VA's dose of WiFi

MEDICAL ASSURANCE: VA's system combines a bar code scanner and wireless connections to ensure patients get the right medication.

Rick Steele

ALL IN THE WRIST: A nurse uses a bar code scanner to check on a patient's medication.

Some hospitals use handhelds with the system, while others use portable PCs.

Wireless system making the rounds at hospitals

Medication and medical mistakes contribute to 98,000 patients deaths each year in the United States. The Veterans Affairs Department is leading an effort to reduce that number with a wireless application designed to ensure that patients receive the correct medications.

VA not only has outpaced private hospitals in implementing health care IT systems, but the department is leapfrogging its private-sector counterparts in using mobile and wireless devices and applications directly in patient care.

The Barcode Medication Administration System, which is in all VA hospitals now, lets doctors and nurses verify the time, dose and name of a patient receiving a medication. It includes a scanner using the IEEE 802.11 WiFi wireless standard and mobile or wireless PCs'moved around on carts'or handheld devices.

VA hospitals give patients a bar coded wristband inscribed with patient information, and applies a bar code to every medication. A nurse scans the patient's wristband for identity verification, and the system retrieves the medication record from VA's Computerized Patient Record System and displays it on the PC or handheld screen.

The record verifies if it's time for that patient to receive a specific number of milligrams of the prescribed drug. The nurse scans the drug to ensure the patient gets the right drug and the right dose at the right time.

'VA set the standard for managing medications in the inpatient space for any hospital environment, private or public, and we're the first health care organization to have deployed it in an enterprise the size of the VA,' said Eric Raffin, deputy CIO of VA's Sierra Pacific Network, or VISN 21, headquartered in Vallejo, Calif.

Better, not faster

Nurses no longer push a patient chart wagon from room to room, checking a paper chart when it was time for a patient's medication and signing off when the patient took the medication. Now the process is more thorough and electronic'though that doesn't make it faster, Raffin said.

'The biggest challenge has been that everyone understands that this is a patient safety system. It is not a system that was designed to make our process more efficient,' Raffin said. 'The project has been successful and [medication] mistakes are being made at a lower frequency than ever before,' he said.
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A nurse still rolls a medication cart into a patient's room, but with either a PC, attached to the cart, or a handheld computer. VISN 21 has two choices for computing carts: mobile carts, which are lighter and easier to push about, or the existing, big medication carts that VA modified to install a computer and battery system so they could be mobile.

Both carts can support a micro PC, with flat-panel display, full-sized keyboard and mouse. VISN 21 will migrate to handhelds in the next year or two, he said.

Some VA hospitals use handhelds with built-in scanners for the medication administration system.

Hospitals have the option; it's a local decision, said Sharon Coleman, enterprise system manager for clinical systems for VA's Veterans Health Administration in Washington. For example, the Washington-Baltimore region, known as VISN 5, uses handhelds and PCs, while the Loma Linda, Calif., facility uses handhelds exclusively, she said.

VA uses a commercial handheld application, Care Fusion, which runs on a Microsoft Windows 2000 platform. The handhelds run Microsoft Pocket PC and CE.Net operating systems.

Physicians and nurses in many VA hospitals also conduct their rounds using wireless notebook PCs on a cart, Coleman said. They pull up a patient's electronic record as they work from room to room. Physicians can document their orders and key-in a progress note.

'Once the wireless system was in, the IT and clinical folks sought to use it. The residents just eat it up. They don't have to carry charts around,' Coleman said of her previous experience at the Washington VA hospital.

VA has started a nationwide initiative to use handheld devices for documenting vital signs and collecting lab results. VA will release a request for proposals shortly, she said. 'There are a lot of users clamoring for it. It will likely be phased in, but once it's available, it's going to go like wildfire,' she said.
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The Washington VA hospital has purchased wireless EKG machines. After a technician performs an EKG on a patient'say, in the emergency room'the tech presses a button and the EKG data automatically feeds to the network. Patients will receive care more quickly because staff won't have to wait for someone to take the EKG disk upstairs, load it and have a physician read it.

At the Sierra Pacific VISN, the wireless network also gives doctors and nurses access to the VistA Imaging and third-party Picture Archiving and Communication systems, Raffin said. VistA Imaging provides for the transfer of digital images from medical devices, such as EKG carts, and select text documents to an image archive that is linked to the CPRS electronic health record. The PACS system supports the archiving and viewing of studies from radiology and nuclear medicine, like MRIs and CT scans.

'Wireless applications will make for better, more timely and efficient patient care,' Coleman said.

Points of access

The wireless system uses access points installed throughout the hospital. The number of access points depends upon the configuration of the patient rooms, how thick the walls are and what's in between the floors.

The Sierra Pacific VISN uses hardware encryption to protect the data that traverses the wireless LAN, Raffin said. The setup includes redundant hardware encryptors and client software on the the mobile cart.

WEB EXTRA: CMS offers a clear incentive for doctors in small offices to use health IT. GCN.com/416, at www.gcn.com

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