As the coronavirus disease (COVID-19) spreads, hospitals around the world are grappling with increasing patient volume and a strain on essential medical supplies. The rise in visitor traffic also brings forth other issues such as crowd management and contact tracing.

The Opportunity to Manage Disease Outbreaks like COVID-19 in a Public Hospital

There was a need for a system which can provide real-time visibility on patient flow, staff deployment, inventory and more, and give a bird’s eye view of the ground situation to decision makers. Possible use of advanced data analytics and artificial intelligence will also enable the hospital to predict situations before they occur and generate actionable insights such as how to better allocate resources to guide decision making.

Related article: New AI-driven temperature screening device by KroniKare and IHiS to save time and manpower

The Solution: Command, Control and Communications (C3) System

This is the case at Tan Tock Seng Hospital (TTSH) where an enhancement to their existing state-of-the-art Command, Control and Communications (C3) System made a difference in how they are managing the outbreak. The C3 System, co-developed by TTSH and Integrated Health Information Systems (IHiS), was progressively rolled out from end 2019 to facilitate the day-to-day management of hospital services.

However, the system’s Disease Outbreak modules were still a work-in-progress when COVID-19 was emerging. TTSH and IHiS accelerated the modules’ development of key dashboards and indicators through rapid development, to quickly deploy relevant real-time monitors over the last two months.

The C3 smart hospital system is very much like the brain of the hospital. Built as a system of systems, it can sense, think, and respond to optimise patient flow and care delivery. This enables the best care, real time, for every patient.

“With the increasing number of patients coming through our hospital, we have to ensure that the patient receives the best care at every touchpoint of our hospital,” said Dr Eugene Fidelis Soh, CEO, TTSH & Central Health.

To allow the C3 system to capture and report the real-time situation on the ground, several enhancements were made and deployed quickly:

• a) Real-time Location Trackers (RTLS) were deployed in the new Screening Centre as well as the National Centre for Infectious Diseases (NCID) to track the real-time movement of staff and patients. This allowed hospital management to view at a glance how crowded the Screening Centre is, and whether additional help was required.
• b) Pulling in key data and information from existing source systems, such as the volume and turnaround time of laboratory and radiology test orders.
• c) Installation and linking up of CCTVs at key access points into the hospital to monitor and count the number of people coming in, to avoid chokepoints due to the checks that are implemented. Through the use of Command, Control and Communications (C3) system, TTSH staff were able to identify and arrest the escalating ground situation. A good example would be in early February, where due to a change in case definition criteria, there was a surge in the number of cases at TTSH’s screening centre. Attendance was three times higher compared to previous days, and this corresponded to a related rise in patient admissions into NCID.

Related article: IHiS creates an isolation facility in four days

Within 24 hours, because of the decision support provided by the Command, Control and Communications (C3) system, the team pulled together the manpower, equipment and other supporting resources to open five wards at NCID, and strengthened support at TTSH’s Screening Centre. C3 system also uses predictive analytics to forecast the projected discharges of COVID-19 patients, by developing forecasting models to determine the likelihood of discharge based on the length of stay. In addition, TTSH manages demand for healthcare services from non-COVID patients concurrently. As such, C3 has forecasting models to anticipate the daily and even hourly arrival of patients. With the help of such prediction models, TTSH is able to adjust manpower distribution accordingly when the need arises.

Command, Control and Communications (C3) System: A Control Tower for the Hospital

Background

The intent of a Command, Control and Communications (C3) system, similar to an airport control tower, is to coordinate and provide better care for patients at a systemic level. It has been in development since 2017, when TTSH and IHiS, in close collaboration with the Ministry of Health, worked to design an overarching system that could improve hospital operations and patient care and experience. The teams translated day-to-day operations into requirements and came up with a comprehensive solution, which could be viewed on a centralised dashboard.

This could be applied across all hospital operations, from peacetime scenarios to determine how they should handle inpatient flow and equipment monitoring, to outbreak possibilities such as how contamination of a care facility should be contained.

Command, Control and Communications (C3) system at a glance:

• Round-the-clock monitoring through dataand video feeds tracks the movement of patient, staff and inventory, including essential medical supplies to guide decision making
• Leverages advanced data analytics and AI to predict demand for hospital beds and offer actionable insights
• Video analytics and image recognition to support crowd control measures and subsequently, contact tracing.