Special report: Almost totally wireless, Calif. hospital a model for IT
California’s El Camino Hospital uses built-in infrastructure and a variety of technologies to improve quality of care, patient experience
Ask Greg Walton, chief information officer at El Camino Hospital, to predict the future of healthcare and what he sees is an ever-increasing reliance on wireless technology. Take, for example, the initiative announced by the Federal Communications Commission in May to allocate spectrum for medical-grade wireless technology. This kind of technology, which connects a sensor placed on a patient’s body to a nearby hub, has yet to be approved by the Food and Drug Administration or the FCC.
However, the FCC’s decision has set the stage for a booming new medical-device market.
“The U.S. healthcare sector is going to change a great deal,” Walton says. “One of the things we’re going to have to do is be where the patient is. We don’t have enough caregivers and resources to do that any other way but electronically. Things like telehealth and ‘ smart health’ on a smartphone and body area networks—I’m going to predict … that’s the next big explosion in care and patient interaction.”
El Camino found a perfect fit with Walton, a longtime health information technology executive who arrived at the hospital in late 2007. The 361-bed community hospital is based in Mountain View, Calif., a city that is home to Google, Intuit and multiple other Silicon Valley technology companies, and is considered one of the most advanced users of wireless and mobile technology among all U.S. hospitals.
“I believe that medical devices and computers are almost one thing already and they’re becoming more and more integrated,” Walton says. “I want to lead us in a way that will cause that to happen and will help it to happen.”
El Camino’s history as a technology pioneer among hospitals is well-established. It was the first hospital to implement a computer-aided medical information system in 1971 and computerized physician order entry the following year. The College of Healthcare Information Management Executives and the Healthcare Information and Management Systems Society even named their CIO of the Year award after John Gall, who led the implementation of healthcare information systems at the hospital in the 1960s.
When Walton joined El Camino, it was preparing to build its new hospital to comply with California’s seismic safety standards. The timing of his hire allowed Walton to develop a wireless strategy that not only serves the hospital’s current needs but the demands of the future.
Walton advocated for a distributed antenna system, much like the one that he established during his tenure at the Carilion Clinic, a seven-hospital system in Roanoke, Va.
How hospitals establish and use wireless utilities varies by facility. Both the costs and the risks are high, making the adoption of a wireless infrastructure and strategy a low priority when compared with financial concerns and the push for adoption and implementation of other technology, especially electronic health records and CPOE, as well as participation in information exchanges.
“Those things are so all consuming, in terms of time and resources and manpower, that wireless communication has been pushed into the background as a lower priority,” says Chris Wasden, managing director of PricewaterhouseCoopers’ healthcare strategy and innovation practice. “There are a significant percentage of providers in the United States that do not have wireless access within their hospital.”
That decision has set many hospital systems far behind other industries and the ways in which they are using wireless. Wasden says pagers and fax machines still play important communications roles in many hospitals.
While it’s not rare to find one or two hospitals in every state that have an established wireless infrastructure, “It is rare enough that it’s still fairly advanced,” Walton says, speaking of his hospital’s accomplishments.
El Camino, which opened in late 2009, is believed to have been the third hospital in California to build a medical-grade wireless utility.
“We decided that we wanted to have a very rich investment in wireless because we knew that over time that it would be stressed by more and more demands,” Walton says. “In hindsight, that’s been exactly the case.”
Now, everything from the clinician com-
munications system and the electronic patient beds to the tablet computers used by physicians employ the hospital’s wireless utility. The hospital has even installed an access point in each elevator car, which allows wireless robots to move floor to floor and patients to be monitored as they move around the hospital.
In addition, the Tug robots that deliver medication, food and laundry throughout the hospital; the fountains located on the hospital’s Mountain View campus; and the emergency systems, mobile phones, and the medical grade telemetry system for patient monitoring all rely on the wireless network.
Next on the list is wireless administration of medication at the bedside and voice-recorded discharge instructions.
“A long time ago, we passed a threshold where if we were to lose our network for a long period of time, our patients would be at risk,” Walton says.
The hospital has not reported a single failure of the network since the wireless utility was deployed in 2009, according to Ken King, El Camino’s chief administrative services officer. The network is “fully redundant” and the backup is built into the system, Walton adds.
The distributed antenna system cost roughly $2.5 million and was part of about $70 million that El Camino spent on new technology for the new facility, which is marketed as “the hospital of Silicon Valley.”
“Financially, we have been very fortunate but we’re not immune to the pressures that everybody has,” Walton says. “The organizations that were ahead a long time ago have an advantage as the race continues.”
Unlike the wireless infrastructure that was built from the ground up at the main El Camino hospital, Walton says the hospital will have to retrofit its Los Gatos campus, a facility previously operated by Tenet Healthcare Corp. that El Camino acquired in 2008. Discussions about the retrofit project, which is usually more costly, are under way.
Even before the development of the new wireless infrastructure, El Camino was testing new technology that relied on a wireless network.
In 2003, the hospital learned through a venture-capital firm about Vocera, a San Jose, Calif.-based company that had developed a wireless communications device.
Since then, the hospital has purchased around 2,000 of the $400 devices, and nearly every clinician, including most of the hospital-based physicians, now uses one. The devices provide patient updates to caregivers by text or voice message, monitor staff whereabouts, and are integrated into the patient call-light system and the patientmonitoring system.
