Case Study to Apply Green IT Strategies and Applications to the Hospital| Information Systems

Major Points ◾ Presents a Green enterprise transformation (GET) case study for a service organization ◾ Uses GoodMead hospital as a hypothetical organization to present the case study ◾ Describes the practical aspects of a preliminary Green IT audit ◾ Describes the Green business objectives of a hospital ◾ Conducts a high-level SWOT analysis of the hospital from a GET perspective ◾ Suggests the use of mobile technologies in optimizing hospital processes that will result in

carbon savings ◾ Lists the lessons learning in applying Green IT strategies to a service sector organization like

a hospital

GoodMead Hospital GoodMead is a hypothetical large hospital in a metro city, providing public sector medical services. These services cover various areas of health including the standard out patient department provid- ing regular consultation to patients, as also various specialities such as pediatric, gynecology and obstetrics, orthopedics, radiology, sports medicine, and so on.

As a result of the recent preliminary Green IT audit of the hospital, it has been revealed that the hospital had a significant carbon footprint. Significant reviews of patient management processes, management of electronic patient records (EPR), laboratory equipment management, medical drugs and material management, and management of equipments and buildings were undertaken. Initial opinion of the auditors and that of the tentatively appointed chief green officer (CGO)

Unhelkar, Bhuvan. Green IT Strategies and Applications : Using Environmental Intelligence, Chapman and Hall/CRC, 2016. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=767875. Created from apus on 2018-07-02 11:37:50.

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was that significant optimization was possible in all these areas of the hospital that will reduce its carbon footprint. The cost-effectiveness and efficiency of the hospital’s service processes is as important as its carbon efficiency. Thus, the benefits envisaged in terms of its cost reduction and process optimization are significant. Further to the attention on processes in terms of their carbon reduction, the initial investigation also highlighted that GoodMead has a significant investment in a data center. The building and infrastructure of this data center is now more than 10 years old, and the server machines themselves are averaging 4 years in use.

The audit also revealed that the hospital, by undertaking a Green enterprise transformation (GET), would be able to influence many of its partnering organizations. These are the labs, phar- macies, and suppliers.

The return on investment (ROI) of the hospital’s attempt to transform to a Green hospital is meant to go beyond the carbon focus and into the overall business optimization arena. Thus, the hospital leadership is keen to make effective use of new fund allocations that have been indexed to carbon reduction. This effective use includes an approach that will benefit the hospital overall and is not limited only to IT-related carbon reduction.

Preliminary Green Investigation As a result of the decision taken by the new, visionary leadership of GoodMead hospital, the aforementioned preliminary Green IT audit was conducted. This audit took place over 4 weeks. The main sponsor of this audit was the tentatively appointed CGO. The CGO, together with the IT auditors, departmental heads, and the CIO sought input into the current state of the hospital. The framework for this audit was based on the four dimensions of GET. Thus, input was obtained in terms of the economic performance, sociocultural or attitude, business processes, and technical infrastructure of the hospital. The CGO is seeking input from Green IT experts as well as experts from the medical administration domain on how to approach the GET.

Below is a list of the noteworthy findings from the preliminary Green IT audit of GoodMead hospital:

◾ The hospital being a large, public sector hospital, has to undertake action in terms of mea- suring, reporting, and reducing its carbon emissions.

◾ The hospital has significant opportunity to influence its partnering organizations. ◾ The OPD (out-patient department) of the hospital is a large and complex department that

operates out of its own separate building and infrastructure. This department is serviced by 220 stationary desktop machines, 100 mobile laptops and PDAs carried personally by the staff and numerous supporting IT paraphernalia—such as printers. This department alone, according to estimates and with assumptions in terms of computer usage, accounts for 60 to 65 kT (kilo Tonnes) of carbon emissions of the hospital.

◾ The hospital has additional desktops, printers, laptops, and PDAs that are in the other departments such as surgical and laboratories. These devices amount to 20 kT of emissions at this stage.

◾ Printers are heavily used for writing of scripts, printing of patient records and reports and related documentation (such as a referral). On an average, the hospital prints 5,000 pages of normal paper and consumes corresponding ink and printer time.

