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California hospital unplugs all wires

Finding medical staff at El Camino Hospital is as simple as saying the person's name.

Finding medical staff at El Camino Hospital is as simple as saying the person's name.

Doctors, nurses and other medical professionals at the Mountain View, Calif., hospital speak into wireless badges worn around their necks to summon each other as needed. A wireless signal is sent to the badge worn by the specific person, who can respond in real time without having to play phone tag or rely on pager systems. Doctors and nurses contact each other throughout the day using this technology, provided by Vocera Communications Inc. of Cupertino, Calif.

The voice-activated badges are the latest wireless gizmos used by clinical staff at the 426-bed hospital, which claims to be the first in the nation with a completely wireless infrastructure. Hospital officials say wireless technologies help improve caregiving and patient outcomes.

Vocera's 802.11b-based devices use VoIP technologies, which stands for voice over Internet Protocol, to send communication packets using the hospital's wireless local area network. Vocera system software, which runs on a standard Windows 2000 server, does the heavy lifting of completing voice-recognition calls between badge users anywhere on campus.

In addition to instant contact between staff, Vocera's three-ounce badges are being integrated in infusion pumps for intravenous machines to replace audible alarms with real-time alerts to nurses. Other applications are in development.

"We're working on integrating the badges with our nurse-call system so that when a patient pushes a call button, the technology automatically finds the nurse for that patient and connects the nurse to the patient in real time via a wireless connection," said Mark Zielazinski, El Camino's chief information officer.

El Camino's wireless infrastructure, including all switches and access points, cost between $80,000 and $125,000. The hospital paid about $250,000 for Vocera's wireless system, which includes 300 badges shared by clinicians on different shifts.

Several years ago, California required hospitals to develop plans to automate more of the bedside drug administration process. Numerous studies have shown that most drug errors occur at bedside. Hospitals in California have until 2005 to comply with the mandate.

El Camino started its plan almost immediately after the new requirements were made public. Hospital administrators say wireless technologies contributed to a drop in drug errors from nearly seven per 1,000 patient days, to fewer than five per 1,000 patient days.

The Vocera rollout is only one part of the hospital's comprehensive wireless strategy. A new drug-ordering system allows nurses to use barcode readers at the patient's bedside to instantly check if dosages, medications, delivery mechanisms, and times for administering drugs to that particular patient are correct. Eclypsis Corp. of Boca Raton, Fla., and Cardinal Health of Dublin, Ohio, collaborated to provide the computerized physician ordering system. Aside from helping reduce the number of drug errors, the new system produced about $150,000 during its first year in 2003, said Zielazinski.

Wirelessly equipped laptop PCs are used by physicians and other clinical staff to review medication orders, check lab tests, document patient records and other paper-intensive tasks. The hospital paid about $75,000 for the 50 laptops provided by Compaq Corp., and 50 more PCs are being rolled out to respiratory therapists this year. Form factor and signal coverage are the two main hindrances to enterprise-wide deployment. "The problem we have now is logistics of the tablets and their battery life of about 2 1/2 to 3 hours. They're good, but not as effective a tool as they will be when they have a full-shift battery life," said Zielazinski.

El Camino encrypted its wireless network for security, although non-broadcast signals are used that keep the network's 1,200 endpoints from advertising themselves to hackers. Layered atop is a virtual private network (VPN) for added security, enabling physicians and other hospital personnel to work remotely. Zielazinski used the VPN to work remotely from his home in Chicago, before relocating to Silicon Valley.

All told, El Camino devotes between 5% and 6% of its operating budget to information technology. Several studies suggest more hospitals will increase IT spending in attempts to control rising health care costs, deliver care more efficiently, and comply with federal regulations like the Health Insurance Portability & Accountability Act of 1996. The health care IT market grew more than 9% to $23.6 billion in 2003, according to Sheldon I. Dorenfest & Associates Ltd., a market research firm in Chicago that tracks the industry.

El Camino's affinity for new technologies dates back to the early 1970s, when it became the first hospital in the world to install a computerized system used by doctors to order medical prescriptions. The system, developed in partnership with Lockheed Corp., became the first commercially available such system. It's still used by El Camino Hospital.

A wireless network dominates the information architecture for El Camino's planned new hospital scheduled to open in 2008. Hospital beds will be equipped with flatbed in-room PCs for use by patients and clinicians.

About the author: Garry Kranz is a freelance business and technology writer in Richmond, Va.

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