By Renee DiIulio
We don’t yet have the fabled Star Trek handheld body scanners that provided “Dr McCoy” with health data and diagnoses in an instant, but with the advent of wireless technology, such equipment becomes more of a possibility. The fictional device essentially brought the lab to the point of care. It should come as no surprise then, at least to Trekkies, that wireless technology today is also bringing the lab closer to the patient’s bedside.
Much of the wireless buzz is happening in this spot, tying clinical laboratories in the front and back ends, where the technology helps to speed the accurate transmission of orders and results. Additional software on devices, such as personal data assistants (PDAs), create that Star Trek illusion by providing physicians with diagnostic and drug information in the palm of their hands at the moment they need it.
Stephen S. Hau
The improvement in work flow positively impacts patient care, reducing discomfort, increasing recovery time, and decreasing costs. Telecommunications technology, however, can be overwhelming, with its many acronyms and constantly evolving products and standards (see sidebars for wireless technology basics). Before going wireless, administrators should have a plan.
“Administrators definitely need a solid plan and approach surrounding the use, benefits, and standardization of technology,” says Raymond Young, VP of Roche Professional Services, Roche Diagnostics (Indianapolis). He suggests that the plan include evaluation of the vendor, compliance with existing applications, user devices, and regulatory matters.
| RFID, newly discovered RFID, or radio frequency identification technology, is not new, but its affordable cost is and has created a buzz in the medical community. Its applications, benefits, and return on investment will influence how rapidly the technology will be adopted. “Hospital administrators are looking at RFID and asking, ‘How do we implement it?’ Adoption is a matter of time and decreased cost over time,” says Jeff Giger, national sales and marketing manager for Maxell Corp (Fair Lawn, NJ). He notes that many already see the value and are adopting the technology in niche markets, from which widespread adoption can radiate. “Research labs can justify the expense, which can run $1 to $2 a chip,” says Giger. An automated identification (auto-ID) technology, RFID stores and transmits data between RFID tags and readers using radio waves—no scanning or other human manipulation is required. The tags are small enough to be affixed to specimen tubes and patient ID bracelets. The chips can store up to 4 kilobytes of data. The readers do not require line of sight and can receive information through condensation and frost, typical laboratory storage conditions. “Maxell technology can read 96 tubes at once in less than 35 seconds, targeting 10 seconds in the next 2 years,” says Giger. RFID can ensure accuracy in care: Real-time communication can ensure that the right preparation is completed for lab tests or that the correct limb undergoes surgery. “You can take a tag and affix it to the subject of surgery to prevent operational errors, which do happen. RFID can be read through intervening objects, so a gown is not a problem, whereas a bar-code scanner must see the bar code,” says Bob Quinn, vice president of engineering and CTO, Epocrates Inc (San Mateo, Calif). He notes that at a cost of about $10 per surgery, it’s an inexpensive tool. The more affordable tags have a shorter transmission range, typically limited to within 30 feet of the reader. But this can be beneficial; the short distance means that interference with other equipment is unlikely. Giger says that no problems have been noted in development. Security has also not posed a problem. Encryption keeps the data secure. “RFID can lock and encrypt data so that only authorized personnel can see it,” says Irwin Thall, manager for RFID in health care, Precision Dynamic Corp (San Fernando, Calif). Currently, RFID is primarily used to track and identify patients, inventory, and samples. “RFID can provide the database and chain of custody on the sample itself,” says Giger. “It’s not random tracking. You can identify the sample at any point in the work flow,” says Thall. The ability helps to reduce errors and turnaround with the resulting benefits in patient care and health care expense.
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Eliminating Cross Talk and Keeping Secrets
“If you look at wireless technologies—PC, voice, 802.11, wireless telemetry, and even physical networks, like two-way radios—all operate in the RF [radio frequency] spectrum, and hospitals are starting to see cross talk. During design, facilities need to look at operating spectrums, frequency ranges, and locations,” says Steve Roehm, chief engineer for the health care information technologies business at GE Healthcare (Waukesha, Wis).
