Mobilizing Healthcare In The ARRA Age

Transcription

1 WHITE PAPER Mobilizing Healthcare In The ARRA Age Tips to implementing wireless and mobile technologies that will help your healthcare facility effectively manage growing data requirements, while cutting costs, increasing efficiency, and improving patient care. Sponsored By: By Ken Congdon, Editor In Chief, Healthcare Technology Online

2 Introduction For years, healthcare facilities throughout the United States have adopted wireless technologies, including smartphones and mobile computing devices, to improve data access and streamline clinical workflows. Not only have these wireless solutions been shown to improve communication between doctors, nurses and support staff, but they also enable clinicians to spend more time with patients, respond to patient needs more quickly, and deliver a higher level of patient care overall. When ARRA (The American Recovery and Reinvestment Act) was passed in 2009, it served as motivation for the healthcare industry to adopt and implement EHRs (electronic health records) by To ensure an EHR implementation doesn t impede clinical workflows, many healthcare facilities demand the capability to access and record patient data in the EHR wirelessly, at the point of care. In fact, in a survey by RIM (Research In Motion), 65% of the healthcare professionals that responded indicated that EHR data was one of the top three processes or applications they would choose to mobilize. Mobilizing EHR data places added stress on the wireless infrastructure and devices deployed within a healthcare facility, and many organizations will need to upgrade their mobile capabilities over the next few years in order to exchange EHR data wirelessly, while adhering to regulated patient privacy requirements. This white paper is intended to provide you with a basic understanding of the key components necessary to build a wireless infrastructure for the ARRA age and shed some light on the mobile technology options that may be most suitable for your specific healthcare environment. Part I: Cellular & Wi-Fi: A Healthy Combination Effective wireless communication all starts with the network.

3 Most folks are at least vaguely familiar with the two main methods for exchanging voice, data, and video communications wirelessly via cellular and Wi-Fi. However, let s take a closer look at each of these options and identify the benefits of deploying each in your healthcare facility. Cellular: A cellular network is a radio network distributed over land areas called cells, each served by at least one fixedlocation transceiver, known as a cell site or base station. When joined together, these cells provide radio coverage over a wide geographic area and enable a large number of cellular phones, smartphones, and mobile computing devices to communicate with other cellular networks/devices and landline networks/devices. Cellular communications allow healthcare facilities to wirelessly communicate and exchange data over large geographic areas with little interference from other radio signals. In today s market, the speed and capacity of cellular networks typically range from 3G (up to 3.1 Mbps peak downloads speeds) to the newly established 4G wireless standard (more than 10 Mbps peak download speeds). See Part II of this white paper to learn more about the potential impact of 4G communications on the healthcare industry. Wi-Fi: Wi-Fi stands for Wireless Fidelity and is an authorized trademark of the Wi-Fi Alliance. It is used to refer to devices that can connect to established WANs (wireless area networks) within range. These wireless networks generally consist of a series of interconnected wireless access points (i.e. hotspots) that are hardwired to the Internet and other systems. These private networks can be confined to a few rooms or floors in a healthcare facility or expanded to serve several buildings on a healthcare campus or located in close proximity in a metropolitan area. In today s market, the speed and capacity of these wireless networks typically range from g (up to 54 Mbps) to the newly passed n standard (up to 150 Mbps). Cellular and Wi-Fi technologies each have their own distinct advantages and drawbacks when it comes to wireless communication and data exchange. However, building a seamless wireless infrastructure for your healthcare facility won t rely so much on choosing between cellular and Wi-Fi, but instead choosing the right combination of the two for your specific needs. Missed communication or delayed communication as a result of poor wireless performance is not an option in healthcare environments. Not only can unreliable communication and data access lead to inefficiency and increased operational costs, but they can also be life threatening for your patients. You need to ensure your wireless solution eliminates any communication gaps and minimizes the barriers to communication inside buildings or while traveling. For example, some healthcare facilities are located in areas with spotty cellular coverage and may need to establish Wi-Fi networks throughout the facility to ensure wireless uptime. Similarly, some healthcare facilities shield areas of their buildings to ensure cellular signals don t interfere with sensitive diagnostic or monitoring equipment. Wi-Fi may need to be implemented to compensate for the wireless coverage gaps created by these protected areas. On the flip side, a Wi-Fi solution alone limits the range in which you can wirelessly exchange information. If a physician needs to access a patient chart, for example, while on the move or at home, they will likely be unable to do so wirelessly if they don t have a cellular connection. The key to establishing a wireless network that optimizes staff communication and uninterrupted access to EHRs and other data is to match the solution to your current (or desired) clinical workflow. The best place to start is to have a certified wireless service provider perform a site survey. Questions that you and your wireless partner will need to address include: 1. What wireless solution will fit best with the healthcare organization s existing network? Interoperability, ease of integration, and support for industry standards all affect the use, maintenance and operation of mobile communication devices. 2. How will the wireless solution be secured? You need to ensure that all wireless communications (via cellular or Wi-Fi) are transmitted securely. This is not only a regulatory requirement, but also an ethical concern particularly when it comes to transmitting patient EMR data or communication among staff members about patient treatment. The data that flows via Wi-Fi or cellular channels needs to be encrypt-

