A simple device and original thinking facilitated this imaging department’s wireless transition
With the health care industry facing the challenges of diminishing capital and shrinking resources, hospital clinical engineering (CE) departments are being asked to go above and beyond accepted responsibilities to provide solutions to an array of unique problems. Once solely charged with repairs and preventive maintenance of hospital medical equipment, CE departments are now “reinventing themselves” and are using the myriad skills of their technologists to create programs for an ever-changing service requirement. CE divisions today are offering solutions to issues ranging from managing medical equipment services and programs to medical equipment strategic planning and forecasting, assessments of technology, technology-utilization optimization, and evaluating technology to enhance patient care and staff workflow. This change in philosophy, this shift in responsibility, is a by-product of the financial constraints faced by health care facilities today.
“Our responsibility goes beyond preventive maintenance and repairs of the equipment we support,” explains Gordon Holder, CBET, Catholic Health Initiatives clinical engineering area manager for two hospitals: St Joseph Medical Center in Reading, Pa, and St Joseph Medical Center in Towson, Md. “Now, we are challenged to forecast, plan, procure, develop, and deploy medical-device technology over a 5- to 7-year projection. It’s about being more proactive than reactive. This is how our team has to evolve to continually stay on the cutting edge of what health care organizations expect from CE.”
Holder and his team of four highly skilled technicians at St Joseph Medical Center—each with individual areas of expertise—provide the resources for any type of technical solution needed or workflow changes. St Joseph Medical Center is part of Catholic Health Initiatives, Denver. One of the largest nonprofit health care systems in the United States, it includes 70 hospitals; 43 long-term-care, assisted and independent living and residential facilities; and two community-based health organizations in 19 states.
Holder has discovered that sharing CE services and resources throughout Catholic Health Initiatives ultimately benefits the staff and patients at St Joseph Medical Center. “One of the things we have found is that we are able to share a lot of our information and data from one hospital to another, which gives us more strength in providing services to our local facility. We can focus on improving patient care, while also learning from one another and leveraging cost-effective strategies.”
Holder, who has been serving in the clinical engineering field since 1990, has confidence in his technicians and encourages them to “think outside the box” when it comes to enhancing patient care by developing time-saving, cost-efficient measures. These efforts can benefit the multiple clinical departments served by CE, and they ultimately enhance patient care.
“I encourage each technician to be creative and leverage their strengths,” Holder says. “They share their specific disciplines and skills with each other and create a true team effort. This philosophy allows them to use their skills in day-to-day preventive maintenance and repairs, and to also create, develop, and deploy strategic solutions for a variety of medical-equipment needs.
“The field of clinical engineering is changing around the country,” Holder adds. “We’re being asked by a variety of departments to provide more cost-effective solutions and strategies to combat the escalating cost constraints facing health care today.”
A Wireless Bridge
When Wade Blessing, CRES, an imaging service specialist at St Joseph Medical Center since 2001, announced that he had devised a simple, effective, and, most importantly, inexpensive way to improve patient services in radiology, Holder gladly gave him the green light.
Holder’s confidence in allowing Blessing to “create and think out of the box,” combined with the image service specialist’s desire to reward his employer for its trust, led to the use of a “wireless bridge” that can be attached to the hospital’s existing infrastructure. This pass-though device allows the systems to communicate wirelessly to the hospital network via access points in the operating room (OR), the radiology room, and other patient-care areas. The radiological encrypted images travel through the hospital and use existing access points.
Blessing said that he, in collaboration with the former hospital picture archiving communications system (PACS) administrator, came up with the “wireless” idea 3 years ago while discussing the installation of the PACS. St Joseph’s was moving in the direction of installing a PACS and becoming fully digital. This encompassed connecting seven satellite clinics, which also doubled as radiology facilities, to the hospital’s main system.
“As we were setting up every modality to the digital world—magnetic resonance imaging, computed tomography, and ultrasound—we came across multiple C-arms and a couple of portable ultrasound units,” Blessing recalls. “The idea of going wireless was easy, but creating a wireless system was another matter entirely.”
The hospital needed to pull the radiology studies off of the system and off of each modality. But when the C-arms and portable ultrasound units were used, there was always the inconvenience of finding docking stations, cables, and network jacks that would accommodate the appropriate connections. Once technologists were done with their scans, they had to take down their machine, wheel it down a hallway, plug it back in, bring it back up, and shoot the images to the PACS.
“Technologists are very good at what they do, and we wanted to streamline their workflow to help them be more productive, letting them do what they do best,” Blessing says. “In our field we get a lot of service calls where there’s either the wrong configuration or damaged cables from constantly setting up or tearing down. We wanted it to be plug and play—turn it on and run the machine. Technologists shouldn’t have to configure a network to get the images they need.”
