Health care: Doctors without desks

As doctors and nurses wander hospital campuses, they need anytime, anywhere access to confidential medical information

No industry has as many mobile knowledge workers as health care. That poses real challenges to hospital IT departments trying to help improve patient treatment and maintain employee efficiency. As a latecomer to technology adoption, the health care industry typically builds on the lessons learned in other industries. But when it comes to mobility, hospitals lead the way.

Hospitals have become the proving ground for wireless networks, both in the capability to provide seamless coverage throughout a building and the capability to secure sensitive data transmitted over the air. “There’s not the same level of sophistication, complexity, and information richness for mobile outside hospitals,” notes Marc Holland, an analyst at IDC Health Industry Insights.

Hospital IT must ensure sufficient radio coverage throughout buildings in areas that networking vendors hadn’t even considered, such as basements and stairwells, because hospital staff may need reliable access almost anywhere on campus. This has pushed vendors to improve both roaming capabilities across access points and to add strong encryption and authentication to ensure patient data remains private.

Hospitals tend to be smaller enterprises, where the role of IT is to manage standard systems such as databases and to manage vendors that customize and deploy key technology, such as electronic medical records systems and wireless LANs. “Very few hospitals develop their own software,” notes Bill Spooner, CIO of the Sharp Health Care hospital group. That’s kept IT at a tactical level, with deep understanding of day-to-day workflows and processes. And that tactical focus has given hospital IT keen insights into how to effectively deploy mobile technology, solving individual problems that would otherwise add up to major adoption barriers.

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Technology on a human scale

Take the challenge of wireless network access control in an extremely fluid environment. One frequent method: Deploy two wireless networks, a private one for staff and accredited visiting physicians, and another for the public, using different radio technologies, says Tanya Townsend, IT director at Ministry Health Care’s all-digital Saint Clare’s Hospital in Weston, Wis. Another approach is to set up quarantine zones that all users first connect to before their credentials and access rights are verified or their systems have been determined to have required security patches, explains Rafael Rodriguez, associate CIO of Duke University Health System in Durham, N.C. According to IDC’s Holland, the quarantining method adopted by hospitals proved to other industries that wireless networks were secure enough to earn widespread adoption.

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Take the challenge of wireless network access control in an extremely fluid environment. One frequent method: Deploy two wireless networks, a private one for staff and accredited visiting physicians, and another for the public, using different radio technologies, says Tanya Townsend, IT director at Ministry Health Care’s all-digital Saint Clare’s Hospital in Weston, Wis. Another approach is to set up quarantine zones that all users first connect to before their credentials and access rights are verified or their systems have been determined to have required security patches, explains Rafael Rodriguez, associate CIO of Duke University Health System in Durham, N.C. According to IDC’s Holland, the quarantining method adopted by hospitals proved to other industries that wireless networks were secure enough to earn widespread adoption.

Another on-the-ground lesson: power. Everyone knows that laptops and other mobile devices last only a few hours on a charge, despite what ads say. But hospital shifts last eight to 12 hours, so a supplemental power infrastructure must be in place, in the form of power recharging stations and battery “libraries.” But where to put them? It’s bad for health workers to bend down to plug a laptop into a wall -- which is why, in most hospitals, you’ll find recharging stations at arm level, says Rich Temple, CIO of Saint Clare’s Health System in northern New Jersey (no relation to the Wisconsin hospital).

Along these lines, Wisconsin’s Saint Clare Hospital discovered that if it kept notebooks near elevator entrances, staff could easily drop off equipment after a shift ended -- reducing the need to track unreturned systems, which had been the case when the laptop repository was in a secure room in the bowels of the building, recalls Wisconsin’s Townsend.

Mobility on a roll
Another realization has been that smaller isn’t necessarily better. PDAs and tablet PCs simply lack the easy data entry and horsepower to run medical records software. Yet laptops are too heavy and awkward to carry around, and they tie up an arm that may be needed for a procedure.

The solution? Most hospitals strap laptops to carts and place computer terminals both at patient beds and in small work areas throughout the floor.

In some hospitals, doctors have adopted PDAs on their own to track drug interactions; some facilities even use wireless PDAs with bar-code scanners to match patient bracelets to the correct drugs at the bedside. But these advanced uses are relatively rare, notes Mary Jo McElroy, vice president of IS at OhioHealth, a regional hospital system.

Instead, hospital IT has focused on developing SSO (single sign-on) access for diverse sets of applications, so people can easily log in and out of medical systems as they go from terminal to terminal. Access to every record is tracked scrupulously to meet regulatory auditing requirements.

Nurses and doctors can have as many as 20 patient accounts to maintain, Duke’s Rodriguez says. That’s one reason hospital IT has had to help vendors develop specialized glue applications that know to synchronize patient data across all open applications. For example, if a doctor opens the medical record of a patient, the window showing the lab results would instantly call up that patient’s current lab data, while another window might automatically load the patient’s treatment plan. “You don’t want to treat doctors as data-entry clerks,” he warns.

The latest area of exploration is how to integrate data from various monitors. Today, nurses spend lots of time recording measurements such as blood pressure and EKG readings into patients’ electronic records. Although some vendors have developed notebooks with special connectors for different types of monitors, that doesn’t allow the flexibility needed within a hospital, much less across them. So, analyst Holland notes, vendors are developing both a standard physical connection and wireless options that would allow any monitoring device to upload its readings into a hospital PC -- something that could benefit many other specialized apps, from oil exploration to field service and repair.

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