◾ The hospital has an attached pathological laboratory that conducts diagnostic blood and related tests. The lab equipment is aging. Similarly, the data stored in the hospital’s servers

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Case Study: A Hospital (Service Organization) ◾ 367

that provides that information to staff on the results from the tests is also significant con- sumer of power and generates carbon emissions.

◾ Pre- and postsurgical activities require substantial number of electronic equipments and information technology support.

◾ The hospital has to need to product substantial amount of legal documentation (such as signing of authority to perform certain operations), and so on.

◾ The hospital collaborates with external pharmaceutical organizations as well as manufactur- ers and distributors of drugs and hospital equipments. This collaboration is a combination of manual interactions and also some initial web services based interaction.

◾ Staff rostering is not optimized, leaving the administrative staff to occasionally use physical notepads, whiteboards, and diaries to book availability of doctors.

◾ Scheduling system for patient appointments, surgical procedures and human relation (HR) (e.g., doctor vacation) is also not optimized and requires a major upgrade. Scheduling patient consultations, scheduling work rosters for nurses and administrative staff is many a times happening manually.

◾ A comprehensive multimedia data warehouse project is underway. This project is aimed at consolidating the large amount of data, in multiple formats, in a single data warehouse. Furthermore, selected past consultations in audio and video are also to be made available to authorized users like doctors, patients, and external specialists.

◾ With the availability of a multimedia database, there is opportunity for optional extensions to the project is to incorporate possibility of remote consulting by doctors through audio and video media using high-speed connectivity.

◾ Security of access and privacy of patient’s data (EPR) is of top priority and is not to be com- promised under any circumstances.

◾ A range of relative cross-functionalities (like sports information) to be included to attract and keep nonpatients to the site as well. This may help in keeping the community aware of the site.

◾ Internal administrative systems (like booking of surgeries to operating rooms, or leave roster of nurses) be moved to the Internet-based system to enable global (or off-site) management.

◾ There are provisional inventories that are in excess. These are both medical and IT inven- tories. For example, there are 15 PCs sitting in the IT departments as potential backups for breakdowns. Similarly, the data center has excessive unused storage capacity.

Green Business Objectives The green business objectives of GoodMead hospital are based on the results of the preliminary investigations into its Green IT maturity level. These objectives provide the basis for the transforma- tion plan. Figure 12.1 shows the overall approach to GET for GoodMead hospital. On the left is the description of the “as is” state of the hospital from the environmental perspective. On the right is the “to be” or desired state of the hospital. This “to be” state of the hospital is based on the formation of green objectives of the organization. In between, in Figure 12.1, is the outline of the GET frame- work, as applicable to GoodMead. The four major phases of transformation—diagnose, plan, enact, and review—interspersed with metrics, are shown in this high-level transformation framework.

Following are the important objectives of GoodMead in undertaking the GET:

◾ Reduction in carbon emissions across all departments and processes of the organization ◾ Compliance with carbon legislations and related carbon initiatives of the government (even

if they are not fully ratified as law)

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368 ◾ Green IT Strategies and Applications

◾ Be a leader in carbon management and, thereby, influence many business partners in reduc- ing their emissions

◾ Undertake electronic collaborations with partners, government regulatory bodies for moni- toring and reporting

◾ Undertake comprehensive Green BPM program that will enable result in modeling, optimi- zation, and merger/elimination of processes

◾ Aim for a comprehensive and holistic GET that is futuristic ◾ Create positive green attitude across the entire staff through Green HR

SWOT of GoodMead Hospital Figure 12.2 shows the SWOT analysis of GoodMead hospital. Such a SWOT analysis is helpful in understanding the approach that can be taken for the GET. For example, GoodMead is a large hospital with multiple campuses and departments within them. A SWOT analysis makes it easier to understand how to capitalize on the inherent strengths of the hospital. The areas that will be directly affected by the transformation and bear risks will also become evident in such an analysis. In practice, this will be a substantial exercise encompassing all these departments. In this example case study, the SWOT analysis can help understand the scope and coverage of work during this transformation.