4 ed, and your overall wireless solution needs to take that into consideration. 3. How will the wireless devices used on the network be provisioned? In other words, will the devices be supplied to clinicians by the hospital, or will physicians and nurses be given the freedom to connect their own personal devices to the system? Perhaps it s a combination of both. In any case, this will be a key consideration when designing your wireless network infrastructure and ensuring that all devices not only have the ability to connect to the network and exchange data, but also are able to be centrally managed and controlled to protect against data breach. 4. Will your wireless carrier be able to provide affordable coverage to all areas of the hospital? Coverage, in many cases, will drive your wireless solution. Without sufficient coverage, your solution won t function the way it s intended. Part II: What 4G Means To Healthcare By now, most of you have probably seen television commercials from cellular carriers or smartphone manufacturers that tout the benefits of new 4G cellular broadband networks. Today, this fourth generation of cellular wireless standards can achieve download speeds upwards of 10 Mbps, with even higher speeds expected for the future. In the consumer world, this significant upgrade in wireless broadband means faster wireless web surfing/downloads and high-quality wireless videoconferencing. However, few have spoken about the potential impact 4G communication can have on the healthcare sector. Quite simply, 4G has the potential to transform the healthcare experience as we know it for patients, caregivers, and facilities alike. Next-Generation Telehealth First, 4G broadband capabilities are dovetailing nicely with the growing trend of telehealth/telemedicine in the United States. Telehealth is becoming a popular alternative to doctor s office or hospital visits in the treatment of the chronically ill and elderly. Telehealth solutions can include physician/patient videoconferencing as well as wireless patient monitors. With 4G, these data-intensive communications can now be conducted wirelessly, making the equipment easier to install and more intuitive and convenient for patients to use. For example, two-way videoconferencing devices can be placed at the patient bedside for regular physician/patient interaction, complete with high-definition video transfer for accurate visual diagnosis. Wireless patient blood pressure, blood glucose level, weight, and bone density monitors may also be integrated into the solution. These devices provide treating physicians with regular insight into the patient s condition by regularly relaying this data wirelessly to the doctor s computer or mobile device. Telehealth solutions promise to have a profound impact on patient care and can also help drive costs out of the healthcare system. For instance, enabling the chronically ill and elderly to receive care from home reduces the number of hospital admissions and office visits, which are riddled with expense. Furthermore, by receiving regular updates on a patient s vitals from telehealth devices, physicians can be immediately alerted to a potential medical problem that requires treatment. Without these tools, the patient might only visit the doctor once the symptoms have progressed to a dangerous level, which may require stronger treatment and lengthier hospital stays. Finally, research also shows that elderly cared for in their own homes live longer, healthier, and more productive lives. With 4G telehealth technology, the remote high-touch personal care these patients require is now not only possible, but fairly easy to establish. 4G telehealth solutions also help remove location barriers from the healthcare equation. With videoconferencing, a patient in a rural area witth 4G coverage can receive a consultation from a world-renowned specialist in an urban location without ever leaving their neighborhood or home. Information Sharing On-Demand The main objective of ARRA is to motivate healthcare facilities to adopt EHRs and use them in a meaningful way. The idea is that once medical records are digital, they become more mobile and can be shared more easily with other hospitals and physicians. 4G will play a significant role in delivering this health information on demand when and where patients or care-

