Look doc, no wires: hospital CEO Curtis James selects a wireless network as a no-headache remedy for physician care. (Cover Story).

Complying with federal mandates to provide accurate and secure electronic patient information should not be an issue for the oldest hospital in Birmingham, Ala. Since the early 1990s, St. Vincent's Hospital has focused extensively on technology. While containing costs is one reason, the most important factor is technology's ability to enable "high-touch" patient care, according to St. Vincent's President and CEO Curtis James.

Founded in 1898 in a city of 100,000 people without any hospitals, St. Vincent's today is the epitome of how technology is transforming healthcare practices. For the past 13 years, St. Vincent's has heavily enlisted the aid of technology in its effort to ease human suffering, improve records management and streamline medical practices throughout the hospital.

St. Vincent's serves a five-county area and is part of Ascension Health, a $8.9-billion healthcare provider based in St. Louis. In fact, St. Vincent's is the flagship "digital hospital" for Ascension Health's 59-hospital system, which has more than 80,000 associates working in health facilities in 15 states and the District of Columbia.

St. Vincent's recorded more than 18,000 patient discharges, 120,000 outpatient visits, 3,200 deliveries and 27,000 emergency-department visits in its latest fiscal year. It has been, to a large degree, paperless for more than nine years, and has piloted and installed a variety of applications, ranging from bedside-pharmaceutical and patient bar-code scanning to speeding the admissions process by allowing patients to preregister from home using the hospital's Web-based community portal.

THE WIRELESS SOLUTION

The most recent digital solution deployed at St. Vincent's is perhaps its most advanced and far-reaching. Traditionally, the hospital has focused on ensuring that its physicians and nurses had electronic access to data and information. Increasingly, however, the priority has become timely access to those resources.

"Providing physicians and nursing staff with real-time information allows them to make the right clinical decision at the time that it makes sense, "explains James. "Wireless communications is a strategy that not only meets that goal, but also overriding mission of delivering the best, most compassionate patient care."

The first step for James was to create a wireless task force, a multidisciplinary group of physicians, nurses and hospital executives. Under the direction of task force Chairman Steve Anderson, The group first evaluated wireless LANs from the standpoint Of whether it would add value to the patient-care providers.

The group evaluated vendors and products over the course of nine months. It saw demonstrations from leading suppliers, including Nortel, Cisco and Avaya. In the first quarter of 2002, the task force recommended and the hospital's chief financial officer approved an $800,000 proposal from BellSouth for Cisco equipment. The expenditure was the latest of $45 million the hospital has appropriated for technology improvements in the last 10 years.

In explaining the decision, CEO James stressed the importance Of St. Vincent's existing strategic partnership with the Atlanta-based Communications services company, which also provides the connectivity, frame relay and redundant synchronous optical network service to access and transport mission-critical data. In addition, in 2000 Bellsouth upgraded the hospital's Cisco network infrastructure.

THE SOLUTION GOES LIVE

With the decision made and budget approved, the project implementation began-what James characterizes as the largest Cisco wireless LAN in the Southeast. The first step was a radio site survey in which BellSouth engineers determined the number of wireless access points required to provide coverage throughout the St. Vincent campus.

Last July, the wireless network went live, covering four main hospital buildings and four professional buildings (with a fifth under construction) for a total of more than one million square feet. By December, the hospital had brought an initial 35 users onto the system, including physicians, admitting clerks and IT staff.

In January, James brought in Tim Stettheimer as the hospital's first-ever chief information officer, to oversee the final touches on the 10-year effort.

"The addition of a wireless network is one of our final steps in implementing an all-digital environment," Stettheimer says. "It is key in allowing us to maximize the systems already in place and to install a computerized physician order-entry system. Through this anytime-anywhere network, our patients and clinicians' joint experience will be highly enhanced. The dollars spent on wireless networks is not only a good investment, but the right thing to do for our patients."

The wireless network consists of 167 Cisco Aironet 350 Series access points, which are remotely administered using Mobile Manager software from Wavelink Corp. A virtual private network provides authentication, ensuring that only authorized personnel have access to the network.

Client devices include Compaq iPAQ pocket PCs, as well as other models, Fujitsu tablet PCs Stylistic 3500 and a mix of Dell and Compaq notebook computers, all of which connect to the network using Cisco Aironet 350 NIC cards. Category 5e cabling was used throughout the network.

TWO PRIMARY APPLICATIONS

In this initial rollout, the hospital is using two primary applications. The first is a browser-based application developed by St. Vincent's that provides physicians secure access via pocket PCs to the hospital's clinical data repository, the heart and soul of the hospital's digital DNA. Today, every order, test and procedure becomes part of that paperless, electronic medical record.

