The Ottawa Hospital (Ottawa, Ontario) is the largest acute care hospital in Canada, sitting on a 12 million square foot campus. It has 1,163 beds and 11,967 staff, including 1,159 attending physicians, 3,886 registered nurses and nurse practitioners, and 944 residents.
The hospital realized that the process through which physicians gather and share information with patients and their families in clinical settings was open to improvement. Doctors had traditionally depended on information stored on computers or in files far from the patients' bedsides to conduct their daily rounds. Accessing this information was disruptive and inefficient, due to the lack of real-time access to important information such as lab results, medical imaging, and other information.
The hospital began looking into computerized physician order entry (CPOE). "However, as simple as it might sound, this proved to be somewhat difficult to implement," points out Dale Potter, CIO. "Even if we put a computer at every beside, a physician would not take the time to log on, find the patient, find the form, and fill it out. Instead, they would jot the information on a piece of paper and hand it to someone. This has been proven over and over in other hospitals."
In early 2010, around the time that the hospital was studying this challenge, the iPad was introduced. Potter realized that this new technology offered some possibilities, so he purchased four of them, giving two to physicians and two to his technical staff to get their input. "All four of them very quickly said, 'We must have these,'" states Potter. He also realized that, if the hospital was going to move to a CPOE environment, mobility was critical, and this platform seemed viable.
"Since we were one of the first organizations in Canada to attempt this, we realized it was likely that our wireless infrastructure would not be sufficient," he continues. The hospital put out an RFP that Potter admits was somewhat vague: "We wanted the newest technology, highest bandwidth, highest scalability, and most adaptable hardware configurations available," he states.
"We looked at all of the big players, but ended up selecting Aruba, even though they were a smaller company," he states. One reason was that Aruba did have some differentiators in terms of technology. Another was that Potter was able to meet personally with the CEO of Aruba, who committed to him that the company would do whatever it took to make things work.
In mid-2011, The Ottawa Hospital deployed an 802.11n wireless network, based on the Aruba Mobile Virtual Enterprise (MOVE) architecture. The MOVE architecture provided a unified wired wireless network infrastructure that created a seamless access solution. The unified approach led to improve productivity and lower capital and operational costs for the hospital - a key consideration for Potter. The hospital's network is currently designed to support over 3,000 Apple iPads, iPhones and iPods. It covers the entire 12 million square foot campus. "The wireless network is perhaps the most critical infrastructure component that we have supporting all of our applications, and is the primary means of network access for our physicians and other clinicians," explains Potter.
There was virtually no training required, because everything was so intuitive. In addition, most of the staff already had experience with iPhones or iPods and were familiar with the interfaces. "We did offer individualized training for physicians at convenient times during the day, but very few of them showed up for the training," states Potter. "Almost all of them learned it on their own."
The iPads were deploying in a graduated fashion, rather than all at once, because Potter and his team needed to understand the impact on the network. "We couldn't afford to throw thousands of them out there in just a couple of weeks without knowing the effect on the network," he explains. Instead, the hospital deployed about 1,000 in July 2011. Since then, the team has been deploying about 150 a week. By the end of 2011, they will have about 3,000 deployed. "A team from Aruba comes in every month or two to observe the network and access requiements," he continues. "They have added some access points in locations where there have been high amounts of activity."
Results and Benefits
"We have engaged four universities to have some researchers come in to do some methodic and exhaustive studies to identify some objective measurements," he states. "Right now, though, all we have is anecdotal evidence that would lead us to believe that there are benefits."
And what is some of that anecdotal evidence? "I know for sure that we could never remove the iPads," he replies. "Physicians especially love them." One day, right after initial deployment, Potter ran into a resident who was visibly upset. She said she had to go home and then come back. "I forgot my iPad at home!'" she explained.
Most important is the more personal care that MRPs (Most Responsible Physicians) are now able to provide to patients. "Our mobile solution has clearly allowed them to get back into their natural workflow," he explains. In the past, when MRPs did rounds, they would go into a conference room, talk about patients with the residents, and plan their care for the day. The residents would then go out and execute the care plans. As a result, the MRPs might never actually see any patients.
"We now require that MRPs must see their patients at least once every day," states Potter. It is called the "Back to Bedside" program. "We didn't get any resistance to this, because they are able to use their iPads. They can be at the bedside, and everything they need is right there. The patients also value it, because they feel that the physicians are actually more engaged."
Dr. Glen Geiger, medical director and chief clinical information officer for the hospital, agrees. "With mobility, we have been able to go back to a pattern where the whole team moves as a group from patient to patient," he stated in a press release. "We go from room to room to review each case, access information and make decisions with the patient or the family in the room. This gives the patient a sense of control, and it is much more direct and collaborative than a group of doctors discussing their care in a conference room and then sending the interns to explain it to the patients."
In one instance, a physician went to see one older patient every day as required. The woman, who had multiple health problems, had just come out of surgery. On the third or fourth day after surgery, the physician realized that something was wrong just by looking at her and talking to her. It turned out that she had an unknown condition in her brain that they were able to treat. "He simply wouldn't have observed that if he had been sitting in a conference room looking at paper documents," concludes Potter.