FREE Health Data Management e-newsletter 
Hospitals Get a Wireless Makeover
Health Data Management Magazine, December 2005
Installed wireless networks;
Advertisement
Rolled out wireless proximity badges that automatically log users on and off computers; and
Installed blade computers paired with mobile carts to cut maintenance costs and improve data security.
"Wireless is the direction the industry is headed, because it just makes more sense to create a hands-free and mobile environment," says Robert Israel, CIO. The Phoenix-based delivery system, which also operates 11 group practices, has invested about $700,000 in its wireless initiatives.
The organization's wireless evolution began three years ago, when it installed wireless networks from San Jose, Calif.-based Cisco Systems Inc. The networks enabled the nursing staff to use wireless communication badges.
The badges-from Cupertino, Calif.-based Vocera Communications Inc.-measure 4.2 inches high by 1.4 inches wide. They can be clipped to belts or placed on lanyards around the neck. So far, the delivery system has distributed more than 400 badges.
Nurses can speak a name into the device and be automatically connected to the person's Vocera badge or telephone. The devices use Voice over Internet Protocol technology to enable conversations within each facility. The wireless network also is connected to the delivery system's telecommunications "box" to enable users to make outside calls.
In addition, the badges can be tracked via the wireless network to enable nurse managers to locate the nurse or nurse specialist who is closest to a patient in need of assistance.
"They are extremely easy to use and enable us to communicate hands-free, which is very important to our nursing staff," says Colleen Scharneck. R.N., vice president of patient services. "The badges have enabled us to dramatically improve the processes for connecting physicians and nurses and locating staff to get them where they're needed."
Kicking off wireless initiatives with communication badges or other VoIP applications is an increasingly common strategy, says James Thompson, a senior consultant at Tower Strategies, an Austin, Texas-based health care consulting firm.
"VoIP will be the primary application for wireless health care because of the numerous benefits and the identifiable return on investment," he says.
Solving problems
The delivery system's information technology department focused on using wireless technologies to tackle other chronic process problems, Israel says.
John C. Lincoln Health Network, like many provider organizations, found that network access and the accessibility of computing devices were big roadblocks when trying to convince clinicians to dump paper forms and start accessing and entering data via information systems. The problems that cropped up will sound familiar to many CIOs. Clinicians balked at having to enter multiple passwords to gain access, and complained about having to locate an open computer, then stay in one place to interact with the network.
In addition, the delivery system's initial tests using mobile devices were not encouraging, Israel says.
Some devices dropped wireless signals, which required users to call the help desk to try to retrieve data. Users, on the other hand, often dropped laptops, which had to then be replaced with devices loaded with the same applications and software.
Some mobile hardware also "walked out the door," Israel says, which created a crack in network security that hackers could crawl through, as well as the chance that HIPAA-protected data was now in someone else's hands.
Some of the data security risks could be mitigated by using a thin-client environment where data and applications resided on internal servers. However, the delivery system had tested thin-client software for remote users and found it to be an "administrative nightmare," Israel says.
"The software conflicted with a lot of our application and network software, which caused all kinds of problems."
To resolve the access and accessibility issues, John C. Lincoln Health Network implemented wireless proximity badges and blade computers, technologies that a few years ago were just making inroads in the health care market.
The wireless proximity badges-from Ann Arbor, Mich.-based Ensure Technologies Inc.-use radio frequency identification technology to log users on and off the delivery system's network.
The ID badges have embedded RFID tags that communicate with small readers attached to wireless and hardwired computers. When an employee gets within a specified range of the computer, the receiver reads the tag on the badge and automatically logs the user onto the network. The log-on is "not full-blown single-sign-on," Israel says, but does not require users to enter numerous passwords.
If a user walks away from a computer, the badges "freeze" their session and the screen goes blank. When they approach another computer, the screen shows where they left off on the last device, so they do not have to log into applications and begin their work all over again.
The delivery system has made a number of tweaks to the proximity badge technology to ensure the system provides adequate security, Israel says. The badges provide access to computers only in the areas where the employee is authorized to work. In clinical areas, users have to get very close-within two feet-before the badge will provide access, a programming decision designed to maintain data privacy and security and ensure that a badge doesn't trigger multiple computers to log a user in, such as in a crowded nurse station.
In addition, the RFID receiver is programmed to detect the slightest movement. If it detects none-for example, if someone leaves a badge on a desk-it will log a user out.
The role of blades
The blade computers took care of the maintenance and security concerns that were growing exponentially as the delivery system committed to wireless communications, Israel says.
In a blade environment, like with the thin-client computing model, all the computing is done on the back-end. Data and applications are not loaded onto a hardwired or mobile device.
In a thin-client environment, multiple devices are programmed to interact with an application server. In the blade computing model, each computing device is linked to a specific blade, which then interacts with application servers.
The blade computers are about the size of a videotape and contain standard PC components such as microprocessors, hard drives and operating system software. Users see a standard desktop "image" from the blade via porting devices connected to monitors.
The blades-from Austin, Texas-based ClearCube Inc.-are stored in racks in a server room.
The delivery system uses them for both hardwired and wireless computing. For desktop computing, the port devices are connected to monitors and communicate with the back-end blades through an Ethernet connection.
Going airborne
John C. Lincoln also has added standard wireless cards to the port devices and connected them to flat-screen monitors mounted on mobile carts from Troy, Mich.-based Enovate IT.
The mobile carts are used in the emergency room for registration and by dieticians taking food orders from patients. The delivery system is starting to enable physicians to connect PDAs and wireless laptops to blades via an online portal.
John C. Lincoln also plans to increase its stable of blades when it introduces computerized physician order entry and nursing documentation systems, Israel adds.
The blade computers provide a number of advantages in terms of maintenance and security, Israel says.
If a blade computer goes down, or if a wireless dead zone causes a connection to be dropped, users can be automatically switched to another blade. The I.T. department also no longer must load software and application upgrades on each computing device, or worry about "wiping" and reprogramming desktop and mobile hardware. In addition, if devices get broken, lost or stolen, the delivery system doesn't need worry about data being lost, or having to rebuild a user's suite of applications on another device.
"The maintenance and security issues kept growing and were eating more of our budget, and were getting more complicated with wireless devices," Israel says. "As we moved into a wireless environment, we wanted to get away from the traditional maintenance model and find ways to increase security."
For more information on related topics, visit the following channels:
