugh, senior director of
UPMC’s Center for Quality Improvement and
Innovation
Bringing intelligence to the bedside
UPMC’s SmartRoom solution is supported by real-time linkages back
into key clinical systems such as pharmacy and lab services. At any
given time, the underlying workflow module compiles a list of required
tasks from various backend systems, using algorithms derived from
UPMC nursing staff activities that indicate the order in which tasks
should be done. To control access to this information, SmartRoom
employs indoor positioning technology from IBM Business Partner,
Sonitor Technologies, which uses in-room ultrasound sensing devices
to identify the nurse—or any other hospital staff member—entering
the room. Once authenticated, the nurse calls up the task list on the
display screen within the room. Upon performing the task, the nurse
can easily confirm on the touch screen that it was completed, and this
triggers the automatic updating of the appropriate electronic records.
Additional clinical information can be pulled up in the room with the
patient’s permission.
Importantly, UPMC designers realized that the true test of
SmartRoom’s effectiveness is its ability to adapt to the decidedly non-
linear nature of the average nurse’s task sequence. Interruptions in the
core workflow can range from brief (getting a blanket for a patient or
new physician orders) to prolonged (an extended discussion with a
patient’s family). In either case, time lapses and priorities change. The
intelligence of the UPMC solution is seen in its ability to dynamically
adapt the task list based on the comparative time sensitivity of the
different tasks on the list. This means, for instance, that a task initially
placed fourth on the priority list could be escalated to the number one
priority, if not performed within a specific timeframe. This rules- and
intelligence-based adaptability ensures that UPMC patients receive the
3
right treatment at the right time. While technology enables this intelli-
gence in the form of algorithms, the logic that guides it comes directly
from the clinical knowledge of UPMC nurses and physicians. Rather
than trying to industrialize nursing or deploy a new gadget, this tech-
nology is making routine tasks easier and allowing nurses more time to
do what they are trained for—critical thinking and spending time with
patients at the bedside.

UPMC’s SmartRoom solution is a textbook example of the technology

and strategic benefits of its partnership with IBM. After developing its
own prototype of the solution using home-grown technology, UPMC
worked with IBM to create more open interfaces with backend sys-
tems. Using IBM WebSphere® Message Broker to create an enterprise
service bus between the solution and its clinical systems, UPMC was
able to redesign the solution using a service-oriented architecture
(SOA) with open interfaces. In addition to making it easier to
deploy the SmartRoom solution more broadly within UPMC, this
SOA-centric approach also facilitates UPMC and IBM’s joint strategy
of offering innovative clinical solutions like SmartRoom to other
healthcare providers as commercial offerings. Moreover, UPMC can
deploy such solutions on its existing virtualized infrastructure (powered
by IBM hardware and software), which help guarantee the high levels
of availability that all clinical applications require.

Improving patient care is the fundamental driver behind all of

UPMC’s clinical innovations, and represents the primary benefit
of the SmartRoom initiative, explains David Sharbaugh, senior director
of UPMC’s Center for Quality Improvement and Innovation.
“SmartRoom improves the quality of care by providing information

4
directly to the bedside—where it’s needed most—not to a computer in
the hallway or to a workstation at the nursing desk,” says Sharbaugh.
“The less nurses have to focus on mundane, predictable tasks, the more
they can focus on the human, compassionate side of patient care.” The
same dynamic holds true for the time spent documenting completed
tasks. By sharply reducing this part of the nursing workload—the
reduction was 57 percent in the initial 22-bed evaluation unit—
SmartRoom enables nursing staff to spend more time at the bedside
and less walking to and from a computer terminal. Finally, SmartRoom
is also expected to improve patient safety by providing nursing staff
with bedside access to detailed, up-to-the-minute information on not
only prescriptions and doses, but also allergies and risk factors such as
patient falls—all of which give caregivers the tools they need to make
the right clinical decisions.

Changing the patient experience

UPMC also designed the SmartRoom solution to alleviate the disori-
entation that hospital stays can induce in patients. The ability to send
and receive emails, for example, provides patients with a crucial link to
friends and family. More powerful is the way SmartRoom removes the
“mystery” element of hospital stays by letting patients know who just
entered the room, what tests or procedures they have scheduled that
day and what they can expect to experience. These are just some of the
ways UPMC expects greater control to translate into higher patient
satisfaction.

Chief quality officer Tami Minnier, RN sees the SmartRoom project as

embodying the vision that guides UPMC’s innovation efforts. “Our
aim is to provide the right care, at the right time, all the time,” says
Minnier. “SmartRoom is an example of how our partnership with
IBM is helping us meet that goal.”

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For more information
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Produced in the United States of America

July 2010
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