By Marleen and Gary Wolfe

 With increasing regularity, mobile wireless communications technology is enabling new diagnostic and health care applications. The term enabler is an important distinction because wireless communications is fundamentally a signal transmission medium in the same way that hardwired local area networks, telephone landlines, T1 lines, and the like are signal transmission media.

The great appeal of wireless stems from a variety of factors, which apply in general to any user community. These factors include freedom from the bonds of hardwired systems; the advantages of microminiaturized electronics; the ability to adapt equally well to voice, video, and data transmission applications; affordability as new communications products emerge; and compatibility with existing communications infrastructures.

Beyond these general qualities of wireless communications is another vitally important issue: end-user applications. Each market segment has its own specific needs. In the case of hospitals and clinical laboratories, which are constantly being driven to reduce costs, provide better patient outcomes, and minimize liability, these needs can be enormously sophisticated.

The challenge for solution providers is to marry their capabilities with the features that their customers are likely to need and use. CLP spoke to representatives of five vendors of wireless solutions and a major West Coast hospital to gain a better understanding of how they are approaching the challenges of wireless technology.

Wireless as a Pipeline for Real-Time Information at the POC
Eclipsys Corp of Boca Raton, Fla, provides knowledge-driven, process-improving software and related service solutions to major health care providers, including integrated delivery networks, medical centers, and hospitals. These solutions are designed to improve a health care organization’s workflow and processes, enabling balanced and improved clinical, financial, and customer-satisfaction outcomes. More than 120 hospitals in North America and Canada use Eclipsys products in wireless LANs.

“Wireless is an enabling technology that is a pipeline for real time information at the point of care. It gets rid of the paper trail and delay. As soon as information is typed in, it is available to everyone. We have seen an evolution in what people are doing with wireless; 5 years ago it was in clinical areas. Now 99% of our customers want to cover the facility top to bottom, front to back. They even want wireless coverage in nontraditional areas, such as cafeterias and tunnels between buildings, although security continues to be a concern for IT [information technology] executives. Prices have come down to be cost-effective, and cost justifications are easier,” says Joel Cook an account executive in Eclipsys’ Technical Services Division.

Any of Eclipsys’ software products can be used over a wireless network. Among the available applications are registration, order entry, medical administration and documentation, and results reporting. Eclipsys wireless devices include the Mobile CareStation™ and Mobile CarePoint™, the PocketXA™ and Pocket 7000™, and the Vocera Communications™ Voice-over IP badge.

The Eclipsys Mobile CareStation and Mobile CarePoint are custom built, UL 60601-1 certified computer systems used for clinical documentation, point of order, and computerized physician order entry–type functions. Eclipsys also offers bar-code medication administration and bar-code blood bag administration applications that add bar-code scanning capabilities to its mobile wireless workstations.

The PocketXA and Pocket 7000 are Microsoft Pocket PC-based handheld applications that provide clinicians with wireless access to electronic medical records via the desktop PC-based Sunrise™ Clinical Manager application.

Another class of wireless product, the company’s Vocera Communications voice-over-IP badge, is a 2-oz communicator that hangs around the user’s neck and allows hands-free messaging with other users and the outside via the PBX. It runs over the same wireless network as the mobile workstations.

 The ePocrates Lab provides hundreds of diagnostic tests and panels, interpretation and follow-up, pricing and Medicare reimbursement, and collection, preparation, and caution information.

Funding Upgrades to Spur Widespread Wireless Usage
San Mateo, Calif-based ePocrates® Inc provides clinical information to physicians and other health care professionals at the point of care via wireless, handheld personal digital assistants (PDAs). The company claims more than 350,000 users in the US, including practicing physicians, physician’s assistants, pharmacists, nurse practitioners, RNs, and medical students.

According to Alan Ehrlich, MD, ePocrates’ co-editor in chief of the ePocrates Lab™ reference applications, “One major issue is the cost of updating the information technology infrastructure to support a wireless environment at a time when all health care is getting more expensive and everyone is trying to control costs. Unless people are willing to spend the money to upgrade to wireless, it becomes a barrier to widespread use.

“Another issue centers on confidentiality and the HIPAA regulations. If you are dealing with a hospital that is controlling all end points of technology, you can be reasonably confident of the security of the information. But if you have doctors and other health care providers with their own handheld devices interacting in a wireless environment, and they walk out the door with the devices in their pockets, what happens to the security of that information with regard to HIPAA? You still have to maintain it,” Ehrlich says.

