Guest Column
Wireless technologies offer new care options
Here’s chance to move action closer to patients
By Matt Hisle, PE
Superior Consultant Holdings Corp.
Southfield, MI
(Editor’s note: This is the first of two articles exploring the biggest gains in wireless technology.)
In the olden days, health care came to the patients. Physicians arrived at the patients’ doorsteps, black bags in hand, ready to provide care whenever needed. Physicians accompanied patients to the hospital and admitted them directly — all without burdening patients to fill out forms, prove insurance coverage, or discuss their health conditions in detail.
While this approach to medicine now exists only in old television shows, the public recalls it with fondness as the Golden Age of medicine. Today, the patient comes to the care, whether it be a physician, nurse practitioner, ambulatory clinic, or hospital. Upon arrival, the patient sets out on a tortuous process, often moving to various locations before actually receiving treatment.
Wireless technologies, combined with new information technology and new ways of working, offer hope for reversing the trend and improving the patient’s view of the process and the health care environment. These technologies also promise to speed response to critical care needs and improve medical staff productivity. Rapid improvements in functionality, combined with dramatic price decreases, make wireless communications systems a feasible alternative.
1. Wireless data communications systems
Most hospitals exploring this area focus on using wireless communications systems to transmit and receive information as data, text, or images. As more information becomes integrated into electronic medical records, on-line insurance databases, and telemedicine systems, critical data about each patient are generated, tracked, and used on-line in real time.
Wireless data systems allow the user to break the ties of geography and create and use this information anytime, anywhere. No longer must terminals be situated behind desks or only in physicians’ offices, clinics, or hospitals. With the proper networking and security, any information in any information technology system in the hospital can be available to the caregiver, regardless of physical location.
There are two major classes of systems: One provides services for access to networks and information within a physical building (local area networks), and the other provides access across wide geographical areas, such as cities (wide area networks).
2. Local area networks
Access to local area networks (LANs) at reasonably high speeds has only recently become technically and economically possible. Imagine a traditional connection of a PC to a LAN in a hospital. Now break the wire connecting the PC to the wall, convert the PC to a more ergonomic, portable device, and add an antenna. Finally, carry the new device anywhere. This is the essence of the wireless LAN. Here’s how it can be used in several situations:
• Registration/admitting: Use a portable laptop or workslate to interview, triage, verify insurance, review medical history, and schedule a patient, all at the patient’s preferred physical location.
• Patient charting: With the rapid advances in electronic medical records, electronic entry and access can be accomplished by anyone properly equipped. Wireless systems allow this data entry and access to occur anywhere, even in transit. For emergency patients, this means data can be entered and accessed simultaneously with the provision of care, regardless of location. For recovering patients, nurses can spend more time at the bedside and less time at the computer desk.
• Real-time lab results: Why wait until someone sits at a terminal and accesses a status screen? Using push technology and terminals as simple as two-way alphanumeric pagers, physicians and other caregivers can be updated with test results as soon as they are completed, without having to lift a finger. When seconds count, this can make a difference.
• Testing on the run: New tools for testing, such as blood analyzers, have become more compact and portable than ever. When linked with wireless systems, handheld labs can report results instantaneously for redistribution to all concerned parties.
• Reconfiguration on the fly: Need to redesign your admissions area to handle different or increased patient flow or new operational methodologies? No need to wait for LAN cabling to be installed — just relocate the wireless connected devices, and you are back in business.
3. Wide area networks
For some patients, the access process starts long before they reach the door of the hospital. In order to bring care to these patients, our networks must be able to reach outside the hospital walls to support patients and caregivers regardless of where they might be.
Wide area network systems are in their infancy. Performance is restricted, and coverage is not 100% complete. However, the rise of digital cellular systems, personal communications service systems, and other digital-oriented radio systems in recent years has created an infrastructure that provides for acceptable speeds of information transmission, regardless of location, within most major metropolitan areas.
Real advances are being made through devel opment of improved information terminals. Ultra-lightweight laptops, personal digital assistants such as Palm-Pilot, and Windows CE palmtop systems have made information entry and access ergonomically acceptable. Nonkeyboard- information entry techniques such as voice recognition will make these systems even more feasible. So what does our well-dressed roaming provider do with this technology? Consider these uses:
• Emergency services: Using palmtops and a wireless-based data network, emergency medical crews can enter patient data, access medical records, and even admit patients while still providing care at the scene or while under transport. When the patient arrives, the admitting process is complete, the emergency department team is completely informed of all relevant medical data, and care transfers seamlessly to the in-house staff.
• Physician notification: Depending on the receiving device, off-premises physicians can receive constant updates on the progress of their patients. These can include test results, charting updates, and even updated imaging and patient monitoring data. Thus, physicians are never out of touch, whether they’re at the office, another patient location, or a basketball game.
4. Wireless voice communications systems
Although wireless phones have been in use for years in the homes as car phones and handhelds, their use is still maturing. New technology available from every major telephone system vendor has shrunk the business phone to cell phone size and made it portable. Now, miniature portable phones can be taken anywhere within a hospital.
These allow users to receive calls on their main number, transfer, access voice mail, manage multiple calls, and even see who is calling before answering. Anything that can be done with a desk phone can be done with a portable. High voice quality can be maintained, and there are no usage charges for phones dedicated to the local PBX.
This capability frees the physician, the nurse, the lab specialist and even the porters from the tyranny of the telephone. One can be responsive to inbound callers, even while performing the key services that patients require. In a real-life example, wireless phones were critical to the implementation of a successful "quiet hospital" program targeted to the neonatal ward.
[James M. (Matt) Hisle Jr. is a corporate vice president at Superior Consulting Holdings Corporation, a nationwide health care and information technology consulting firm. He can be reached at 4000 Town Center, Suite 1100, Southfield, MI 48075. Telephone: (248) 386-8300. Next month’s article will discuss wireless technology in admitting/registration, charting, medical transport, and neonatal care and explore emerging technologies expected in the next decade.]
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