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The Converged Wireless Hospital a progress report Annual VAHIMSS Fall Conference


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Title: The Converged Wireless Hospital a progress report Annual VAHIMSS Fall Conference

The Converged Wireless Hospital(a progress
report)Annual VAHIMSS Fall Conference
  • October 16, 2008
  • Rich Pollack
  • VP CIO
  • Division of Information Services and Clinical
  • Virginia Commonwealth University Health System

Virginia Commonwealth University Health System
(VCUHS) - Richmond, VA
  • Medical College of Virginia Hospitals
  • MCV Hospitals is the teaching hospital component
    of the VCU Health System
  • 779-bed academic medical center with 2,200
    Nursing Staff
  • Full activation of the new Critical Care Hospital
    will provide 275 replacement beds
  • 600 physician, faculty group practice
  • 80k visits/year Level 1 Trauma Center ED
  • 30k admissions/year in 45 inpatient units
  • 500k visits/year in 85 outpatient clinics

  • VCUHS Education
  • 656 Residents and Fellows engaged in 70 training
  • 728 Medical Students taught by 791 faculty
    (clinical, teaching, administrative)
  • Schools of Dentistry, Medicine, Allied Health,
    Nursing and Pharmacy on Campus
  • Information Technology
  • June 2008 VCUHS recognized as CIO 100 honoree
    by CIO Magazine for using information technology
    to create business value

Critical Care Hospital
Critical Care Hospital
  • The 184 million Critical Care Hospital is the
    largest capital construction project in the
    history of the VCU Medical Center. The all
    private room hospital houses 232 adult patient
    beds and 43 neonatal rooms, increasing the
    medical centers ratio of private to semi-private
    beds from 37 percent to 70 percent.

Critical Care Hospital
  • 15 levels
  • 368,000 square feet
  • 275 beds

Former Space Challenges
MRICU (Medical Respiratory ICU) Locations on Main
Hospital 4th Floor
New Space Challenges in the CCH
MRICU (Medical Respiratory ICU) Critical Care
Hospital 4th Floor
Nursing station
MRICU (Medical Respiratory ICU) Critical Care
Hospital 4th Floor
Creating a parallel project effort
  • Findings at beginning of 2006
  • No provision made for IT infrastructure beyond
    Cat 6 cabling
  • Naïve assumption of simply bringing over existing
    PCs/Phones/network gear
  • No consideration of wireless and other new
    converged technologies
  • No appreciation of the impact of radical change
    in nursing unit geography has on communication
  • Little participation by I.T. in a holistic way
  • Lack of imagination to create a Digital
  • Little budget for additional IT costs

Creating a parallel project effort
  • Remedies
  • Engagement of CIO and Sr I.T. leaders to
    determine and specify requirements
  • CIO educates the CCH steering committee on the
    fallacy of prior technology assumptions and need
    to contingency fund the now known IT needs (4M)
  • Introduction of the concept of a single collapsed
    antennae infrastructure for all wireless needs
  • Assignment of an I.T. nurse (critical care
    trained) F/T to project (nurse liaison)
  • Provision of a I.T. project manager experienced
    in new hospital technology activation (single
    point of contact)

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Creating a parallel project effort
  • Approach
  • Contracted with IT Project Manager to work with
    building construction management, architects,
    contractors, vendors, clinicians, senior
    leadership, and information systems groups
  • Formed IT project team reporting up to the CCH
    steering committee
  • Engaged IT nurse liaisons to work with clinicians
    on future hospital workflow and nursing
  • Conducted technology fair for clinicians and
    leadership to expose them to latest technology

Critical Care Hospital(Clinical Liaison Role)
  • Attend and participate in all of the Critical
    Care Hospital project meetings
  • Meet regularly with the architects and unit
    management teams to discuss build and design of
    the new hospital
  • Meet with units to review staff requirements for
    fixed and mobile device usage
  • Discuss how new unit design will dramatically
    change the way clinicians practice and socialize.
    Focus has been to address current clinical
    workflows and the integration of new technologies
    to facilitate future workflows in the expanded