Ehrlich points out that ePocrates products can be used either independently of other systems or in conjunction with existing IT structures “because there is not a lot of IT setup needed.”

The newest wireless solution offered by the company is ePocrates® Essentials, a three-module software program described by the company as an “all-in-one mobile guide to drugs, diseases, and diagnostics … developed by clinicians for the PDA environment’s Palm-sized screen and unique user interface.”

The ePocrates Lab™ provides hundreds of diagnostic tests and panels, interpretation (disease, drug, and spurious causes) and follow-up, pricing and Medicare reimbursement, and collection, preparation, and caution information. The ePocrates Rx Pro™ offers information on more than 3,400 drugs including herbals, a multiple-drug interaction checker, built-in dosing/medical calculators, formulary coverage and retail prices, and an infectious disease treatment guide.

The ePocrates Dx™ provides information on more than 1,200 diseases and conditions, diagnosis and treatment strategies, and a comprehensive disease summary including causes, symptoms, differential diagnoses, labs, and drugs of choice.

 PatientKeeper Clinical Results delivers clinical information to the point of care, improving patient safety and simplifying work flow.

Integrating New IT With Existing Systems
PatientKeeper Inc of Boston provides health care professionals with mobile computing solutions designed to help improve patient care and curb rising costs. The company’s mobile wireless solutions span the health care continuum from entire health systems to large academic medical centers to community hospitals to group practices.

Stephen S. Hau, founder and vice president, marketing, says, “The most important challenge for health care CIOs is integrating new information technology with existing systems. Hospitals have already made significant investments in their IT solutions; therefore, new wireless solutions must integrate to these systems. For example, our product has sophisticated integration capabilities, taking advantage of HL7, direct integration though Web services and database calls, and other methods.”

The company’ wireless mobile health care solution, PatientKeeper, is designed to leverage existing IT systems, while providing robust security, centralized administration, application interoperability, connectivity, personalization, and other capabilities. Software development kits are also offered to facilitate developer and institutional efforts to produce custom mobile applications.

In the future, Hau anticipates many exciting advances in this field. “An example is care-team messaging, which allows all caregivers to communicate through their PDAs by instant messaging, Voice-over-Internet Protocol (VoIP), and other technologies.”

The PatientKeeper Platform™ provides an open, extensible infrastructure for integrating, managing, developing, and deploying mobile health care applications. PatientKeeper provides a broad portfolio of mobile applications, including:

• PatientKeeper Clinical Results™, which delivers clinical information to the point of care, improving patient safety, simplifying workflow, and increasing physician and nurse job satisfaction.

• PatientKeeper Charge Capture™, which is designed to increase revenue on professional services delivered to improve billing accuracy and streamline the billing process for clinicians and billing staff.

• PatientKeeper Mobile Dictation™, which records dictation at any time from any location on a PDA. This reduces errors, streamlines workflow, and enables timely sharing of patient information with the care team.

• PatientKeeper ePrescription™ (powered by DrFirst), which creates legible prescriptions on a PDA and forwards them directly to the pharmacy to save time, improve formulary compliance, and enhance patient safety.

 Misys Laboratory-Collection Manager, a hospital-based, clinical laboratory software application, assists in automating specimen collection and print labeling at the bedside.

Understanding Cost Factors, ROI, and Value Gained
Misys Healthcare Systems of Raleigh, NC, a member of the Misys Group of companies, develops and supports reliable, easy-to-use software and service products, including electronic health records for ambulatory, acute and post-acute settings, departmental systems, practice management systems, and EDI connectivity. The company serves physicians’ practices, hospitals, home care providers, and hundreds of commercial laboratories, clinics, managed services organizations, integrated delivery networks, and other organizations.

Scott Mattingly, product line director, Clinical Systems Integration, says, “There is a minority of sites running wireless networks today. When we ask customers if they have a wireless network, less than 25% say they do. The challenge is to promote greater use of wireless diagnostics by helping them understand cost factors, return on investment, and the value that can be gained from this type of infrastructure in terms of patient safety and benefits.”

Mattingly’s colleague, Deborah Tillman, senior product manager, Misys Laboratory, agrees. “When customers see the potential ROI, they want to get it into the budget. It’s just a matter of timing,” she says.

