By William Atkinson
Whether the goal is a finding reliable wireless network capable of circumnavigating architectural challenges, improving asset tracking, or revamping medication administration practices, mobile solutions are playing an increasingly integral role in healthcare facilities nationwide.
While each of the three case studies featured here highlights a solution specific to the hospital environment, their solutions have relevance for any enterprise grappling with similar needs.
Orlando Regional Health System Faces Network Challenges Florida's Orlando Regional Health System (ORH) serves 1.6 million area residents plus a steady influx of vacationers that can number more than 50 million a year. Its campus encompasses the Orlando Regional Medical Center (ORMC), Arnold Palmer Hospital for Children, Winnie Palmer Hospital for Women & Babies, the M.D. Anderson Cancer Center, the Lucerne Medical Center, and the Dr. Philips Hospital.
ORH offers BlackBerry devices and standard cell phones to its 1,500 employees. Coverage is provided by Sprint Nextel and AT&T. In the past, cellular signals were sufficient to maintain coverage inside hospital buildings, but problems arose in 2004, when inconsistent coverage was noticed on the first floor of the ORMC building.
Toaddress the problem, AT&T provided a rooftop antenna with a twoantenna indoor system from LGC Wireless. The system delivered strong and consistent coverage throughout the administrative areas.
The Winnie Palmer Hospital for Women & Babies, completed in 2006, presented a new problem: the construction plans had made no special provisions for indoor wireless coverage. In addition, the building's energyefficient reflective glass made it difficult for cellular signals to penetrate. "A lot of the coating on the glass did not allow outside cell signals to get into the hospital," says Ron Carroll, corporate manager of telecommunications. "Near the windows, you could get a signal. As you moved toward the core of the building, you would lose the signal."
Since cell phone communication had become common practice for doctors and administrative nurses, the hospital felt it had to address the issue in the new facility. As the structure neared completion, ORH asked Sprint Nextel and AT&T for advice. Each was willing to provide coverage, but only for its own frequency. As a result, ORH decided to purchase the InterReach Fusion system directly from LGC Wireless. The multi-carrier indoor cellular coverage system was able to support both frequencies, cost less than having twocarriers, and had a relatively quick deployment time.
LGC installed two main hubs in the hospital's telecommunications center and placed six expansion hubs on various floors. These were linked to rooftop antennae supplied by Sprint Nextel and AT&T, which capture signals from nearby outdoor cell towers and relay them into the building.
ORH's cabling contractors deployed the fiber optic cabling that connects the main hubs to the expansion hubs, and then installed CATV cabling to connect each expansion hub to the remote antennae. A tunnel joining the old hospital building to the new facility came in handy. "All of the equipment was installed in the old hospital, and we ran the wiring through the tunnel [to] the new hospital," says Carroll.
Now, coverage is provided in patient rooms, administrative areas, operating rooms, labs, and emergency rooms. "As soon as we turned the system on, we could see immediate improvement," says Carroll. "The bars on the phones almost maxed out, and we got communication throughout the hospital."
He adds that "the doctors and administration people who rely on communication for emergency situations noticed the improvement right away."
The future? "We are considering expanding the technology to some of the other hospitals that may be built [on the Orlando campus]," says Carroll. For example, the next hospital they're building will be the Bert Martin Champions for Children Emergency Department & Trauma Center, which will be able to treat 60,000 pediatric emergency patients a year.
"In such instances, we will probably specify the technology in the original [construction] plans, so it will be installed as the hospitals are being built. We may also go back and retrofit some of our older buildings."
Denver Health Tracks Assets With Real-Time Location System Denver Health in Colorado is a 480-bed hospital that serves the needs of 25% of the Denver metro area's population of more than 2 million residents. In late 2007, administration made the decision to expand its RFID asset tracking throughout the 1.5 million-square-foot hospital to keep tabs on more than 2,500 devices. The effort also was part of an initiative called "Lean Thinking" created to identify and reduce waste. Being able to track equipment throughout the 1.5 million square foot facility reduces the time staffers spend looking for misplaced equipment. It also enables staff to quickly identify and locate equipment that's scheduled for preventive maintenance, repair, and/or replacement.
Denver Health selected PanGo, a real-time location system (RTLS) provided by InnerWireless. PanGo is an asset tracking technology that provides a Web-based view of thousands of assets from a variety of RTLS and RFID sources. It integrates these, allowing users to view assets from any or all of these sources.
Denver Health was able to integrate PanGo with its existing Cisco Unified Wireless Network and the Cisco Wireless Location Appliance. Cisco Systems has defined a standard protocol for WiFi-based active RFID tags to communicate their location and status. This protocol is called CCX-Tag, and the current version is v1.
