Wireless, One Step in N.H. Hospital's MU Journey

Nov. 9, 2011
To better serve clinicians and patients, the 295-bed Concord Hospital in Concord, N.H. recently upgraded its wireless infrastructure. With more and more clinical systems relying on the wireless network like Vocera voice-recognition badges, an upgrade was imminent and necessary.

To better serve clinicians and patients, the 295-bed Concord Hospital in Concord, N.H. recently upgraded its wireless infrastructure. With more and more clinical systems relying on the wireless network like Vocera voice-recognition badges, an upgrade was imminent and necessary.

Wireless Evolution
In the early ’90s Concord Hospital embarked on a proprietary wireless network, primarily to run the Clinicom bedside charting medication reconciliation system. As the Internet became a global standard, Concord realized a generic Ethernet connection, rather than a proprietary network, was more the direction the hospital wanted to travel. Besides patients having access to a wireless connection in the hospital, nurses started using computer on wheels (COW) to run charting applications and wireless registration. At that time having a rare wireless outage wasn’t a huge upset, as there were backup systems available and clinicians could always use nursing stations computers to chart.

"The wireless network never had the resiliency of our core wired network,” says Mark Starry, director of enterprise architecture and security at Concord Hospital. With the wireless system’s Trapeze (Pleasanton, Calif.) multiple controller configuration, the hospital needed three to four controllers for 400 access points, as well as a spare controller in case one failed.

Mark StarryVocera Badges, A Game ChangerConcord starting using Vocera voice-recognition badges about four years ago in its emergency department. Deployment in the ICU came soon after and workflows began being built around clinicians receiving instant voice communication and alert notifications from equipment such as glucometers, ultrasound, and EKG machines. Once the Vocera badge started replacing the pager as the main communication device among medical and support staff—which includes more than 750 physicians and nurses—a wireless upgrade became paramount. “Vocera became essential,” says Dean Morrison, CIO at Concord Hospital. “When we saw interruptions in our wireless network, we saw much more disruption in our clinical areas to the care that people were able to provide."
Dean Morrison

Morrison also notes that over the last three years, more and more critical applications were migrated on to the wireless network. “We put all our money into making sure our wired network would have complete redundancy, but we hadn’t done the same thing with our wireless network, and we felt we had too many critical applications running on the wireless network,” he says.

With the upgrade of the Trapeze Mobility System Software, the hospital went down to two controllers and bought a cluster license, which treats all WLAN controllers as a pool of connections available to access points, instead of having a traditional one-to-one mapping between access point and controller. “Now, when you reboot the controller, it fails over instantly and no one knows,” says Starry. “It gets rid of downtime associated on the wireless network so it’s a big win.”

Serious Savings
With the new wireless infrastructure, a 60 percent savings in operating costs including maintenance and hardware was realized. Starry says operating costs for the wireless network have reduced about $15,000 to $20,000. Even this rough estimate of cost savings can be on the low side, as it doesn’t factor in clinical cost savings resulting from fewer network disruptions, which are hard to quantify. Concord Hospital also saw savings in staffing. “We went from one full FT [full time employee] to support our wireless environment to half an FT,” says Starry.

Patient Portal and Clinical System Interoperability
With the new network in place, many of the hospital’s core clinical systems now run wirelessly. Bedside medicine reconciliation is sent remotely to Concord’s EMR. EKG and glucometer results also go directly into the EMR, while ultrasound machine images are delivered into the PACS system. The wireless network also allows wireless reprogramming of Alaris IV infusion pumps and linkage to the pharmacy to record dosages into the medication management system.

Wireless is just one step Concord Hospital is making in the direction of meaningful use. Concord plans to release a portal soon to allow patients to make follow-up appointments, refill medications, access lab results, as well as schedule referrals. The hospital is also in the process of linking its McKesson (San Francisco) inpatient clinical system with outpatient practices running GE Centricity (Barrington, Ill.). “We’ve started along these paths and put a lot of intellectual energy into developing decision support, clinical rules and alerts, improving quality from the inpatient and outpatient side through the vendors that we have,” says Morrison.


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