Following understanding develops as a result of the SWOT analysis of GoodMead hospital in its “As is” state:

Strengths ◾ Well-known public sector hospital. This popularity of the hospital is an important impetus for

the hospital to undertake GET. The impact of such transformation will be far reaching, beyond the hospital. There is significant support to the hospital in terms of patients and corporate.

◾ Financially well supported by government. GoodMead has been a flagship hospital in the region, with sufficient funding from the government over the last decade, enabling it to undertake its services, together with its research and training.

Green Enterprise Trans. “As Is” “To Be”

Diagnose—Preliminary Audit; Identify Drivers and Dimensions;

High-Level Budget

Plan—CGO; Detailed Project Plan; Assign Resources

(Green BPM, Green Mobile)

Enact—Manage risks; Green HR Social and Process Changes

Review—Green IT Metrics/KPIs; Compliance Audits;

Lessons Learnt

Un- Optimised Processes

Patient- Admin

Disconnect

HR and Non- Green

Attitude

Fully Carbon Compliant

Influencing Partners

Positive ROI on Green

Investment

Figure 12.1 GET for GoodMead hospital.

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Case Study: A Hospital (Service Organization) ◾ 369

◾ Green IT budget. A recently elected government has provided additional, specific grant to the hospital to enable it to improve its environmental credentials.

◾ Reputed teaching and research hospital. There is an atmosphere of research and experimenta- tion. Therefore, the hospital will be ideally placed to experiment with carbon reduction and wastage reduction across its various departments and processes. Besides, the staff it highly skilled in what it does—including medical, administrative, and IT support.

Weaknesses ◾ Aging IT infrastructure. The preliminary Green IT audit finds that the data center is more

than 10 years old and the average server is 4 years in use. This implies a rapidly aging infrastructure that is not able to capitalize on the benefits of newer server designs and tech- niques for cooling. Furthermore, such infrastructure also implies high overhead costs for its operation.

◾ Attitude not conducive to Green IT. A preliminary survey carried out during the audit, and one-on-one interviews with a few volunteer staff indicated clearly that the attitude within GoodMead was not positive toward Green IT. Understandably there was skepticism for the initiative—particularly from the medical staff who considered IT-related carbon savings as not substantial.

◾ Carbon inefficient processes. Numerous processes were identified at the organization level that was carbon inefficient. These processes included patient management, inventory man- agement, and staff rosters. The IT systems supporting these systems were also not carbon efficient. This implied the processes were taking unnecessarily long, bureaucratic steps that the activities were redundant and the systems supporting the processes were data intensive

Strength Well Known Public Sector Hospital Financially Well Supported by Govt. Reputed Teaching & Research Hospital Green IT Budget

Weakness Aging IT Infrastructure/High Overhead Costs Attitude Not Conducive to Green IT Carbon inefficient Processes Lack of Collaboration with Partners IT Inexperience (New Technologies)

Opportunity New Leadership (CEO, CIO) Govt. Focus on Environment Green Portals integrated with Regulatory Portals

Uncertainty of Focus Changing Legislations Patient Privacy Risks exposure Infrastructure/Change Management

Œreat

GoodMead Hospital

Figure 12.2 SWOT for GoodMead hospital.

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370 ◾ Green IT Strategies and Applications

without providing required value. There were no technology innovations within the systems such as use of Cloud computing or web services.

◾ Lack of collaboration with partners. Especially the supplies to the hospital were arriving unco- ordinated and the hospital’s IT systems were not integrated with those of the supplier.

◾ IT inexperience (new technologies). While the hospital was advanced in research and training in the medical field, it was lagging behind in terms of experience with new and upcoming information technologies. Therefore, there was little initiative from the current IT manage- ment to undertake major changes relating to carbon reduction.

Opportunities ◾ New leadership (CEO, CIO). One of the most significant opportunity Goodmead has to

develop and implement environmentally responsible business strategies is the formation of the new leadership team. The appointment of the CGO to oversee the entire green transfor- mation and, together with the CIO, report to the corporate board, is an important develop- ment in itself.

