A revolution is under way at Vassar Brothers Medical Center. Clinicians and staff at the 365-bed hospital in Poughkeepsie, N.Y., are experiencing a new kind of freedom — liberation from medical and communications devices tethered to electrical wall sockets and traditional phone and computer networks. With the installation of a robust wireless network and several new applications, the IT staff is seeking to match the hospital's data gathering and dissemination to the mobility of its employees.
The driving force that led to Vassar Brothers' wireless revolution was patient safety, not efficiency.
In early 2004, concerned by national studies about clinical errors and adverse drug events, CEO Daniel Aronzon, M.D., wanted the hospital to consider moving to computer-based physician order entry (CPOE). But because Vassar Brothers is a community hospital with no physicians on staff, hospital executives realized that getting physicians to change their work habits would be difficult.
Nick Christiano, vice president and CIO of Health Quest, parent company of Vassar Brothers, says he warned Aronzon that his chances of success at implementing CPOE were "probably less than 10 percent, just because of the cultural issues."
Christiano and Aronzon next considered nurse-administered medication bar coding. Because nurses are hospital employees, the CEO and CIO pair figured the implementation would have a better chance of success. But after studying some solutions, Christiano wasn't convinced. "This is a very busy hospital," he explains. "Everything is in motion, but these systems were reliant on static devices plugged into the wall. It seemed obvious to me then that we had to go wireless."
After some research, he found a wireless system from Bridge Medical Inc. (purchased in 2005 by Cerner Corp., Kansas City, Mo.). The system allows nurses to quickly cross-check patients' wristbands, medical records and medications.
But once they made the decision to go wireless, Aronzon and Christiano stepped back and envisioned a wireless environment that could help with everything from doctor-nurse communication to patient registration and asset tracking. They decided to invest in a broadband system robust enough to support current and future voice, data, telemetry and RFID applications.
After sending out a request for proposal to several wireless vendors, Christiano was disappointed by the limited response. He says many vendors told him they chose not to bid because the implementation was too large or too complex or they hadn't worked in a hospital setting before.
Vassar Brothers chose a network infrastructure from InnerWireless Inc. (Richardson, Texas). The company describes its passive antenna system as acting "like a wireless utility" that supports wireless LANs, BlackBerrys, cell phones, PDAs and pagers.
Because it involved a complex multi-vendor solution, the hospital chose IBM Corp., Armonk, N.Y., to handle project management. The infrastructure project cost just less than $1 million, Christiano says. While that's almost three times more than a plain-vanilla 802.11 wireless network, he says "every wireless application we consider going forward will plug into it."
He believes some hospitals make the mistake of not investing enough in infrastructure. "They find themselves supporting lots of different individual wireless projects and their network isn't built out to support it," Christiano says. "Well, you've got to build for success, not failure."
In July 2005, IBM started work at the 515,000-square-foot hospital and adjoining 130,000-square-foot ambulatory care center and finished the build-out within five months. "I only had one complaint in that period," Christiano recalled, "and it was about a little dust left on someone's desk."
Besides the medications bar coding, the infrastructure allows the hospital to address other inefficiencies:
Nurses and doctors often had difficulty locating each other via pagers and phone calls. Now, they communicate quickly through wireless devices from Vocera Communications (Cupertino, Calif.) worn around their necks.
The registration staff, which uses Invision software from Siemens Medical Solutions (Malvern, Pa.), has shifted from using desktop computers to mobile wireless laptops.
Employees are using the "Spot" RFID asset tracking system from InnerWireless to keep tabs on the whereabouts and usage rates of 134 IV pumps. As the asset tracking system is expanded, it is expected to slash the time clinicians spend searching for medical devices.
Marc Holland, program director in health provider research at Framingham, Mass.-based IDC's Health Industry Insights, calls Christiano "very visionary." Holland says that although Vassar Brothers is not a large teaching hospital, Christiano has been able to create an environment that allows it to take advantage of the second generation of wireless network technology. (See sidebar.)
Christiano sold hospital executives on the investment by focusing on the long-term benefits. He stated upfront that the wireless infrastructure would have no direct return on investment (ROI) of its own, but stressed to the hospital board of directors that all wireless applications must demonstrate ROI. He uses a highway construction metaphor to make his point: "It's like we're building a two-lane highway, and if all this development grows up around it, I'll come back to seek funding to turn it into a four-lane highway," he says. "That's progress."
David Raths is a contributing writer based in Philadelphia
Nick Christiano, vice president and CIO of Health Quest, parent company of Vassar Brothers Medical Center, a 365-bed hospital in Poughkeepsie, N.Y., may be reached at firstname.lastname@example.org.
"I only had one complaint in that period," Christiano recalled, "and it was about a little dust left on someone's desk."
"It's like we're building a two-lane highway, and if all this development grows up around it, I'll come back to seek funding to turn it into a four-lane highway," he says. "That's progress."
Vassar Brothers Medical Center's robust wireless environment exemplifies the shift to a second generation of wireless networks, says Marc Holland, program director in health provider research at IDC's Health Industry Insights (Framingham, Mass.).
Many hospitals took a limited plunge for specific applications when the technology was relatively new, Holland says, but as more applications become available, those hospitals are moving to build out on their initial infrastructure investment to get more bandwidth. "They're expecting a lot more traffic, in more places and involving more people," he says.
"There's been a virtual blizzard of activity in wireless applications for healthcare," Holland adds, "because it is an ideal setting. It's information-intensive, there are lots of crosscurrents of communication and it happens in very tight timeframes. It's a natural environment for it, and the vendors have responded."
U.S. healthcare spending on wireless network infrastructure equipment is expected to grow from $42.1 million in 2005 to $121.2 million in 2010, a five-year compound annual growth rate of 23.5 percent, according to research by IDC. That compares with overall market growth from $474 million in 2005 to nearly $829 million in 2010, a compound annual rate of 11.8 percent.
Converging communications and asset management are among the leading drivers of wireless networks in healthcare, according to Stan Schatt, vice president, broadband and wireless networks for Oyster Bay, N.Y-based ABI Research.
"The ability to locate mobile staff quickly with a single portable device rather than using pagers and wire-line phones is a huge advantage," he says. "Also, hospitals lose a lot of valuable equipment and the use of wi-fi tags is allowing them to keep track of expensive medical equipment a lot more accurately."
Security is another huge concern for hospital CIOs seeking to make sure their wireless networks meet HIPAA guidelines for privacy and security. Basic 802.11 wi-fi networks still have security gaps that industry standards do not cover, Schatt says. "Hospitals typically add pieces of equipment to handle intrusion detection."
ABI Research's recent report "Wi-Fi in the Healthcare Vertical Market" listed some of the major players offering wireless networks to the healthcare field. Schatt says among the leaders in the field is Symbol Technology, recently purchased by Motorola Inc., Schaumburg, Ill. "Cisco (San Jose, Calif.) has jumped into healthcare in a big way," Schatt says. Other leading vendors mentioned in the report include SpectraLink Corp., which focuses on phone systems and was recently acquired by Polycom Inc., Pleasanton, Calif.; Meru Networks, Sunnyvale, Calif.; Aruba Networks, Sunnyvale, Calif.; Siemens Medical Solutions, Malvern, Pa.; and Colubris Networks, Waltham, Mass. Another vendor in this space is Vienna, Va.-based MobileAccess. — D.R.M.