Patient Care Goes Wireless

Childrens Memorial Hospital, of Chicago, is like many of the facilities that serve the critically ill. The building is not really old, but many of the practices inside are, such as jotting down life-or-death instructions on paper, which are passed along several times before they are entered into a computer.

Two years ago, The Leapfrog Group, a Washington-based coalition of health care purchasers, released a study concluding that better technology such as computer-assisted ordering of drugs could reduce serious prescription errors by more than 50 percent. Childrens Memorial, the pediatric teaching arm of Northwestern Universitys Feinberg School of Medicine, took notice.

"Generally, in hospitals, there is some morbidity and some mortality that results from giving the wrong medicine to the wrong patient," said Bill Brooks, director of IT at Childrens Memorial. "Our error rate wasnt very high versus peer hospitals, but this is an area where you dont want any errors."

In addition, after years of adopting disparate communications systems on a piecemeal basis, the hospital had accumulated a functional yet somewhat sloppy hodgepodge of technologies. There was a traditional phone network, along with newer networks to support cell phones. The hospital also had a wireless surveillance system, a variety of patient-monitoring technologies, pagers and radio-frequency location systems for tracking the electronic tags worn by doctors.

But one signal often would interfere with another, creating dead spots within the facility where phones or pagers wouldnt work. Exacerbating the situation was the basic physical structure of the hospital, comprising steel floors, thick concrete walls and lead barriers surrounding radiation rooms, all of which blocked communications flow throughout the building.

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As he went about looking for a new wireless network, Brooks had multiple concerns to address. He wanted a system in place immediately that would support improved technologies for nurses and support the hospitals needs as it continued to update more processes, which would hopefully include computerized physician order entry. Brooks also wanted a system that would not conflict with existing networks supporting security, paging or phone communications.

"We wanted to have one thing that would serve multiple purposes," Brooks said. "We looked at different ways to do this, and they all involved implementing a real-time network."

The first thought, Brooks said, was to deploy a collection of Cisco Systems wireless access points to connect to a switch on each floor to provide overlapping coverage throughout the building. While this solution appeared fairly simple and economical, he said it posed a problem in terms of irregular service and substantial maintenance down the line.

"If one access point would break, you would lose coverage throughout an area of the hospital," Brooks said.

He eventually selected InnerWireless, of Richardson, Texas, to deploy a broadband distribution system. Unlike a collection of separate wireless access points, InnerWireless broadband distribution system supports a wide range of wireless applications on a single infrastructure. The system also offers uniform wireless coverage and facilitates the addition of future applications and devices to the network.

"We looked at different solutions, and all involved implementing a real-time network," Brooks said. The advantage InnerWireless system offered was that it would require fewer access points to be installed, while still providing continuous coverage throughout the hospital to eliminate dead spots.

Ed Jungerman, senior vice president for marketing and product management at InnerWireless, equates his companys network to a heating ventilation system that distributes air uniformly throughout a building.

"It unifies a range of wireless signals and frequencies," Jungerman said. Because the system is passive rather than active, it works without electrical components that are typically needed to convert radio signals.

"Active systems cannot carry the whole set of radio signals in one piece of electronics," Jungerman said. "They are more cumbersome and costly."

InnerWireless systems are custom-designed to meet the requirements of different buildings. Typically, there is a wireless portal that rests in the basement and is connected to cable that runs up the spine of the building, as well as a distribution system for each floor.

As Childrens Memorial prepared for this improved network, it upgraded the technology that nurses used to keep records of the drugs they administered to patients. Brooks said he wanted a solution that would not saddle health workers with cumbersome equipment or make their jobs more difficult.

Under the new system, each time nurses get ready to administer drugs, they can scan the bar codes on medication bags and record them on the thin clients attached to their carts. The data is then automatically sent back to a central computer, which confirms it is the right medication being administered at the right time to the right patient. The Childrens Memorial pharmacy, one of the more modern parts of the hospital, routinely bar-codes the medication it sends out, so all the hospital had to do was install equipment on the other end that could read the codes.

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Costs of the new equipment and the installation, totaling approximately $500,000, were about twice what it would have cost to install a new network based on multiple access points. Brooks said the hospital is hoping to recoup some of these costs by avoiding follow--up maintenance.

As Brooks had hoped, nurses proved adept at mastering the new thin-client system, and he said the underlying Inner-Wireless technology functioned without error in recording and transmitting patient data. Nurses on their rounds can now send and receive e-mail in real time, using the thin clients on their carts.

"The system is working—it is doing what its supposed to be doing," said Karen Carroll, manager of nursing infomatics at Childrens Memorial. "The bar-coding tool assists the nurses in preventing errors at the point of administering the medication. In the past, there was no warning system. Now there is."

But that doesnt mean all the hospitals problems are solved.

"Doctors are not the most adaptable. Change comes slowly," said Brooks. "Today we still write medical orders on paper. Two or three years from now, I hope to have a better answer."

Andrea Pettis is a freelance writer based in San Francisco.

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