◾ Government focus on environment. The regulatory bodies are now getting a push through government initiatives on carbon reduction. As a result, new legislative requirements are about to be implemented, making it mandatory for large organizations in particular, to calculate and report their carbon emissions. The particular focus by the government on organizations that are semi- or quasi-government is providing the necessary opportunities and impetus to carbon reduction initiatives—such as in this hospital.

◾ Green portals integrated with regulatory portals. The push from the government for carbon reduction is not only an opportunity for the hospital to transform its business models, portfolios, and data centers, but also upgrades its IT systems and portals with carbon data and information. To that effect, the government is now providing web services through its regulatory portals that can be used by “consumers” of web services. Telework and telemed- icine—the telemedicine market is growing at a high rate with developed nations having already implemented several projects and the technology is becoming increasingly afford- able. Therefore, there are greater opportunities for reducing emissions through telework and, in particular, telemedicine. More and more economical by the day.

Threats ◾ Uncertainty of focus. While the senior management of the hospital is committed to a green

hospital, there is occasional shift in the focus due to the changing nature of the technol- ogy domain. For example, the social aspect of Green IT is not positive at this stage, but to bring about a change in that sociocultural domain will require significant training and education of the staff. Changes will also be required in the user devices such as PCs and laptops. There is high possibility of conflicting objectives and therefore further uncertainty of focus. The senior management has to be taking the initiative and remain in charge to maintain focus.

◾ Changing legislations. While the government is supporting the initiative and is pushing for GoodMead to be environmentally responsible, the legislations themselves are not firm yet. Therefore, there are changes to the way the scopes 1 and 2 are calculated, changes to the emission benchmarks, and so on. This is creating further uncertainty and risks in formulat- ing and implementing Green IT strategies.

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Case Study: A Hospital (Service Organization) ◾ 371

◾ Patient privacy risks exposure. Privacy and confidentiality requirements of the patient’s information needs to be protected as the transformation of technical systems and data warehouses takes place.

◾ Infrastructure/change management. Due to the aging and underdeveloped nature of the technical environment, it may be hard to implement some of the technological solutions in which reliability of the service is crucial.

Strategic Concerns of Management The aforementioned SWOT analysis provides significant input in identifying the drivers for environmentally responsible business strategy (ERBS) and vice versa. The senior management can start with a general understanding of the drivers for ERBS which, later, get formalized as the SWOT analysis is undertaken.

Figure 12.3 shows the key drivers for environmental responsibility for GoodMead hospital. Out of the six drivers that drive ERBS (as discussed in Chapter 2), Figure 12.3 shows social- political pressure, and enlightened self-interest as the two key drivers for ERBS. These two drivers are described as follows:

◾ Sociopolitical pressure: The hospital has a substantial standing in the community. Besides, it is also a flagship hospital within the region. There is significant social and political pressure on the hospital to demonstrate its environmental credentials. This pressure comes from the general community that views the hospital as a symbol of good service-based organization and cross-section of patients (e.g., youngsters, sports-people).

Costs (Energy, Operational)

New Market Opportunities

Social and Political Pressure

Government Legislation

Enlightened Self-Interest

Responsible Business

Ecosystem

Primary Green IT

Drivers for GoodMead

Hospital

Figure 12.3 Drivers for environmental responsibility of business.

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◾ Enlightened self-interest: The senior management of the hospital, the leaders/decision mak- ers are keen to take up the challenge of changing their processes and internal social attitude to a positive, green attitude. While they are certainly buoyed by the availability of funds dedicated for this purpose, they are themselves realizing the need to undertake this green enterprisewide transformation to enable them to remain as a leader in the upcoming carbon economy.

Steps in Developing a Hospital’s ERBS Figure 12.4 shows the major steps in the development of an Environmentally Responsible Business Strategy. This figure is based on Figure 2.13, which was discussed in detail in Chapter 2. Here, though, Figure 12.4 not only serves as a reminder for the steps in developing an ERBS for the hos- pital, but also shows the key drivers, dimensions, risks, and metrics for this GoodMead ERBS.