Critical Care Hospital(Clinical Liaison Role)
  • Promote and attend vendor meetings for mobile
    devices, nurse call systems, communication
    systems, bedside monitors, telemetry equipment,
    and middleware solutions
  • Educate and work with the architects Revisions
    recommended to make provider sub chart areas
    compatible for desk space and mobile device
  • Focus on system design that will ensure a safe
    environment and a successful transformation

Critical Care Hospital
  • Approach (contd)
  • Developed IT infrastructure budget and secured
    senior leadership approval for procurement of
  • Hardware and services for wired and wireless
  • InnerWireless DAS for WWAN and WLAN services
  • PCs, network printers, computers on wheels,
  • Ascom wireless phones and middleware for
    integration with nurse call and patient
  • Developed detailed project plan for procurement,
    deployment, and move management for existing

Critical Care Hospital IT Objectives
  • Install a passive Distributed Antenna System for
    all wireless services in the CCH
  • Support many services across a broad spectrum of
  • Move from discrete to centralized AP locations
    for 802.11 and WMTS
  • Provide ubiquitous computer access throughout the
  • Support transition to nurse and physician
    documentation in EMR
  • Deploy wireless VOIP solution for nursing and RT
  • Enhance unit communications and patient care
    workflow in transition from a pod to nearly
    25,000 sq ft per floor

InnerWireless Scope
  • Wireless LAN (802.11 a/b/g) support within the
    Critical Care Hospital totaling 367,792 sq ft.
  • Philips Wireless Medical Telemetry support
    deployed on floors SB1, 2, 3, 7, and 10 totaling
    116,045 sq ft.
  • Supports all wireless services in the frequency
    range 400 MHz to 5 GHz
  • Excluded from scope
  • ground floor (future ED expansion)
  • elevator shafts and motor rooms
  • enclosed stairwells
  • first floor public restrooms

Critical Care Hospital DAS
  • InnerWireless
  • June 2007 - Contracted with InnerWireless
  • Project phases
  • Scope definition
  • Design
  • Procurement
  • Installation
  • Testing and acceptance
  • March 2008 - Completed installation and final
    testing of DAS

Critical Care Hospital DAS
  • CCH floor 4 above ceiling cable routing and DAS
    antenna placement

Critical Care Hospital DAS
  • Design Phase Signal Prediction
  • 10th floor Wireless Medical Telemetry (WMTS)1400

Services Supported by InnerWireless
InnerWireless DAS
  • Implemented one infrastructure in the CCH for all
    wireless services in the frequency range 400 MHz
    to 6 GHz

InnerWireless Design
Percentage of Coverage Area to Meet or Exceed
Designed Signal Level
Critical Care Hospital DAS
  • By final hospital activation in mid-November
    2008, the following services will be injected
    into the DAS portal
  • Philips Wireless Medical Telemetry support
    deployed on floors SB1, 2, 3, 7, and 10 (116,045
    sq ft)
  • Wireless LAN (802.11 a/b/g) support for all
    floors (367,792 sq ft)
  • Verizon voice and PCS data services
  • Two-way radio for hospital plant operations and
  • Paging services for clinicians
  • Wireless clocks controller

CCH Device Deployment Planning
  • Floor plans marked for PCs, computers on wheels,
    network printers, label printers
  • Used for network drop configuration
  • Facilitated planning meetings with nursing

CCH Ubiquitous Computer Access
approx 140 computers on wheels (new existing)
approx 470 PCs (new existing)
sub-chart outside pt. rooms
typical nurse station
clinician work rooms
CCH Wireless Communications
  • Wireless Phones
  • Performed evaluation in 2007 of Vocera versus
    Ascom for use by CCH nursing
  • Completed site visits to Sentara Leigh and
    Sampson Regional hospitals to review Ascom
  • Completed pilot of Ascom FreeNet phones and
    middleware in Cardiology/Telemetry unit in
    February 2008
  • Procurement of Ascom phones, middleware, services
    for installation, integration, training and
    deployment from Hill-Rom in July 2008
  • Integration with Emergin (Philips patient
    monitoring alerts) and Rauland-Borg nurse call
    system completed August 2008
  • Nursing staff training currently underway
  • Phones deployed in CCH upon unit move-in

The NICU problemFrom Baby Barn to a
  • Reconciling radical changes in geography with
    breakthrough technology

