It took time to get it just right, but healthcare staff and patients are reaping the benefits of the network installed by wireless veterans at Rush University Medical Center
Electronic medical-records systems are all the rage in hospitals around the country, promising to improve accuracy and efficiency. EMR fairly screams for a wireless network to support it, however.
Electronic medical-records systems are all the rage in hospitals around the country, promising to improve accuracy and efficiency. EMR fairly screams for a wireless network to support it, however, given that healthcare professionals need access to medical records from pretty much everywhere. Karl Oder, senior director at Rush University Medical Center in Chicago, knows well what it takes to deploy a wireless network that can support not only EMR but RFID and VoIP as well. He and his team, which includes Alden Brugada, manager of telecommunications and networking, tried various iterations of wireless before hitting on their current winning formula.
When did you first get into wireless? We had wireless around 1995. It was a very early system that didn’t work very well, and we eventually pulled it out. Another wireless deployment went in around 2000 or so. That was again a proprietary system. It worked better. It was upgraded in 2003 to a nonproprietary Cisco system, and that has since been upgraded to what we have now.
Karl Oder:
What does the network look like now?We have roughly 700 LWAPs [Lightweight Access Points], all Cisco [Aironet], models 1231 to 1242. Most of our controllers are WiSMs [Wireless Services Modules] that sit in the [Cisco Catalyst] 6500 Series chassis. We have six chassis with two WiSMs per chassis, for redundancy. Each WiSM has two controllers, and each controller can handle 150 access points. So, the capacity is about 300 access points per WiSM, but we don’t go over about 250. We have a [Cisco] Wireless Control System, which basically monitors the entire environment. The network extends to roughly 10 buildings in a campus environment, plus one hospital in Oak Park, about 15 miles away. It has its own wireless controller and is connected across T-1s to our main campus. How has the network evolved since 2003?The big difference between 2003 and what we have now was the move to LWAPs from the individual access points being managed one-by-one. We also needed more capacity and more coverage. The biggest impetus for that was an expanded EMR initiative. Initially we provided only computerized provider-order entry, where the physicians mainly worked on computers in the halls. So, our 2003 deployment only covered the hallways. When you go to a full EMR, with nurses entering vital signs and such, you need to get the computer inside the patient room. We were also looking forward to deploying VoIP throughout, as well as RFID.What were some of the challenges in rolling out wireless? Let’s start with the 2003 implementation. We didn’t do extensive site surveys for that, more like templates. For a 12,000-square-foot area, we put three access points. The coverage was there, but the signal strength didn’t span the floor as we would have liked it to. For example, we piloted VoIP at that time. It was a passive system, meaning the [IP phone] wasn’t scanning for active access points. You could attach to an access point, walk over to another access point 50 yards away and not attach to that new access point until you had dropped your first signal. So, we saw a lot of degradation and choppiness.
Alden Brugada:
Looking at the newer wireless implementation, with respect to RFID, we set that up so you could triangulate among three access points. So, on a given floor we may have 30-plus access points. The problem was signal strength. We had so much bleed that we had problems with devices dropping and degradation of VoIP. And RFID just did not work because there was so much signal strength that an RFID tag would beacon to almost 30 devices. So, the control system couldn’t identify where that device was.
The fix was to basically resurvey each floor not just horizontally but vertically to see what bleed we were getting between floors, and the signal strength throughout the horizontal floor. We changed the signal strength and also changed the channels for each one of the access points for VoIP. We’re finishing that up now, and it seems to stabilize the infrastructure quite a bit for VoIP, data and RFID.
Any other big challenges with the wireless network itself?RFID was probably the biggest challenge. In talking to AeroScout and Cisco, we’re probably the largest implementation they’ve seen in a healthcare environment for what we’re trying to accomplish with EMR, VoIP — which is starting to roll out more — and with RFID, which is probably the biggest thing. And RFID is still an emerging technology. It’s not quite to the point where I can identify to spec where a device is going to be. We’re still about 3 meters off, which is in the range of what they’re saying we should be hitting.
KO: Cisco is saying you can get within 3 meters of the exact location of the device. One thing we had with the initial rollout was an issue with our mobile carts that the nurses use. We struggled for a little while finding a network card that would hand off properly between the access points as the cart was pushed down the hall. A hospital is a little bit different from quite a few businesses in that the devices are actually really mobile. It’s not that you sit down in a conference room and open up your laptop and start working. You’re actually moving that device, and it has to stay connected as you move down a hall that could be almost a block long.
AB: We really should’ve stabilized the infrastructure before implementing the devices. Because it was so dense, the devices couldn’t figure out what access point to jump to and/or they would hold on to an access point until the access point dropped the signal, which would cause problems. Say you’re on a Citrix Systems client typing away, and you walk a ways, and all of a sudden your session gets dropped. The fix was we updated, or actually back-revved, the driver for that Cisco card and also stabilized the infrastructure. We resignaled the floors and changed the channel for each one of the access points, so you’re not getting that much bleed between access points anymore.
How has the wireless network changed the way doctors and other staff work? They are able to provide better care. They get real-time, up-to-date information as opposed to the old way, where you had a paper record and that record may be misplaced or was hard to find. And the information was not necessarily kept up to date. The EMR and the wireless system allows them to see the patient’s information right at the patient’s bedside, and share that information with the patient more effectively.