“Where are the antennas going to be placed? You want to avoid missing areas, but you also want to avoid interference. For instance, you don’t want to put an antenna right next to the MR machine,” Roehm advises. Certified installers can help with this design if the needed expertise is not in-house.
As more facilities are built with the infrastructure in place, interference becomes less of an issue, says Stephen S. Hau, founder and VP of marketing and business development, PatientKeeper Inc (Boston).
Another issue that can be resolved with proper design is security. “Tremendous security is included in the system—storage, transmission, audit trails, robust authentication—only authorized personnel can get in,” says Hau.
“There are concerns about sniffing [a method by which hackers ‘sniff’ out passwords], but keys and other security measures can be put in place to protect against these threats. It requires solid network and wireless design,” says Roehm.
Though security is a concern, it’s not a reason to pass on the technology, says Bob Quinn, vice president of engineering and CTO, Epocrates Inc (San Mateo, Calif). He predicts that security will continue to improve. “There are new standards coming down the pipe that are more secure but not yet implemented as hardware,” he says.
Software, however, can give the information technology department complete control over what data is reviewed. “There are applications on the server that give IT administration almost complete control over data displayed on a PDA, as well as where physicians can access the information—for instance, in the hospital only or outside as well,” says Kevin Rivers, PhD, US clinical marketing manager for integrated solutions at bioMérieux (Durham, NC). If the data is released outside the hospital, the data is encrypted, making it less likely to be stolen or read by the wrong party.
Working Together
Of course, it must be readable by the right parties. “Are doctors supported throughout the entire day as they move around multiple environments?” asks Hau. Three years ago, he would have advised using developing standards to avoid obsolescence, but now he no longer thinks it’s an issue. “Wi-Fi is popular within hospitals, and cellular coverage is widespread,” he says.
Roehm agrees that standards are well enough along to allow interoperability at all 802.11 points. “But you need to make sure the technology is sufficient for the applications you want to use. Pathology images will require more bandwidth than text,” says Roehm.
Software can be easily tested for compatibility with wireless technologies, but interactions with other applications is a bit trickier. “Systems like Stellara can’t be tested with every possible application that might be residing on a shared server. There could be 100 other applications on that SAN [storage area network]. So compatibility in that sense is harder to manage,” says bioMérieux’s Rivers, citing security applications as an example. Compatibility records are built with each client, and if the company can provide information, it will.
Speeding Results Delivery
Stellara is a real-time clinical-intervention software system that delivers microbiology results directly to the pharmacist and clinician—wirelessly, if desired. The customizable program also provides disease-specific recommendations for medication treatment management that are based on the patient’s record, including the logic and Internet references. The intent is to speed treatment decisions. “The information can narrow the treatment scope,” says Rivers.
PatientKeeper’s Clinical Results is another customizable program that offers clinicians immediate access to lab results, medication profiles, microbiology and radiology reports, allergy profiles, and clinical notes. “Physicians can view results before or just upon arrival at the hospital and use the information to determine which patient to see first. Physicians can set thresholds for critical values so that they are alerted when they need to be. Doctors with critical patients will have a different threshold for abnormal results than a general internist,” says Hau.
Epocrates Lab offers a diagnostic and laboratory test reference with information on preparation, interpretation, follow-up, and reimbursement. The program can be linked to other company products, such as Epocrates RX, a drug and formulary reference, or Epocrates DX, a disease reference. All deliver the information wirelessly to PDAs. “Physicians can enter up to 30 medications to see possible interactions,” says Quinn.
“Doctors get encrypted information that only they can view in real time. They can analyze the data as it relates to the patient and determine treatment direction. The lab is still using regular diagnostic testing but providing information more quickly,” says Young of Roche Diagnostics.
