Costs go up and the quality of patient care goes down in a hospital if doctors, nurses and other staff don’t have fast, easy access to information and each other. That was the problem faced several years ago by Vassar Brothers Medical Center in Poughkeepsie, N.Y.
Nicholas Christiano, vice president and CIO of HealthQuest, the hospital’s parent organization, said that computers were centralized in nurses stations and in individual offices. That meant that a nurse administering medication, for instance, couldn’t immediately verify whether the medication might inadvertently cause a reaction in that particular patient.
Given the constantly on-the-move nature of the work force in the hospital, the answer was clear, Christiano said.
“I told [the hospital president] that the only way we could make it work is to put in a wireless system,” he said.
Since September, a new wireless infrastructure has been in place at Vassar Brothers thats combines 802.11, cellular and paging networks. Even more, applications that use the wireless system are providing better care and have led to a stellar return-on-investment that is paying for itself in a relative blink of an eye, Christiano said.
The initial impulse by hospital executives was to deploy a computerized physician order system, which enables doctors to order tests and medication in real time and to view the potential impact of specific drugs on specific patients, according to Christiano. But that wasn’t feasible because of the way Vassar Brothers is organized.
Vassar Brothers is a so-called community-based health care system in which doctors are independent and are not hospital employees. Since they are not compensated for making rounds in the hospital, they aren’t as likely to use computer systems while they’re there but, rather, tend to get back to their own offices as soon as possible.
“Everybody wanted a computerized physician order entry system,” Christiano said. “But when you’re dealing with community-based physicians who aren’t on staff, it takes longer for them to get to a computer.”
If the system couldn’t focus on the doctors, then it had to focus on nurses, Christiano said.
“If you break this down, the next battle line where you can control medications is at the nursing level,” he said. “Nurses are employees. So instead of a computerized physician’s order entry system, I said let’s look at a medication barcoding system.” That, at least, would solve the critical problem of safely and efficiently administering medication, he noted.
“Medication errors can mean the wrong med going to the wrong patient, the right med at the wrong dosage — there are a lot of permutations,” Christiano said.
The next step was to figure out what type of network was needed, he said.
“We turned this into a large process model before we even looked into the [networking] technology,” Christiano said. In other words, the hospital first looked closely at its processes, then designed wireless capabilities to match those processes.
For instance, the primary way of communicating with doctors who were making their rounds was via cell phone, although some doctors still used pagers. Employees, however, could more efficiently use a wireless 802.11 network, Christiano noted. The network had to handle all those types of wireless technologies. “Next, I asked what happens when you have a medication that doesn’t work for the patient,” Christiano said. “Say the computer system says don’t give this medication to this patient. Where would [a nurse] go to make a call? Probably back to the nurses’ system. So we looked at wireless voice technology that worked more quickly.”
Building the network and applications
Because the network required reliable indoor cellular and paging access as well as 802.11 wireless LAN access, Vassar Brothers selected a passive distributed system from InnerWireless, which handles all those types of wireless transmissions.
“It mostly consists of coaxial cable maybe an inch in diameter that is wound throughout the facility,” Christiano said. “All signals run off the large cable. Off of that, you can have, say, an 802.11 access point or broadcasting antennas for cellular or pagers.”
The cable had to be run throughout the 515,000-square-foot hospital and the organization’s 130,000-square-foot ambulatory care center. While Ethernet has long been in place, it wasn’t always possible to use the same cable runs, Christiano said. Still, the cabling was relatively easy.
“Because it’s only one big cable, we were able to wire both facilities in under six months,” he said. “The hospital was full of patients, but it was still easy, not much disruption at all.” The old Ethernet network remains in place as a backup and for use with specific applications, such as transmission of high-bandwidth medical imaging. Building out the 802.11 portion was simple — Christiano said Vassar Brothers already is a Cisco shop, and access points from that vendor were installed as needed to ensure proper coverage.
The next hardware issue was voice communications. The answer for Vassar Brothers was voice devices from Vocera Communications that operate over the 802.11 network. These devices are small enough to be worn around the neck and they support voice commands so users can make calls without using their hands. The intelligence behind the voice system, such as call and user management, resides on a standard Windows server.
“It’s like Star Trek. You push a button, say a name and you’re connected,” Christiano said. At any given time, there are 600 Vocera devices in operation on the two-building campus.
Another crucial part of the hardware puzzle was COWS — computers on wheels that nurses and other personnel take around when visiting patients. There are 158 COWS used in the hospital, according to Christiano. Finally, the medical barcoding application was put in place.
“Every single piece of medication is individually barcoded,” Christiano said. “Before giving the medications, the nurse barcodes herself, barcodes the patient and barcodes the medication.” The system not only tracks who is giving and receiving what medications, but it also notifies the nurse if there’s a problem such as providing the wrong medication or the wrong dose.
The network build-out began in July 2005 and started going live the following spring with the entire campus up and running by the end of September 2006, Christiano said. That timeframe included training, he added.
The entire system, including deploying the network, the Vocera voice devices and the medication barcoding system, cost between US$4 million and $4.5 million, according to Christiano.
“We booked this project in a couple of phases,” Christiano said. “The pure-play infrastructure had no return on investment at all. We decided to defray the cost of the infrastructure by charging projects on top of it.” One benefit of this approach is that it encourages the development of more applications that use the wireless infrastructure, Christiano said.
The ROI projections (projected out to September of this year) for the first two projects, the voice and the medication barcoding systems, have been overwhelmingly positive, he said.
“With the Vocera system, just taking into account lost time for nurses, we’ll recapture $1 million in lost salary. We’re re-gaining 45 to 50 minutes per nurse per shift. And that’s just time they were going somewhere to talk