March 5, 2007

Stepping Up to Mobility: Making the Transition to Wireless Technology
By Selena Chavis
For The Record
Vol. 19 No. 5 P. 16

It works on so many levels that it’s surprising more healthcare organizations have not made the transformation.

Mobility and healthcare. When it comes to improved accuracy, efficiencies, and better delivery, many healthcare entities are finding that the two go hand in hand.

“No one answers telephones at their desk anymore,” says William McClatchey, MD, chief medical informatics officer with Atlanta-based Piedmont Hospital in support of the 458-bed facility’s decision to provide a network for clinician cellular telephone use.

It’s one of numerous industry-recognized realities that add credence to the belief held by many wireless technology vendors that healthcare is “the strongest wireless vertical.”

“Healthcare is much more of a mobile environment fundamentally,” says Lou Martinage, director of marketing and business development with Virginia-based MobileAccess, adding that there are many opportunities to garner benefits from wireless technology in the healthcare setting. “It runs the full gamut.”

And whether it’s an identified need for the use of cellular phones by clinicians or the implementation of mobile computerized carts and handheld devices for improved patient care, the benefits of a mobile workforce are driving the adoption of wireless technology in hospitals across the nation.

In fact, according to New Jersey-based Insight Research Corporation, the U.S. healthcare telecommunications services market is expected to grow at a rate of 5.4%, from $6.3 billion in 2006 to $8.1 billion in 2011, and spending on wireless technology is expected to grow at more than twice the overall rate.

The nature of how wireless technology is used may look different in various healthcare settings, but the consensus offered by several hospitals is that the transition is well worth the investment.

“We knew up front that the return was going to be millions of dollars,” recalls Carol DiBiaggio, director of medical informatics at Michigan-based Battle Creek Health System (BCHS), noting that advances in wireless technology are opening an ever-increasing field of opportunities for cost reduction, increased patient safety, better data collection, and increased convenience for practitioners and patients. “We have ROIs [returns on investment] that we weren’t expecting.”

Safety First
For some hospital systems such as BCHS and Ohio-based Smith Clinic, it has been the strategic move toward electronic medical record (EMR) adoption that has sped up the adoption of wireless technology. Rorry Retterer, manager of information services at Smith Clinic, questions whether a hospital setting can approach EMRs without some wireless infrastructure in place. “To be mobile with that EMR is certainly beneficial,” he says.

For others, like Piedmont Hospital, wireless was a consideration before the hospital made the move to EMRs. “We had an extensive wireless network before we went to the EMR,” McClatchey notes, adding that the benefits and efficiencies that could be achieved through a wireless infrastructure were recognized early on. “Our pharmacy error rates are now some of the lowest in the nation.”

Regardless of the initial motivators, hospitals agree that the key strategy in undertaking the initiative to go wireless is patient safety. “The driver behind all of this is to move toward safer healthcare,” DiBiaggio says. “The more we can integrate wireless technology into the overall clinical system, the more it lends to us making healthcare safe.”

Different Approaches
Advanced configurations and flexibility lend to wireless adoption in many areas of the hospital setting through the use of technology such as cellular telephones, WiFi, location-based services, and public safety radio. According to wireless technology vendors, healthcare organizations can realize benefits from various wireless deployments ranging from use with supplies and inventory to emergency services. Mobile workstations can allow for real-time access to patient EMRs at their bedsides, and the rollout of wireless local area networks can arm healthcare workers with mobile handheld devices that provide instant information on patients’ records, lab results, pharmaceutical and insurance information, medical resources, and work schedules.

A multicampus healthcare provider serving approximately 200,000 people in southern Michigan, BCHS was recently recognized by Hospitals & Health Networks magazine as one of the top 25 most wireless hospitals in the United States. Wireless computer carts and handheld devices were introduced to clinicians and physicians as part of the organization’s Genesis initiative—an overall effort to standardize clinical information and transition to an EMR.

Among other benefits, the wireless-networked devices allow hospital staff to track and update patient care and billing information while on the move, rather than storing handwritten notes until the end of the day then performing time-consuming and mistake-prone manual data entry.

“Charges are automatically captured in a lot of ways,” notes DiBiaggio. “In the paper world, we use stickers … stickers fall off. Plus, sometimes the charges wouldn’t be captured until two weeks later.”

Smith Clinic, a multispecialty medical group, also found success in distributing BlackBerry PDA devices and physician tablets. “We implemented 250 physician tablets,” Retterer notes. “Over half of our physicians are totally paperless at this time.”

Based on his experience with wireless technology since 2001, McClatchey says the use of physician tablets and notebooks was never embraced by Piedmont Hospital. “It was a surprise—we had anticipated a large capital investment for [PC tablets and notebooks],” he recalls, noting that while the physicians fully embraced the EMR implementation, they preferred to sit at a keyboard to access information or make notes. “We are maximizing the technology for our purposes.”

Piedmont Hospital has realized significant benefits to the implementation of wireless technology in conjunction with inventory and pharmaceutical activity. In fact, all three healthcare systems realized some of their greatest returns through the pharmacy department.

“The [use of wireless technology in the pharmacy] literally eliminates transcription errors, improves turnaround time for medication distribution, and enhances communication between pharmacists and clinicians,” DiBiaggio says, stating that wireless technology can be used to input medication orders, monitor patient laboratory values, collect data for medications, submit adverse drug reaction reports, and help with drug cost reimbursement.

