Health Management Technology

The situation is one in which many of today’s organizations find themselves—purchase and install the current technology or wait until the new standards–based systems are ready. It’s an all too familiar scenario, which Sentara Healthcare faced in 2006 when considering installing wireless phones to replace the obsolete, proprietary wireless phones in place since 1998.

Health Management Technology Sentara Healthcare operates more than 87 caregiving sites, including seven acute care hospitals with a total of 1,722 beds, three outpatient care campuses, seven nursing centers, three assisted living centers, and more than 292 primary care and multi–specialty physicians serving southeastern Virginia and northeastern North Carolina. Wireless phones have been utilized in one form or another in Sentara’s hospitals since 1993. However, by 1998, a proprietary wireless system was in place at our Sentara Bayside hospital. This set the standard for features and functionality that all subsequent systems had to meet, such as familiar handset design for ease of use and training, as well as dedicated direct inward dialing numbers assigned to each phone with integration to the wired phone system. This feature allowed wireless phone extensions to work like wired phones and utilize the enterprisewide voice–mail system. The new standard put in place at that time was the integration of a nurse call system with the wireless phones, which enabled patients to communicate directly and immediately with their caregivers.

Back to the Future

Though the technology and integration was great in 1998, by today’s standards the phones were bulky and more than demonstrating their age. The batteries, which snapped on the back of the phones, physically lost the ability to maintain contact. Calls to physicians for instructions, or to the lab for results, suddenly would get cut off Keeping them working was difficult and staff frustration with their use grew daily.

The implications increased as the phones failed during direct calls from caregivers to patients, leaving the patients wondering if they’d been hung up on. Every call from the outdated wireless handsets was unreliable. Once the battery issue was discovered, staff devised their own fixes employing rubber bands to keep the battery connection stable. Often the phones had to be replaced, which was costly.

At some locations, staff ceased using the phones altogether. Calls to these phones created constant complaints from departments and physicians who would call the numbers, get no answers, and then call the nurse’s stations or the hospital operators.

Callers never connected with the persons they were trying to reach in the majority of these cases. An inventory of the phones assigned to the locations revealed that more than half of the 300 phones were missing and had to be removed from the system.

The proprietary wireless phone system ultimately wasted more time than it ever saved. That staff refused to use the phones indicates the level of frustration reached at that point. No matter what value they originally brought, they were not worth the trouble. Though October 2002 marked the end of the production cycle for the proprietary wireless system, Sentara continued to employ them in multiple hospitals. The question was, what technology should replace them and when?

Looking and Listening for a Solution

The answer came as Sentara embarked on multiple expansion projects. New construction is one of a number of avenues through which new designs, new processes and new technologies can be adopted, and wireless phones were definitely one of the coveted technologies. But which one to choose? The complex decision meant first finding a phone staff would embrace. We simultaneously needed a system that could continue to provide the functionality and integration to which the staff was accustomed, while also considering future requirements and cost.

Sentara looked at current proprietary wireless voice systems, which bring advantages in hospital environments, but decided that investing in a separate wireless network would not be advantageous. A wireless IP system, on the other hand, was appealing technology. We found that Sentara’s IP network was robust enough to handle voice, and the infrastructure’s configuration would allow us to integrate the technology. We then faced the choice of which IP wireless system to use.

During our decision process, the wireless Voice over IP (VoIP) industry was on the cusp of implementing IEEE 802.11e quality of service (QoS) standards, however we continued to hear of implementation dates that would come and go. The IEEE standards such as 802.11b and 802.11g define bandwidth and compatibility, while the 802.11e standard controls the bandwidth by prioritizing voice and other traffic and improving error correcting. These controls reduce the delays to which voice traffic is sensitive. If the standards are not in place, then wireless VoIP systems will provide their own method of policing these controls. The next questions were exactly how do those systems handle QoS and once the standards are in place, what is the migration path? Will there be a need to purchase new phones or other equipment when the standards are in place and the vendor moves to embrace it?

Pilot Test Rollout

Though technology is a major consideration, staff satisfaction also was an important component in deciding to proceed with a pilot of potential IP wireless systems. We chose two hospital locations: Sentara Leigh Hospital (SLH), in which the current aging technology was still in place; and, Sentara Virginia Beach General Hospital (SVBGH), in which wireless phones would be a new technology. We chose to pilot the Ascom FreeNet system, which uses the new IEEE QoS standard and a comparable solution from another vendor.

