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Far From Child's Play

May 29, 2008
by Kate Huvane
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Hospitals are leveraging wireless technologies to ensure that babies and mothers never lose touch.

David selman

David Selman

Like many areas of hospital management, infant security has changed drastically over the years. The measures that are being taken to protect infants from abductions have grown by leaps and bounds thanks to the evolution in the technologies used to monitor security. As these systems have expanded, the responsibilities that were once allocated mainly to security departments are now being shared by security, facilities, clinicians, and, of course, the IT department.

A number of facilities have implemented tagging systems that integrate with wireless systems by incorporating RFID technology to provide enhanced security. Unlike previous models, these systems are part of a larger, hospital-wide effort rather than being isolated to one or two departments.

“We view the system as simply another extension of the technology that is in play to ensure the safety and security not only of our employees and staff, but of our patients and of our visitors,” says David Selman, CIO at ProMedica Health System, a 10-hospital organization serving patients in northwest and west central Ohio and southeast Michigan. Four of its facilities have implemented the Hugs infant protection system from Grand Rapids, Mich.-based Innovative Medical Systems, Inc., a partner of the Verichip Corporation (Delray Beach, Fla.).

Hugs is one of a few systems available on the market that work to prevent instances like abductions and switching of infants, with the latter occurring far more frequently. According to Jeff Aldridge, founder of the Durham, N.C.-based Security Assessments International consulting firm, around 250 infant abductions have been reported since 1983, while there are an estimated 23,400 mix-ups in the United States every year.

They may not be the kind of numbers that would cause a hospital administrator to hit the panic button, but for Mark McMath, CIO of Bloomington Hospital (Bloomington, Ind.), statistics are irrelevant in cases like this.

“The challenge with infant abductions is one is too many,” he says. The decision to implement the Hugs and Kisses systems, by Ontario's Xmark Corporation, wasn't driven by a specific incident, but rather as a preventative step. “We wanted to be proactive.”

Along with the risk management component, the systems can also assist facilities in complying with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Environment of Care standards (see sidebar).

Getting wired with security

McMath was able to address security and compliance concerns when the Regional Center for Women and Children, part of the 355-bed Bloomington Hospital organization, installed the Hugs and Kisses tagging systems in 2006. With the Hugs technology, if an infant is taken out of an authorized area or if the tag is broken or removed, an alert is immediately sent to the hospital staff, whereas the Kisses function works by sounding a soft beep to signify that a mother is matched up with the correct baby.

According to McMath, infants are banded following delivery with a soft bracelet which is automatically entered into the facility's computer system. A screen then pops up immediately on the computer indicating that the tag has been activated, at which point the clinician enters the mother and infant data into the system.

When an infant is transported within the maternity wing, an alert is transmitted to the computer by the local area receivers that are installed throughout monitored areas of the facility, enabling the staff to identify and track an infant's precise location. As the data moves through the internal processes within a unit, the information is time-stamped on the controller for that network, which is connected back to the master network. If a person who is carrying an infant approaches an exit (which is outside of the authorized zone), the system locks down the doors and renders the elevator inoperable, says McMath.

According to Selman, when the alarm is activated, several components of the facility are shut down by zone. The system, which controls the door monitoring device, will close any open door by releasing a magnet, and will lock the door via an electronic signal sent through the unit-based device. If at any time the wristband is broken or tampered with, the circuit that goes around the band will be disrupted and the wireless network will identify the potential breach, he says.

Although Bloomington and ProMedica utilize similar protection systems, they differ as to network preferences. Toledo Hospital (the ProMedica facility that most recently implemented Hugs) operates on a separate secure 802.11 network, while Bloomington's system utilizes its own RF frequency.

Aldridge, who has conducted numerous threat assessments and vulnerability evaluations of maternity units, recommends that facilities operate on separate LANs in order to avoid having the system go down during periodic updates.

