According to a report from New York-based Kalorama Information, the total United States healthcare market for wireless technologies in 2007 was valued at $2.7 billion. This figure, it states, is expected to increase at a compound annual growth rate of 29.5 percent to reach $9.6 billion by 2012.
The potential for wireless technologies in the hospital setting is, as they say, ‘sky-high.’ As technology advances and additional wireless applications enter the market, it will be increasingly more critical that CIOs have a solid strategy in place.
As CIOs are learning, there are several aspects in the development and maintenance of a wireless strategy. Key pieces include identifying primary drivers, determining how to most effectively link wireless strategy with clinical goals, building a sufficient infrastructure, and establishing an appropriate guiding philosophy. Once that's been established, says Mike Davis, executive vice president at the Chicago-based HIMSS Analytics, the sky truly is the limit.
“One of the great things about wireless technologies is that there's a lot you can do with it. I'm always amazed at how some people are using it to improve their efficiency and operations or patient care,” Davis says. “The challenge isn't, 'do we put wireless in?' Almost every hospital environment I can think of has wireless. The issue is, ‘how do you use it and how well do you use it?’”
When Ellen Swoger was hired as CIO at Methodist Medical Center of Illinois (MMCI) — a 353-bed rural hospital located in Peoria, Ill. — in 2005, the organization was experiencing problems with its wireless network, which she says was about three- to four-years-old. Tired of dealing with spotty cell phone coverage, the organization's leaders began examining their options.
“We started evaluating where we wanted to go in the future and what kinds of other things were we looking at from an organizational perspective and from a technology perspective,” Swoger says. She and her team had already discussed deploying asset and patient tracking down the road; therefore, they needed a solid network. That network needed to have infrastructure in place to support robust future applications, without having to add more wires. With this in mind, Swoger selected the Enterprise Access wireless infrastructure from United Kingdom-based GE Healthcare.
MMCI was already utilizing monitoring equipment from GE, so when IT leadership opted to add some telemetry wiring, it was a no-brainer to go to the same source. “It kind of came up at the same time that we needed to wire some additional units and we were rehabbing some units, so that was timely,” Swoger says. The goal was to set it up so that the entire organization didn't need to be rewired for future roll-outs such as RFID. “We will, of course, have to add access points and add different software components to facilitate the tracking, but the wiring itself is pretty much all there.”
Concerns about access points and coverage will always be present in the development and maintenance of a wireless strategy — from the planning stages through go-live, and beyond, Davis says. “Anytime you start to extend your capabilities and add more technologies, infrastructure is always going to be something the CIOs have to go back and look at, and say, ‘Do we need to improve our infrastructure, or maybe change some technologies,’” he says. “You have to look at your networks, the number of processors you have — all of that comes into play.”
Infrastructure, however, is just one piece of the puzzle. For Swoger and her team, strategic planning may start with wireless, but the end goal is focused on clinical outcomes.
“We tie all of the things that we do and the technologies that we bring in here to our strategic plan, and the things that we focus on are clinical quality, safety, patient satisfaction and clinician satisfaction,” Swoger says. “We didn't just look at it from an infrastructure perspective, although you have to have an infrastructure, otherwise you can't put applications out there. But we had the goal in mind to improve our clinician satisfaction, especially with physicians that used cell phones in the organization who really couldn't get good coverage.”
After implementing the network, MMCI's team rolled out a wireless phone system from Morrisville, N.C.-based Ascom, which was tied to the nurse call system. This, Swoger says, enables patients to directly contact a nurse using a call button located at the bedside. The nurse can then answer as if he or she is on a regular call; if the nurse is not available, the call rolls over to a nurse aid.
“It's a great way to leverage wireless to improve patient satisfaction,” Swoger says. “They get an immediate response rather than waiting for a nurse to answer a panel at the nursing station.”