"It seamlessly integrated into our existing infrastructure," says Jeff Pelot, chief technology officer for Denver Health. "We piloted it for about a month in the in-patient tuberculosis clinic. We chose this area because it posed a real challenge for the system to work well, due to the long, narrow corridors and thick brick walls."
After proving its abilities there, PanGo was deployed in the hospital's Women and Children's Pavilion, and ultimately rolled out across the whole hospital. "Throughout the process, InnerWireless provided dedicated customer support and continues to make sure that PanGo meets our immediate and future needs," says Pelot.
The RTLS system is used to meet the needs of a variety of hospital departments, notes Pelot. "Our biomedical department uses PanGo for equipment maintenance purposes, while central supply can control infusion pump inventory."
Denver Health uses PanGo to track expensive equipment, such as wound vacuums, which the hospital leases by the day. By being able to track the location of these items and make them more readily available to medical personnel as needed, the hospital has reduced the number of wound vacuums it leases.
The RTLS solution also enables the facility to control spending on less costly but more frequently used items, such as infusion pumps and wheelchairs. For example, after tracking wheelchairs with the system, Denver Health discovered that many were sitting unused, scattered throughout a number of locations. Now, the transportation department can quickly locate and retrieve unused wheelchairs. This ultimately enabled the hospital to reduce its overall inventory of wheelchairs.
Now, Denver Health is exploring other uses for RTLS. "I am meeting with other departments such as nursing and engineering to determine additional needs," says Pelot. "I hope to continue expanding the use of the technology to continue to improve Denver Health's processes, workflow, and bottom line, but most importantly, the patient experience."
Island Hospital Keeps Clinicians On The Move Island Hospital in Anacortes, Wash., went live with bedside verification for medications in 2006. At the time, the hospital utilized computers on wheels (COWs), which are simply carts bearing laptops and scanners. "Nurses could roll the carts into patient rooms, log in, barcode the patient's wristband and medication, then administer the medicine," says Rick Kiser, assistant director for the hospital's IS department.
However, the carts turned out to require a lot of maintenance and were very difficult to clean.
Around that time, Motion Computing introduced its C5 Mobile Clinical Assistant (MCA), and Island Hospital opted to give it a whirl.
MCA is a product category created by Intel with the support of Motion Computing and other hardware and software suppliers. It's designed to offer point-of-care information and documentation for healthcare professionals.
Motion Computing's C5 handheld computer is one of the first products in the MCA category. It includes a builtin barcode reader; an RFID reader; a built-in camera; and a fingerprint reader. It offers Tablet PC functionality and utilizes Intel mobile technology and IEEE 802.11 standards-based highspeed wireless connectivity.
For medication administration verification, employees use the tablet's barcode scanner to scan the patient's wristband, then scan the medication to ensure accuracy and to electronically record the procedure.
Island uses a wireless LAN (WLAN) system provided by Cisco. It didn't require the installation of any special networking equipment or upgrades to the hospital's existing wireless infrastructure. "We already had a Vocera system in place, and their requirements are higher than Motion, so our wireless system was already sufficient to meet the needs of Motion," says Kiser.
The durable device is highly-sealed and can be fully disinfected. It also features smooth surfaces and the absence of ports and recesses that might otherwise become reservoirs for pathogens.
Island is using the barcode reader technology for medication administration and patient record-keeping, but it isn't yet using the RFID or fingerprint readers. 'We may use RFID in the future as a doorway scanner to keep track of equipment," says Kiser.
A digitizer pen allows C5 users to enter handwritten information directly into patient records. Users can pull up patient history on the spot and instantly view the latest chart entries. Since it eliminates double documentation, information accuracy is increased, and the potential for transcription and medication administration errors decreases. It integrates with the Meditech software application, as well as Microsoft Exchange and allows Internet access.
When it's time to administer medication, staff can scan a patient's wristband with the barcode reader, then scan the barcode on the medication to verify and record the procedure. The technology helps to enforce what's known in the healthcare industry as the "5 Rights" of medication administration: the right drug for the right patient in the right dosage via the right route at the right time.
The technology is in use in Island's ICU and ER, among other locations. By press time it had only been in place for a few weeks and 35 of the devices had been deployed. Kiser says he's already hearing requests from staff to get more C5s.
The facility has already learned a key lesson in encouraging employees to use the shared devices: the location of the docking stations makes all the difference. "Docking stations for charging are in patient rooms, not at the nurse's stations, so we need a better system," Kiser says. "We're planning to purchase a charging station to charge a number of batteries at once."
Nonetheless, Kiser says he's seeing more and more empty cradles at any given time, indicating that nurses are using the devices on a regular basis. "A few other departments are asking for them, so we will probably buy more of them," he adds. //