System integration

One key advantage of the Hugs security system is the fact that the technology is not confined to the infant care unit. The presence of a shared infrastructure at facilities like Bloomington and ProMedica enables integration into other departments where security threats exist, including the pediatrics unit, which Aldridge says is an area that may soon face stricter JCAHO standards for protection against abductions.

“Each year, they add more and more locations in the hospital that qualify as sensitive locations that need a higher level of security than the standard area,” says Aldridge, who identifies psychiatric and senior care units as areas that can benefit from heightened security, as well as the emergency department.

In terms of enterprise-wide integration, wireless security systems are believed to offer a great deal of potential. But for many health systems, the concept is still a work in progress — and for others, it isn't quite on the radar yet.

ProMedica is in the first stages of implementing the Horizon Clinical EMR suite from San Francisco-based McKesson Corp., which includes CPOE with decision support and bedside bar code-enabled medication administration management systems. Although the software is not yet integrated with the infant protection system, according to Michael Ruhlen, M.D., vice president of medical informatics at ProMedica, the capability is there.

The integration aspect is something that may be considered further down the road at Bloomington's Regional Center for Women and Children. With the current system, data from infant tags is manually entered into the Centricity Perinatal Clinical Information System from U.K.-based GE Healthcare and is documented. However, although the information is transferred into the EMR, Centricity Perinatal and the Hugs systems are not connected, according to Dana Watters, executive director of Bloomington Hospital's Regional Center for Women and Children. But if they should decide to integrate the systems down the road, the option is there.

Paradigm shift

With the new capabilities of today's security systems — which can interface with access points, video surveillance, and RFID technologies — comes a new set of roles and responsibilities that are no longer solely handled by the security department. Nowadays, the duties are shared by clinicians, the facilities department, security, and IT, according to Selman.

At the ProMedica facilities, when a band is tampered with, the clinician responds while security personnel are alerted and called upon to provide immediate back-up. Security must then collaborate with facilities because of the lock-down capability that the system offers, and in turn, facilities works with IT to manage the technology that interfaces with the elevator systems to shut down elevators and alarm doors. The IT component comes from the fact that the security and facilities systems are linked into other technologies, says Selman.

“There's more of a partnership among these areas now,” he says.

This paradigm shift, according to McMath, is forcing different staff members to get out of their silos, something that he feels is critical for any facility.

“The challenge is that there are so many needs in the organization and how you balance those with these types of very specific requirements is critical,” McMath says. One way in which he is trying to accomplish this at Bloomington is by involving other departments in addition to IT directly in driving these processes. This way, he says, “We become more of a consultative resource, which I think will helps us even better balance those needs, and that's a shift that's underway right now in our governance.”

Infant security in hospitals has evolved significantly in recent years and has now reached a point where it is almost a non-issue for the facilities that have taken all the necessary measures.

According to Aldridge, it is an area that is seeing marked improvement.

“We're getting to the state now with access control and infant tagging systems where we have pretty good security,” he says. “What we're trying to do is fold that into the new convergence. And what we're seeing is a movement toward convergence that's increasing in hospitals. As more organizations are recognizing the need to embrace this new paradigm shift, we're seeing hospitals move toward that.”

Finally, while different facilities may vary in terms of what they may expect or require from a wireless security system, there is one component of these systems that is almost universally sought by users: prevention of a major incident.

“I think it is incumbent upon every CIO to really look at technologies like this as part of their risk management program,” Selman says.

As Aldridge points out, not only can having this type of technology deter potential abductors, but it can also protect facilities against lawsuits that can be both costly and damaging to a hospital's reputation.

McMath is careful not to underestimate the gravity of a potential abduction.

“You've got to understand that we are seeing societal changes,” he says. “There is a greater risk today than there has ever been, and you have to factor that in as well as the impact it has on the child and the parents if it does occur, and the caregivers and the hospital that are trying to provide a safe and nurturing environment.”

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