Misys offers a variety of products that are based on handheld wireless and bar code reading technologies. The newest offering is Misys Laboratory-Collection Manager™, a hospital-based, clinical laboratory software application that assists health care professionals in automating specimen collection and print labeling at the bedside. Increased accuracy of patient identification, specimen data entry, and tube labeling at the point of care lead to improved outcomes, reduced errors, and enhanced patient safety. The software runs on a Symbol PPT 8846 handheld device with a built-in bar-code scanner.

Misys Laboratory-Collection Manager is a fully integrated module of Misys Laboratory™, a comprehensive, high-performance, information system that automates all aspects of a laboratory department, facilitating the management of specimen data from requisition entry through specimen tracking to final cumulative report production. Application modules include Blood Bank and Blood Bank Donor, Microbiology, Specimen Collection, Anatomic Pathology, Specimen Collection, Specimen Management, Routing & Tracking, Outreach, and Multi-Facility Support.

Integration into the Work Flow
Care Fusion® of McLean, Va, designs bar-code enabled, mobile point-of-care solutions that run on wireless PDAs, as well as tablet and laptop PCs. The products help clinicians reduce risk, improve patient care, and provide a safer care environment. The company works mainly in acute care settings in hospitals of all sizes where high patient turnover is the norm, although the products are applicable to any health care environment.

Sandra Trakowski, RN, MS, CIN, vice president, clinical products and CNO, says, “Convenience, ease of use, and integration into the care provider’s workflow are all important considerations. Users need comprehensive, up-to-date patient information fast. From a handheld device perspective, which is the environment in which our products work, there are two important challenges. One is the small view screen that we have available to provide information, and the other is finding a way to allow the user to drill down into the application quickly to get needed information without spending time searching for it.”

Speaking from the vendor’s perspective, Trakowski cites one other challenge. “Users need to understand that they are not making changes for the sake of change, but rather to ensure patient safety, enable faster collection and delivery of care information, and make the care provider’s job easier.”

Care Fusion’s portable mobile products all utilize bar-code technology for positive patient identification to reduce the risk of errors. Information is constantly updated in real time and can be shared with existing LIS, HIS, and pharmacy systems. The rugged Symbol PPT 8800 is the company’s standard wireless handheld device.

 The wCareView enables clinicians to view, monitor, record, and act on patient information from anywhere in the hospital.

The wCareView™ enables clinicians to view, monitor, record, and act on patient information from anywhere in the hospital. The wCareAssist™ enables caregivers to enter and review patient data, such as vital signs and I&O at the bedside. The wCareCollect™ provides positive patient identification for collection activity and prints container labels with bar codes on a portable printer at the bedside for test specimen identification and tracking.

The wCareMed™ supports bar-code scanning for positive patient identification and medication administration at the point of care. The wBloodCare™ provides functionality for confirmation of the patient and the blood product order, and then completes a cross-check of this information to the blood product prior to transfusion activity. The wCareCapture™ provides electronic charge capture functionality, enabling entry of charges for supplies used in patient care.

 Any Eclipsys software product can be used over a wireless network. Applications include registration, order entry, medical administration and documentation, and results reporting.

Wireless Pushes IT Closer to Patients
Mark Zielazinski, CIO of El Camino Hospital in Mountain View, Calif, discusses the advantages of wireless from an end-user perspective. “As new wireless technologies have become available, we have taken advantage of them to make it easier for the staff to use our clinical information systems anywhere in the hospital. Some examples of the wireless devices in use by our clinicians include communicator badges (Eclipsys Vocera); tablet and laptop PCs that work in conjunction with our clinical information systems (Eclipsys 7000 systems) and all of our other systems; and PDAs or specialized handhelds in our laboratory (Roche Diagnostics devices) and our pharmacy (Cardinal devices).

“The communicator badges are used across the board by about 1,100 people: most of the nursing staff, lab technologists, anesthesiologists, physicians, pharmacy, environmental services, facilities, patient transport, and respiratory care. They have allowed us to remove the pager-based system that typically drives the staff and patients crazy. It has been tremendously useful in taking steps out of processes, and eliminating unnecessary phone calls.

“When you look at tablet PCs and PDAs, there is a smaller population, mainly our high-end clinical users. Our nurses primarily use computers on wheels or tablet PCs. There is a pretty wide distribution of wireless devices in the hospital. With the wireless tablets and PCs we have been able to take a facility, which was built in the 1950s and 1960s with nursing areas that lacked adequate space to handle conventional computer workstations, and give the staff easy access to the information they need. In this way we are pushing IT out closer to the patient, which is a huge benefit for everyone.”

Marleen and Gary Wolfe are contributing writers for Clinical Lab Products.