LAPTOPS AND PALMTOPS REDUCE PAPER DEMON AT HOSPITAL

By Ron Levine

There’s much less paper being shuffled at Pitt County Memorial Hospital these days thanks to a mobile wireless LAN that utilizes over-the-air data transmission to eliminate the reliance on often-illegible, scribbled clipboard notes, charts, and the associated error-prone human transcription and data entry process. With these wireless computers, data is collected or accessed right at the patient's bedside. And because the patient information is entered and stored directly into the computer by the attending doctor or nurse in real-time, its accuracy is assured.

While the prospect of the "paperless hospital" may never come to pass, the combination of wireless computers and smart patient care software can put a big dent in that paper jungle that plagues all medical care establishments. Pitt County Memorial is a large 800-bed, 4500 staff hospital located in Greenville, NC. This 35-year-old hospital has a reputation of being a top patient care facility and is also known for its state-of-the-art use of technology in serving its patients. About a year and a half ago, it began using mobile wireless computers to replace its stationary PCs and paper charting and data reentry procedures to better service its expanding patient load.

"It’s quite a job collecting and transcribing for computer input the paper-based documentation generated during the admissions procedure and during the doctor/nurse patient encounter. A problem for any hospital." said Bruce Hedreen, Network Systems Analyst at Pitt County Memorial hospital. "We needed a way to improve both information collection and information access throughout our facility."

Paper-based information is cumbersome to work with, difficult to track, and time consuming to reenter into the computer system. Most hospitals have turned to standard terminals or PCs scattered throughout the facility where a nurse or staff member can walk to and enter the data. While this is an improvement over the "old" centralized computer at the nurses station, it still means originally documenting the patient’s record on a paper chart or clipboard for reentry later into the facility’s computer. "We wanted to improve on this – we looked for an alternative that could completely bypass the paper generation step and the time involved with reentry of the patient data," states Hedreen.

And Pitt County Memorial Hospital found it – in wireless LAN technology. Selected groups of Hospital staff can now connect to the facility’s computer network for information exchange from within areas equipped with wireless, at any time, even at the patients’ bedside with portable computers.

The wireless computers are really electronic clipboards pre-programmed with numerous point-and-click selections that the caregiver can choose from. For example, if the patient has a cough, a click of the mouse records it as a symptom. If a patient's description of their ailment is not available as one of the selections, the operator simply clicks on "other" and enters the information. This reduces patient information gathering time, and it eliminates the intermediate paper-based recording step and the reentry of the paper documentation into the hospital’s network.

Another benefit of using wireless computers is that mobile hospital staff is able to make their rounds while remaining connected to the facility's LAN and its reservoir of patient records. When transporting a patient to other parts of the hospital, radiology, or the heart center for example, the wireless handheld PCs allow the patient’s chart to be accessible while "rolling" through the hallways.

CHANGING TECHNOLOGY

Like many hospitals, Pitt County Memorial originally utilized a mixture of stationary PCs and mobile pushcarts to move standard PCs around the hospital. They are now in the first stages of replacing these with wireless laptops and possibly palmtops. The laptops are still on carts, but they are much smaller and easier to roll around the floors and run easily over a shift without having to plug-in or charge batteries, according to Hedreen. More importantly, they are always connected to the network and critical patient information.

Currently the hospital is in its initial phase of the technology changeover, utilizing four laptops for bedside registration and five others at various staff stations throughout the hospital’s critical care tower.

Pitt County Memorial Hospital transports its Dell and Toshiba laptops around the facility in small pushcarts. Each machine is equipped with 32MB to 64MB of RAM and from 2.1GB to 3GB of hard disk capacity. The wireless devices operate under Windows NT and run Marquette patient care application software, a patient admissions program, and download various network resources. The laptops are connected to the facility’s IBM ES9000 series host mainframe and 30 Windows NT and Novell servers.

The palmtops are Hewlett Packard handheld PCs equipped with 4MB of RAM. They are running the Microsoft Windows CE operating system. Hedreen notes, "These are in the early try out stage as we are waiting for the final release of the OS and real patient care application software to become available from a third-party vendor." For now, the palmtops are not running any medical applications, but are being evaluated as a wireless screen connection to the mainframe during patient admissions." Continues Hedreen, "We are one of the first sites using Windows CE in our wireless network. As such, we’ve already had a fair share of experience with it, even though it is a new product. We believe Windows CE devices will be a great solution for many of our staff. By integrating the handhelds into the Windows methodology, there is nothing new to learn; all familiar Windows operations work as-is. Perhaps the biggest benefit of the new Windows CE Operating System is that it provides an industry standard foundation upon which developers can build CE-based wireless portable networking solutions."

