Managed health care is based on predefined fees for medical procedures. However, those predefined amounts often are lower than the amounts that hospitals otherwise would charge to cover costs. To continue delivering superior patient care, hospitals are looking for ways to manage the costs of patient visits and procedures more closely. Denver-based Saint Joseph Hospital, founded more than 100 years ago, is recognized for excellent care at very competitive rates. In 1995, the information services group at Saint Joseph took a look at what emerging information technologies could do to help the hospital maintain its strong competitive position.

Application: Access to Patient Records and Medical Reference Helps Nurses Keep Patient Care on Track
The hospital's plan was to put access to information - both patient records and the hospital's medical reference library - closer to the point of care. Doing so would allow the hospital to analyze and manage patient information more closely and concurrently, and control the costs of patient visits and treatment.

"Our goal was to choreograph a patient's stay, detailing exactly what needed to happen and when. We saw that one of the most effective ways to ensure that everything happened according to plan would be to give nurses access to patient records directly from a patient's bedside," said Douglas Hahn, Manager of Information Services at Saint Joseph. "We knew we could provide the required care without excess costs by following a carefully defined process."

The hospital wanted nurses to be able to chart patient information from bedside. The information services group already planned to replace the existing mainframe-based network with interconnected Ethernet LANs, so it considered extending the hard-wired network to each room in the 600-bed hospital. However, Hahn quickly recognized major disadvantages in that plan. First, the cost of installing cable and purchasing PCs for every room would be prohibitive. Also, unintelligent terminals would not provide the computing power that nurses would need to run applications or access patient records stored on CD-ROM. Furthermore, in pilot tests, patients found the fan noise from the computers annoying. Because the building was not new, laying cable would be difficult, and in many hospital rooms there simply wasn't enough space for a computer. Finally, Hahn feared that PCs installed in hospital rooms would be exposed to tampering, which could result in damage either to the equipment itself or to the security of the information on the network.

The hospital overcame all of those obstacles by using wireless LAN technology instead of extending the wired network to every room. A specially designed cart carries nurses' supplies, such as alcohol swabs and I.V. caps, as well as a laptop computer with a wireless LAN adapter. Nurses take the carts with them from room to room, using the laptops to enter information or access patient records. Before the hospital installed the wireless system, nurses took notes on patient information and later entered the information on a patient's paper chart. Now, nurses can enter patient information on the spot, and a clinical application on the network makes the information easy to chart. When a patient arrives, the hospital maps out every aspect of the patient's stay - what treatments the patient should receive, and how long the patient should stay in various departments - according to the managed care prescription for the procedure in question. Nurses use their access to the up-to-date information on the network to make sure that each patient is treated according to plan.

"Although people often resist new technology, we were able to make it easy for the nurses to use the new applications and the wireless units, so the new system isn't a burden to them. It has been very successful," said Hahn.

Benefits: Minimized Installation and Maintenance Costs, Streamlined Procedures, Better Security
The most obvious benefit of the wireless system was its cost: By installing a wireless LAN, Saint Joseph avoided purchasing, installing, networking, and maintaining a huge number of PCs. However, the wireless LAN's advantages go far beyond equipment savings. Entering information directly into the network eliminates the step of reentering handwritten information into a central terminal and reduces the chance of transcription errors. In addition, because nurses take their laptops with them wherever they go in the hospital, the equipment and the network are secure.

Installation Size
Saint Joseph now has 70 carts with notebook computers on the wireless LAN. Ten access points connect the LAN to the hospital's Ethernet network.

Hahn said Saint Joseph plans to expand its use of wireless technology. "We are looking at providing other groups in the hospital with wireless capabilities. Physical therapists, for example, often go from room to room or floor to floor, and it's inconvenient for them to use a stationary PC. With wireless units, they'll be able to access and update patient records or other information from anywhere in the building." Another advantageous use of wireless technology that the hospital is considering: By using a wireless LAN to link surgery rooms to the hospital network, Saint Joseph can avoid both the risk of contaminating the rooms and the need to shut them down while cable and other hardware are installed.

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