Wireless LANs: Just What the Doctor Ordered

By TERI ROBINSON

Most of the stories published on wireless LANs focus on older government buildings, retail outlets or Wall Street. But one market that's emerged as a real natural for wireless LANs is health care. Hospitals and medical centers are under enormous pressure to cut costs and improve service. Wireless technology helps hospitals streamline paperwork, which improves customer service. But more than that, wireless LANs free health-care workers from the confines of the desktop. Now, doctors and nurses can bring their palmtops and notebooks right to a patient's bedside, enter data on the spot or simply access a patient's condition online. Although other industries are moving ahead as well, we focus here on how wireless technology is helping medical facilities gain a competitive advantage.

Doctors and nurses at Florida's Sarasota Memorial Hospital are developing a new bedside manner, thanks in large part to wireless LANs. In an upcoming pilot program, physicians will carry notebook computers along with their stethoscopes as they make their rounds. The notebooks will let them collect and record information at the patient's bedside--data that will be sent to the hospital's legacy mainframe and stored as a permanent record.

The 952-bed medical center already has a Digital Equipment Roamabout wireless LAN in play for patient admissions, says Denis Baker, director of IT at Sarasota Memorial.

"Originally this was a customer service issue for us," Baker says. "Instead of patients having to sit in the lobby and do paperwork, we can get the patient up to a room and then let the admissions person work with them."

Baker says the hospital expects to have 50 to 100 physicians participating in its latest venture into the wireless world. The hospital also plans to use the wireless notebooks in the emergency room, mostly to admit and assess patients.

As the medical community grapples with the realities of managed health care and tries to extricate itself from the mound of paperwork that each case or procedure generates, many organizations are using wireless LANs to automate critical aspects of patient care and record keeping. Health professionals say they hope wireless LANs move them closer to their ultimate goal: dispensing with thick paper file folders, rife with inaccuracies and spotty and extraneous information, in favor of electronic medical records.

"You see the differences [in record keeping] between a nursing station on one floor and one on another floor," says Doug Hahn, director of IT at Exempla Saint Joseph, a hospital conglomerate that recently merged the Saint Joseph and Lutheran hospital centers in Denver. Three years ago, Hahn implemented a wireless LAN in Saint Joseph's Hospital to help nurses improve patient care. The IT department originally built 10 access points and issued 70 notebooks to nurses, doctors and clinicians. "This is just a precursor to developing electronic medical records," Hahn says.

Patient information can be accessed or input at the point of care--the bedside, the admitting office or a procedure room. "We use it for our bedside charting of vital signs," Hahn says. "We also use it for head-to-toe body assessment."

Healthy Competition?

Health care is now so competitive that hospitals are implementing a bevy of tactics to attract patients. For instance, New York-based hospitals are in a tight race to build comfortable, homey labor and delivery suites that appeal to urban moms-to-be, while Bayshore Community Hospital in New Brunswick, N.J., has taken a cue from the Domino's Pizza marketing strategy to guarantee that a doctor will see an emergency room patient within 30 minutes--or the patient doesn't have to pay.

Similarly, medical facilities are sinking IT dollars into wi reless technology that will let them automate everything from admissions to relaying data from patient examinations at the bedside, organizing billing information, ordering lab tests and writing prescriptions. Hospital administrators reason that by delivering more efficient care and services, they can lure patients to their facilities rather than those of their competitors.

But why wireless? Exempla Saint Joseph's Hahn says wired solutions often don't work well at medical facilities. Saint Joseph's initially considered interconnecting Ethernet LANs as a replacement for its old mainframe system. But Hahn says the expense of putting a PC in each room was simply too great. "It is cost-prohibitive, if you have hundreds of beds, to buy technology that's virtually obsolete the day you install it,'' he says.

Saint Joseph's also was concerned about the privacy and confidentiality issues of having PCs located in unmonitored rooms, Hahn says. And, wired PCs consumed a lot of space in rooms already crammed with equipment, furniture and people.

"We couldn't risk a PC falling off [a stand] and hitting a patient," Hahn says. Not to mention, PCs were too noisy to remain in a room full time. "Patients don't like the fans," he explains.

By all accounts, the medical community is ripe for wireless LANs since its workers--doctors, nurses and clinicians--are not officebound, but rather on the move within a hospital clinic or medical center. They often must act quickly, unencumbered by wires and cables.

Medical personnel also come face to face with an astronomical number of people on a daily basis. At the Austin Regional Clinic, a network of 16 outpatient clinics in Austin, Texas, the staff encounters more than 600,000 people a year, says Audrey Nudd, chairwoman and executive vice president of MediView, the managed service organization to which the center belongs. The hospital has about 200 doctors and clinicians that electronically enter each visit with a patient, Nudd says.

Each patient visit and order for lab tests or prescriptions generates a flurry of paperwork--in triplicate. Exempla Saint Joseph's Hahn says some industry estimates have nurses spending 25 percent to 40 percent of their time documenting care. Until recent years, notations were made manually on paper, then taken to a wired PC and keyed into the hospital system. Too often the end result was information that was inconsistent, inaccurate, incomplete and downright messy. Now, nurses at Exempla Saint Joseph follow a series of electronic forms to assess a patient's condition and a set of comprehensive, more precise descriptions. "They don't just write 'within normal limits' any longer," Hahn says. "And, there are more choices for things like 'wheeze' and 'red.' "

Having a standard format and a well-understood nomenclature goes a long way to bridge the gulf between disparate cultures when two hospitals merge, which happens quite frequently in health care these days.