Using hand-held devices, caregivers can now immediately access years of patient clinical data, including lab results, medication orders and surgery notes. Because the wireless network is browser-based, doctors never need to take the time or attention away from patients to synchronize the handhelds with hospital systems.

"Staff are able to access our electronic medical records and clinicalresults viewer via PDA in an XML format," says Anderson. "This enables physicians and other caregivers, some using their HP iPAQs, to view historical and real-time patient data quickly and conveniently."

The second application is wireless bedside registration. Deployed in both the emergency department and pain clinic, patients are placed in beds upon arrival. Via the wireless connection, admitting clerks come to the bed and can function exactly as if they were in the actual admitting department. This includes scanning patients' insurance cards and driver's licenses, as well as inputting medical and demographic data.

"The wireless bedside registration is fantastic," says nurse Kay Buchwald, "especially in the emergency department and the pain unit, where you want to get the patient in a room and get them comfortable as quickly as possible. With the wireless carts, everything comes to the patient. The patient's driver's license and insurance card never leave their sight. We scan them right at the bedside."

ADDITIONALS USES PLANNED

By the end of 2003, James and Anderson anticipate more than 500 users will be on the wireless LAN. The two also plan to deploy a variety of additional applications, including the ability to wirelessly collect patient consent forms.

Since 1999, St. Vincent's has had thin clients and other tablet computers at every bedside for nurses and doctors to electronically chart medical care and orders. The hospital's clinical data repository provides caregivers and physicians with clinical data on patients, and can be accessed through PCs in every patient room, with some records available to physicians using wireless PDAs. The result is instantaneous access to both real-time and historical clinical data for physicians wherever they are.

While many hospital wireless systems require physician PDA users to first synchronize their handhelds with the hospital system, St. Vincent's has developed and copyrighted a real-time wireless connection and PDA browser that links physicians to the hospital's clinical data repository. This ensures that patient data can only be accessed through the hospital's secure wireless network, and that an audit trail is provided that the hospital can use to survey physician use patterns and viewing habits. Six physicians are now piloting the wireless clinical browser on hospital-owned PDAs.

The wireless solution also begins the final phase of the facility's digital hospital initiative, which includes computerized physician order entry, allowing physicians to instantaneously review vital patient information and electronically place orders for care. Physicians will be using a sophisticated computer program to assist them in plotting therapeutic courses: a system that brings together the latest treatment options, pertinent patient information and drug alternatives to save money and time, while improving patient care and safety. It will offer treatment options as individual physicians decide on their course of action.

BellSouth's wireless LAN network solution is one of the final steps in achieving a digital environment that places both historical and real-time patient data, along with best practice and medical information, in the caregiver's hands.

"The most important benefit of wireless communications is the efficiency it gives our caregivers," explains Anderson. "The ability to access information from literally any point on the campus at any time has a profound impact on their ability to make the right decisions at the right time."

James adds that, "Wireless is an integral part in our strategy to become all digital. We are seeing more and more ways to utilize the new network, especially as new pen-based tablets become available. Virtually every day we identify new ways to capitalize on this investment.

"I am a big believer that technology can deliver a competitive edge if it's used correctly. Wireless is that for St. Vincent's-it enables us to better deliver the quality care that we're in the business of providing."

For more information from BellSouth: www.mleads.com/303cn-251

Atlanta's southern belle 

BellSoulh is a Fortune 100 communications services company, headquartered in Atlanta, that serves more that 44 million customers in the United States and 14 other countries. The company provides a full army of broadband data solutions to large, medium and small businesses.

BellSouth's suite of data transport and WAN services includes VPN. optical services, dedicated Internet access, metro Ethernet and frame relay. BellSoulh expects to launch its Network-VPN service at the end of March, which will allow businesses to have WAN/LAN connections with multiple transport options (e.g., DSL, private line, frame relay).

Duane Ackerman is chairman and chief executive officer of BellSouth and has served the company in that role since 1998.

Ackerman began his communications career in 1964, and has served in numerous capacities with BellSouth. He was named president, chief executive officer of BellSouth Telecommunications, BellSouth's local telephone service unit and largest subsidiary, in 1992. Ackerman was promoted to vice chairman and chief operating officer of the parent company, BellSouth Corp., in 1995, and was elevated to the position of president and chief executive officer in 1997.A year later, he was appointed chairman and chief executive officer of BellSouth.

A native of Plant City, Fla., Ackerman holds a bachelor's degree in physics from Rollins College in Winter Park, Fla., and a master's degree in business from the Massachusetts Institute of Technology.

St. Vincent President & CEO Curtis James, above left, demonstrates one of many digital initiatives the hospital has implemented in the past 10 years. At left, St. Vincent associate Terry Dalton verifies patient information with a scanning device to ensure proper medication safety is administered.