The pilot phase allowed the staff to test the new wireless phones and compare them with the existing wireless phones. It also allowed us to work with the administration and system support via PBX interface. In addition, the differences in QoS and call control could be tested with our IP network components.

We found distinct technological differences between the two test systems in both phone operation, administration and network interactions. The Ascom i75 Medic handset functions like a cell phone, which the staff liked. However, administration of the Ascom system was completely new and non–intuitive. The Ascom system is intended to operate as a stand–alone system, and as such, is set up as a true IT network via a series of LAN connected servers based on customer and application needs. Understanding how to use the corporate voice mail systems, for example, would have to be learned. Once installed, we also would have to learn how to use the application’s server, and how to set up phones in conjunction with our Avaya PBX, so it could utilize the same voice mail system. (Incidentally, EC500 capabilities on the PBX are required.)

Conversely, while the second pilot–vendor’s system was familiar and easy to manage, the phones operated similar to wired desk phones and much of the clinical staff expressed discomfort with the technology.

Finally, a huge factor in the decision–making process was the integration of the long awaited IEEE 802.11e standards into Sentara’s existing network and the FreeNet system. By integrating this new standard, phones can mark their IP packets, which the network detects and uses to prioritize the voice traffic on the network. Regardless of how many data and voice devices are in operation, traffic on the network flows uninterrupted and without bandwidth loss.

The successful testing of this standard, and how it worked in our environment, was key in convincing us that the Ascom system positioned us for the technological future of IP wireless phones.

Pilot Feedback

Both locations had two weeks to pilot the systems, with training provided for the staff on phone use and feature functionality—long enough for any issues with battery life, durability and functionalities to surface. Both staffs found that the Ascom phones provided good call quality and were lightweight, durable and easy to operate.

The biggest change for the SLH staff was the way the new system handled the interface to nurse call. The new interface displays the patient’s call information from the nurse call system on the caregiver’s phone. However, pressing the button that would normally answer that call places a call back to the patient room, which the patient can answer via nurse call. This adds five seconds to the process not experienced with the old technology, however it is the way all nurse call/phone interfaces are handled today. Ultimately, the time delay should decrease as technology advances. This was an acceptable change for the staff, given that the old, unreliable phones may not have answered the call at all.

System Implementation

The first Ascom solution installation at Sentara took place at SVBGH, and was as successful as a first installation can be. The nurse executive and nurse managers were, and continue to be, fully engaged in the decisions determining both the number of handsets needed per floor and how the phones will be utilized. Both of these considerations are based on their workflow and in conjunction with how the other Sentara hospitals were using the old phones.

The pilot allowed them the opportunity to experience the system functionality and to receive feedback from the staff. They were ultimately responsible for doing all the hard work determining how many handsets and who will have them—from RNs and LPNs to care partners and ESD staff on the floor. This also determined who would be trained. In addition, they determined such issues as how voice mail will be used, policy on how to use the phones when in a patient room and what happens if a phone is mistakenly taken home or lost.

The involvement of senior management at the hospital ensured the system install, handset deployment and customer training went well. Unfortunately, the integration to the PBX via T–1s did not progress so smoothly. After days of working the issue with all levels of engineers, we concentrated on the timing source for the circuits. Once we worked to provide the same timing clock for the circuits, PBX and FreeNet system, everything worked as designed.

Today, the FreeNet system is deployed at three of our seven hospitals, with two locations using i75 handsets across our network from those hospital systems. A cost consideration of the Ascom system, as with any wireless IP system, is the value of utilizing a network that is already in place and successfully managed for data traffic today. This is in contrast to the old proprietary system needing its own network.

The cost of Ascom was approximately 5 percent less than the others we looked at or piloted. However, the real benefit is realized from the relief of staff frustration and additional work due to the unreliability of the old phones. Two additional hospitals will install and deploy the system this year, while the remaining two are working on the budget to install in 2008 or beyond. After more than a year of working with the Ascom system, current customer surveys indicate the phones continue to be the correct choice for providing clear and uninterrupted communication, which enables our staff to provide the best possible care.

Debra Naderhoff is communications technologies director at Sentara Healthcare. Contact her at dlnaderh@sentara.com.