These days, hospital CIOs are under a great deal of stress. There's pressure from the Joint Commission to improve patient safety and reduce adverse events. It's a pressure compounded by the fact that Medicare no longer reimburses for costs related to preventable errors.
And it's not just CMS. Recently, payers have also started to refuse coverage for “never events” such as surgery on the wrong body part, hospital-acquired infections, and even patient falls and trauma.
On top of that, there are the constant demands to keep costs down and staff members happy. It's a lot to juggle, and while no solution will solve everything, leading-edge organizations are making headway by implementing wireless systems that track vital signs and patient movement, providing what Fran Turisco calls “a technological safety net for busy caregivers.”
Unlike the monitoring devices of the past, the newer systems are highly automated and integrate with the HIS to alert nurses and other staff in real-time when a patient tries to get out of bed or experiences trauma, says Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.). “If you can prevent a cardiac arrest by noticing that the vital signs are starting to go in the wrong direction, there's a huge amount you can do to help the patient's outcome and the cost of care,” she says. “It's like another set of eyes and ears.”
Elizabeth Rockowitz, a Miami-based regional manager at Beacon Partners (Weymouth, Mass.), says the big appeal of wireless monitoring systems is the ability for clinicians to cover more beds while obtaining a broader scope of the patient's condition. “With this technology, you're actually managing the patient more effectively because you're getting a better snapshot,” which can result in shorter patient stays. “So it's going to save money, not only from a managed-care side, but also the hospital side and the patient side,” she says.
Connecting the dots
At Ball Memorial Hospital, a 395-bed facility based in Muncie, Ind., the opening of a state-of-the-art, 108-bed critical-care tower in March presented a golden opportunity to deploy wireless patient monitoring. According to Dlynn Melo, director of clinical informatics, the organization took advantage of the ubiquitous coverage by installing wireless bedside monitors from U.K.-based GE Healthcare.
The monitors are linked with the Ascom (Research Triangle Park, N.C.) communication system through an interface engine from Emergin (Boca Raton, Fla.) to keep nurses updated on a patient's condition. Each patient bed is assigned to a specific nurse. The patient's data, as well as the nurse's name and phone number, is housed in the monitoring system through interfaces with both GE and Ball Memorial's McKesson (Alpharetta, Ga.) EMR. All of this, says Melo, is configured so that within seconds of a life-critical alarm, the nurse receives an alert.
Vice President and CNO Doreen Johnson - who worked on the project along with Melo - says, “Our goals were to have the highest quality of care in the safest possible environment and to support our staff by giving them the tools and equipment to do their jobs and not waste their time with inefficiency.”
And that meant building escalation rules into the system so that if the nurse assigned to a particular patient fails to reply to a call within a short window of time, an alert is sent to another staff member, and then another, until the call is answered. “It's a very complex set of rules that nursing had to sign off on and agree on,” says Melo. “But it's something we needed in place.”
Ball Memorial also deployed sensor technology that detects movement by patients who are at a high risk of falling, triggering an alarm to nurses through the Rauland (Mount Prospect, Ill.) nurse call system if they attempt to exit the bed. This interface is also set up through the Emergin engine, says Melo, noting that bed-exit alarms are another key facet of the organization's goal to improve safety as well as patient satisfaction. “We're hoping our scores will continue to rise,” she says, referring to the surveys that are conducted to measure the patient experience.
While CIO Bob McKelvey didn't participate in the planning of the wireless monitoring project (the go-live coincided with his arrival at Ball Memorial in the spring), he says he fully supports the initiative. “The special thing about it already being in place is that it aligns with everything that I agree with, in terms of the direction health IT should be going,” he says. “The patient experience is the ultimate goal of anybody working in healthcare, and to see IT integrated so well within a hospital setting like Ball Memorial is a great thing.”
University Hospitals, a 1,032-bed, multi-hospital system based in Cleveland, is in the midst of a $1.2 billion construction project and change-management initiative called Vision 2010. One of the key components of that strategic plan, according to Division CIO Ryan Terry, is the newly opened, 38-bed neonatal ICU at UH Rainbow Babies and Children's Hospital, which includes an advanced wireless monitoring system that he hopes will become the standard for future neonatology projects.