The hospital has 12 access points from Proxim Inc. under the RangeLAN2 brand, strategically located throughout the facility. The mobile wireless computer users are automatically "switched" to the access point closest to their location when requesting LAN usage. RangeLAN2 products operate at a data rate of 1.6 MBPS per channel with 15 independent channels available. This allows users to implement up to 15 separate wireless networks in the same physical space providing up to 24 MBPS of aggregate network bandwidth. RangeLAN2 meets IEC 601-1-2, the European safety specification for RF devices in healthcare, and has been implemented in a number of areas considered sensitive to RF interference, such as neonatal monitoring and intensive care units.

Today, doctors, nurses, and staff routinely access the network for any type of patient information without thinking much about it. Their handheld PCs and laptops are employed to enter and access patient records right from the patient’s bedside or during the admitting process. Data is transmitted from the wireless computer through the access points, and then relayed to the facility’s hardwired LAN, explains Hedreen.

Each of Proxim’s RangeLAN2 access points can handle over-the-air transmission up to 1000 ft in open areas. The access points and associated PCMCIA adapter cards used in the laptops and palmtops provide transparent bridging to the facility's Ethernet LAN. This is what makes the wireless LAN integration so smooth, according to Hedreen. "The Proxim RangeLAN2 products are the key to the flexibility and mobility of the network. These products operate in the unlicensed 2.4 gigahertz (GHz) frequency band and utilize frequency hopping spread spectrum radio frequency technology. We’ve investigated a number of different wireless technologies and decided on Proxim’s because the frequency hopping gave better results than the others tested. The RangeLAN2 access point’s WEB based management is great; it was easy to connect to the existing LAN; the access points are directly powered from our wiring closet. Proxim’s field proven track record with other medical institutions also played a role in our selection decision."

Of course, ease of installation, use, and affordability are important considerations, but the main reasons for implementing a wireless LAN over standard "wired" PCs are the patient benefits and operational cost reductions gained. In the hospital, the ability to have reliable immediate access to needed information resources at any time, and controlling the content of that resource, are the main pluses provided by the wireless system. Eliminating the time and cost of re-entering paper-based data and the ability to access patient records from anywhere in the building is the real advantage.

PROGRESS: REALIZED AND FUTURE

"We’ve been able to show how we can reduce paperwork all around - at both the collection and output ends. Patient information is recorded online and in real-time mode. This will eliminate many of the previously used admission forms, patients encounter charts, and other handwritten documentation normally recorded during patient sessions. This information can now be simultaneously accessed, viewed and updated by other staff throughout the hospital via the network. This eliminates the need to output many of the hardcopy reports," claims Hedreen.

This initial stage of wireless network access for Pitt County Memorial includes the use of 11 wireless laptop and palmtop computers, patient care and medical facility administration software, RangeLAN2 Access Points, and PCMCIA wireless adapter cards in each PC. Each wireless computer is equipped with a radio frequency antenna. The signals from these antennas are transmitted to the closest access point. Access points are strategically placed devices that transparently bridge the mobile computers to the hospital's Ethernet LAN via a radio frequency which is proven safe in even the most sensitive areas of the hospital. The three-story hospital currently has 12 strategically placed access points to ensure network connection from any location within the facility participating in the initial phase of the wireless LAN installation. Over the next several months, Pitt County Memorial plans to increase the number of wireless computers and add 20-30 more access points making the wireless LAN a reality throughout the facility.

Hedreen is quick to point out that in addition to the improved patient care and reduced paper documentation benefits of the wireless system, its implementation will allow Pitt County Memorial to save on information systems costs. By not having to purchase, install, and maintain a large number of stationary PCs, the hospital can save considerable money.

After the wireless LAN is fully implemented, nurses will simply wheel in the laptop and record information as they go from one room to another and patient to patient. Doctors will be able to use their palmtops to enter treatment and prescriptions. The wireless technology brings the point-of-transaction down to the point-of-care. It eliminates staff having to go back and forth and writing down or remembering information on their way to a nurse’s computer input station. This improves the accuracy of the recorded information. The mobile wireless LAN connection reduces the medical professional’s time spent on non-medical tasks (like documentation and data entry).

"We’re using the wireless LAN technology and patient care software to improve patient services, reduce paper work, and lower operating costs. "To date we’ve been extremely pleased with the performance of the Proxim RangeLAN2 wireless network. It and the patient care software worked well right from the initial installation."

Ron Levine is a features technology writer with Coast Writing, an independent firm specializing in computer application articles. He can be reached at (805) 566-9747 or e-mail ron@coastwriting.com.