5 givers want and need it most. EHRs are data-intensive applications that require significant bandwidth to access and manage. Historically, physicians may have had a difficult time interacting with these systems effectively via a cellular connection. 4G changes that. 4G now delivers the bandwidth necessary for electronic medical data to be transmitted cellularly at faster speeds than ever before. This capability not only makes the patient record more mobile, but it also significantly impacts the speed with which care is delivered in emergency medical situations in the field and abroad. The M2M Connection M2M (machine-to-machine) communication is a term common to the wireless industry, but currently isn t prevalent in the healthcare industry. The capacity of 4G cellular networks promises to usher the healthcare industry into the M2M age by interconnecting healthcare devices with devices in other industries to improve medical response times and the quality of care. For example, imagine a car is involved in an accident. Sensors in the car can immediately register the impact and send out a call for help complete with the vehicle s location. Current telepresence systems such as OnStar already do this, but 4G will enable another level of action. For instance, the sensor in the vehicle can identify who the car is registered to and identify all the members of his or her family. The medical records of all of these individuals can then be automatically downloaded to the first emergency medical responders on the scene and the receiving hospital. As you can see, 4G broadband is a key component to ushering in the next evolution in mobile healthcare delivery and is crucial to realizing the federal government s ultimate vision of healthcare delivery under ARRA. These carts allow full-sized computers and/or laptops to be wheeled from room to room and provide a full keyboard to facilitate the extensive data entry that is typically required when using an EHR. There are three main types of mobile workstations that healthcare facilities can choose from, all of which can be equipped to provide wireless connectivity via Wi-Fi or cellular networks: Powered workstation A full-featured mobile computing solution for clinicians. Powered workstations provide mounting options for a variety of computing options including laptop computers, all-in-one PCs, and tablet PCs. These devices typically have sophisticated onboard power systems that not only provide extended power to the PC itself, but also enable powered ergonomic adjustments and drawer security features. Powered medication cart These devices are powered workstations with a series of locking drawers for secure medication transport and an onboard medication server for accurate medication administration. Integrated medication cart While a powered medication cart provides a stand-alone medication administration solution, an integrated medication cart integrates these units with the healthcare facility s back-end IT systems (e.g. EMRs, practice management, etc.). Part III: Mobile Devices Making An Impact Thus far, we ve focused on the features, benefits, and implementation best practices of today s wireless networks. Now, let s turn our attention to the hardware devices that leverage those networks to put information at the fingertips of today s clinical caregivers. Mobile Carts/Workstations While handheld computers and smartphones continue to gain popularity in healthcare settings, one of the most popular means in which to interact with EHRs wirelessly at the point of care continues to be via mobile computing carts and workstations. In evaluating the numerous mobile carts/workstations on the market today, hospitals must sort through a wide range of features, from storage features to battery systems. But in determining which workstations are best for a given hospital, the most important issue is not as obvious as a specific feature or option. Rather, hospitals need to take a long-term look at their mobile computing strategy and look at how readily workstations

