Cordless phones take charge in the ED
Wireless communication technology used in the ED continues to expand in capability While capabilities have increased, costs have decreased. "When we installed our system two years ago, it was significantly more expensive than it is today," notes Thomas McCotter, director of communications for University of North Carolina Hospitals, which uses wireless phones in the ED. "Just as with personal computers, costs are going way down. There are also a number of options which didn't exist at that time."
Here are several options for wireless communication in the ED:
Digital technology. Compared with the analog signal of the typical cellular phone, digital phones have a much clearer signal. They also don't present the confidentiality concerns of conventional cellular phones. "A major advantage of digital is that it's fully encrypted," says Mark Wightman, manager of Marketing Communications for Ericcson Inc. "Companies are concerned about confidential information or trade secrets getting out through cellular phone conversations, but that is not a problem with this technology. Digital phones also cannot be "cloned," resulting in the possible theft of your cell phone number and signal."
Digital service also can include paging and voicemail capabilities, whereas conventional cellular does not. "It can constitute a cost savings if a physician is willing to give up his or her cellular phone and rely solely on digital," says Doug O'Neill, senior marketing manager of BellSouth Mobility. "The only drawback is that incoming calls would then be charged to the owner of the digital system."
Digital phones that vibrate instead of ring are available, which cuts down on the noise in the ED. "There is a Murphy's Law of Telephony at work that dictates a physician will be called back at precisely the least opportune moment, such as being gloved during a procedure," notes William Cordell, MD, FACEP, director of emergency medicine research and informatics at Methodist Hospital in Indianapolis, IN, which uses wireless phones.
Incoming calls can also be routed directly to voicemail. "In the ED, you might be tied up with a crisis, and unable to answer your phone," says Wightman. "If the digital phone is turned off, the call automatically goes to voicemail and has a paging capability as well."
The calls would also be routed to voicemail if the system can't receive them. "While technology has advanced greatly, radio waves still have their limitations, so you won't get a strong signal in every nook and cranny of the hospital, like a basement or elevator, unless you choose to add extra space stations, which typically isn't worth the cost tradeoff" notes Wightman. "In that scenario, your phone may not ring, but the caller would still be able to leave a voicemail message. Then, when you step out of the elevator, you receive a page letting you know the call was received."
In-building wireless systems. With a digital in-building system, base stations are installed wherever coverage is needed, whether hospital-wide or just in the ED. "Each has approximately a quarter-mile mile radius, so if you have a fairly small area to cover, you would only need one base station," says Wightman, adding that a single bay station can handle eight simultaneous calls or 96 simultaneous calls in a 150 foot radius by co-locating base stations. He estimates the cost per user at approximately $1100 per line (for 50 users), including all hardware and software components.
In Methodist Hospital's ED, an in-building wireless digital phone system is used. "Each of these phones has its own PBX (private branch exchange) number, so each pocket phone has its own unique phone number, as opposed to our home cordless phone which is merely a wireless extension to our home number," Cordell explains. "Thus, I can have a consultant call me directly at my pocket phone number and bypass the secretarial queue. However, the coverage area is limited by ceiling antenna placement."
Larger networks. Systems can be linked across a large geographical area, using digital technology. "If you had a hospital with five clinics in multiple locations, this technology allows you to network multiple systems without paying cellular charges, even across the country," says Wightman. "The cost would be somewhere in the range of $40,000 for the system, not including the $1000 per user cost."
Users can take handsets from building to building on a hospital campus and have seamless coverage,"says Wightman. "If you move outside the campus coverage area, you can't roam on this system, but as soon as you return to the coverage area of another branch office or another campus you have the same phone features you would have at your home base."
Single phone numbers for personal and ED use. Physicians can use a single telephone number for both their cellular phone and the portable phone used in the ED. "If you're in the ED, you will get all your calls on that phone, and when you leave, all those calls can be directed to your cell phone number," says Wightman. If the call isn't picked up, it can be routed directly into voicemail, he notes.
Outside sites. "If you don't want to shell out the capital to build your own private system, you may find a service provider willing to install a site outside the building to provide service inside the building," O'Neill explains.
If a hospital has three buildings that need wireless phone service, a single outside site can serve all of them, he explains. "It may be a less expensive approach than an in-building system if you don't expect large numbers of users to be active on the system at any given time. Otherwise, blockage could be an issue," he adds. "The advantage of this solution is your phones will work in the building, and also throughout the city because you are using the cellular network."
In that situation, the carrier gets a monthly fee for the use of handsets. "So, it's a business decision made by the hospital administrator. Is it better to pay a monthly charge for using the handsets, versus shelling out capital for an in-building system and the cost to maintain it?" says O'Neill.
Dual Modality. Specialized dual mode handsets access the in-building system while you're in the ED, but when you leave, the phone automatically switches to the public cellular network. "At that point, you would pay airtime charges," says O'Neill. "This would enable clinicians to have a single phone that works in the ED, but also when they're out on the town or at home." The phones have call waiting, messages, cell phone, pager, and voicemail capabilities, eliminating the need to carry multiple devices.
Having just a single phone would be cost-saving, since pocket-sized phones left in the ED tend to disappear. "The more portable an appliance, the greater the chance of loss or theft. Tracking the phones down was often difficult and time-consuming, so now I keep my phone locked in a charger cradle in my office," says Cordell. A dual mode phone would eliminate that problem, he notes.
Although the technology exists as a prototype system, dual mode phones aren't currently commercially available. "At this point, we are trying to look for anchor customers to accelerate the commercialization of the product. At this point, we expect the product to be available in 1999," says Wightman.
On the horizon: A headset system is being developed by Temco Communications, based in South Barrington, IL, which uses bone conduction for more effective communication. "Your ear canals are left open, so you can still easily hear patients and colleagues, and also use your stethoscope," reports Gregory Jay, MD, PhD, FACEP, assistant professor of emergency medicine at Brown University in Providence, RI. "The wearer can communicate with other people who are on the same headset with a whisper."
In addition to providing wireless communication, other information could potentially be accessed from the headset. "We can possibly put other communication on that band length," says Jay. "Emergency medicine desperately needs an information management tool that is portable. With this tool, you would be able to click on the chief complaint of chest pain and document as you are moving, and have that information transported directly to a server in the department."
Microcellular technology. This system enables users to have seamless coverage. "This system is still digital but is running on the cellular band for licensed PCS," says Wightman. "With the microcellular solution you have coverage wherever you go because you are on the cellular network; however, you are paying for the roaming charges."
The microcellular solution has a low power setting that will not interfere with medical equipment in hospitals, notes Wightman. "If the majority of a hospital's users will be mobile across large geographical areas where roaming is important, then the microcellular solution is better," he says.
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