◾ The business objectives of the hospital in becoming a green hospital were identified earlier on. These objectives and visions provide the initial direction for the hospital in its strategy formulation. The drivers for the objectives are enlightened self-interest and sociopolitical pressure on the hospital.

◾ Green IT strategies: These are the medium terms (3–5 year) strategies that are driven by the CGO and that are based on the drivers and objectives of the organization. Strategies for Green IT also contain elements of risks or threats, as were identified during the SWOT.

◾ Green IT policies and preconditions: These are the policies that are formed at the depart- mental level and are implemented in practice by the departmental heads and/or process

Business Objectives in

becoming Green

Green IT Strategies

Green IT Policies and

Preconditions

Green IT Resource Plans

Green Transformation

Plans

Good/Mead Hospital’s

Dimensions (Process and

Social)

Drivers • Self-interest • Socio-political

• Per Patient • Per Staff

Risks (Privacy)

KPIs

Figure 12.4 Steps in developing an ERBS.

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Case Study: A Hospital (Service Organization) ◾ 373

owners. These policies related to procurement of new equipments (Energy Star ratings), changes to processes and delivery of training to staff.

◾ Green IT resource plans: These include details of resources required in undertaking trans- formation. For example, in case of GoodMead, the green transformation team itself would be lead by CGO, supported by the Green HR (as shown in Chapter 8) and will be interact- ing with the operational staff (doctors, nurses, administrators). Resource plans also include budgets and resources for procuring and implementing CEMS. The success of the transfor- mation can be measured here based on Green KPIs (see chapter 2).

◾ Green transformation plans: These are the business transformation and change management plans that will focus on the dimensions and the work areas as described in Chapter 9.

Green Transformational Elements Putting together the discussions thus far, Figure 12.5 shows the major green transformational ele- ments of GoodMead hospital. The overall green transformation framework is shown on top with the various important elements underneath. These elements are as follows:

◾ The drivers and areas of influence. The drivers for GoodMead are shown earlier in Figure 12.3.

◾ The major dimension along with the GET will take place. This is the process dimension also supported by the social dimension for transformation.

◾ The demographics of the organization can play a role in deciding on the type of transforma- tion, its budgets, and its resources. In case of GoodMead hospital, these demographics are large-sized service organization in a metropolitan city of a developed region.

GET framework

Green Drivers and Areas of Influence

Major Dimension- Processes

Demographics (Type, Size, Location)

Maturity (Possibly Level 1)

G re

en , L

ea n

H os

pi ta

Systems and Lifecycle

At titu

Wa stag

Data Centre

User Devices

Figure 12.5 GoodMead hospital’s major green transformational elements.

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374 ◾ Green IT Strategies and Applications

◾ Maturity of GoodMead in terms of its Green IT performance is very basic (This cannot be fully ascertained at the start of the project as the process for measuring itself are not matured enough. However, a rough indication of the maturity level can be provided.).

Once these aforementioned aspects of GoodMead are ascertained, the transformation of the hospital can be undertaken as follows (also shown in Figure 12.5):

◾ User devices—Measuring, upgrading, and recycling monitors, PCs, laptops, and mobile phones; desktop virtualization; centralized green services

◾ Data center—Virtualization, optimization; self healing networks; network topology, database design, hardware and software components, security issues, and backup strategies. Redesign of data center to include flexibility and agility to enable easy upgrades of future infrastructure

◾ Systems and lifecycle—IT systems supporting hospital processes like booking, consultation, diagnosis, treatment, prescription, and education; Equipment procurement, installation and usage; integration of supply chain with local as well as overseas pharmacies and drug suppliers. Interaction with government and other regulatory bodies should also be enabled electronically

◾ Wastage—Electronic waste resulting from unused or broken devices; also, due consideration is given to areas of bio waste

◾ Attitude—Undertaking training and consulting programs for staff (doctors, nurses, admin) and promoting it amongst patients and business partners. Internet-based system to facilitate global management of the administration, rosters as well as the most HR (human rela- tions—People) functions. Change management for telework and telehealth

The Green Transformation Project The overall GET project is to last between 12 and 18 months, with the full carbon value realized over 3 to 5 year’s strategic time period. $ 1 million is the budget sanctioned by the corporate board and the CGO is authorized to undertake this transformation.

