Hospitals are choking on paper. The endless trail of treatment orders, signatures, prescriptions, and yet more signatures can force a physician, it often seems, to spend more time in the records department signing off on myriad paperwork than with patients. And the paperwork can't be ignored; many regulations require verbal orders to be signed within 24 hours.
St. Clair Hospital, Pittsburgh, was in better shape when it came to paper than many hospitals. The 314-bed general acute-care hospital, selected as one of the top 100 regional hospitals by HCIA and The Health Network, had developed an output management system that captures and monitors output from the hospital's many clinical systems. The output management system would monitor the flow of output, grab documents that needed physician signatures, and fax them to the physicians at their offices or at home or wherever the physician preferred. The fax system proved very popular with physicians, saving them innumerable trips to the records department.
At a regular physician meeting this past April to discuss system enhancements with a team from Sculptor Develop-mental Technologies Inc., a subsidiary of St. Clair Health Corp., "the physicians started pulling PDAs out of their pockets and talking about them," recalls Richard Schaeffer, Sculptor's development director. The hospital already could route documents to the physicians' desktop systems and fax machines. Why not, someone suggested, send the documents wirelessly to a PDA, such as a PalmPilot or similar device?
Top management immediately grasped the value of the idea. "If we could send information to the physician via wireless and get a response back, it would save time that would be better spent with patients, and it would save money," explains Tom Ague, executive vice president.
A plan and design based on Sculptor's output management system quickly took shape. The system would look at the stream of information flowing through the hospital's systems. It would recognize any verbal order that needed to be followed up with a signature and route it to the physician via wireless. The physician would sign the order right on a PDA and send it back.
And why stop with the need to sign verbal orders? The system could be used to get any information to a physician fast, regardless of where the physician was. For example, reports routinely dictated by radiologists can be intercepted and sent wirelessly to the physician, who can then issue the appropriate instructions right from his or her PDA.
Implementing the plan immediately raised the question of which PDA to support. It is possible to support a wide range of wireless devices, but that substantially increases the cost and complexity of the project. "Initially we looked at the WAP phone and thought we could combine the PDA with voice," says Schaeffer. However, the WAP phones proved inadequate; the screens were too small, navigation through the system was difficult, and input was frustrating. The team looked at the Palm, which many physicians already had, but it suffered from short messages and weak security. The team liked RIM's Blackberry, but physicians would likely have had trouble with the RIM keyboard. Also, the RIM device wasn't expandable.
Finally, the hospital settled on the Pocket PC device, especially Compaq's iPAQ. The plan called for the hospital to provide both the device and the Internet messaging service to the physicians. It justified the expense based on increased efficiency. The wireless system "was much more efficient for the hospital," says Ague.
With the device selected, the team turned to the actual development, using the existing output management system — which already interfaced with the hospital's clinical systems — as the foundation. For wireless, the hospital used software from Infowave Software, which encrypted and compressed the information. The rest proved to be simple. "We had a working prototype in a couple of months," Schaeffer reports.
Today, the hospital is wrapping up the pilot deployment, which runs about 2,000 pieces of information through the system in 24 hours. It will soon begin deploying iPAQ devices to all its physicians. The total cost, including a new Windows NT server and iPAQ devices for over 500 physicians, will come to less than $1 million. And already the hospital is making plans to enhance and expand the capabilities of the wireless system.
Fedex Ground
FedEx is almost as famous for pioneering wireless computing as it is for pioneering overnight delivery. The ability to capture shipment tracking data and send it back wirelessly allowed the company to provide an unheard-of level of customer service. Pittsburgh-based FedEx Ground, a subsidiary of FedEx, turned to wireless for a different reason. "We wanted to eliminate paper at the point of delivery," says Roman Hlutkowsky, managing director, operations technology.
FedEx Ground, started in 1985, enlists the services of approximately 9,000 independent contractors for pickup and delivery. The company has been using handheld devices for bar code data collection since 1990. In 1993, it rolled out its first wireless system, based on analog cellular, to send back bar code data and recipient names for package tracking. By 1999, the system was aging and clearly needed upgrading; the technology had advanced in six years and business requirements had changed. Elimination of paperwork for the contractors had become a major focus.
To begin, FedEx Ground needed a new device. It partnered with Symbol Technologies, Inc., Marietta, GA, to develop a new, digital device that sported a large screen and provided longer battery life. It also upgraded the in-vehicle computer for packet radio, which would deliver better coverage at a lower cost. "Packet systems charge by the packet, so drivers could send as frequently as they liked rather than wait to batch up transmissions," Hlutkowsky explains. The company added satellite transmission capabilities for areas lacking packet coverage, and also installed wireless LANs in 370 distribution centers.
To facilitate the wireless communication, FedEx Ground added Broadbeam's wireless middleware client software to the in-vehicle system. The server piece was installed at the data center. The Broadbeam middleware would recognize which network — packet, satellite, or wireless LAN — the vehicle was communicating with and process the message appropriately.
The wireless communication from the truck speeds critical delivery information to and from the data center, but it still didn't provide a crucial piece — the signature required for proof of delivery. For that, the company turned to a wireless LAN deployed at its distribution centers. "It is too expensive to send the digital signature over a wide area wireless network," Hlutkowsky explains. Instead, the digital signature and other less time-critical data are uploaded to the wireless LAN when the driver returns to the facility.
"By capturing the digital signature through the wireless LAN, we could shrink proof-of-delivery time from 48 hours to 12 hours, and we get rid of the clipboard the drivers had to carry around," says Hlutkowsky. In addition, the company gave every package handler wearable terminals and ring-mount scanners to capture information every time a package is handled, further leveraging the value of the wireless LAN.
The $80 million project represented a joint effort by FedEx Ground, Symbol, and Broadbeam. FedEx Ground developers built the handheld applications and server systems that collect and feed data. Symbol developed the handheld device and worked with Broadbeam on the in-vehicle applications. The wireless system now includes 10,000 portable devices, over 9,000 in-vehicle computers, 6,000 wearable scanners, and 370 wireless LANs. This past March, the company also set up another 150 facilities with wireless LANs for use in home delivery.
To deliver the wireless system, Hlutkowsky's team, which numbered about 60 at its peak (plus another 18 in a field deployment group), had to overcome a number of daunting challenges. "The potential for scope creep is pretty spectacular," he notes. The team controlled the scope of the project by adamantly sticking to the stated, agreed-upon objective of paper reduction.
The team also had to draw the line when it came to technology. "You can't chase technology or you'll never get it done. There's a new advance every 12 months," Hlutkowsky continues. Integration of all the pieces — packet and satellite transmission, wireless middleware, handheld and in-vehicle systems, wireless LANs — required close teamwork among FedEx Ground and all its vendors.
The business case for wireless at FedEx Ground was straightforward, Hlutkowsky explains: "We knew we had to move information better to improve the productivity of the contractors, and we needed new technology to do it." Wireless proved to be exactly the right solution.
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