Patient satisfaction, Davis says, is often a key driver in developing a wireless strategy. “CIOs are re-engineering portions of their operations based on point-of-care or point-of-service,” he says. Davis says he views wireless as “a supplementary type of technology” that can work to create more efficiency. “What people are finding is, when they put all these applications in place and they start to become more efficient at the point-of-care, metrics like time of order to point of administration for the medication is significantly reduced. And that has a big impact on outcomes, which will eventually have a big impact because of pay-for-performance.”
Wireless as a tool
At Methodist Hospital, a 460-bed facility located in Arcadia, Calif., CIO Kara Marx views wireless technology “as a tool to reach our goals. We look at the hospital's strategic plan, which incorporates patient safety and quality of care, and we say, how can technology support that strategy.”
Marx was originally recruited to roll out the EMR system from Atlanta-based Eclipsys and guide the organization's clinical strategy. But as Marx — who was hired as interim CIO before assuming the full-time roll in 2006 — found out, any discussion around EMR implementation will inevitably include wireless, particularly if there are plans to deploy nursing documentation at the point of care.
“We wanted to try carts, and in order to do that, we needed to have wireless,” Marx says. “That's how we ended up with wireless as the preliminary driver, and the timing to roll out our current environment was aligned with the go-live of our EMR.” However, while Methodist's leaders may have originally installed wireless to enable bedside documentation, they found that it offered additional functionalities. “We said, if we're going to invest in this architecture, what other constituents can we serve? We ended up building out our wireless network to include three other networks to support guests and visitors in the hospital, physicians, and our education department.”
Methodist's wireless network, the 802.11G from San Jose, Calif.-based Cisco Systems, went live with the EMR in November of 2007. According to Marx, it was developed to support future roll-outs such as RFID, wireless voice over IP, and medication administration, all of which are in the planning stages.
Davis says, it isn't at all rare to see an EMR and wireless network rolled out simultaneously, as the two are often intertwined. “I think wireless is one of those technologies that is actually pulled along depending on the strategies CIOs have for their different applications, whether it's clinical or supply chain or even patient access.” Any time an organization looks to extend applications out to clinicians, whether by automating CPOE or improving the ability to capture data, the key component is in enabling clinicians to be mobile, he emphasizes.
Leaders and fast followers
Swoger agrees that clinical and wireless are closely tied together. “You can't have one without the other. What differentiates what you do is your level of vision for technology,” she says. “Are you a leader, an innovator, a follower? And what kind of strategies do you have in place that makes you go one way or another — state-of-the-art versus tried-and-true technology.”
While she wouldn't quite characterize MMCI as leading-edge, Swoger says she considers her institution to be a leader when it comes to wireless technologies, particularly among its neighbors in rural Illinois. And while clinical outcomes are certainly the objective, technology is the vehicle by which the organization's end goals can be obtained, she says.
“Our organizational strategic plan really drives everything we do,” Swoger says. “Our primary goal of course is patient care, so our clinical technologies drive us and our clinical and patient satisfaction drive us, but we also have a really strong technical vision and technical goal in this organization, so that helps force us to look beyond what is just standard and look at more what is state-of-the-art from a technology infrastructure perspective.”
The philosophy is somewhat different at Methodist, which Marx considers to be a “fast-follower” rather than an early adopter. “I wouldn't say that we're cutting edge,” she says. “We don't want to be too far behind, but we don't want to go first either. We don't have the money or the risk tolerance to be first on a lot of things, but we don't want to get too behind, so we'll come in after we've seen it proven at a few other locations that are about equal to our size and volume.”
Marx says she knows that Methodist isn't always going to be a leader; what's more important to her is that she and her fellow leaders have their finger on the pulse of the wireless strategy and are constantly aware of what direction it is headed.
This type of care and monitoring is crucial, Davis says. Wireless may be supplementary technology, but is by no means an afterthought. “Wireless is extremely important; it allows for clinicians to make decisions at either point-of-care or point-of-service. As a result, we're much more efficient. We're capturing more data so we can make much better decisions.”