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August 17, 2009

Mission Mobility
By Alice Shepherd
For The Record
Vol. 21 No.16  P. 16

By employing wireless technologies, hospitals can give healthcare professionals the freedom to provide quality care from anywhere in the organization.

Healthcare organizations that are going high tech with EMR systems want equally progressive voice and data communications. Yet, while physicians are reachable on their cell phones 24/7, whether at home or on the golf course, critical cellular coverage is often absent where it is needed most: inside the hospital. And while EMRs supposedly make data available anytime, anywhere, their benefits cannot be maximized as long as computers and medical devices remain stationary rather than following physicians and clinicians to the point of care.

Three healthcare organizations recently enhanced their voice and data mobility by deploying wireless technologies. Their experiences can serve as best practices for planning and implementing such systems.

Florida Hospital in Orlando rolled out in-building wireless technology from MobileAccess to support a full range of wireless services and applications, as well as support the diverse needs of more than 16,000 staff, 2,000 physicians, and countless visitors. The result is a wireless infrastructure that delivers pervasive coverage for all major wireless operators and ensures support for cellular voice and data services for more than 1,500 BlackBerrys and visitor cell phones. The system complements the 802.11 wireless infrastructure the hospital had previously deployed.

Oklahoma City’s Mercy Health Center deployed Coleman Technologies' (CTI) in-building wireless system to enhance wireless signal strength and call quality throughout the medical campus to enable physicians, clinicians, and visitors to take full advantage of their voice and data applications, regardless of location.

In Memphis, Tenn., Baptist Memorial Health Care implemented Johnson Controls’ in-building wireless distribution system for complete wireless coverage throughout its facilities. The infrastructure supports voice and data systems such as personal communications/cellular carriers, local area networks, two-way radios, digital paging, handheld clinical devices, medical telemetry, and the EMR system.

Assessing Needs
Planning for wireless implementation involves the same kind of due diligence as any other technology deployment: understanding the organization’s precise requirements now and in the near future, researching the marketplace for suitable applications, and on-site testing of two or three finalists. Baptist Memorial’s Stuart Mitchell, vice president and metro-market leader, observed real-life demonstrations of wireless technologies at other hospitals, which convinced him that wireless worked. Market research to identify the most suitable system narrowed the search to three vendors, at which point Baptist Memorial conducted site visits, checked references, and noted lessons learned by other facilities which could be incorporated into the decision-making and planning process. Management studied workflow, patient flow, how clinicians practiced medicine, and how information was recorded and exchanged in the process of care.

“Understand your present and future requirements and include them in the contract,” advises Keith Scarbrough, Baptist Memorial’s administrative director of IT. “One of the facilities we visited did not include voice quality specs in the contract because it was originally only concerned with data. When the time came to expand into voice, retrofitting caused additional expense.” Once Baptist had chosen a Johnson Controls-distributed antenna system, the hospital’s networking group worked closely with procurement to develop a contract with all the requisite technical specs. Engineers then mapped out every square inch of six hospital campuses, including elevators and stairwells, because the idea was to keep staff and physicians connected wherever they were.

Florida Hospital’s priorities in choosing a vendor were cost-effectiveness, modularity, and flexibility. “We wanted to deploy just enough to meet today’s needs and be able to extend coverage to other areas as demands increased and as budgets allowed,” says Associate Chief Technology Officer Todd Frantz. Like most hospitals, Florida Hospital had various wings built over decades, and some walls were impenetrable to wireless signals. “For example, the x-ray department left behind its lead shielding when it moved,” says Frantz. “To get an objective assessment of our problem areas, we hired an engineering company to conduct a radio-frequency survey. They took measurements and provided a quantitative validation of our hypotheses. The result was a color-coded floor plan, which showed levels of coverage.”

