In addition to all the latest in amenities, most hospitals being built today are paying special attention to wireless infrastructure. “I think any facility moving forward has to put in high-speed backbones,” says Dykehouse, who is using a San Jose, Calif.-based Cisco system. “They will have to begin to really build out their wireless network.”
With the increased use of wireless in new facilities, he says, wireless management systems are needed to provide a real-time overview of the wireless network that can see where devices are, check out the coverage, and remotely tune the wireless network system. Hence, Dykehouse is implementing a wireless management system at the Reagan facility.
“There needs to be a focus not just on implementation, but on the management of the systems, with the ability to respond, adjust, and tune these systems immediately,” he says. “That's the type of thing that will become more critical as more and more medical devices are implemented,” explains Dykehouse.
McDaniel has plans for the medical devices at St. Vincent's as well. He will have USB ports that plug directly into the various medical devices in the room. “So as opposed to the nurse actually having to document the information on a device, it will populate the patient chart electronically,” he says. “All she will do is verify.”
As PACS has moved into the mainstream of the hospital specialties, and CT scans move from 32- to 64-bit (and up), bandwidth is also an important consideration. At Maple Grove, Taffe has what many say is the best solution to the bandwidth issue — the hospital has laid its own dark fiber.
“It isn't cheap,” he says. “It's very expensive to have your own private fiber, but we felt that we could easily pay it back in five years by not paying rent for fiber.” Taffe says that will allow his hospital a virtually unlimited amount of bandwidth in the future.
Most CIOs involved in a new construction project are also spending a lot of time on device, communication, and application integration. Lindsey Jarrell, CIO for Tampa, Fla.-based BayCare Health System, a nine-hospital system, is using U.K.-based Philips' Emergin integration engine. He says nurses today can have pagers for nurse call, pagers for general communications, an internal wireless phone, a PDA to check drug-drug interactions and a computer on wheels (COW). “We want to take things down to one mobile device like a PDA that has phone capabilities, put it all on one device and also give them access to corporate e-mail.”
Integrating new applications into a new facility is challenging, but what about legacy systems? Does a new facility represent an opportunity for “all new”? Apparently, not many CIOs are going that route.
At UCLA, Dykehouse is putting together a new clinical portal from Orion Health (Santa Monica, Calif.) so clinicians don't have to search through multiple systems. “Many of our systems, good or bad, have been custom-developed over the years, so that's part of the challenge — we have to refresh our application portfolio.”
At St. Vincent's, McDaniel, in a sense has it easy — he has no EMR. “We don't even have order entry. It does simplify things to a great degree because basically I have no legacy applications out there, or very few that I have to convert from.” McDaniel says he does plan to preserve the few legacy investments he has by creating an application programming interface (API) that can be accessed from anywhere.
Though most agree that wireless technology and patient-centric rooms are the most popular elements in new hospital design, today's CIO has a wealth of IT opportunities to choose from, which in itself can present another challenge. “The technician in us is always drooling about virtualization, blade servers, RFID, Vocera, and all these technologies,” says Taffe. “But we made a decision early on that technology was going to be prevalent, but not overly evident. We were not going to deploy technology for the sake of a new toy to play with.”
One area he decided to downsize was RFID. Since it's possible to track virtually anything in a hospital, the project was a bit overwhelming. So Taffe says he opted to move into that area slowly. “We decided not to put RFID into everything that moves the day we opened up the hospital.” He says although there is certainly value in being able to track everything, it is costly. “We decided to make sure we're using it where we can get the most benefit.”
For Taffe, that meant tracking devices and equipment that nurses need at the bedside, but can never seem to find—like wheelchairs and IV pumps. “Our goal is really for technology to anticipate the needs of the caregivers, versus them telling us what they want, and then we go off and do it.”
The green movement has also taken hold in the hospital building arena. “The phone PBX is a good example,” says Jarrell. “It went from the size of a car to the size of a chair. So that requires less heat, less cooling.” His new hospital will be LEED certified silver (see sidebar).
Another green option is virtual machine software that runs more applications off less servers. “It reduces footprint, it reduces square footage requirements, it reduces energy requirements, it reduces the heat, and it truly reduces my cost because I don't have to buy as many servers,” says McDaniel.
At MapleGrove, Taffe is using blade servers to reduce his footprint. “We've been very conscience about greening this facility. Virtualization is in the strategic plan, and the hospital will open with virtual servers.”
For CIOs, the constant battle of how much space they can allocate for technology is a big challenge. But there's an even bigger one.
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