Guest interview post from our media partners, iHT2’S blog:
Ed Lowell, Director of Technology Infrastructure at the Lucile Packard Children’s Hospital at Stanford University, participated in the panel discussion, “Patient Management Without Walls: Enabling mHealth & Telemedicine,” at IHT2’s Health IT Summit in San Francisco, March 27-28th.
Lowell has over 23 years’ experience in the healthcare information technology industry. Prior to joining Lucile Packard, he was a senior healthcare consultant for HealthLink and IBM. He was VP and CTO for Centura Health’s 11 hospitals in Colorado. Before Centura, he was the director of IT at Sharp HealthCare in San Diego, Calif.
Lowell leads the technology team for the new, state-of-the-art, 521,000-square-foot hospital expansion project scheduled to open at LPCH in December 2016. This includes the coordination of LPCH Information Services, Stanford Hospital and Clinics Information Technology department, Stanford University Information Technology Services, Clinical Engineering, Imaging, Security and other major technology users.
In advance of the HIT Summit, IHT2 Editor Joseph F. Jalkiewicz spoke with Ed about LPCH’s expansion project, which includes a state-of-the-art wireless distributed antenna system (DAS) that provides guaranteed RF coverage for 802.11, cellular, paging and Wireless Medical Telemetry Services. Joining their conversation was Gary S. Close, Vice President of Marketing for InnerWireless, which provided LPCH with the wireless DAS and is a sponsor of the panel discussion.
Ed, why don’t you start by telling us how the LPCH expansion is coming along?
Ed Lowell: It’s coming along quite well. We’ve had a mild dry winter so far, so we haven’t had any construction-related delays. We’re beginning the construction phase now, and we’ve scraped a few feet off the lot already.
What types of technologies will you be implementing that you expect to transform care at LPCH?
Ed Lowell: The challenge is we’re opening at end of 2016, so the technology decisions are going to be made at the last responsible moment. We have current technologies planned for the facility, but I think there are a lot more opportunities I’m going to be keeping a close eye on to see what’s going to change. Obviously, mobility is going to be key. A lot of patient care is done at the bedside, and it’s untethered. So we want the clinicians and providers to be able to access devices right in the patient room. We’re looking at Smart Wall technology. We’re looking at indoor GPS. Wayfinding is a challenge. We’re going to be attached to the existing Packard hospital with our new facility, which is connected to the existing Stanford hospital, which will be connected to the new Stanford hospital, and it’s probably a mile from one end to the other. It will be quite a challenge to get families and patients from one facility to the other, and so we’re looking at indoor GPS, digital wayfinding. [We’re also looking at] real-time locating systems. I see that as a huge change in the future for workflow, for work processes, and for being able to track staff and assets throughout not only our facility, but also our sister Stanford adult hospital.
Gary Close: I think it’s also important to connect that statement to new, more efficient and productive care models. All of this has to have an economic payoff for the hospital.
How did the partnership between LPCH and InnerWireless get started?
Ed Lowell: It was around 2006 that I originally started dealing with InnerWireless. We had an issue at the hospital where our code team wasn’t always getting their pages, particularly if they were in the lower level of the hospital, where our cafeteria is located. So the organization came to me and said, “Hey, can you help us with this?” I had heard something about InnerWireless and its distributed antenna system (DAS) that gives you guaranteed coverage within the hospital, and so I reached out to Innerwireless originally to help with a paging problem. But then when I found out more about their capabilities, we looked at coverage for cellular and for our 802.11, our Wifi systems, and it was a very good fit. [Ultimately] it was in the 2008 time frame that we had a contract and were installing the antenna system.
Gary Close: Our relationship is not too dissimilar from other engagements with other hospitals around the country, where there is a particular issue with regard to the level of a particular wireless service in the building. As Ed just mentioned, they were having problems receiving pages in the lower levels of the hospital. That would not be too dissimilar [from other facilities] where they’re saying, “We don’t have adequate cellular service within the hospital.” Our relationship with virtually every account, including Lucile Packard, always seems to emanate from the lack of a reliable wireless service coverage issue somewhere in the facility. And since most of [a hospital’s] use of wireless service is really mission and life critical to their operation, to have an unreliable service you can’t count on is quite unacceptable. So we installed one of our systems, a relationship developed, and the success of the solution was such that they spec’d us in to their new tower project.
Ed, with your background at Centura Health System and Sharp Healthcare, can you reflect on the differences associated with working at an academic health system?
Ed Lowell: It’s a significant difference. At both Sharp and Centura I worked at an organization that was acquiring other hospitals, and we were building a large integrated delivery system. Here, it’s a very complex environment. We’re the children’s hospital, and we’re connected to the Stanford adult hospital, and we’re on the Stanford University campus, so there are some services that we receive from the University. For example, our dial tone and all our telephony come from the University. There are other services that we receive from Stanford Hospital, the adult hospital, and certain services, like materials management and our laboratory, are shared services with the University. And then we also have the School of Medicine, so a lot of our physicians are on the faculty of the school of medicine.
So we all have very distinct networks, and they’re not always trusted networks. It adds a layer complexity to our environment that you wouldn’t understand unless you lived it, and we don’t always have the same strategies or solutions. For example, we’re building a new hospital extension, and Stanford Hospital is building a brand new hospital. It would be common sense to do a lot of things jointly, but our opening is about two years ahead of [the new Stanford hospital’s opening]. But we’re making progress in coming up with the same technology solutions.