Mercy Health Center’s main challenge was a tunnel system that interconnected several buildings. “We wanted to provide all physicians and visitors access to their cellular carriers for voice and data applications, but underground, there was absolutely no signal,” says IT Manager Tom Bonadio. “We researched a number of carriers and ultimately chose CTI based on a recommendation from our main carrier. CTI performed a survey, taking readings and measurements of the entire area, and presented us with a complete layout of the proposed infrastructure.”

Getting Buy-In
At Baptist Memorial, wireless was not an easy sell. “Our clinical side was worried about safety and quality, and our technical people wanted to stay with the tried and true,” says Vice President and Chief Nursing Officer Beverly Jordan, RN. “They needed convincing that it was the right thing to do and that we could become experts at wireless. It was a perfect example of what Colin Powell meant when he said, ‘Leaders take people to places they didn’t know they could go and to do things they didn’t know they could do.’ We also had to persuade McKesson, our EMR provider, to certify its equipment on this wireless infrastructure.”

“The breakthrough came when we started thinking of wireless as a utility,” says Mitchell. “After all, we wouldn’t run a new power line every time we purchased new electronic equipment.”

Bringing all parties to the table—clinical, technical, and corporate—generated a grassroots commitment and made it feel more like “our idea” rather than buying into someone else’s concept, according to Scarbrough. “Getting buy-in meant that we wanted executive management to drive IT to deploy the infrastructure,” he says. “It wasn’t IT forcing a solution but providing it for business needs.”

“We wanted the executive team of each facility to think futuristically in defining its coverage needs,” says Chris Hopper, director of nursing informatics. “That meant educating them on the applications that would require the use of wireless devices in the future.”

“Our change management process was about knowing what we wanted and then figuring out how to get there,” says Jordan. “We were committed from the beginning to build it for the future because if we build it for today, it’s going to be outdated by the time it’s complete.”

Doing It Right the First Time
The ideal way of installing a wireless infrastructure is in the process of construction or refurbishment of an existing facility. When that’s not possible, scheduling around hospital operations is never easy. “Be flexible and work with your users, identify their priorities, and give them scheduling choices,” says Frantz. “You may assume that 2 am on Sunday morning is a good time to bring a system down, but at that time, staffing levels may not be adequate to handle the extra workload if cell phones are down. Communicate well in advance and spell out working conditions. Make sure everyone understands where containment tents will be required when ceilings are opened.” Tenting can add significantly to labor costs.

At Mercy, all installation work was performed in the evenings, so there was no disruption to the daily workflow. Bonadio coordinated with management and security to ensure access for installers.

Baptist Memorial established a test site at the corporate office that allowed the information systems department to reach a level of comfort with the system before addressing the unique challenges of thick hospital walls and other antennas competing for space. Johnson Controls’ engineers worked closely with the single points of contact they had been given for each hospital. “In implementing both our EMR and the wireless system, we decided we were going to do it right,” says Jordan. “There was no skimping on hardware or devices. We purchased the right devices and the right mix of devices, and we invested heavily in the infrastructure. We also bought additional containment carts, knowing that it was an additional financial commitment and would slow down the work.”

Project management at Baptist Memorial included the establishment of a wireless oversight committee, which staged and managed the deployment and made sure the infrastructure would not be overloaded. “A couple of other health systems warned us that once you install wireless, everyone will want to connect everything to it, such as hospital security systems,” says Jordan. “We decided to limit it initially to the EMR system.”

Frantz also notes the importance of managing user expectations. “If your north wing and south wing both have poor cellular coverage, and you only deploy in the north wing, you’d better communicate valid reasons, such as budgetary constraints or a major overhaul planned for the south wing in a few months,” he says. “Communicate all limitations as a positive. Don’t say you can’t afford to deploy the system in the south wing. Instead, explain that you’ve prioritized the deployment by wing to address the staff’s primary areas of concern.”