Wireless LANs have added a level of automation that medical centers couldn't achieve before without sacrificing the mobility of health professionals by binding them to wired desktops and without compromising patient comfort by cramping their quarters with extraneous technology.

Austin Regional Clinic turned to wireless to eliminate the need for rewiring when moves and changes were initiated," Nudd says. Today, its doctors and nurses carry pen-based GrID computers when they come face to face with patients and link into a Proxim Inc. wireless LAN.

And the CareVision application from HealthVision, implemented with Sarasota Memorial's wireless LAN, gave the medical center "the opportunity to provide all the information the physician needs at the point of care--in real time," Baker says. Examples of the kind of information accessed include test results, patient information and reference material.

Hahn says Exempla St. Joseph is reaping some unexpected benefits from its wireless LAN. "One of our expectations going in was that the wireless initiative would be a great time saver, " he notes. "Although we found out that it was not saving time, because caregivers actually spent more time going through the full process answering all the questions, the quality of the assessments was higher."

Rising Standards

The wireless LAN terrain has changed significantly during the past year. First, the 802.11 standard for interoperability between wireless LAN solutions was approved in the summer of 1997--and a slew of products emerged around it. Guaranteed interoperability gives users the confidence to expand their wireless plans. Additionally, prices have dropped significantly. "Prices have started to come down," says Mack Sullivan, director of the Wireless LAN Alliance. "Five years ago, an adapter was $595 for an ISA card, now it's $395."

But as primed as it is for wireless LANs, the medical market is a tough sell for wireless vendors. First, medical organizations are tightly focused on the bottom line. The move toward managed care keeps hospitals and clinics obligated to predefi ned fees for procedures, although they may fall short of what a hospital needs to charge to stay in the black. Therefore, medical facilities are constantly attempting to better manage patient costs as well as their care.

So wireless solutions must be able to prove themselves long before they're admitted to the hospital IT landscape. "Vendors must show cost savings in a nuts-and-bolts kind of way--if they can't, they might as well stay home," says Michael French, president of Technology Planning Associates, a technical consulting firm.

And, hospitals have safety and environmental concerns that can confound vendors. "When trying to sell into this market, vendors run into a lot of regulations that they haven't heard of before," French says.

The rapidly dropping prices that characterize the wireless market today will only encourage medical institutions to turn to wireless solutions--as will the success stories of their peers, which have found that, in many cases, wireless solutions are cheaper than th eir wired counterparts.

For wired solutions, laying cable is costly and outfitting each room with $1,500 PCs can add up. Wireless offers mobility, which means medical facilities don't need a computer for every room--or even for every health-care provider on staff. Austin Regional Clinic estimated that each clinic would recoup its wireless investment in less than 15 months.

As cost and interoperability issues are resolved, the remaining obstacles for most companies are either structural or cultural. Medical facilities pose a number of peculiarities that wireless architects must deal with. First, hospitals and medical centers already house an overwhelming amount of equipment--some of it sensitive--with which the wireless LAN must coexist.

IT must ensure that the LAN operates on a different frequency from other medical equipment and must not be cumbersome or physically intrusive since lives and patient comfort are at stake. "We are always cognizant that there's an awful lot of medical technology all running on its own frequencies," says Sarasota Memorial's Baker. "We go through an elaborate process to make sure the [wireless LAN] doesn't interfere."

Also, by their very nature, hospitals, medical centers and clinics are constructed in a way that can be prohibitive to wireless technology. Impermeable areas, such as elevator shafts and the lead-lined walls that house nuclear medicine units and prevent innocent bystanders from becoming exposed to radiation from X-rays, make it impossible for the wireless signal to pass through. So, wireless network architects must consider how to structure LANs to get around these "blackout" areas. "There are places where the wireless signal just can't get through," Baker says.

A more common problem that IT pros in any industry can relate to is how best to build network access points and integrate wireless technology into their IT wired infrastructures. This is of greater concern in medical centers where nurses' stations and logical access areas aren't constructed w ith computer technology, particularly wireless solutions, in mind. It's also where the greatest expense can be incurred, according to the Wireless LAN Alliance's Sullivan.

Exempla St. Joseph built access points to the hospital infrastructure at the nurses' stations on each floor. Because most of the stations are round, with rooms surrounding them, they created natural hubs for an access point. "When the nurses' stations were long, we had to put in several access points," Hahn says.

Elsewhere, Austin Regional Clinic originally outfitted 12 of its 16 clinics with wireless adapters--a total of 250, each of which provides 150 feet to 200 feet of wireless coverage. Nudd says Proxim worked with the health-care organization to determine where in the clinic ceilings to place the access points.

Once the technology is worked out, cultural issues may be more formidable--and more critical--to the success of the wireless initiative. Medical organizations themselves must persuade doctors and nurses to use the w ireless technology. "Some physicians don't prefer to practice medicine like this," Baker says. And, it's no wonder that a wireless solution--or any new form of automation--might meet with resistance.

"You have a staff of professionals who have been doing the same job the same way for 100 years," says Hahn. "This significantly changes the way they do their jobs."

According to Baker, "The key issue is getting an application that physicians would use. And it has to be fast enough and value-added enough."

Physicians and nurses must be on board if a wireless app is to survive. "It's not going to work just because you install it," Hahn says.

Ultimately, it may not be what the doctor ordered, but rather, patients who demand that doctors give up pencil, paper and notoriously bad handwriting in favor of the technology that will ensure that they get better, faster and less expensive care. Wireless technology just may be the medicine hospitals need to stay competitive.