Figure 12.6 shows greater details of the 18-month GET plan. It is divided into six quarters of 3 months each.

◾ First quarter: The first quarter of the hospital transformation is primarily focused on inves- tigation and diagnosis. This work includes identification of the key drivers for green trans- formation (in case of the hospital it is sociopolitical and enlightened self-interest). During the first quarter, the CGO will lead the strategic planning for the hospital, creating a 3–5 year actionable strategic plan. This plan will also include the return on investment metrics for the hospital.

◾ Second quarter: This is the quarter where enactment of the plan created in the previous quarter takes place. In case of GoodMead, the enactment of GET in this quarter deals with the process dimension of transformation. Therefore, Green BPM (as discussed in Chapter 5) comes in to play during this quarter. In the context of the health-care industry, process changes require extensive modeling, verification and validation, and tools support. Carbon content of the key processes needs to be established beforehand. This will happen in an approximate way in the diagnosis phases. Here, in the Green BPM activities, processes are reengineered and their carbon contents calculated again to ensure it has indeed reduced.

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Case Study: A Hospital (Service Organization) ◾ 375

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◾ Third quarter: In case of GoodMead, this quarter of GET is dedicated to transformation of the social dimension. Therefore, this quarter focuses on the attitude and behavior of indi- vidual staff. Social dimension also becomes important in a service organization as the out- put of the organization is the service to the customer (patient in this case). Thus, while the employees are equipped here with training that enables them to tap into the environmental data, information and knowledge within the organization, the patients, and the society in general is updated with the changes occurring within the hospital. Metrics and measure- ments associated with the social dimensions come in to play.

◾ Fourth quarter: This quarter is for the “Review” phase of the transformation. Therefore, there is heavy focus on measurements based on the earlier defined metrics. These include the Green KPIs—such as CO2E per computer/laptop/mobile, CO2E per Staff member or per patient, KPIs associated with recycling of computers. The KPIs can also be fine tuned for ongoing and continuous improvement in the future. Review phase can include Green IT audit to ascertain the maturity of the organization. Reduction in complexity of processes, improvement of quality of service and compliance with legislative requirements are included in the criteria for success.

◾ Fifth quarter: If the Review phase indicates success in terms of GET, then the organization like GoodMead needs to immediately focus on providing the transformation support to its partners. These are the pharmaceuticals, laboratories, equipment suppliers and, of course, various patient-related bodies such as medical insurance providers.

◾ Sixth quarter: This is the quarter where feedback from the transformation will have a sub- stantial effect on the next steps by the hospital. Formal external Green IT audits are con- ducted in this quarter and compliance with the regulatory requirements can be formalized. This quarter also starts an ongoing journey for environmental program management for the hospital that will work closely with the Green HR function in ensuring Green IT specific roles are maintained, and individuals working in those roles are motivated and trained.

Figure 12.7 shows the returns on the GET project for GoodMead hospital. While these returns are not the core drivers for the ERBS, they are still important to prove two key points: (a) the GET is closely tied with the profits and (b) GET will lead to increase in the overall performance.

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

2009 2010 2011 2012 2013

Re tu

rn s P

er Y

ea r

Year

GoodMead Green IT ROI

No ERBS With ERBS

Figure 12.7 GET cost-benefit (ROI) analysis.

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Graph 1 in Figure 12.7 shows the growth of the organization and its returns over 4 years with the business as usual. With the investment in the ERBS, the initial expense is higher and therefore the net returns for the first year are lower—this is visible in Graph 2 in Figure 12.7. However, over the period of next 3 years, the overall efficiencies and effectiveness resulting from ERBS also produce returns on the original investment to “go green.”

