Carolinas HealthCare unplugged

Respiratory therapist Christopher Brumfield was administering a simple breathing treatment at the Carolinas Medical Center (CMC) in Charlotte, N.C., when his phone rang. A fellow therapist needed Brumfield for a second opinion on a patient who appeared to be in cardiac arrest. Brumfield rushed upstairs and confirmed the diagnosis. After calling code blue, the therapists readied an intubation bag and other lifesaving equipment just in time for a seamless resuscitation when doctors arrived.

Such efficiency was due, in part, to the respiratory department's new wireless phones that use voice-over-IP technology. "Before [VOIP], we'd have to communicate by pager, and that took a while," Brumfield said. "We'd have to wait by the phones for doctors to get back to us. Sometimes we'd miss each other by the time they'd call back. This phone is one of the best things we've done as far as tools to improve patient care."

CMC is the flagship hospital of Carolinas HealthCare System (CHS), one of the country's largest health care providers. It is introducing wireless technologies across all of its major campuses in North Carolina and South Carolina. VOIP is one of several applications that some facilities are adding. Newer technologies, including radio frequency identification (RFID) for equipment tracking, are also in the works.

No more 'gas and go'

To support the new applications, CHS has deployed more than 500 wireless access points for 802.11b and 802.11g networks since 2004. Two hundred access points went into the 11-story, 1.5 million-square-foot main hospital, and additional nodes should go in by 2006, said Craig Richardville, vice president of information services at CHS.

The system enables clinicians to access a wealth of patient information, from lab results to ordered medications, via laptop computer or personal digital assistant, depending on physicians' preferences. Options range from a laptop PC for the home or office to a Hewlett-Packard iPaq for use in hospitals.

Before the wireless technology was installed, physicians had to load their PDAs with patient information at sync stations throughout the hospital, a "gas-and-go" concept, Richardville said. Now they can obtain lab results and patient records throughout the day without stopping to sync a device.

Dr. Vanessa McPherson, residency director for family medicine at CMC, said up-to-date information decreases some of the frustration associated with an already high-pressure job.

"Basically, I just enter the hospital and [my PDA] automatically synchronizes," McPherson said. "It downloads my patient list and all of their data: any pending test results, radiology or X-ray results, medication lists, medication allergies. I can go straight up to the floor and start seeing my patients."

But the wireless network helps more than just clinicians. CMC is testing wireless hot spots in select locations so families and visitors can connect to the networks, too.

This massive technological program receives no government funding. Richardville said he can't quantify the cost, but he pointed to the inherent value in improving patient care. The timing of the program is right, he added.

"If we did this several years ago, it would not have been as good of an investment as it is today, as the technology was not stable, secure nor had the return in value," he said. "Now, with the improvements in security, high availability and the management of the network, we are able to optimize the investment by running multiple applications, such as voice, data, RFID, etc."

Replicating architectures

CHS is now preparing to build the same type of architecture in the rest of its hospitals, said Michelle Somers, director of information services. Although the process has been smooth, officials have had to overcome some hurdles. "In the beginning, the wireless industry in general was the stumbling block," she said. "As we were designing the infrastructure [with Cisco Systems], the technology itself was changing, We went through a couple of design iterations as a result of that."

The biggest concern upfront was reliability, so Cisco engineered the system's servers and switches to be fully redundant. To ensure security, the system uses password protection and wireless encryption. Also, information stored on PDAs can be set to self-destruct after a certain amount of time.

There is little concern about clinician errors escalating in a wireless environment. Physicians cannot yet submit orders via their PDAs -- they're primarily output devices. Instead, physicians must write down lab orders on a piece of paper, and an assistant then administers the order.

Tagging equipment with RFID

CHS is now testing the use of RFID to track medical equipment, which is not easy to find in a place as large as CMC. With RFID tags, hospital employees could easily locate mobile clinical equipment, such as an IV pump or a wheelchair. If the trial proves successful, hospitals could use RFID to track anything mobile, possibly including the locations of patients or important staff members.

CMC officials plan to buy new clinical equipment and applications with even more advanced features. For instance, CHS is considering high-tech IVs known as smart infusion pumps. The pumps contain information libraries of guidelines, or "guardrails," on acceptable high and low drip rates for various medications. The pumps transmit a warning when an IV drip is not in its acceptable range.

The scope of CHS' innovation might seem broad to those who have practiced medicine without electronic bells and whistles. Richardville said no one is forced to use the new technologies, although several physicians said that almost everyone at CMC does, especially because training and technical support are user-friendly.

"We're not forcing change but rather building highways of options," Richardville said. "We think most will take advantage of these new opportunities, of the new ways to access information."