Users also need to be educated on the new infrastructure. At Baptist Memorial, education on the opportunities and limitations of wireless was a success factor. “Staff were used to wired devices with 100% connectivity at all times,” says Hopper. “Even though we have excellent coverage, there are certain exceptions. For example, close to windows coverage may deteriorate because the signal is finely tuned so it does not bleed outside our building.”

Florida Hospital chose to have its cabling work performed by contractors it had used in the past because they already knew the hospital’s cabling standards. The cabling proceeded according to a design provided by the solution provider (a MobileAccess reseller). “The solution provider’s staff had received MobileAccess training and certification,” says Frantz. “They were also able to complete the tuning, testing, and validation of the system.”

At Mercy, CTI performed the complete installation, including cabling, antennas, access points, and other gear. Because it mainly affected the lower section and tunnel system, patient care on the upper floors was not affected. Work was done in the evenings to minimize impact on pedestrian traffic and patient transportation.

Off to a Good Start
The wireless infrastructures at all three facilities operated flawlessly from the beginning. “It has no moving parts; it just sits there and runs,” says Frantz. “We have emergency power and UPS [uninterruptible power supply] power on the equipment to protect against downtime. Network closets require a badge swipe or key to prevent unauthorized access.”

Baptist Memorial initially had intermittent problems with its voice-over Internet protocol phones, but wireless technology was not to blame. “Our phone switches were set incorrectly for the use of wireless,” says Scarbrough. “We also had some difficulty getting the signal to penetrate the tiled walls at our oldest facility and chose to wire all of our in-room devices there to guarantee stability.” To protect against downtime, redundancy has been created with extra access points. Constant monitoring by the IT department ensures that any problems are immediately addressed. “We have enough wired devices so patient care would not be impacted by downtime of the wireless,” says Hopper.

“The CTI infrastructure handles all types of carrier signals within range,” says Bonadio. “We get a better signal through the system than we do standing outside. One reason is that the CTI directional antenna was designed to point directly at a cell site on top of a physician office building.”

Working closely with cellular carriers is key to providing coverage, according to Frantz. “Get the carriers involved early in the design of the infrastructure,” he says. “Make sure they understand what parts of the building have poor coverage and how users are affected. Keep them up-to-date throughout the process. In fact, one of our carriers alerted me to a coverage problem of which I was unaware because doctors had complained to them directly. We work with the carriers to make sure those problems are addressed. Carriers may choose to invest directly in your distributed antenna system, but if not, they can at least help with information and education.”

At Mercy, physicians, clinicians, patients, and guests are now able to communicate without lost coverage, even in the tunnel. “The physicians are elated that they can stay connected through their wireless mobile devices as they go from one clinic to another,” says Bonadio. “If there is great demand to provide improved coverage for other mobile carriers, we have the option to piggyback off the system to include them.”

Wireless Improves Care
All three organizations agree that wireless has improved communication quality, patient care, and safety. “Patient care is a 24/7 job where real-time, quality communications are mandatory,” says Bonadio.

“Private practice physicians with urgent matters can now call hospital physicians on their cell phones wherever they are,” says Frantz. “Cardiologists are reachable without overhead paging and can talk to anesthesiologists on the way to the OR [operating room]. If a physician is reachable by cell phone on the golf course, but not at the hospital, it seems a loss of credibility. Patients’ family members, too, want to be able to call loved ones without having to step outside or use a wall phone.”

At Baptist Memorial, clinicians can document patient information in real time from mobile workstations on wireless carts and computers on wheels. Mobile disciplines, such as respiratory, physical and occupational therapists, clinicians, and chaplains, stay connected to the wireless infrastructure through tablets or notebooks. “The wireless infrastructure really functions as a utility,” says Jordan. “We use it with the same confidence as electricity. It’s just there.”

“We’re able to serve our patients better and deliver a safer product and higher quality outcomes,” says Mitchell. “The wireless utility helps us deliver care in the right place at the right time.”

— Alice Shepherd is a southern California-based business-to-business journalist specializing in healthcare topics.