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.
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.
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.