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

Modern Healthcare - - FRONT PAGE - Jaimy Lee

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.

Mak­ing progress

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.”

Stay­ing con­nected

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.”

MIKE ICHIKAWA

Dr. Drew Chavin­son, an emer­gency de­part­ment physi­cian at El Camino, uses a tablet com­puter that takes ad­van­tage of the hos­pi­tal’s wire­less ca­pa­bil­i­ties.

MIKE ICHIKAWA

A wire­less in­fra­struc­ture was a key com­po­nent built into El Camino’s new hos­pi­tal, which opened in late 2009.

MIKE ICHIKAWA

The VGo ro­bot al­lows ex­panded two-way video mon­i­tor­ing and com­mu­ni­ca­tion.

MIKE ICHIKAWA

“The (wire­less) in­fra­struc­ture makes new things pos­si­ble all the time,” says El Camino CIO Greg Wal­ton.

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