Going wireless was the only answer, but with St Joseph moving to a new, state-of-the-art hospital and health campus in 2006, any changes would have to be made without installing an entirely new infrastructure.
“The information technology (IT) department told us they already had wireless access points throughout the hospital that they used for patient administration and registration computers,”Blessing notes. “We asked them if we could piggyback on that. We researched and found a wireless bridge.”
Blessing considered the idea of installing wireless access points and using wireless cards, but the system he was dealing with was proprietary, meaning nothing could be integrated with the existing software. The solution was to find a piece of noninvasive equipment—in this case, it was a wireless bridge and a power source.
From there, it was simply a matter of buying the bridge at a neighborhood computer store and taking it back to IT, which set Blessing up with the security he needed to access the existing wireless LAN network. Then, Blessing went to each of the modalities and investigated power-distribution possibilities for the DC converter, which powers the wireless bridge. The wireless bridge was then anchored to the top of a machine, and a wireless jack was plugged into the back of the modality being used.
“Bingo,” Blessing says. “We had connection to the network.” And at a price soothing to the bottom line. It sounds too good to be true, but the cost is approximately $200 for the wireless bridge and a few special cables.
“This solution is so easy and cost effective that every hospital should do this,” Blessing says. “It’s an inexpensive solution, complete and ready to be used. Let’s quit waiting for manufacturers to design something when we can build it just as easy ourselves. It doesn’t have to an expensive solution to be effective.”
Not only was the process inexpensive, but it also facilitated the transition to a wireless digital system. “There was no in between,” Blessing notes. “We went from a completely film-basedanalog system to being completely digital. The transformation was amazing.”
Imaging workflow changes in patient-care areas were dramatic and immediate.
“As radiology technicians were acquiring images, all they had to do was hit ‘send’ and the images would be transmitted into the PACS, where the physicians could view the images,” Blessing says. Sending an encrypted image takes approximately 30 seconds, although transfer time varies based on the image’s size and the modality’s range to the access point.
The only problem—more of an inconvenience than an actual stumbling block—was several blind spots in the OR. The OR didn’t have access points. Soon, however, at a cost of about $400, two access points were added to the OR and the hospital was wirelessly connected.
Blessing adds that there can be unexpected complications from trying to make something mobile that is not meant to be mobile, or something portable that was not meant to be portable. Wireless bridges and power strips fall into that category. “They can unattach when being wheeled down the hallway when they bump into other obstructions. We had to engineer ways to attach these devices onto the portable units. It’s something you learn along the way.”
The OR is not the only department that is benefiting from the wireless innovation. Blessing’s efforts also have been a benefit to other departments at St Joseph Medical Center.
“Technologists who use our portable ultrasound absolutely love it,” Blessing adds. “Radiology is on the second floor, but they may be doing exams on the third or fourth floor. But now they can do their scans, take 60 to 100 images, hit ‘send,’ wait a few minutes, after which they upload the machine, push the machine downstairs, log into PACS, and every image is there.”
With this technology, it is possible for physicians to view a live feed of a scan being performed. Whether he or she is in the emergency department or across the street at his or her office, the physician can log into the PACS and have the capability of watching the live feed of a scan.
“We’ve given them the tools to do their job better and more efficiently,” Blessing maintains. “We’ve increased the productivity and the efficiency of the department by maximizing available technology.”
Even more exciting is the possibility of using the wireless system on any application that is mobile that, in the past, would have required a network connection. And in today’s hospital setting, this encompasses a large scope of procedures. Blessing suggests that a wireless application would be perfect for electrocardiogram (EKG) testing. “If you have a wireless EKG-management system, a wireless bridge and appropriate connections, and you’re performing an EKG on a patient, you can view the results quickly. If the infrastructure has a complete wireless setup, the possibilities are limitless.”
Blessing admits that one of the many rewards of working for Catholic Health Initiatives is the opportunity to use his skill set to increase efficiency and improve patient care.
“I have the support to create effective solutions that benefit the hospital,” he explains. “The ideas and concepts that I create, I have the chance to implement here. Many people do not get this type of support from their employer. Catholic Health Initiatives is committed to helping you grow and develop new skills. It shows it by investing in your professional development.”
Holder insists that giving his clinical engineering technicians the freedom to find simple solutions to complex problems gives them pride in their daily work and satisfaction in seeing their contributions come to fruition.
“When the clinical engineering technicians are empowered to develop these concepts and the hospital utilizes them, it increases job satisfaction and provides personal affirmation,” he relates. “More importantly, it integrates them as part of the hospital team.”
Dave Cater is a contributing writer for 24×7.