6 can be upgraded. Point-of-care technology is evolving rapidly, and will continue to do so for the foreseeable future. A workstation s role in a given facility this year may change dramatically next year and again several times over the useful life of the unit. To ensure long-term value for a hospital s investment, it is essential that mobile workstations easily integrate with emerging technologies and give hospitals the flexibility to use one workstation for numerous applications. Tablet Computers The tablet computer is not a new device by any means. It has been a viable computing option in the healthcare industry for years. However, recent upgrades to the form factor of tablets namely improved ease of use, power consumption, and operating system options are making these devices the point of care computing platform of choice for today s physicians. There are many features of today s tablets that make them intriguing for clinical use. First, today s tablets are highly portable. They are smaller, thinner, and weigh less than traditional tablet computers most even fit in a physician s lab pocket. Despite this portability, these tablets offer a large screen size so clinical information (e.g. EHR data, medical images, lab results, etc.) is clearly visible. Second, today s tablets offer high-resolution visual displays for quality photo and video presentation, which can come in handy for remote diagnostic purposes. Third, the battery life of today s generation of tablets can last well over eight hours without the need for a recharge. Fourth, many of the tablets on the market today offer simple application downloads, access, and integration. Fifth, the touchscreen interface of tablet computers provide an easy and convenient way for clinicians to navigate through numerous applications. Finally, most tablets today are available with both Wi-Fi and cellular wireless connectivity options. Handheld Computers & Smartphones Handheld computers and smartphones are clearly the most portable of the today s wireless device options. Plus, smartphones offer the benefit of integrating wireless voice, paging, and data capabilities into a single device. Today s handhelds and smartphones also have the ability to accommodate several healthcare-specific applications, facilitating point-of-care interactions (e.g. medication administration, lab result access, etc.) that improve the accuracy and efficiency of care. However, the size and data processing capabilities of these devices can be a drawback of using the device to display and interact with EHR data. As more point-of-care technologies are introduced, mobile device selection must become a strategic decision within healthcare facilities. A best-of-breed strategy rather than a single device option is typically the most beneficial solution. For instance, small, handheld devices, might be more appropriate for routine care (e.g., recording medication or fluid administration, or supplies used). The detailed EHR documentation required shortly after inpatient admission, however, might require a larger mobile computer mounted on a mobile cart. Likewise, a tablet computer might also be required for streamlined physician/patient interaction. On a medical-surgical floor, a secure medication cart with a tablet PC might be preferred, rather than wheeling both a medication cart and a full-sized computer cart into the area. Furthermore, critical care units with limited floor space and intense patient care requirements might consider wall-mounted, in-room computers. Selecting the proper devices requires a thorough examination of you clinical workflows and data requirements. Part IV: Mobile Device Management Regardless of the mix of mobile devices you choose to implement at your facility, all will need to be properly managed and secured. Mobile devices present a unique challenge to IT administrators because most devices can t be physically accessed to perform an upgrade or install new applications. In many cases, devices in use at a healthcare facility are distributed across a large campus, and oftentimes clinicians purchase their own devices for use with hospital networks and applications. Healthcare administrators need a secure way to manage all mobile devices in use at their facility both corporate assets and personal devices. Fortunately, technologies are available to help you with this task. The following are a few features to consider when selecting a solution and implementing your mobile

7 device management strategy: Remote deployment and provisioning of applications globally (rather than having to configure and deploy applications one device at a time) A central means of reconciling device usage for billing purposes and monitoring usage patterns Management capabilities for disabling or wiping devices clean in case of device loss or theft A flexible security configuration that allows settings to be changed on an individual basis from a central management dashboard Built-in encryption of all communication streams to ensure no data is leaked during the configuration and deployment process The capability to lock devices or change passwords remotely Summary The new wireless network capabilities and mobile devices available to the healthcare providers today will be instrumental in ushering in the access, exchange, and meaningful use of EHRs and other medical data outlined in ARRA. However, it is the responsibility of us as an industry to ensure this wireless exchange of patient data is secure. A new era of healthcare delivery is upon us, and if done correctly, the impact on patients, caregivers, and the healthcare economy will be measurable and profound. About The Author Ken Congdon is the editor in chief of Healthcare Technology Online (HTO) produced by Jameson Publishing, Inc. (Erie, PA). HTO is an online publication and resource center that delivers healthcare technology system news, implementation trends, best practices, and product information. HTO s mission is to provide healthcare professionals with expert guidance on technology system selection, integration, project management, and change management. HTO covers all technology solutions that impact the productivity, efficiency, patient care, and cash flow of a healthcare facility from the latest EMR (electronic medical record) and HIM (health information management) software to point-ofcare solutions and medical imaging systems. Congdon has been a technology journalist for nearly a decade serving as editor in chief of Integrated Solutions magazine, and ECM editor for Business Solutions magazine in that timeframe. Congdon is a graduate of Duquesne University with a BA in Journalism.

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