January 07, 2004

Wireless and Hospitals

Partners HealthCare, recognized as an I.T. trailblazer, isnt rushing its wireless initiatives.

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Partners HealthCare Systems Inc. has long been considered a leader in clinical automation. Its reputation has led many health care information technology vendors to its doorstep, beseeching the Boston-based delivery system to pilot their latest applications.

But Partners also has a reputation for being cautious. It goes to great lengths to ensure new applications fit the needs of its clinical staff. And it often develops software in-house, instead of buying off-the-shelf technology, because of concerns that commercial applications lack features its clinicians need.

Partners is using this same aggressive/deliberate approach to health care I.T. as it enters the wireless world. Most of Partners eight hospitals have implemented 802.11b standard wireless local area network technology. And the delivery system already has implemented enterprisewide wireless applications and has more on the way. But Partners is in no particular hurry to tear up its wired network, says Steve Flammini, Partners CTO.

The maturity level of current wireless platforms isnt high enough to completely displace our hardwired network, he contends. We havent taken the approach that every application must be wireless. Instead, we try to add value to existing systems by introducing mobility or recognizing new opportunities to enable clinical workflow not previously thought possible via a traditional hardwired network.

Nevertheless, Partners already has implemented complex, enterprisewide wireless applications. For example, it provides nearly 2,500 hospital-based clinicians with secure, anytime/anywhere wireless access to its Web-based homegrown electronic medical records system via subnotebooks and cart-based laptop PCs.

Partners also is using the Cache database system from Cambridge, Mass.-based InterSystems Corp. to enable wireless access to an integrated clinical data repository. More than 5,000 clinicians use the homegrown wireless clinical data repository viewing application.

Further, Partners plans to deploy more mobile applications this month, including an ambulatory medical records application and a bar code enabled-nursing medication administration system. Partners also has started testing some wireless PDA applications, such as charge capture, with smaller groups of clinicians.

The pace of Partners wireless software implementationsall done in the past 18 monthsmight be considered furious by some provider organizations. But the delivery system actually is being quite deliberate in its approach, and has set up a series of hoops wireless applications and devices must jump through before theyre implemented, Flammini says.

Before considering mobile technology for implementation, Partners ensures that any new wireless system or technology provides needed functionality and is secure enough for its wireless environment.

In addition, it also evaluates the technology to ensure it will interoperate with the delivery systems current and futureWi-Fi network, he explains.

The 802.11b technology that Partners uses for its wireless local area network is one of a family of specification standards available for wireless networks. Some hospitals are considering implementing the up-and-coming 802.11g standard, which offers more bandwidth than 802.11b. Others are waiting for the release of 802.11i and 802.1x standards, which are designed to provide more advanced, integrated wireless security applications.

Tread carefully

Health care organizations should be careful how much they deploy on 802.11b standard wireless networks, Flammini says. For the next several months well continue to go live with 802.11b applications and manage them carefully. Further down the road, we can support newer wireless network standards across our enterprise, giving us more capacity and authentication technologies for future mobile applications.

Before Partners implements any wireless application, it evaluates the need for mobility in a particular process. For example, before developing its mobile medication administration applicationwhich is set to go live this monththe delivery system sized up how effectively its current processes were working, Flammini says.

Partners nurses and doctors already use a plethora of clinical information systems to manage patient prescriptions, including an automated medication administration system and a computerized physician order entry system. But planners found that adding mobility to the process could improve workflow as well as help the delivery system accomplish some of its enterprisewide goals.

We developed the mobile medication administration application to help nurses improve their workflow by being able to take the system from patient to patient, Flammini says. By bringing such decision support to the point of care, we are able to address patient safety concerns.

Providing wireless access to its electronic medical records system also helped Partners improve clinician workflow, he adds.

The delivery system also takes clinical workflow into consideration when it evaluates what types of mobile hardware would best work with each of its proposed wireless initiatives. Clinicians mostly use subnotebooks and laptop PCs on carts to wirelessly access the electronic records system. They likely will use the same mobile technology to access the new medication administration application, Flammini says.

Partners did evaluate PDAs and Tablet PCs for use with the applications. But like some other health care organizations, it found that clinicians preferred using the subnotebooks and laptops because they feature larger screens and keyboards, which are important for such applications that require physicians to view large amounts of data simultaneously.

Most health care organizations first wireless deployments go out on laptops, says Mat Raftree, managing consultant at ArcStream Solutions Inc., a Watertown, Mass.-based wireless consulting and systems integration firm.

This might be because a PDA sometimes isnt the best fit for complex software such as computerized physician order entry systems. Or an organization might choose laptops because Tablet PCs are more costly. But it also might be simply because they already have laptops hooked up to their hardwired networks.

Obvious benefits

Peter Greenspan, M.D., since July has been using a Lifebook Series B laptop from Santa Clara, Calif.-based Fujitsu PC Corp. to wirelessly access Partners medical records system while treating patients from his Waltham office. Though he spent a few months learning to use a computer to take patient notes, the pediatrician says he likes using the technology.

The benefits of wireless access are obvious, says Greenspan, whos also the associate director of primary care for Massachusetts General Hospital. But using the laptop still isnt as fast as writing for me. Id be willing to try a Tablet PC, but it would have to have good enough handwriting recognition capabilities.

Right now, though, the gains I get from using the laptops to wirelessly access our records system outweigh not being able to write my notes by hand.

Another reason for Partners cautious wireless approach is that wireless networks present new data privacy and security challenges. Hardwired networks have well-established security technologies. But providing wireless security is a complex and evolving task, Flammini says, more so in light of the data privacy and security mandates of the Health Insurance Portability and Accountability Act.

Now that our network goes beyond our hospital walls, we must ensure that HIPAA security measures are in place, including encryption, strong authentication and auditing, Flammini says.

Partners uses the LEAP wireless encryption protocol from San Jose, Calif.-based Cisco Systems Inc. to provide more security on its Wi-Fi network than standard 802.11b technology. In addition to encryption, it conducts security audits on its patient records to evaluate patterns of wireless and hard-wired access and abuse, Flammini says.

Though Partners exhaustive evaluation of wireless technologies could lengthen the implementation process, the delivery systems cautious approach is a strategy that most health care organizations should follow, contends Raftree at Arcstream.

By assessing a variety of mobile hardware, working with clinicians and phasing in implementations, the delivery system is poised for successful wireless applications, he adds. Before implementing wireless technology, health care organizations must identify each workflow process and fully understand how their clinicians use it, Raftree says. Then they should map a wireless application to these functions and needs.

Posted by Craig at January 7, 2004 07:13 PM