NICU (Neonatal ICU) Locations on Main Hospital
6th Floor
NICU (Neonatal ICU) Locations on Main Hospital
6th Floor
Nursing station
NICU (Neonatal ICU) Critical Care Hospital 6th
NICU (Neonatal ICU) Critical Care Hospital 6th
NICU Move to a Single Room ModelAdvantages
  • Controls environmental (noise/light) exposure to
    infants that effects development
  • Creates privacy for families
  • Promotes Interdisciplinary care for the infants
  • Mobile communication system provides visitors the
    means to communicate between clinical staff and
    the families

Alarms in the NICU Single Room
  • Closed doors can reduce the ability to hear
    patient alarms by clinical staff
  • Most medical equipment does not broadcast alarms
    outside of the patients room
  • Device alarms are very disruptive to the infants,
    many device volumes are decreased to reduce
    environmental stimulation
  • The NICU environment generates many alarm
  • 90 of the NICU alarms are generated by movement
    (artifact, false alarm) and are not a true
    clinical alarm condition
  • A device alarm notice is not detailed enough to
    distinguish a True from a False alarm
    condition Staff has to respond to the patients
    bedside for each generated alarm and eyeball
    the waveform displays

Wireless Remote Waveform Solution
  • Nature of the alarm should be sent to clinical
    provider anywhere in the NICU environment
  • Real-time alarm streaming on a mobile wireless
  • This allows the clinician to view the actual
    patient waveforms, distinguish between true and
    false alarm conditions, and prioritize a
    response to the patients bedside

Cerner Smart Room
Future Smart Room concept
Cerner CareAware
Critical Success Factors
  • Notify vendor and hospital services early for
    injection of signal to InnerWireless - long lead
    times for signal surveys, cable path coring, and
    equipment procurement
  • Develop partnership with clinicians early on and
    include them in device strategy, placement,
    collection of special requirements, and training
    program development
  • Test early and often all devices attached to
    wired and wireless networks before hospital
  • Pursue a comprehensive IT strategy that insures
    the proposed budget encompasses all projected
  • Develop and communicate wireless network usage
  • Coordinate with patient monitoring vendors on use
    of network drops

A Cutting Edge Environment
  • ASCOM over DAS is unique we are the first
  • VCUHS has one of the most complex and
    sophisticated Wireless NW weve seen Cisco
  • High reliance on wireless devices of all types
    (e.g. Computing devices, Telemetry, Waveforms,
    voice devices, etc.)
  • Lots of hard work, planning heroics to get
    us ready

Challenges to opening the CCH
  • Device deployments delayed 5 weeks due to back
    orders of furniture, etc.
  • Compressed time frame for setup, testing
  • 5th Floor network closet reconstruction
  • Dust, heat, destroyed 2 ASCOM servers, severely
    damaged Cisco switch (100K device)
  • Unknown bug in IOS
  • Resulted in ASCOM failure work around found
    root cause still being diagnosed by Cisco ASCOM
  • Lead lining of OR resulted in changes to
    Innerwireless RF modulation and coverage
  • Have only one WLAN engineer
  • Need 2 additional Wireless Engineers to support
    our environment (per Cisco)

Somewhat Painful Lessons Learned from CCH
  • Need to be there at the onset to insure an
    adequate IT infrastructure budget. Its
    new. Its very complex. And its not cheap. And
    most facilities/construction folks havent got a
  • Staffing for support
  • Need for a true Clinical Engineering group (not
    just BioMed maint.) to partner on the device
  • IT needs their own highly skilled wireless
    network engineers
  • Mobile devices and COWs will need far more
    proactive on-site weekly support if they are not
    to end up being discarded
  • Its all about nursing workflow. Do it correctly
    up-front to determine device needs and locations.
    Especially when the geography is changing.
  • Make sure that clinician expectations for IT are
    grounded in reality. Their vision may not yet
    match mature product technology.
  • Integrating 4, 5 or 6 different vendors is the
    infrastructure equivalent of pursuing best of
    breed clinical system integration.
  • GE Monitor alarm feeds
  • Emergin middleware feeds
  • InnerWireless DAS feeds
  • Ascom nursing phones OR COWs OR Tablets

  • and manage it as professionally as you would any
    major system implementation.

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