Wireless from End-to-End: Why Converged Networks May Be the Answer

With a converged wireless network, hospitals can transport patients from the postanesthesia care unit using mobile wireless patient monitors. The Philips Healthcare MMS X2 easily undocks from the larger wired monitor.

Clinicians are in data overload and the potential exists for this information excess to stall decision-making, thereby negatively impacting patient care. The solution is to provide the right information at the right time to the right caregiver. Advanced wireless technologies are at the forefront of helping physicians and allied staff better handle the enormous amount of continually flowing patient data, as well as to communicate throughout the enterprise with patients and staff.

But what is the best way to enable a facility for wireless transmission? A current favorite is called converged wireless network and it just might be the answer to many pressing problems, including an impending shortage of intensivists, an ever-increasing population with chronic diseases and the need to be able to receive and transmit wireless signals from anywhere in a hospital.

Totally wireless, even in the cafeteria

Memorial Health System in Colorado Springs, Colo., consists of 619-bed Central Hospital and 98-bed Memorial Hospital North. Parts of Memorial Central are more than 100 years old, while Memorial North was built two years ago. Central’s wireless network is the conventional model, consisting of separate telemetry units installed throughout the hospital. This model tends to leave gaps in wireless access.

For the new construction at North, however, officials wanted to ensure that the entire hospital was wireless-enabled, including elevators, hallways and even the cafeteria. Many standalone telemetry systems are available, but the hospital wanted to avoid installing multiple networks, which can be cumbersome, expensive and also have the potential of interfering with each other. Memorial Health decided to install a converged wireless network (Carescape Enterprise Access; GE Healthcare) at North, which allows one central network for multiple wireless functions including medical telemetry, cell phone service, pagers, two-way radios, security alarms, data networks and radio frequency identification (RFID).

“In a traditional installation, you set up a separate network for each of those wireless capabilities,” says Tom Kerwin, CIO of Memorial Health System. “Converged technology allows us to install one network and then plug in additional modules as new wireless technologies are adopted.”

The system relies on a distributed antenna system, according to Director of IT Bob Barrett. Small antennas are installed throughout the facility that then link back to a central system, generally housed in a closet-sized room. Whenever the hospital wants to enable a new wireless technology, Barrett installs the required module into the master switch of the central system, and that wireless signal is now available throughout the organization.

Earlier this year, Central installed the converged wireless network, but has utilized it so far only for cell phone coverage. There are plans to add wireless telemetry to the system, but for now, telemetry is done the old-fashioned way. Separate networks are installed in each area and the wireless signal does not propagate beyond the rooms to the halls or corridors, nor is the signal available in places like radiology and the emergency room. When patients have to be transported through halls or to radiology, for example, their vital stats are no longer being transmitted via a wireless monitor to the remote bank of 72 display monitors located on Central’s campus. “Patients have to take off their portable wireless monitors for these trips,” says Dawn Lovejoy, RN, clinical coordinator for the coronary care unit (CCU). From a labor perspective, Kerwin notes, these patients have to be escorted everywhere. It’s a one-to-one ratio with the patient in transport. “It’s not always the most efficient process,” he says.

At North, it’s a different story because the wireless telemetry signal is part of the converged network. Patients’ vitals are always streaming into the remote monitoring station located on Central’s campus. “We are able to see patients on telemetry in the ER, in the surgical unit and even when they go down to the cafeteria to visit with their families,” Lovejoy says. Two telemetry techs monitor the central bank. They also are cross-trained to perform critical-care tasks.

“If your goal is to have 100 percent coverage of all wireless signals at all places, a converged network is less expensive in the long run,” Kerwin says. “Even though the one-time installation of a converged network costs more money than to install a telemetry system in one unit, you will incur more costs trying to correct all the gaps in signal reception that can occur with multiple separate telemetry networks.”

In 2008, Memorial North installed ApexPro FH (GE), which protects the wireless signal from interference and dropout. The system uses a bi-directional, frequency-hopping, spread-spectrum infrastructure, allowing it to “hop around” the frequency spectrum to help prevent interference. “We have to have continuous cell phone coverage throughout the facility in any location. Physicians are on call, they are receiving pages, and they are communicating back and forth with patients and staff. The wireless signal must be there for them. The best way to ensure this happens is by installing a system like this,” Kerwin says.

More space, fewer FTEs

Last year, Virginia Commonwealth University Medical Center in Richmond, Va., opened a new 367,000-square-foot critical-care hospital. Despite being three times the size of its predecessor, the new hospital needed to operate with the same number of nurse FTEs, meaning its staff required advanced communication technologies, including comprehensive wireless coverage, to enable full clinical mobility.

Challenges included a particular configuration of private rooms that made it tricky for nurses to communicate; larger patient care areas compared to the nursing units in the original facility, so new point-of-care processes would supplant repeated trips to and from the nursing station; and a restricted-use overhead paging system, according to Greg Johnson, chief technology officer and director of technology and engineering services at VCU Health System.

Nurses and the IT department collaborated to determine the best way to address these challenges and streamline workflow. Like Memorial Health, VCU Medical Center chose to install a converged wireless network (Horizon; InnerWireless). “The converged wireless solution has provided us with a single managed platform that hosts virtually every wireless service, including Cisco WLAN (Wi-Fi), along with a wide range of mission- and life-critical applications operating on a diverse range of wireless devices,” says Heather Craven, RN, a nurse clinician in the acute care medicine department at VCU Health System.

Integrated into the wireless platform are a number of wireless and mobile solutions that address the challenges identified prior to installation. For example, enhancements to the nurse-call system allow the nurses to be more responsive to patient needs, while the wireless voice-over IP communications system allows nurses to conduct more immediate and direct communications with other care team members.

In addition, VCU Medical Center provides ambulatory patient monitoring in more than 50 percent of the care area by utilizing wireless medical telemetry from Philips Healthcare (IntelliVue). And the clinical staff utilizes more than 300 mobile computers to electronically collect and review clinical information from the hospital’s Cerner HIS.

Body sensor networks

The next breakthrough will be with body sensor networks (BSNs), which would allow bedside wireless monitoring of patients. GE Healthcare has requested that the Federal Communications Commission (FCC) dedicate a vendor-neutral radiofrequency band for BSNs and the FCC is considering the request. GE has invested in the research, which, the company says, could help “promote improved patient mobility leading to reduced length of stay and enhanced clinical outcomes.” Stay tuned.