Social Dimension in Hospital GET Changes to the social dimension of the hospital is particularly brought about during the third quarter of the transformation. These changes include the following:

◾ Creation and delivery of training programs for staff at all levels: These training programs range from a 2-hour seminar on what Green IT means through to the detailed 3–5 days worth of training (spread over 3–5 weeks to ensure minimal disruptions to the normal working of the hospital).

◾ Review of attitude toward Green IT through quick surveys and feedback: These surveys can be run online within the hospital’s systems ensuring immediate collation and analysis of the results. Surveys are required before and after the transformation—in this case in the first and after the fourth quarter.

◾ Use of IT systems support to reduce the routine pressures on doctors beyond the needs of their own specialist or generalist skills. This would be the result of Green BPM, but is also requires training for the doctors to enable them to use the new green processes.

◾ Implementation of metrics to provide real-time feedback to users on their daily carbon foot- print: A CEMS implementation is inevitable in GoodMead; and such a CEMS will provide the necessary means of capturing and using carbon data on a regular basis.

◾ Creation of telework program for support functions: Some admin. and support functions in the hospital can benefit by telework. For example, scheduling of rosters, billing of patients and some HR functions can be partially carried out by support staff through Telework. This will create opportunities to reduce people and equipment movement, and also reduce carbon emissions.

◾ Telehealth: It does more than provide assistance of patients in need of medical support but who are not in physical proximity of a medical officer. A physician or a health-care specialist using telehealth also, directly and indirectly, contributes to reduction in the carbon of that process; improve health support in remote regions; education, research, and administration in the field of medicine can be improved through telemedicine without increasing the carbon footprint.

◾ Development of a Green HR function that includes training, reward, and growth structure, particularly for admin and support staff, in terms of Green IT.

Technology Changes in Hospital Technology changes in the hospital as the green enterprise transition program gets underway relates to the user devices, data center, equipments, and wastages. Following are the technical changes during GET:

◾ Replacement of servers to the low-carbon emitting servers in the data center. ◾ Gradual replacement of devices to low-carbon devices.

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◾ Changes to the current backup, including off-site backups of data on the data servers. ◾ Upgrade of IT systems to automate processes. ◾ Upgrade to the EPR by implementing a strategy to move it on the Cloud. EPR can enhance

medical record documentation and optimize the consulting process of the doctor with the patient. Despite the risks associated with this strategy—particularly from privacy view- point—the approach of using the Cloud for EPR is likely to provide significant carbon reductions.

◾ Paper-less medical reports to reduce not only the paper wastage, but also time and effort in maintaining the manual records is saved.

◾ Collaboration with partners—such as sending of prescriptions electronically, or sourcing of medical drugs using web services.

◾ Green BPM for processes, including ordering and retrieving laboratory tests, prescription writing, consultation or referral notes, and billing.

◾ CEMS will be involved in recording carbon data that corresponds to various clinical activities. For example, consultation with a patient can be recorded in terms of time, types of examina- tions, reviews, progress notes, prescriptions, and follow-up consultations. Pathological tests and the delivery of results to the physician’s computer will also be calculated for its carbon contents.

◾ CEMS will be measuring and monitoring the hospital processes surrounding staff roster- ing. While the actual rostering process is currently a combination of the HR system and some whiteboard manual process, CEMS will be configured to measure the “slack” in the rostering process. The principles of “Lean” business can be applied here to reduce the slack and tighten the process. Corresponding reduction in carbon can also be calculated based on reduced rostering overheads, reduced or elimination of double booking of staff, and so on.

◾ User devices changes includes end-user devices such as PCs in the consulting rooms, exami- nation rooms, nursing workstations, and administrative hardware.

◾ Communications and network equipments. Network infrastructure includes virtual private network (VPN) for high-speed collaboration with other hospitals, service providers, and paterning organizations. Local area network (LAN) supports local communication within the GoodMead precinct.

◾ Non-IT equipments and their lifecycle has to be subject to the Green P-O-D. These equipments, such as are used in operating theatres or X-rays or in the pathological tests may not come directly under IT domain, but are still significant contributors to carbon emissions.

