AAMI: Heart hospital goes mobile for patient monitoring
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Steve Miller, CIO at Oklahoma Heart, explained the provider doesn’t look like a hospital, but instead like a hotel, and strives to provide five-star hotel experiences for patients, their families and friends, as well as the physicians and staff. "For instance, we maintain a four- to one-patient-to-nurse ratio,” he said.
He spoke about the mobile platform that helps caregivers monitor patients during a June 3 session at the 2012 annual conference of AAMI, the Association for the Advancement of Medical Instrumentation.
The 145-bed hospital, with 12 cath labs and one hybrid operating room, has an EMR system with 14,000 EMR logins, 30,000 chart opens and 35,000 orders placed on any given day. On a monthly basis, the provider performs more than 1,500 cardiac catheterizations and more than 6,000 echocardiograms.
To support this infrastructure, Miller and his IT team have two data centers with more than 300 servers—70 percent of which are virtualized—and more than 300 terabytes of storage.
“We base our architectural concepts on the fact that clinical and business needs should drive the applications or solutions, which should drive the infrastructure,” said Miller. “These concepts should be supported by the provider’s governance, security and usability/adaptability of the applications and systems.”
However, these capabilities are only important if they can directly benefit the experience of the patients or the providers, noted Miller, who added that patient solutions are where the line between IT and the biomedical/clinical engineering departments seems “to get thinner and thinner.”
Oklahoma Heart sought an engine that would enable the connecting of people and devices in “the care continuum,” according to Miller, when faced with the quandary of selecting a proper patient monitoring technology platform. Specifically, for a better solution, the caregivers requested the elimination of a central monitoring room because space is at a premium; information at the nurses’ fingertips; alerts based on specific requirements; visual indicator, room and waveform (more than just a pager); automated escalation capabilities (if an alert wasn’t responded to in 15 to 30 seconds); and speed and reliability.
Based on these requests, the team selected Connexall technology integrated with a Draeger/Research in Motion monitoring platform. Research in Motion is the parent company of Blackberry. The platform was FDA-approved for clinical applications about five years ago, when the project was undertaken.
The provider’s heart and vital signs monitoring solution is tied into a Connexall alerting system that sends real-time critical alerts to Nurses Caring Blackberries. The nurses can see the patient unit/pod room number and alert details for all critical alarms and oxygen saturation (SPO2) alarms, along with a graphical wave form. Alerts not responded to in 30 seconds get escalated to other caregivers/unit managers.
Also, the Blackberry devices do not have a SIM card, so they can serve purely as wi-fi devices and act more like clinical devices, according to Miller. Similarly, the device comes with strict policies that prohibit users against taking pictures or adding applications. Also, to avoid battery failure, the provider maintains one set of Blackberries for the morning shift and one set for the evening shift.
“When a patient has an event, the device captures critical alarms and routes it to the Blackberry, which occurs in less than one second,” he said. “Also, the nurse has to go to the bedside or the central monitor to turn the alarm off.”
Of course, no solution is perfect. The biggest residual problems with the platform, according to Miller, are three-fold:
- Educational issues with the staff;
- Occasionally, the wi-fi on the mobile devices gets inexplicably turned off; and
- There are occasional instances of “zombie” or failed units, where the devices freeze.
Also, with these technologies, administrators can generate reports from the logs on a daily basis. At Oklahoma Heart, the hospital nursing management and IT teams review the reports daily and follow-up with appropriate staff members.
Miller touted the technology as meeting the initial requirements set forth, in addition to giving nurses more time with patients and decreasing noise on the floors and alarm atrophy.
Miller concluded that an enhanced, future solution would:
- Streamline reporting via SQL add-on;
- Increase solution resiliency; and
- Enable and trial new devices (iTouch /Cisco Wifi).