A wireless voice communication system is one type of new technology that can help improve the flow of information, communication, and quality of care in the healthcare environment
Today, many healthcare systems are looking closely at how patients, staff, and materials flow through their campuses. We hear often about Lean design and how its tenets aim to minimize costs. However, the reasons for looking at process flow are compelling and go far beyond cost savings. The endgame is really about putting better controls in place so the quality of care and patient experience are enhanced.

For instance, one of the chronic problems across the nation is patient overflow in emergency departments due to lack of staff, too few exam rooms, and not enough inpatient beds. Patients are either “boarded” in the ED or sent to other hospitals. This creates delays in delivering the care patients need. Bottlenecks in surgery departments are also prevalent.

However, as hospitals start to really analyze these bottlenecks, they are finding out that better communication, standardized processes, and the implementation of technology vastly improves the flow of people and equipment within the hospital, thereby greatly reducing bottlenecks, increasing quality of patient care, and more quickly disseminating information to those that need it most. The key to success is determining what technology is best for the hospital, and, equally important, planning infrastructure for future technologies.

There are several high-value technology tools gaining a stronger foothold in today's hospitals that can be used to improve flow and quality of experience and care. Many of these relate to identification of assets, communication tools, and improved flow of information. Two high-value, growing technologies are Radio Frequency Identification (RFID) and Voice over Internet Protocol (VoIP).

Tracking assets and improving communication

The RFID system consists of a miniature electronic tag called a chip that has a unique identification number. It also includes an RFID reader with an integral antenna that is connected to the hospital's data network. Tags can be placed on assets such as equipment, patient records, patient beds, and even patients themselves. As tagged people and assets traverse through a department or the hospital, the RFID readers capture information from the chip and report it to enterprise servers in the hospital. In turn, this data is used to manage assets, patients, and rooms by serving as the basis of real-time reporting to caregivers and staff.
Technology, and thus infrastructure, is a facilitator of delivering medical care

New technology can also improve communication among staff—a key factor in fostering flow in a hospital. Traditionally, a great deal of time is spent looking for staff either by calling different phone numbers, using overhead paging systems, or typing numbers into pocket pagers. VoIP is a method of transmitting voice data over a network or the Internet. VoIP's ability to instantly message its users can greatly enhance operational efficiencies and flow in the hospital. Staff members are able to contact one another quickly, rather than spending time hunting for them by phone or overhead paging. Personal communicators that are voice activated and allow for speech recognition can be issued to staff and caregivers so that they are always connected, even when they are not in their office. Alerts and alarms from a patient room can be automatically sent to the caregiver overseeing the patient, allowing for faster response times.

Both RFID and VoIP require a wireless infrastructure backed by a wired infrastructure. Many hospitals already have an 802.11 network in place that is supporting other applications. Adding RFID to this existing bandwidth is possible, but the bandwidth of 802.11 is limited and it can be quickly consumed as each application is added. In addition, if VoIP is deployed over an 802.11 network, the density of the wireless access points must be higher to maintain consistent and quality voice. An existing 802.11 infrastructure will support limited and department systems, but if one is thinking globally with enterprise-wide systems, then 802.11 infrastructure may not be the answer.

Getting the infrastructure and implementation right

The starting point to getting the infrastructure right is preplanning and figuring out what technologies are really important in your hospital. Ironically, this step is usually given very little attention and infrastructure “solutions” are pursued relatively quickly without really thinking things through. Planning really begins by identifying the key stakeholders in the organization. At a minimum, this should include representatives from physicians, clinical and nursing staff, biomedical engineering, administration, facilities, information technology, and engineering. The reason for such an all-encompassing sample is that all of the technologies that each of these representatives traditionally oversee are converging onto common platforms and common infrastructure. Technology, and thus infrastructure, is a facilitator of delivering medical care. The key stakeholders must first decide what technologies will truly help their process flow and how those technologies integrate with their model of care.

The process of deciding infrastructure starts with a visioning session where ideas and technologies are thrown on the table for discussion of process flow. This should include present technologies that are proven, as well as future technologies in development such as context-aware environments. Once the arsenal of technologies has been master planned, then one can get about the business of planning infrastructure.

Infrastructure consists of four elements: Physical rooms where equipment is housed and cabling is terminated, conduit and cable tray pathways, copper cabling and fiber optic plant, and wireless infrastructure. Getting sufficient conduit and cable tray pathways within the hospital is paramount. It will minimize the risk of performing disruptive work later to add more pathways. Getting a sufficient cabling infrastructure in place is the next area, but one should be cautioned that some developing technologies may evolve on proprietary infrastructures.

