Hospital reaps healthy returns from wireless

by Joanne Cummings

February 4, 2008 —

Seattle's Swedish Medical Center, a three-hospital campus with more than 7,000
employees and annual revenues of $1 billion, was mired in paper.

Like many healthcare organizations, the center relied on paper-based charts
to track and care for the thousands of patients its serves each year. But reliance
on paper often led to delays in care and in billing, as doctors and nurses searched
through files to find the right information to diagnose and treat patients.

"In healthcare, a lot of the process is hand-offs," explains Steve
Horsley, director of IT at the center, and a speaker at Network World's recent
IT Roadmap Conference
& Expo in Dallas (hear a podcast
interview with Horsley). "Information passes from the patient to the
medical assistant to the nurse to the doctor, back to the nurse, and back to
office personnel. Forms would be sitting on people's desks or were hard to read
and so forth, leading to delays. And through all that series of hand-offs, the
services that were provided were not always captured appropriately."

That meant problems in billing. "Physicians weren't documenting services
appropriately on paper, and if something isn't documented correctly, government
regulations say you can't bill for it," Horsley says.

In 2003, the center decided to tackle its paper problems by implementing a
wireless network among its metropolitan campus as part of a new electronic medical
records (EMR) system. The idea was to provide real-time, easy-to-use, accurate
information to clinicians right at the point of care.

"With wireless and the new EMR system, critical, accurate information
is available to nurses and physicians in real time, reducing delays and resulting
in better patient care overall," Horsley says. "It also makes it far
easier to code the procedures appropriately for billing purposes."

The center's new wireless network, which cost $3.8 million and was completed
in October 2007, consists of more than 1,300 Cisco access points distributed
among eight locations and linked via a metro Ethernet network. Overall, it supports
about 600 wireless workstations on wheels (WoW), 400 wireless laptops and 200
tablet PCs. And the benefits have rolled in accordingly. (See related
story on lessons learned.)

A bevy of benefits

"The key benefit of the new setup is the mobility of information,"
Horsley says. Physicians no longer have to search for charts that may be on
a nurse's desk or in a different office. "With the wireless network, any
clinician that needs access to a patient's information can get it right away,
wherever they are. It's always available."

Billing problems have also been greatly reduced. Each time physicians provide
a service, they key it in to the EMR system along with the appropriate code
for tracking and billing purposes. If the service doesn't match the diagnosis,
the EMR system raises a flag and notifies the physician immediately. Similarly,
if a service is miscoded, the system flags that, enabling the physician to fix
it -- before it leads to delays in care and in billing.

And the new network increases overall efficiencies. The WoWs provide caregivers
with real-time information at the point of care, eliminating the need for patients
to move from location to location, while the use of tablets in the emergency
room has enabled clinicians to make better decisions and place orders quickly
-- a big benefit in a fast-paced environment. The network also supports voice
via wireless phones, streamlining communications between surgical staff and
transport staff, resulting in quicker turnaround of operating rooms.

Overall, Horsley says the new setup has led to 2% higher revenues for the hospital
system so far, due to increased efficiencies in care and billing.

Plenty of plans

But that's just the start. With its strong wireless foundation in place, the
organization is now poised to garner increased savings and revenues via new
wireless-based applications, including planned hands-free communications services
from Vocera, as well as location-based services for tracking hospital equipment.

"With Vocera, you hit the button on your badge and just say, 'Call nurse
Jones,' or 'Please call the nurse on 3West,' and it automatically connects the
call," Horsley explains, noting that the hospital system began implementing
the Vocera technology in January. "From a clinician's perspective, it's
all about that quick communications, because it's a fast-paced environment and
there are so many people involved. The wireless network helps us improve communications
and overall workflow."

Similarly, Horsley's group is planning to augment the network with more access
points to implement location-based services, primarily to better use and track
expensive equipment, especially its Smart Pumps. Smart Pumps are integrated
with hospital computer systems and can stop a nurse from giving 50 ml of a drug
when it should be 5 ml, for example. The pumps are mobile and expensive, so
linking them into the wireless network and tracking their usage and location
will save money.

"With location-based services, there is definitely the potential benefit
of saving greater than $100,000 per year," Horsley says. "That comes
from the efficient use of assets that tend to migrate in a hospital. Items such
as Smart Pumps, surgical instruments, wheelchairs, and so on, get misplaced.
And then services are delayed and staff spend time looking for them."

And time is, perhaps, the greatest savings for the organization. Horsley says
he initially saw resistance from physicians regarding the wireless and EMR system.
"It slows them down at first because they're just not used to doing everything
on a computer and they are actually inputting information, where before they
could just bark an order at an RN," he says. "But what they come to
learn is they actually save time. They don't realize how much time they spent
looking for information before, in the paper world. With the new setup, all
the information they need to make a good decision is right at their fingertips."

Network World