These days, hospital CIOs are under a great deal of stress. There's pressure from the Joint Commission to improve patient safety and reduce adverse events. It's a pressure compounded by the fact that Medicare no longer reimburses for costs related to preventable errors.
And it's not just CMS. Recently, payers have also started to refuse coverage for “never events” such as surgery on the wrong body part, hospital-acquired infections, and even patient falls and trauma.
On top of that, there are the constant demands to keep costs down and staff members happy. It's a lot to juggle, and while no solution will solve everything, leading-edge organizations are making headway by implementing wireless systems that track vital signs and patient movement, providing what Fran Turisco calls “a technological safety net for busy caregivers.”
Unlike the monitoring devices of the past, the newer systems are highly automated and integrate with the HIS to alert nurses and other staff in real-time when a patient tries to get out of bed or experiences trauma, says Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.). “If you can prevent a cardiac arrest by noticing that the vital signs are starting to go in the wrong direction, there's a huge amount you can do to help the patient's outcome and the cost of care,” she says. “It's like another set of eyes and ears.”
Elizabeth Rockowitz, a Miami-based regional manager at Beacon Partners (Weymouth, Mass.), says the big appeal of wireless monitoring systems is the ability for clinicians to cover more beds while obtaining a broader scope of the patient's condition. “With this technology, you're actually managing the patient more effectively because you're getting a better snapshot,” which can result in shorter patient stays. “So it's going to save money, not only from a managed-care side, but also the hospital side and the patient side,” she says.
Connecting the dotsAt Ball Memorial Hospital, a 395-bed facility based in Muncie, Ind., the opening of a state-of-the-art, 108-bed critical-care tower in March presented a golden opportunity to deploy wireless patient monitoring. According to Dlynn Melo, director of clinical informatics, the organization took advantage of the ubiquitous coverage by installing wireless bedside monitors from U.K.-based GE Healthcare.
The monitors are linked with the Ascom (Research Triangle Park, N.C.) communication system through an interface engine from Emergin (Boca Raton, Fla.) to keep nurses updated on a patient's condition. Each patient bed is assigned to a specific nurse. The patient's data, as well as the nurse's name and phone number, is housed in the monitoring system through interfaces with both GE and Ball Memorial's McKesson (Alpharetta, Ga.) EMR. All of this, says Melo, is configured so that within seconds of a life-critical alarm, the nurse receives an alert.
Vice President and CNO Doreen Johnson - who worked on the project along with Melo - says, “Our goals were to have the highest quality of care in the safest possible environment and to support our staff by giving them the tools and equipment to do their jobs and not waste their time with inefficiency.”
And that meant building escalation rules into the system so that if the nurse assigned to a particular patient fails to reply to a call within a short window of time, an alert is sent to another staff member, and then another, until the call is answered. “It's a very complex set of rules that nursing had to sign off on and agree on,” says Melo. “But it's something we needed in place.”
Ball Memorial also deployed sensor technology that detects movement by patients who are at a high risk of falling, triggering an alarm to nurses through the Rauland (Mount Prospect, Ill.) nurse call system if they attempt to exit the bed. This interface is also set up through the Emergin engine, says Melo, noting that bed-exit alarms are another key facet of the organization's goal to improve safety as well as patient satisfaction. “We're hoping our scores will continue to rise,” she says, referring to the surveys that are conducted to measure the patient experience.
While CIO Bob McKelvey didn't participate in the planning of the wireless monitoring project (the go-live coincided with his arrival at Ball Memorial in the spring), he says he fully supports the initiative. “The special thing about it already being in place is that it aligns with everything that I agree with, in terms of the direction health IT should be going,” he says. “The patient experience is the ultimate goal of anybody working in healthcare, and to see IT integrated so well within a hospital setting like Ball Memorial is a great thing.”
University Hospitals, a 1,032-bed, multi-hospital system based in Cleveland, is in the midst of a $1.2 billion construction project and change-management initiative called Vision 2010. One of the key components of that strategic plan, according to Division CIO Ryan Terry, is the newly opened, 38-bed neonatal ICU at UH Rainbow Babies and Children's Hospital, which includes an advanced wireless monitoring system that he hopes will become the standard for future neonatology projects.
The monitoring system integrates with the Vocera (San Jose, Calif.) communication system through what Terry calls a “communication hub” that sends out alarms through various mediums, including e-mail, text, text-to-voice and voice-to-text. “Part of the model we have is a wireless ecosystem around notification and communication, and our goal was to put in place preventative measures that provide clinicians with wireless alerts and give them the ability to respond before any type of incident occurs,” he says.
In addition to the patient monitoring alerts sent from the nurse call system to clinicians, visual alarms are triggered in the hallway, ensuring that all the bases are covered by creating a layered alert system. Clinicians can also monitor patients via a wireless stream video from anywhere in the unit - or, in the case of an attending, from their office. This way, says Terry, if an alarm sounds, the clinician can watch the video stream to determine how serious the situation may be.
It's all part of University Hospitals' strategy to provide optimal care for the vulnerable neonate patients, according to Mary Alice Annecharico, senior vice president and CIO. “It's consistent with our vision that we are a world-class organization. It is in keeping with what defines us and what we need to do to continue to improve the delivery of care.”
And that, according to Terry, means going beyond sending alerts via phone or e-mail to create a system where patient data can be leveraged for clinical-decision support.
“It's a core component of the system we designed, to be able to extract discreet data and log it into the patient record as we evolve our EMR process,” says Terry (University Hospitals has an EMR system from Atlanta-based Eclipsys). The information, he says, can be utilized “for future preventative and research programs that give us insights into not only that point of care but also, in retrospect, to aid our clinical teams on future clinical care education.”
Designing and installing a sophisticated system requires a high level of collaboration among the various groups involved, primarily IT and clinical, according to Rockowitz. “The key to success with any implementation is in achieving the right combination of people, processes and technology.”
The IT team at University Hospitals spent months walking through units with clinicians to gain a clear idea of “what it is they do on a daily basis, how they communicate, and the types of messages they use verbally,” says Terry. “We wanted the opportunity to understand their workflow and their objectives as we designed the system.”
Annecharico echoes Terry's sentiment, noting that successful operational change requires three pieces - “integrated thinking, the absolute support of all constituencies, and actively listening to what it was the clinical community needs,” she says. “Technology can do a lot of things, but you need to configure it in a way that represents what you're trying to achieve.”
The Sound of Silence
While planning to deploy wireless patient monitoring, the staff at Ball Memorial Hospital (Muncie, Ind.) took precautions to ensure nurses weren't bombarded with noises once the system went live in the spring of 2009. According to Dlynn Melo, director of clinical informatics, the implementation team worked with students from the Ball State University graduate program to conduct a study. Through a series of four-hour sessions, nurses were interviewed and observed to determine the right balance of alerts, she says.
As a result, Ball Memorial chose to configure its alerts so that only events like a ventilator disconnecting or a life-threatening arrhythmia triggered an alarm.
Says Fran Turisco, research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC, “The algorithms have gotten a lot more complex; there aren't a lot of false positives anymore. And you can set it for the patient so you know what ranges you're looking for and what you want to be alerted about. That's significant.” - K.G.