“It’s our most successful wireless venture because it’s integrated so much throughout the hospital,” says Cheryl Reinking, the hospital’s vice chief of clinical operations. “It was ‘Star Trek’ at that time.”
The hand-held devices, which Reinking calls “the genie,” also support El Camino’s
mission to be a quiet hospital, in part by reducing the need for most overhead pages. In addition, the staff is piloting a new text feature in an effort to cut down on noise from the devices themselves.
Both Reinking and Walton cite a staff culture that is receptive to new technology as a factor behind the success. About 1,100 nurses are employed at both the Mountain View campus and in Los Gatos. There are about 1,200 physicians on the medical staff.
A Vocera working group meets monthly as well as a medical staff IT group made up of physicians and nurses. Decisions made during the construction of the new facility, such as the inclusion of bedside computers, stem from the opinions of the nursing staff.
Although the new facility put medicalgrade bedside computers in each patient room, the hospital is looking at ways to use its EHR in a “more wireless way,” especially with physicians’ growing interest in iPads and other wireless devices, she says.
However, the EHR used by the hospital appears in a more basic form on the iPad, which has led to waning interest from many of the hospital’s physicians in using the devices. El Camino’s nurses are using the several hundred iPads that the hospital has purchased for non-EHR practices, such as Joint Commission readiness rounds.
The hospital also provided six Motion tablets to emergency department physicians in April and will be buying more tablets for dietary staffers to take menu options at the bedside.
“There is a lot of waste between the information generator—the medical device—and the information receptacle—the medical record. You want to take all that waste out and make those two man-made things exchange data,” Walton says. “Huge productivity and quality improvements can come from that integration of technology.”
A recent patient case put El Camino’s technology and wireless network to the test. A pregnant woman with a heart condition was admitted to the hospital in May, leading clinicians to question whether she should be placed in a cardiac unit for monitoring or in the separate women’s hospital to prepare for the birth of her baby.
Around that time, a sales representative from IVCi had dropped by to demonstrate the VGo, a robot with two-way video-monitoring capabilities.
Walton agreed to buy the VGo, borrowed the sample that day and the hospital staff placed it in the patient’s room in the women’s hospital, which allowed a cardiac nurse in a separate facility to remotely monitor her.
“It really makes a difference when you meet the caregiver where they are in a mobile fashion and meet the patient where they are in their course of treatment,” Walton says.
Using the robot opened up the hospital’s staff to the different ways that two-way monitoring can be used, such as in the hospital’s nursing home or as a security tool.
“The infrastructure makes new things possible all the time,” Walton says. “If I was still fighting dead spots and if I was dealing with other more traditional problems, we wouldn’t be tackling these kinds of things. We wouldn’t have the confidence.”
El Camino’s confidence in its technology and wireless capabilities has started to extend beyond the hospital campus.
It is moving forward with three telehealth programs, one of which will monitor patients leaving the hospital with the two-way communications robot in an effort to reduce readmissions. The VGo will connect the patient in the nursing home with his or her physician.
The hospital launched the Family Medical Officer, a free app for Android and Apple mobile devices that provides a family’s healthcare decisionmaker with information such as ER wait times, a physician search function, and a password-protected medical history tool.
A spokeswoman for the hospital says El Camino plans to conduct focus groups with mommy bloggers later this summer. The app has been downloaded by about 800 users.
“Mobility, convenience, ease of use and access are all going to manifest themselves in those other things that are far more important,” Walton says. “Technology is a tool.”
The impending addition of medical-grade wireless technology, also called medical body-area networks, to the medical-device market will likely lead the way toward further use of the hospital’s wireless network.
“There’s a whole new era opening up as the body can transmit real-time to the systems that can capture it and help the caregivers provide care,” Walton says. “That’s going to require wireless. You don’t want to tether anybody. You want them to have complete mobility.”
The hospital is also actively involved with the West Wireless Health Institute, a La Jolla, Calif.-based medical research organization that was founded by billionaire telemarketer Gary West. The institute said in February that it had developed a medical-grade wireless open framework in an effort to address the lack of a standard approach for hospitals and other providers to install wireless infrastructure.
“We’re watching as chief information officers and chief technical officers of hospitals are more and more aware of the future that’s coming and their need to prepare for it,” says Dr. Joe Smith, the West Wireless Health Institute’s chief medical officer and chief science officer.
Six hospitals and health systems, including El Camino, were cited as examples of successfully deploying the architecture. In addition, the institute plans to build labs to test the wireless interoperability of devices and technology used in hospital settings, an initiative that Walton says he supports.
“There is a risk involved as we build more and more of our operational dependency on something as sophisticated as this network,” Walton says. “On the other hand, when we measure that against the inability to do the impossible, we take the risk. Technology makes the impossible possible. You look at the risk of doing the impossible versus the risk of failure. We’ll take that risk.”
Dr. Drew Chavinson, an emergency department physician at El Camino, uses a tablet computer that takes advantage of the hospital’s wireless capabilities.
A wireless infrastructure was a key component built into El Camino’s new hospital, which opened in late 2009.
The VGo robot allows expanded two-way video monitoring and communication.
“The (wireless) infrastructure makes new things possible all the time,” says El Camino CIO Greg Walton.