My View: People-centric digital twin technology

eHealthNews.nz: Infrastructure

Friday, 30 June 2023

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VIEW - Michael O’Sullivan, Ilze Ziedins, Cameron Walker, Melanie Reuter-Oppermann, Matthew Parsons, Paul Rouse and Tom Adams (Auckland and Waikato Universities)

It was with a mixture of delight and concern that we read “Digital Strategy for Aotearoa highlights digital health innovations”. Delight because the concept of digital twin (DT) technology was described in the article, but concern because the DT “would show the origin, composition and likely replacement date of each item used in both constructing and running the hospital, mapping thousands of items digitally”. While we agree this is a laudable and worthwhile goal, it also brought to mind a well-known whakatauki: “He aha te mea nui o te ao? He tangata, he tangata he tangata | What is the most important thing? It is people, it is people, it is people.”

A vision of healthcare using people-centric DT technology
A patient arrives to hospital for elective surgery, they have been prepared for the surgery for some time as their treatment plan/appointments are available via their healthcare pathway portal (Pathway Modelling - PM), but they are still nervous. They are not familiar with the hospital layout, but the same portal provides a wayfinding app (Wayfinding through Hospitals) and they easily find their way to the surgical centre. Along the way they share a link on the pathway portal with their whānau so that PM can keep them informed about progress.

While the patient makes their way to the surgical centre, the centre is notified of their arrival and the relevant patient history is shared with the centre - the patient receives a notification about their data that is shared (Electronic Health Records). In parallel to a nurse reviewing and getting consents with the patient, the anaesthetist and surgeon use different views of the patient record to check for complicating conditions and recent scans respectively.

Both the anaesthetist and surgeon have time to view the patient’s information as their schedule is running smoothly. A surgical scheduling (Surgical Scheduling) system has enabled planners to easily find the best schedule, balancing time overruns due to variation in surgery times with operating room utilisation. This schedule also leverages PM and integrates with occupancy monitoring for ICUs/wards (Ward Occupancy) to make sure no “downstream” issues ensue.

After the surgery the patient spends a short time in an intensive care unit (ICU) recovering. ICU beds are available because data-informed tactical decisions ensure nurse rosters match the surgical schedule (CVICU Planning) and strategic decisions on ICU capacity (Critical Care Planning). As the patient is transferred from the surgical centre to the ICU, the patient portal updates to let their whānau know their status (PM).

The patient is transferred to the ward to complete their in-hospital recovery after some imaging to check for infection in their surgery wound. A DT of the radiology department (Radiology DT) - part of the overall hospital DT - provides patient prioritisation and right-sizing of critical radiology resources.

The hospital DT ensures patients are transported between services in a timely manner via an automated, optimised dispatch of orderlies and transit nurses (see Optimised Patient Transit).

The whole hospital runs efficiently (the right equipment, at the right time at the right place). The right equipment through automated communication between the hospital and its suppliers (see Sharing Data to Improve the Supply Chain) and the Surgical Sterilisation Unit DT – part of the hospital DT – ensures key equipment is sterilised and ready in time.

Clinicians and administrators can get real-time visibility of patients throughout the hospital by location (see Ward Occupancy) or treatment pathway with either dashboard views or accurate geo-spatial visualisations, all provided by the hospital DT and the healthcare pathway portal.

Previous system bottlenecks can be replayed and alternative mitigation processes developed to ensure they don’t reoccur, for example using the Emergency Department DT. The hospital’s “air traffic controllers” continually fast forward the hospital’s DT to predict, understand and alleviate any impending issues.

Hospital management get certainty for CapEx investment as the hospital DT can also experiment with big changes and evaluate their effect on the overall hospital system using empirical data (Deploying AGVs within a Hospital).

DTs extend to the community, also utilising data sources to ensure patients receive the required resources for quality healthcare (Data-Informed Districting).

Putting people at the centre
People are, in general, harder to model and keep track of than items. However, there is over a decade of research into precursors of people-centric digital twin technology within the Aotearoa New Zealand healthcare system. The focus of digital twin technology for healthcare delivery in Aotearoa New Zealand should be the people within healthcare. It is only by placing people - i.e., tangata whenua and tangata Tiriti, not items, at the centre of healthcare digital twins that Aotearoa New Zealand will be able to provide the best quality of care for its people.