Health care ahead of wireless curve

Put 30 different corporations with 30 inter-related disciplines under a single roof. Add dozens of different communications systems, and you’d have today’s hospital campus — an extremely challenging communications environment.

“Communication in health care is absolutely critical; it’s daunting,” said Richard Mohnk, chief information officer of the multi-facility HealthAlliance in the Boston area.

Indeed, most hospitals not only have a tangled web of communications wiring, but also a wireless antenna farm that would make a broadcaster envious. Some departments use radio frequency identification (RFID) to track equipment, some use cell phones or Wi-Fi handsets to communicate inside and outside the facility, and still others communicate with emergency personnel in the field with conventional land mobile radios (LMR) or cell phones — or both.

That’s just scratching the surface of what’s becoming an increasingly complex and necessary mix of multiple technologies and purposes. Nearly every square foot of many hospitals is covered by at least one wireless communications system, including those for visitors.

At first glance, a hospital seems an odd place for such a high-tech mix. Not so, according to Alastair Westgarth, senior vice president of product line management for InnerWireless, which builds wireless networking equipment for hospitals.

“Many people will say that health care is technology-backwards if it doesn’t involve some sort of procedure or medicine or whatever, but the funny thing is they’re [also] one of the most aggressive and successful adopters of wireless out there,” Westgarth said.

Most health-care communications were installed piecemeal as organizations bought the latest gear to meet rising patient-care demands. And, as with any business, the top honchos — the physicians — prescribe how work place communications operate.

“Doctors don’t want to get paged and find a phone; they want you to call their cell phones,” Westgarth said. “A surgeon wants to be able to make the call from the O.R. and not run to another phone.”

However, cell phones caused a major disruption when they first entered the health-care space. The ubiquitous handsets interfered with more important monitoring and dispensing devices needed for patient care and didn’t really work very well within the multi-communications hospital atmosphere. First responders and police, who had learned to count on commercial push-to-talk services to talk with hospital personnel, found themselves pushing and talking, but not getting a response.

The interference problem has been resolved, and many facilities have gone so far as to install their own cellular PCS network. In the process, an important lesson was learned, Mohnk said.

“You have to test every device that you put in,” he said. “I don’t care if it’s Verizon Wireless; we want to be able to provide cellular service in the hospital, too, but before we make that hot, we do testing on it.”

However, an even bigger problem looms — where to put all the equipment and how to manage and maintain it. It’s not unusual for a hospital to be running a paging system at 400 MHz, a telemetry system at 1400 MHz, an RFID network at 900 MHz and a Wi-Fi system at 2.4 GHz, as well as a cellular network and a traditional LMR system.

“They all have different antennas,” Mohnk said. “That’s part of what drives us all crazy because all the antennas run at different bandwidths, and they require different support — anything from power to technical support.”

Consequently, it helps to converge as many in-building communications devices as possible. Vocera Communications believes it has accomplished this goal with its Wi-Fi badges — small Wi-Fi phones/messaging devices — that keep everyone on the same frequency inside the building.

“Imagine hundreds of nurses walking around with cell phones and picking up and dialing numbers. That’s not a very efficient way to communicate with people,” said Niraj Jain, director of business development for Vocera. In addition to improving work flow and productivity, the Wi-Fi badges also reduce “stadium noise,” an annoying byproduct of over-the-air paging, Jain said.

Kim Bonzheim, director of non-invasive cardiology at William Beaumont Hospital in Royal Oaks, Mich., is focused on increasing staff productivity and improving patient care. Bonzheim has been testing Vocera’s badges in Beaumont’s centralized telemetry monitoring space where cardiology patients are equipped with small transceivers that send their status to a central monitoring station.

In the past, when an anomaly popped up, the monitoring technician paged the appropriate nurse. If the nurse didn’t respond, the page was resent. Typically, the frazzled nurses who didn’t answer the first page became angry nurses.

“It was a lousy process. It was taking us too long to complete that communication loop between sending out the page and having the nurse say she got the communication,” Bonzheim said.

Using the hands-free badges changed the process.

“The technician activates the badge by asking the patient’s room number, and the nurse taking care of the patient can communicate and hand off that information and close that loop within 39 seconds,” she said.

The old way took just less than 10 minutes — when the nurse was located.

“That’s a problem in a hospital. It’s very busy. Obviously, you want your caregivers in the patient rooms taking care of patients, which can make it difficult for staff members to find each other,” she said, adding that Beaumont is considering expanding use of the Vocera badges to other locations in the hospital.

Because hospitals are housed in very large and open buildings or campuses, locating staff isn’t the only concern — equipment and, increasingly, newborn babies also must be tracked. That’s where RFID comes into play.

RFID technology lets hospitals locate and monitor anything — from wheelchairs to gurneys to medicine dispensers — that tends to move around. It’s also enabling the monitoring of high-value patients. Hospitals attach an ankle bracelet to an infant shortly after birth, and an active RFID microchip verifies the child’s location and sends off a warning when the child is somewhere he or she is not supposed to be.

“The nursery or larger area is equipped with RFID readers on a room-by-room basis or even a doorway,” said a VeriSign spokesman. “The primarily utility for the system is to prevent infant abductions.”

Although there is no denying the value of such an application, RFID represents still more equipment that must find a home. Hospitals used to be able to hide such technology in the ceiling, but that cluttered space is quickly moving off-limits.

“Any time you get up in the ceilings, it’s more and more strict for engineering,” HealthAlliance’s Mohnk said. “There are some cities … already requiring you to seal off when you open the ceiling because of infection-control issues.”

“Our docs said they wanted to be able to have cellular coverage,” he said. “The only way to do cell phone coverage in a traditional environment is to have Verizon, Cingular, AT&T and Sprint Nextel pull in their own antenna systems. I would have to pull literally four antenna systems to support them.”

That was the last straw. Although doctors are important, and their demands are more often commands, “I said this is nuts, and we have to find a different way.” Mohnk used InnerWireless to consolidate all his communications gear via one cable that contains all the different spectra.

“We put a piece of infrastructure in place that allows one piece of cabling and one infrastructure to be able to provide service from 380 MHz all the way up to 6 GHz,” InnerWireless’s Westgarth said.

That covers PCS, cellular, two-way paging, Wi-Fi and anything else the hospitals can think of installing. New vendors coming in with new frequencies are told to fit into that cable, Mohnk said.

InnerWireless’ solution also helps resolve another problem. Multiple wireless devices “generate an interference nightmare,” Westgarth said. “If you treat it as a system with multiple frequencies and controlled interference environment … it’s managing it to a level that allows all your systems to perform correctly.”

The side benefit is cleaner aesthetics.

Mohnk realizes that this won’t end the story. A cleaner communications pipe is just room to add more communications and more devices.

“It’s creating a lot more work because you used to be able to say no,” Mohnk said. “Now you can’t say no; you have to go figure out how to get it done because it’s an expectation. I don’t mind. It helps patient care.”