KO:
Does the EMR system improve accuracy?Yes, and it improves patient safety. Medication administration is much safer with an EMR. There are no transcription errors. The communication with the pharmacy is through the computer, so there are fewer callbacks. And when they administer medication, nurses check the patient’s wristband to determine it’s the correct patient, using a bar-code reader. And the medication list is instantly upgraded whenever a physician changes a patient’s medications.Does EMR improve your billing systems at all?Yes, it does. For example, medications are now billed on administration, when the patient actually receives it. Previously it was billed based on what was ordered for the patient, [but sometimes] the patient may not have actually received that medication.Are doctors able to see more patients now?Whenever you get a new system, initially it slows everybody down. But we’ve been at this for over a year now, and it is actually helping everybody be more efficient. There’s less information that they have to chase down; it’s just in the computer, so they don’t have to look for the information.What other benefits do you derive from the wireless network?The RFID system is helping our clinical engineering staff who take care of infusion pumps and other medical devices to locate devices, to bring them back for service. Before, it was hard to locate the pumps at the correct time. It’s a regulation that they have to be serviced every so often.Were you having a problem with equipment being lost or stolen?Well, yes — disappearing, let’s put it that way. You don’t know whether it was stolen or left in an ambulance when it shouldn’t have been. With RFID, we know when it goes out the door, and the system can record that the equipment left on this ambulance and is going to this location, so you can ask for it back.
We also have a few floors that are using wireless IP phones for communication, so they’re able to better communicate with each other. Out at Oak Park Hospital, it’s tied in to the nurse call-system, so the nurse gets the calls on the VoIP phone and she can immediately call the patient and see what they need without having to go to the room. Previously [the patient’s call] would go to the nurse station, and there’s also a light in the hall. Then the nurse would have to go down the hall into the patient’s room to talk to the patient.VoIP helps free up their time. If it’s a minor thing, they might be able to take care of it just by talking to the patient.
Do you have plans to expand that to other hospitals?Yes, we have plans to expand that campuswide. Rush is going through a transformation. We’re building new buildings and upgrading infrastructure in existing buildings. That’s underway right now.Can patients or hospital visitors tap into the wireless network?Yes, we have a public wireless network here that is available to patients, visitors and family. They are able to go on to a wireless network that allows them access to the Internet. That’s on a [virtual LAN] that’s separate from the internal Rush network that allows you to get to the clinical systems.What’s involved in an RFID rollout? What kind of equipment are you dealing with?There are RFID tags that have 802.11 radios in them, and they beacon out to the access points. The back-end infrastructure includes a location appliance that has algorithms in it to triangulate on the tag. So, the RFID uses all 802.11 infrastructure. AeroScout gives you a nice little interface that you can look at to see where the device is located.How would you assess the maturity level of RFID technology?We had big issues in the beginning but we’re slowly working through them. In the beginning if you just plugged it in, it didn’t really work. There’s a lot of work involved in adjusting the radios to ensure that you’re getting within 3 meters of the tag. For some applications, 3 meters is not going to be close enough. In the future we might want better accuracy, such as for patient tracking — because 3 meters could put you outside of the patient’s room.If you had it to do over again, what might you do differently with respect to each of your wireless efforts?We should’ve done more thorough testing prior to the rollout of the EMR system. That’s the biggest thing. We would’ve been able to spot these problems with too much coverage and the ability of the cards to hand off between access points, things like that. But there were time constraints because there were a lot of other things going on.Any advice for others who are looking at big wireless rollouts? Instead of deploying access points out to the floors, centralize them in the closet and then deploy antennas in a distributed antenna system. That’s something we’ll be looking at, but the RFID portion is still not quite there.
AB:
KO: That’s a good point. The wireless we deployed here is totally 802.11. As you move into the future, cellular data services are becoming more important. So, [we’d like to have] an antenna system that would be able to provide for the cell data services, as well as the emergency-services frequencies and anything else that comes along. Doctors carry BlackBerries around with them, and right now we’re not providing that service.
AB: Full coverage and full integration of mobility is what you’re trying to get to. You can use a cell phone that works on both VoIP or wireless 802.11 and also works on a cell network. So, if you run into a place that doesn’t have cell coverage, it jumps on the VoIP network; and when you run into a place that has cell, it’ll jump back on the cell.
KO: You don’t want separate antenna systems for each of these systems because there’s limited room in the ceiling. And these antennas are located in the patient rooms; having to go into a patient room is a big problem because you have to shut down the room in order to replace the antenna or upgrade the system.
So, is that a future plan, to implement a distributed antenna system?Yes, it is. It’s a future plan in the new building, and as we remodel old buildings we’re going to reassess what we have. This will be a few years from now, so we’ll have a better idea of what the technology is out there and it’ll probably be time to replace what we have now.Anything else you want to add?The most important takeaway is, we had a lot of support from the user community here in implementing these systems. It wasn’t really an IT win, it was a win based on user commitment and the whole institution coming together to deploy these things.
Desmond is events editor for Network World and president of PDEdit, an IT publishing company in Southborough, Mass. Reach him at paul@pdedit.com.
Getting personal: Karl Oder
Title: Senior Director
Organization: Rush University Medical Center
Responsibilities: Requirements gathering, review and approval of software and hardware for the university and hospital
Annual IT budget: $10,000,000
Number of IT staff: 160
Education: Master of Science, Engineering, University of Illinois at Chicago
Previous jobs: At Rush for 10 years in a number of positions from entry-level programmer, Unix system administrator and network engineer, to director
First PC: Commodore 64
Home network: Category 5 cabling to every room along with a wireless router supporting three computers, a home-automation system capable of turning lights on and off, an alarm system, and 5M cable Internet connection.
First Internet experience: “Using a mainframe at the University of Illinois at Chicago for research and mail, using Gopher and that kind of thing — the text-only Web.”
Words to live by: “Life is all about learning.”