“Our pharmacists are mobile, changes can be made on the spot,” says Jim Keller, information services director at BCHS, noting that the organization also has pharmacists working from home in case the pharmacy gets bogged down with admissions.

McClatchey says Piedmont uses a combination of robotic software, radio frequency identification, and barcode scanning technologies to automate pharmaceutical activity, reducing the risk for errors and increasing patient safety.

Both Smith Clinic and Piedmont Hospital have plans to further enhance wireless offerings with considerations for medical telemetry devices and wireless networks for customer and patient relations. Wireless telemetry allows the monitoring of patient physiological parameters over a distance by using radio frequency communications between a transmitter worn by the patient and a central monitoring station.

Best Practices
McClatchey and DiBiaggio both agree that formulating a strategy that garners a cross-functional team approach goes a long way toward creating a smoother transition to new technology.

“Physician and nurse buy-in is always a major issue,” McClatchey emphasizes.

Now providing consultation services to other healthcare systems seeking to implement wireless, DiBiaggio notes that “one of the first things we ask is who is driving the project,” suggesting that the undertaking is really a clinical project.

BCHS began the process 23 months out from their anticipated “go-live” and spent a year meeting with departments to get a better handle on the work processes. “Understanding the clinical work is absolutely needed or you’re not going to do well,” DiBiaggio suggests. “Minimize the changes you need to make to processes. If a process works well in the paper world, bring it into the new system.”

Keller notes that BCHS achieved clinician support by making them an integral part of the planning process. “The clinicians picked the devices they use … we just helped them make the best possible decisions,” he says, adding that his department made suggestions about considerations such as weight, battery life, and how a particular device would interface with the entire clinical system. “We introduced the new devices while they were still using the old systems for training purposes.”

At Piedmont Hospital, McClatchey recalls that alongside efforts to allow clinician design of the process, many buy-in obstacles were overcome by implementing a mission statement that eventually became part of an internal public relations campaign. The acronym QUEST was established as an identifier for “quality, uniformity, efficiency, and standardization through technology.” “Almost all of our clinician staff could repeat the acronym,” he says.

DiBiaggio warns that you can never start too early on a project that encompasses the scope of transformation like that of the wireless piece. “You don’t know what you don’t know,” she emphasizes, recalling that in BCHS’ experience, “we were forging unknown territory from a clinical perspective.”

Cost Considerations
Some initial costs for implementing wireless technologies can be minimized if healthcare organizations plan carefully, says Martinage. Martinage suggests that, historically, hospitals have often addressed their wireless needs reactively, sometimes deploying multiple ad hoc systems to meet the in-building connectivity requirements of doctors, nurses, patients, security personnel, and first responders.

While this fragmented approach can help hospitals make the initial transition from wired to wireless communications, Martinage says it creates significant financial and operational inefficiencies. Installing new wireless systems on an as-needed basis can be costly and without a well-coordinated installation plan, there is a possibility of generating interference among the different wireless systems.

Martinage suggests that as wireless becomes more vital to operations, healthcare organizations will need to take a deliberate, strategic approach to their wireless infrastructure requirements and should seek a universal solution offering a single, flexible infrastructure to support all potential applications and services.

“A multiservice solution unlocks the promise of wireless by overcoming in-building coverage issues and ensuring pervasive coverage and reliable performance throughout a facility,” he says, adding that a properly implemented system will have built-in interference mitigation and will readily adapt to evolving requirements, enabling the hospital to add new wireless applications and services easily and cost-effectively without disruption.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.

Championing the Effort
When Michigan-based Battle Creek Health System (BCHS) initiated a recent endeavor called Genesis that would ultimately transform patient care and medical recordkeeping, proponents of the plan sought a way to build teamwork and buy-in from its clinician and physician base.

Through the installation of a new state-of-the-art computer system and infrastructure for wireless technology, the multicampus healthcare provider sought to standardize clinical information through physician order entry, online patient documentation, electronic medical records, and adverse drug event alerts.

Realizing up front that the key to successful implementation hinged on the attitude taken by clinicians to the new technology, steps were taken from the outset to identify champions of the program.

“The physician piece is huge,” says Carol DiBiaggio, BCHS’ director of medical informatics. “It’s where most organizations struggle most.”

Emphasizing that a lot of the younger physicians were waiting to see how physicians with longer tenure would react, DiBiaggio says the organization sought help from its most senior physician, John Girardot, MD.

“A lot of people assume that an older physician will not be able to use the system,” DiBiaggio recalls. “We posted big ‘Uncle Sam’ posters with his face throughout the facility that said ‘I want you to be a super user.’”

Recalling the plan’s success, Girardot, a 76-year-old general surgeon, notes that BCHS had a much better reception than some of its sister facilities. “They really hyped it up,” he recalls, adding that BCHS now has healthcare providers from all over the nation coming to look at their system. “Because I’m the oldest member of the medical staff, they thought that would be most helpful.”

Now that the system is fully implemented, Girardot says most of the physicians find it easy and recognize the benefits. “They wouldn’t go back [to writing],” he emphasizes. “The system from a doctor’s point of view—it makes the practice a little safer.”

DiBiaggio recalls that before the implementation, Girardot had not been using a computer at all. “After that, his son came and put a real fancy computer in his office.”

— SC