 Wired in to wireless technologiesCell phones, personal data assistants (PDAs), and laptops don’t work just because they are turned on, though this simplicity is what makes them so user-friendly. Rather, these wireless devices rely on a somewhat invisible infrastructure of hardware and software to function. The various available wireless technologies create an intangible network that keeps us plugged in, even when we are not. Facilities can choose to rely on one or more of these technologies to support their wireless needs, selecting them based on current infrastructure, needs, budget, and cost. There is no singular technology that yet fulfills all needs or has become the universal choice. According to Bob Quinn, vice president of engineering and CTO at Epocrates Inc (San Mateo, Calif), hospitals typically have selected Wi-Fi technologies because they are inexpensive. “A standard router is $30 to $40 and has a wide range, so it is relatively cheap to wirelessly enable a facility. At this cost, it’s easy to believe reports that state that 65% to 75% of hospitals are going wireless,” says Quinn. Individual devices, such as cell phones, PDAs, and laptops, may be enabled for one or more of these technologies and will search for access points on their own. “Any application will automatically see that it can get to the Internet and will connect,” says Quinn.
Each technology has its advantages and disadvantages. Below is a chart that compares the major wireless technologies using common characteristics, such as range and frequency. ABCs of wireless technology
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Wi-Fi has been one of the first high-speed wireless technologies to enjoy broad support, and it is an excellent choice for networking a building. Newer technologies, such as WiMAX and 3G, enable even greater mobility. WiMAX is best for computing platforms, such as laptops; 3G best supports mobile devices, including cell phones and PDAs.1
Enhancing the Lab’s Role
These capabilities bring the lab closer to the point of care, enhancing its role. Now, unless it’s a critical result, such as a positive blood culture, lab data goes to the laboratory information system and is released once per day through the hospital system—usually at night, when no one is there to act on them, explains Rivers. “Wireless technology speeds the delivery of those results. They can still be released for chart copy, but the physician will have received notice long before that. This positively impacts patient care from the lab perspective and makes the lab more involved,” says Rivers.
“Wireless connectivity shortens the time between orders and results. Doctors note that they are able to make critical decisions sooner. They use the programs and find that it saves them time,” says Hau, who also notes that these physicians experience enhanced satisfaction. “With the market pressure to retain physicians, hospitals are concerned with their [doctors’] satisfaction and can use IT as a competitive advantage,” Hau adds.
The ability to operate untethered provides one edge. “Up until now, we have been chained to a computer. The paradigm shift under way emphasizes that through portable devices, we can access information anywhere,” says GE’s Roehm.
He predicts that ordering and results delivery will eventually merge. “Order systems will eventually be expected to display the results,” he says. Already, ordering systems reduce waste by catching duplicate orders. The systems show what orders are pending so a specialist knows not to duplicate the tests ordered by an internist. “This was a natural next step,” says Hau, who notes that PatientKeeper’s customer base is really embracing wireless.
Fast Forward
So what steps can we expect to be taken in the future? “We really try more to automate the environment rather than re-engineer the work flow,” says Hau. New wireless technologies, such as RFID (see sidebar, page 30), mean that completely automated processes will eventually be enabled. Specimens could be tracked from draw-through to billing and insurance; assets can be tracked throughout the hospital, and patients can carry their profile on a bracelet.
Wireless order entry and results delivery will continue to expand and will be used through all areas, not just microbiology or chemistry, says bioMérieux’s Rivers. Smart systems will deliver more information to physicians, not just data, and a disease philosophy may emerge. Roche’s Young suggests this will include wireless patient communication of health care data directly to the physician. “Cardiac patients may be able to send data from their treadmill to their doctor,” says Young.
GE’s Roehm looks even farther out, citing research using VeriChips, which are implantable RFID devices. One possible application that’s raising debate is the insertion of a miniature chip containing a person’s electronic medical record under the skin. It’s not instantaneous body scanning and diagnosis, but it does bring science fiction to mind.
A Comparison of Wireless Technologies
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Renee DiIulio is a contributing writer for Clinical Lab Products.