◾ Electronic wastage—policies and procedures. These have to discussed, updated and brought in practice through training of staff.

Applying Mobile Technologies in GET The use of mobile technology in the health-care services can provide substantial process benefits that also translate to carbon advantages. These various mobile advantages to Green IT were dis- cussed earlier in this book. A large number of hospital staff, such as the physicians, nurses, and administrative staff are using mobile laptops, blackberries, and iPhones to connect for both work and social networking. Following are the specific advantages that mobile technologies offer to the major users in GoodMead hospital from a carbon reduction viewpoint:

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Doctors Mobile technology can reduce carbon throughout the physician’s work and social processes. For example, handheld tools dedicated to a physician’s routine (e.g., TouchWorks from Allscripts Healthcare Solutions) can provide instantaneous data and information to the doctor. This can not only improve health-care services to patients and eliminate geographical distances but also reduce carbon content of the service.

GoodMead is providing dedicated health-care mobile tools and supporting technologies to all doctors that will enable them to serve the patients most efficiently, engage in conversations and conferences through their devices, and have fast access to patients’ data. The actions taken by the physician are also documented through the device, enabling easy tracking of actions when a staff member hands over the care of a patient to another member.

Nurses The use of mobile technology is also helps the nursing staff to coordinate with the doctors and the patients on a regular basis. GoodMead finds that the use of handheld devices by nurses is improving the consulting/advisory roles that nurses play (especially in a postoperative situation). Furthermore, mobile devices also improve the vital record keeping of patients with high effi- ciency and no physical paper. Checking the availability of doctors, quick consultations with doc- tors, handing over during the shifts and personal HR data access—all of these processes are improved for nurses through the use of mobility in the hospital which, in turn, has reduced carbon footprint.

Patients GoodMead as a large, public sector health-care provider needed to provide excellence in ser- vice without the carbon overheads. Use of mobile technology has given greater flexibility for the patients without being physically go to the hospital for check up. Starting right with the use of the mobile phone, patients are now able to connect using various PDAs and mobile laptops. This has reduced patient movement, patient queuing and has provided location-independent advise to patients where they needed it most. Additional mobile gadgets that monitor patient data remotely, provides it to the hospital and also raises relevant alerts has optimized the processes and reduced their carbon contents.

Suppliers (e.g., Pharmacies) Mobile technology improves receiving and ordering processes between hospital and its drug sup- plier. In addition, it also provides better management and storage system. GoodMead has pro- ceeded with Mobile Solutions, a handheld device from Cardinal Health, which has scanning facilities based on a pocket PC. This device enables GoodMead’s staff to work directly with hospi- tal inventory, resulting in optimized inventory for the medical drugs and also medical equipments in use.

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Lessons Learned in Implementing Green IT Strategies Following are the lessons learned as a result of the GET initiative for the hospital. These lessons indicate the significant role of Green ICT in the hospital domain.

◾ Strategic reduction in carbon will require significant changes in the social, process, and also technical dimensions of the business. These changes are across the board and not restricted to a single department or process.

◾ Service organizations are particularly influenced by customer expectations. In the case of GoodMead, the patients and the society in general was more keen to see the hospital become a green hospital, as compared with the internal staff and administrators.

◾ Telework and telehealth are likely to play a significant role in not only improving the busi- ness processes of the hospital, but also its carbon emissions record.

◾ Operational carbon reduction is more effective when processes are to be changed as com- pared with the changes to the procurement and disposal cycle.

◾ Training and education play a significant role in carbon reduction in a hospital—and similar service organizations—as they bring about a change in attitude and approach to Green IT restructuring to Green HR is also a significant boost to the carbon reduction effort from a social angle.

◾ Changes to IT systems that support business and technical processes should be made with the backdrop of environmental intelligence. Simple carbon data mining will not provide strategic value of directions for a transforming organization.

◾ Ongoing monitoring of risks associated with GET should be planned for enacted. These risks are not restricted to only the main dimension for transformation but can emerge from any of the four dimensions.

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