Improving life for patients and clinicians

The explosion in wireless technology in recent years has delivered a wealth of new applications in the delivery of ‘anytime, anywhere’ information for all of us as we go about our daily business. A new market analysis report from Frost & Sullivan, ‘Mobile/Wireless Healthcare Technologies in Europe’, has estimated that the total mobile/wireless technologies market in Europe during 2008 was $1,479.2 million and will reach $6,791.7 million by 2015.
    
The report then goes on to say that the wireless technology transforming various areas of business today is yet to be fully explored by the healthcare industry to support quality maintenance and improved efficiency. Against this backdrop, it seems that further exploitation of wireless technology within healthcare will be indisputable, not only to realise savings and increase efficiencies in an increasingly uncertain financial future for the NHS, but also to capitalise on opportunities for delivering improved clinical care.

Collecting information
Wireless technology can used in a variety of ways in healthcare delivery, but a key objective is to bring together all patient-related information in a timely way to give an optimal basis for clinical decision making, given that the information is likely to come from a diverse set of sources and that clinical staff themselves form a very mobile workforce, who are often difficult to track down.
    
Ways in which this is achieved differs across the different care settings. This article provides a high level overview of some of the more widely adopted uses of wireless technologies across a variety of settings, focusing on benefits derived by patients and staff. As well as identifying opportunities and successes it also reviews the ongoing challenges faced in realising the benefits on offer.
    
In an acute setting, clinical staff reap the rewards of wireless through the use of COWs (Computers on Wheels), or tablets, which can be moved or easily carried from patient to patient, allowing both the viewing of a complete set of electronic patient data and providing the opportunity for real time update. This can be particularly effective when coupled with a ‘Single Sign On’ application, to give consolidated access to the full patient record, including pathology or other results, images and recent vital signs observation. This allows more informed and faster clinical decision-making, since the clinician is no longer reliant on paper notes (which may or may not be to hand, and may or may not be complete).
    
Electronic prescribing and medicines management systems can also be brought to the bedside, which reduces clinical risk of missed or duplicate prescribing and when integrated with drug clinical decision support capability can provide real time alerts for adverse drug interactions, or potential side-effects. In a fully integrated environment, real time pharmacy stock control is a by-product of real time prescribing and data entry.

Staff communications
Many hospitals have been using wireless to improve communications between staff through the use of a voice-activated badge worn around the neck. Badge wearers can call other badge wearers or landline users simply by saying the name of the person or team they want to contact. This delivers enormous efficiencies in staff time and improved care across a wide range of areas – including A&E and theatres management. Staff are able to speak to each other instantly, questions can be answered immediately and patients are moved to be in the right place at the right time.
    
A number of wireless applications have been developed in response to the NSPA’s 2007 report ‘Safer Care for the acutely ill patient:learning from serious incidents’, which recommended earlier identification of deterioration through appropriate monitoring of vital signs. Such systems typically make use of wireless technology through the use of PDAs for nurses to input vital signs at the bedside. Once a full set of vital signs has been entered, centralised software calculates the patient’s risk score, automatically alerts any escalation necessary, and indicates when the next observation should be taken, based on the patient’s condition.
    
In many cases, such systems have been extended to directly connect monitors (for example in cardiac patients) to a central decision support and alerting platform. Not only does this lead to a safer environment through the removal of wires and cables, again, it also provides the means for rapid clinical intervention, if necessary.

Benefits outside the hospital
The benefits of wireless are not just for hospitals. Many peripatetic health workers are able to take advantage of the technology, allowing them to perform their jobs more efficiently and provide better care to patients at home – again through access to timely and relevant information. In a recent trial in Nottingham, community-based clinicians and therapists used high-speed wireless laptops securely connected to N3 to access and update records as they moved from patient to patient on their home visits.

Patients at home increasingly benefit from wireless technology using applications that can directly transfer data from a sensor to a base station. Miniature sensors capable of being implanted are available that can accurately monitor a variety of physiological functions. Output can either be monitored through wireless transmission of data to a central base station or linked to a longer range external network, allowing opportunities for remote patient monitoring – and, if necessary, rapid action before complications occur. Such applications are often used for monitoring chronic diseases and increasingly provide feedback to the patients themselves, giving them greater visibility and control in self-managing their conditions.
    
RFID is becoming an increasingly popular wireless technology, with the potential to support more robust, efficient and safer healthcare delivery. RFID tags may be applied to people – patients and staff – and to objects, allowing readers on door frames, wards and treatment areas to detect and record interactions.
    
RFID can be used to reduce preventable medical errors, such as occurrences of equipment being left in a patient during surgery, the administration of a mismatching blood products or an incorrect medication. In the UK, many adopters of RFID focus on its potential for reducing delays in treatment by being able to locate the key players needed – the patient, equipment required and staff – capitalising on the data captured for stock control and asset management purposes.

Finding the right device
From a wireless perspective, the choice of an appropriate mobile device often causes some contention. COWs, tablets or PDAs (and even notebook PCs, as technology continues to evolve) all have a part to play. A key demand on any device used in a clinical environment is that it must conform to stringent infection control requirements – many newer devices have alerting capability when they need to be cleaned. In general, it has been found that doctors much prefer full-size screens – and will opt for either a COW, or tablet (provided it is sufficiently lightweight and easy to use when walking around) since they need a full screen view on many applications (for example to see trends of test results) and may also wish to switch between different applications to access supplementary data. For vital signs entry, research has demonstrated that PDAs are popular with nursing staff, with a well laid out and simple data entry screen for input. Studies conducted by different vendors have revealed that the simpler the data capture screen the better, since fewer input errors are made.
    
Given the sensitivity around the use of mobile devices (and the ease with which they can be lost) all mobile devices must be configured such that sensitive data is secured and remains on them no longer than absolutely necessary. Sometimes the network itself provides such capability, since the mobile device itself is simply a means to capture and transfer transient data to a secure server. In other cases, if not docked, all data is automatically removed from a device after a preset period of time.

Secure wireless network
There are numerous examples of successful wireless deployments supporting applications described above, but these are not without their challenges.
    
From a technical perspective, the wireless network must be secure, robust and resilient, without loss of coverage or any drop of signal. Both of these can lead to clinical risks, and, importantly will lead to lack of confidence in the technology and low adoption by the clinical staff. For some of the older hospitals in particular, this can present considerable demands (e.g. number of access points for full coverage). Device battery life can be a problem – particularly for those working in the community for extended periods.

Cost is often a barrier. Although cheaper to install a wireless network than a wired one, if a wired solution is already in place, the business case for change can be difficult to justify.

Problems raised most often are around guaranteed security and the clinical safety of the networks and devices themselves – and an ongoing campaign to assure both of these continues.
    
Ultimately, the adoption (and successful realisation of benefits) for wireless comes through an enthusiasm for staff to take up new working practices and for those with success stories to continue to share them.