Hospital networks take key role in health care as IT makes further clincial advances

Hospital CIOs stress the need for constant wireless connectivity, but wired networks also have a role in health IT

The health care industry's increased use of electronic medical records (EMRs), wireless medical devices and personal mobile technology has turned hospital networks into important components in patient treatment. Practicing medicine now requires maintaining constant wireless connectivity and possibly managing wired network traffic if doctors and nurses are to fully leverage health IT according to health care professionals.

As IT's role in health care expanded from basic tasks on desktops to the more complex functions involving EMRs and clinical care, the network's importance grew, said Jon Morris, CIO and senior vice president, of the WellStar Health System, which operates hospitals, urgent care centers and medical practices in the Atlanta area.

"When we first started out doing relatively simple tasks the technology worked great," said Morris, who has served as an emergency department physician at WellStar Kennestone Hospital for 26 years. Health IT has advanced "a long ways from the days when you had a single lab test flipping up on the screen," he said.

Now networks carry EMRs as well as the extensive amounts of clinical data that they store. Wi-Fi allows wireless blood pressure cuffs to automatically transfer readings to a patient's chart and permits doctors to view lab results on their iPad. Wired networks also play a role in health IT and handle large radiology image files and ensure backup connectivity between hospitals and data centers.

"A critical piece of rolling out an EMR is the network environment," said Jack Kowitt, executive vice president of business development at health IT consulting firm Anthelio. With EMRs every transaction and data exchange passes through the infrastructure and that places unprecedented capacity and quality demands on the network, he added.

This infrastructure allows medical staff at Eastern Maine Healthcare Systems' hospitals, nursing homes and physician groups to access and update patient EMRs across the organization, said Cathy Bruno, its CIO and vice president.

"To have a single unified electronic patient record across all our locations, so that information is available no matter where our patients access care, we need network connectivity," she said. "It would be impossible without network connectivity."

This connectivity comes at a costly price, said Morris. Developing reliable networks means expensive revamps of existing facilities since most health care providers are not building new hospitals that include the required infrastructure, he said.

"Hospitals are going to have to make tremendous investments in infrastructure," he said, as they overhaul dated buildings that were "never built for a robust N-class wireless network. Reliability comes into play if you tell me the only place I can get lab results and tests is a computer."

Even the slightest network delays can turn physicians against health IT and ultimately hinder their ability to practice medicine, Kowitt said.

"If it takes five seconds to get a reply they're not going to like the wait," he said. "And those five seconds accumulate and its going to impact their productivity."

At Eastern Maine Healthcare, clinical and hospital staff associate wireless mobility with productivity. Last year Bruno noted an uptick in the number of employees who brought their personal tablets to the organization's facilities, which span across Maine.

Nearly all the doctors and executives in her organization purchased iPads and use them for tasks such as taking notes and checking email, she said.

The influx of wireless devices means "you need that connectivity so you're going to see more and more robust wireless networks."

Connectivity looks only more important to health care as hospitals adopt cloud computing and health IT software vendors develop mobile applications for specific care functions.

Morris questions whether hospitals will install their software on every personal mobile device as well as service a diverse hardware array. They may outsource these tasks to the cloud to avoid "a maintenance nightmare," he said.

"Are you going to install clients on iPads? Really? More people will leverage Web-based solutions," he said.

Bruno predicts that more physicians will adopt mobile computing as Cerner, a major health IT vendor whose EMR system her organization uses, improves its mobile app offerings.

Cerner is working on a mobile app for ambulatory settings but "they don't really have it for the inpatient setting," Bruno said. Some doctors at Eastern Maine Medical Center in Bangor are using Cerner's health IT software via a virtual desktop, but since that software was written for use with a keyboard and large monitor "it's just not elegant yet" for mobile devices. That elegance will come with a dedicated mobile app, she added.

While the place of mobile hardware and software in patient care is still being figured out, health IT doesn't lack wireless devices in the meantime. Clinical staff depend on wireless medical devices "that will ID a patient, transmit securely and not lose continuity," said Morris. "Nurses taking vital signs want to put on a blood pressure cuff, hit start and have it wirelessly transmit to the patient record."

When Eastern Maine Healthcare rolled out upgraded clinical carts last fall its wireless coverage became "particularly important," said Bruno. These devices feature all-in-one PCs mounted to carts and are mostly used by nurses for bedside medicine verification. Nurses use barcode readers to scan barcodes on a patient's wrist band and medication to verify the person's identity, the drug, the dose and the dispensation time. This information is automatically added to a patient's chart, which ends up in the EMR.

"We do regular analysis of the coverage of our wireless network, particularly for the use of the clinical cart," said Bruno.

Eastern Maine Healthcare administration and physicians aren't the only ones who need Wi-Fi.

"More and more people are bringing wireless mobile devices to the facility and they want to get onto our wireless network," Bruno said.

To address demand, three years ago Bruno opened the wireless network to visitors by creating a guest network and placing a firewall between that network and the one used for clinical purposes.

As guest mobile device use continued to expand, the hospital moved that traffic to the older 802.11a wireless band, which is also used by the clinical carts.

"We've segregated the carts from the regular wireless network band and that is helping because that's the only traffic on that band," she said.

Even with the clamor for wireless access, wired networks have a place in health IT. In rural locations with limited telecommunication options, WANs (wide area networks) help establish backup connectivity between hospitals and data centers, Bruno said.

"One of the challenges in Maine is that the connectivity between where some of our servers reside and our remote hospitals might be only one set of telephone poles," she said.

The organization has redundant connectivity between its Bangor, Maine, data center and the Kansas City data center that hosts its EMRs. It uses a fiber network to link its Bangor facilities, which include two hospitals, a cancer treatment center, a walk-in clinic and the data center. For its more remote hospitals, "some places you can get redundant connectivity and some you can't yet."

To address these connectivity concerns, Eastern Maine Healthcare is working with the New England Telehealth Consortium to build out the WAN infrastructure that will link its data center and satellite locations. This effort will give the organization "redundant lines to places where we don't have it," Bruno said.

At some hospitals wired networks handle radiology images since the files' size can strain a wireless network, said Kowitt. Network traffic management then becomes a possibility since physicians would place a priority on those images over less critical data, he added.

"It isn't just do you have enough network capacity," Kowitt said. "Is the network segregated to properly support the requirements [of the staff]? When moving images you may want a certain speed, but when you're dealing with normal transactions you may want to move it at a different speed."

With tech holding a secure and growing role in health care, providers lack the option of avoiding IT and its infrastructure demands. Those who do try to dodge tech may need to change professions.

"In this age using a computer to care for a patient is no different than using a scalpel in the operating room," said Morris. "If you're not ready on the go live date we're really going to miss you because you're not going to find a place in town that's going to let you use a pencil and paper anymore to take care of our patient."

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