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Without Wires

July 1, 2007
by Daphne Lawrence
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St. Joseph Health System signs a $1 million contract to implement wireless at three hospitals.

In March, St. Joseph Health System (Orange, Calif.), a 14-hospital network serving California, New Mexico and Texas signed a $1 million contract with Embee Technologies (Irvine, Calif.) for the installation and integration of a wireless network at three of its hospitals. The goal was to implement a wireless network with the quality to manage emerging requirements of new data and voice applications without putting any of the shared services at jeopardy.


Bill Lazarus

A wireless system can encompass a variety of applications in healthcare. Anything that's wired is potentially wireless; and going wireless can range from adding wireless access to some terminals and global platforms, to wireless patient tracking and monitoring, and even to medical devices throughout the hospital. Choosing a wireless system, though, takes careful planning.

The right fit

"I think it's all about having your vendor understand the 24/7 nature of healthcare and the potential impact on patient care. It can come right down to somebody's life," says Bill Lazarus, assistant vice president of architecture and security at St. Joseph. "If critical information cannot be transmitted or accessed, then wrong decisions can be made." Backup systems are important, and for medical equipment, redundancy is critical, he adds.


Luke Slymen

Bryan Bergeron, president of Archetype Technologies (and a member of the Healthcare Informatics editorial board), agrees that reliability is the biggest issue. "It doesn't so much matter if you're talking on the phone, but if you're sending patient information, you don't want that data to be lost."

St. Joseph had previously used Embee to deploy wireless at some of its other hospitals for an "advanced clinicals" initiative, an umbrella for CPOE, nursing documentation, e-medication administration and PACS, but on an older technology that didn't have as wide a bandwidth range. According to Lazarus, St. Joseph had the opportunity to do three hospitals at once on the newer technology.

"We had the opportunity to do three hospitals at once on the newer technology, so we went to an RFP. Embee was successful in terms of design, solution and pricing."

Bergeron says there's an advantage to using a single vendor. "It may not be the best fit, but there's one point of contact so it's easy to manage. If you go with best-of-breed or a niche system, you have an integration issue, so you'll either need to have that expertise in-house or hire a vendor."

St. Joseph's wanted a system that provided the densest possible coverage to support as many devices and clients as possible. "We did that initial needs assessment," said Lazarus, "then Embee did a more specific design."

St. Joseph's did its own internal needs assessment, determining maximum concurrent device usage within a nursing unit and identifying the types of users and devices, including carts on wheels, tablet devices and wireless telephones. The hospital focused on an indoor wireless LAN to run applications, including patient record information, voice over IP using wireless phones, and wireless medical equipment like IP (insulin) pumps. The design included future applications like location awareness and asset tracking.

According to Luke Slymen, president of Embee, a positive outcome is about more than just the software and the hardware. "The design and the process are integral parts to the success of the implementation," he says. "That means using the right antennas, the right enclosures, and that the network can support it with the fault tolerance and redundancy a hospital needs."

Embee is training the St. Joseph's IT staff to manage the system, while providing escalated support if needed. Lazarus had budgeted for all the technology infrastructure within the clinical areas. "I had a comprehensive budget with component pieces. Wireless across the three sites was probably about $1.25 million," he says.

The system is a Cisco wireless platform that supports streaming media like voice and video applications as well as the industry standard 802.11 I-compliant security to satisfy HIPAA. "We designed it for a very low power output per access point so we could get more applications to support more devices," Slymen says. "It's a platform that will serve their wireless needs for the next few years until there's a big paradigm shift."

One soft point of ROI is more immediate access to patient data: the wireless phone solution enables integration from the clinical applications to the phone, passing out alerts and critical values to the handset when the nurse is in the hall, for example. Another is integration of hemodynamic monitoring back to the medical record—through wireless, the hemodynamic monitors immediately update values into the medical record. And smart pumps that communicate back to a server (and correspond to preset thresholds with medications) ensure better medication administration and tracking within the patient record.

Within the St. Joseph network, clinical users can go from hospital to hospital and use the same device because of consistent authentication. It has also been implementing an active directory and standardizing on that.

St. Joseph's is also using single sign-on, enabling users to log in one time and access all their applications. It's tied to the hospital's remote access portal as well. "As we roll that functionality out in the rest of the hospitals, they can have that same single sign-on functionality and same set of validation," said Lazarus. "It helps as we go from hospital to hospital to validate credentials."

St. Joseph's learned some lessons during the install. "We found that we couldn't get all the vendor solutions that we will be using on the network to comply with our security model," said Lazarus. "The smart pumps, for example, worked on an older level of wireless encryption. We had to put them in their own virtual LAN and create internal firewalls in our network to remove its vulnerability so it wouldn't affect the rest of the network."

Slymen points out that wireless installations in hospitals are always more challenging because of their many restricted areas. "You just can't go in and start taking ceiling tiles off." That also goes for areas like the OR and radiology—as they have lead shielding that affects the signal.

Older hospitals have an additional issue: "Some of them have their ceilings crammed full already and that makes it hard just to cable through them. And all hospitals have infection control issues that will impact the installation," he says.

St. Joseph's also found that, for wireless, comprehensive governance was better. "Our data mobility solutions committee historically focused on devices like carts on wheels and PDAs," said Lazarus. "I've recently broadened that to include overall wireless technology because I want organizational governance to look at potential issues, conflicts and evolution of the wireless environment."

Lazarus also believes in the involvement of stakeholders at the local level. They're the best qualified to identify both the potential access and the potential solution that will leverage wireless in the near and long term, he says. RFID (radiofrequency ID) solutions are one example.

"They're quite a buzz in healthcare now with the ability to implement asset tracking," said Lazarus. "As soon as you have a wireless network, before you know it, out of the woodwork come all of these niche applications and suddenly they're trialing RFID. And you want to be on top of that for security and standardization. I really think it's about getting the right governance and involvement from stakeholders so you can set standards and have the right quality of service."

St. Joseph's future plans include completing wireless for the other hospitals and opening up hotspots for visitors by 2008. Bergeron says that a hospital or network can go wireless at any point and upgrade later. "If you have an infrastructure that can be extended, then you're fine," he says. "As long as you set it up with a backbone that supports bandwidth, you can always add more channels. Start off with the infrastructure—you can expand it later."


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