Physical room infrastructure. Equipment to support process flow technologies such as VoIP and RFID is likely located in a centralized server room that houses other technology applications as well. Application servers sit in vertical racks within the server room. There is no “one size fits all” for a server room as it is dependent on the campus square footage being served, as well as envisioned technologies that will be implemented. The proper way to plan the physical space infrastructure and HVAC for the room is to determine how many populated equipment racks are needed for existing technologies in place, and then add on racks for known future technologies. Now comes the hard part—what about those technologies you don't know about? One way to go about determining these unknowns is to look at your past growth history as a starting point. Adding 50% more space than what you need presently for what is known of current and future technologies is neither unreasonable nor uncommon.

Communication and IT closets on each floor should be located to serve a 250′ line of sight radius from the room. Minimum-sized closets are suggested at 10′ x 12′, or even longer in length as future growth capacity to add racks requires a longer room. Here again, the room should be sized on potential equipment racks. It is strongly advisable to keep closets stacked floor to floor to allow growth in the vertical infrastructure in the future.

Conduit and cable tray pathways. Even though RFID is wireless and VoIP can be wired or wireless, they both require a physical cable plant to support the devices: RFID readers in the case of RFID, and access points or hardwired network connectivity for VoIP. Copper cable technology continues to evolve as higher grade cables are able to carry more bandwidth. Currently, Category (CAT) 5e is a standard, with CAT 6 moving to replace it. The issue here is that, as cable technology evolves to carry more bandwidth, the cable is growing in diameter. This means that it bends less and will require more space in conduits and cable trays, along with larger bending radiuses. This obviously has an impact on the physical space required for the pathways to support cabling for technologies such as RFID and VoIP, among others. In addition, both of these technologies require a higher density of readers or wireless access in order to maintain continuity of information or voice communication. This translates into more cabling, which means more pathway space needed above the ceiling. For this reason and to accommodate future growth, minimum cable tray sizing is recommended at 18″ or even 24″ wide. If space allows, smaller but stacked trays also work well.

Supporting cable plant—wired and wireless. Attention to the cable plant that supports voice and data transfer is crucial as technologies that support process flow improvement begin to converge onto the same network and integrate with each other. The wired network will be driven by the points of connectivity needed within the facility. Key areas that are taking more connections than before are operating rooms to support process flow tools such as RFID tracking as well as telemedicine and telepresence applications. The e-ICU areas that are in hospitals also require a higher density of network cabling.

However, many process flow improvement applications will be supported on a wireless infrastructure. One solution that provides some flexibility for the future is a Radio Frequency (RF) distribution system. RF distribution systems have traditionally been used to reradiate public safety radios, cell phones, pagers, and other communication devices within a building. In addition, they can also reradiate 802.11 wireless LAN networks. The advantage of the RF distribution system is that, when planned and designed properly, it can host a variety of different bandwidths, thereby accommodating multiple types of signals and technologies. The basics of an RF distribution system consist of either a reradiating large coax cable or a system of distributed antennas throughout a building, or a combination of both. Each communication system that rides on the RF distribution system requires its own interface electronics as a head-end that is plugged into the distribution system. Both RFID systems for tracking as well as VoIP telephony can operate on an RF distribution system. This system can be more costly from an infrastructure point of view, but in the long run it provides greater flexibility. The key is to plan the implementation well and the physical space needed for the system's head-end electronics, as the RF system can be built in modular fashion over successive projects.

Making the case

The healthcare systems that have implemented RFID and VoIP in their facilities have proven that, in many cases, the technologies can improve work and process flow while increasing efficiencies and patient care. These technologies break down the barriers of traditional, laborious and time consuming methods to track patients, monitor assets, and engage in communications. They allow for greater teamwork and greater dissemination of important information among team workers. They should be considered as key technologies in any hospital planning or renovation.

These technologies will certainly change as time goes on, but a solid, well planned out infrastructure can accommodate those changes that allow deployment of RFID or VoIP rapidly and with low impact cost. The key to success is to analyze how current processes in the hospital are encumbered and define the issue first, rather than just throwing technology at the problem. The technology should follow the analysis of the needs. By doing so, one will improve outcomes and flow, as well as add positively to the financial bottom line. HD

Tom Leonidas, Jr., PE, is a healthcare practice leader and vice-president at Sparling, a Seattle-based electrical and technology consulting firm that specializes in healthcare planning and design. He can be reached at tleonidas@sparling.com.