Yesterday I presented at a workshop in Seattle held by Cardinal Health. The topic was Wireless Infusion Information Technology and was educational - being remarkably free of sales pitches for a vendor event. There were about 17 attendees, which I thought was pretty good for a mid market city like Seattle. I promised the attendees that they could download my presentation, so here it is. As you might imagine, I talked about medical device connectivity and differences between proprietary end-to-end solutions and enterprise solutions like the one from Emergin (a Cardinal vendor-partner).
Alaris was the first medical device vendor to develop a network based solution where the network was intended to be part of the hospital IT infrastructure and not an embedded controlled private network. The decision to embrace the general purpose computing environment, versus a tightly constrained private network was radical at the time. In hindsight, given the enterprise-wide deployment of infusion pumps, Alaris had little choice - no hospital would deploy a second wireless LAN just for their pumps. Since Alaris' move, Draeger is the only other vendor I'm aware of to fully embrace the hospital IT infrastructure rather than force a private network on customers. As patient acuity continues to raise in all patient care areas and medical devices are deployed enterprise-wide, vendors will have little choice but to take the route Alaris and Draeger have taken.
Cardinal currently has 111 hospitals running their smart pumps. That equates to 32,000 pumps with 55,000 channels. M.D.Anderson in Houston has the largest single installation with 1,300 smart pumps. Alaris has installations with both InnerWireless' passive DAS (distributed antenna system) and Mobile Access' active DAS.
Do you remember all the buzz about bar coding 5 years ago? It seemed everyone from the government to the Leapfrog Group were breathless about the patient safety potential for bar codes in patient identification and meds administration. In the past 5 years, adoption of bar coding at the point of care has barely moved, while in the same period smart pumps have virtually become a standard of care. I think the fact that many infusion pumps are leased had something to do with that rapid adoption. And the poor adoption of bar coding can be attributed to one thing - workflow. The 5-rights are a workflow hit for caregivers, especially during peak busy times. If the meds administration workflow does not result in a net reduction in work, successful adoption may never be achieved. The win for caregivers is the EMAR or electronic meds administration record. The EMAR can significantly reduce meds admin paperwork, providing the nurse with a significant net benefit. Even with an EMAR, how effectively workflow is automated is the make or break adoption factor.
Also presenting was Bob Schaefer from the IT department at Kingston General Hospital. Bob described their experience justifying and installing an enterprise-wide wireless LAN. They have installed a Cisco 802.11a/b/g WLAN with 185 access points (APs) covering 800,000 square feet. They spent $200,000 on Cisco APs (plus some management tools and switch upgrades), $110,000 on site surveys, and $90,000 cable drops. The big hidden cost for them was the infection control costs of getting into the ceilings. Their annual costs are around $20,000.
In addition to designing their network for coverage they had to do some rework based on what Bob called "traffic patterns." Users and devices seemed to congregate in higher concentrations in certain areas (especially the ED), sometimes overwhelming the AP covering that area. They used a high density deployment model in the ED where they turned down the power on their APs and doubled the AP density. On nursing units they are looking at a different deployment strategy with paired APs to double capacity. Many WLAN distributors unfamiliar with hospital environments throw up APs every 100 meters that result in poor to non existent coverage in some areas. Even experienced folks usually miss the capacity variable - you must anticipate the number of wireless devices (VoIP phones, PDAs, COWs, RFID tags, medical devices, etc.) that could congregate in a particular area and ensure your network design provides sufficient AP loading capacity.
Kingston's WLAN is segmented into 4 VLANs to provide optimized security, performance and network management for specific applications. They have a VLAN each for infusion pumps, wireless VoIP phones, point of care computing devices, and public access to the Internet. I asked Bob if they would add other wireless medical devices to their infusion pump VLAN in the future. He noted that if future devices included UDP they would, but if they did not use UDP (a hard to secure internet protocol) they would put them on a separate VLAN for security reasons. There are a number of continuous patient monitoring vendors who currently use UDP to stream physiological waveform data across the network. Bob suggested there were better ways to stream data that was easier to secure.
Tom Steinhauer from Cardinal wrapped things up with a great description of how and why Cardinal's bar coding solutions have evolved over time. Tom laid out each piece of technology and showed how workflows mapped back to the system, and the changes Cardinal has made over time to better match how drugs are actually administered. Of particular interest was his description of integrating their IV meds administration system with third party systems that support "pills, shots and drops" - currently not a simple endeavor.
Pictured right, folks start to trickle in during the pre seminar meet-and-greet.
UPDATE: Dan Pettus, the MC for the above seminar, emailed me with some clairification regarding their installed base. Cardinal has about 400 hospitals that use their "smart" pump - i.e., pumps with Guardrails. The 111 hospitals mentioned also include the server.