For example, when we installed our InnerWireless DAS, I don’t want to say we spoiled our physicians, but their pagers worked, their iPADs worked, their phones worked, their laptops worked [throughout our hospital]. But when they went over to Stanford Hospital, it was not the same case. They had spotty reception, and it’s actually forced Stanford Hospital to go ahead and install an Innerwireless DAS there as well.
Gary Close: From a marketing perspective we believe the academic institution is in even greater need of reliable technology for collaboration, with all of the people involved in taking care of a patient. You potentially have nursing students, interns, residents, et cetera. The academic center is in exaggerated need for collaboration between the care providers, and I believe especially when we talk about mobility, the ability to use mobile devices to collaborate, it’s in exaggerated need.
Ed, how critical are the mHealth applications and the reliability of the wireless infrastructure?
Ed Lowell: Very. It’s key that we have guaranteed wireless coverage within our hospitals. For example, we have wireless telemetry with our Philips monitors. We can take the patient out of their bed and let them be more mobile while we continue to monitor them. You need reliable infrastructure for that to occur. I sit on the West Wireless Health Council where we talk about a medical-grade wireless utility. This presents challenges to the FDA today where, for instance, in my hospital because of the DAS, these wireless devices work, but if you go down the road to a different hospital that doesn’t have a guaranteed wireless infrastructure, that same device might not work reliably, and the FDA is really being challenged [in that] can they approve this device if it works in hospital A but doesn’t work in hospital B? So they’re actually looking for this medical grade wireless utility so they can certify these devices will work, provided you have the proper infrastructure in your facility. That’s certainly something the InnerWireless DAS has provided us.
Gary Close: Ed hit the nail on the head with mobility. It’s the new care models that are enabled by mobility that I believe Ed’s new hospital will be able to pursue in earnest. So when we talk about moving processes to the point of care, the bedside—and we know there’s going to be a lot of technology there—having the assurance of a reliable wireless connection will enable Lucile Packard’s staff to move unencumbered as they explore new care models. It’s really the key to transforming acute care within the hospital. Having the wireless infrastructure in place and provisions for expanding capacity will enable Lucile Packard to adopt new mobile care models clinically and securely. I believe that’s the main contribution that InnerWireless will make to the hospital.
Can you expand on the concept of mobility in new care models?
Gary Close: When we’re talking about a new care model, and here we’re focusing on medical telemetry, most hospitals have it available on only 1 or 2 floors of the hospital. And in the case of a cardiac patient on telemetry monitoring, you have to stay within the confines of these two floors. Now imagine a new care model where the patient can go anywhere in the hospital and be monitored. That, to me, is an example of a new care model because Lucile Packard can use any room in the hospital they choose to put a patient that requires cardiac monitoring with a telemetry module. From an asset utilization perspective, they’ve effectively increased the efficiency of what type of patient they can put in a room.
Gary, how does your team manage the coordination for a project like the one at Lucile Packard?
Gary Close: We have been doing this for a decade. We not only pioneered the use of a DAS in healthcare, but I believe InnerWireless also pioneered and developed a best practice, if you will, of how to work in a hospital when you’re deploying this type of infrastructure solution. Understand that we deploy in two very different environments—existing buildings, like Lucile Packard, which we call a retrofit, and then in new construction. You can imagine that the considerations are quite different, for an existing building is filled with patients, but we don’t have that as a constraint that has to be managed [in a new hospital]. In the past 10 years, in both instances, InnerWireless has developed a time-tested best practice of how to interface with all of the stakeholders in the hospital and do it in a way that they can continue to deliver medicine if it’s an existing hospital and get the system installed. I personally believe any company that’s doing this has to understand the environment they’re working in. Hospitals are tricky because of the type of business they’re in. There are many stakeholders, and I think a company only develops proficiency in this vertical if they’ve done it successfully over a long period of time.
Ed Lowell: I’ll also vouch for InnerWireless’s involvement with our design. We’re implementing an MIBG room for nuclear medicine and we’ve got tons of lead in a particular patient room, and I’ve worked very closely with InnerWireless to ensure that we’ll get wireless coverage in this room that’s lined with several tons of lead.
Ed, with regard to the project itself, is it more difficult to coordinate between groups like physicians and the IS team, or to coordinate between the different parts of the new facility, like the new cancer center and the pediatric surgery center?
Ed Lowell: Frankly our challenge is not so much internal as it is coordinating with our external partners, such as the Stanford adult hospital, the School of Medicine, and Stanford University. We’ve got to be collaborative and cooperate on some of these technology decisions, and that’s where my challenges come in. Obviously, if we pick an RFID solution, it’s most beneficial if the adult hospital picks that same solution so we can track staff and assets between the facilities. That’s where the challenge comes.
How about when it comes to coordinating the many departments and stakeholders associated with the expansion project?
Ed Lowell: It is challenging, but it’s fun work, too. In the design of our expansion we have 33 different user groups that we’ve been meeting with over the last 2 years. We have made huge design changes, and we’ve also developed a mock-up area where we’ve mocked up operating rooms, med-surg rooms, ICU rooms, PACU rooms, and even hybrid MRI rooms so we can run nurses and physicians through these mockups. They do simulations, and we’re able to make modifications and adjustments to the design based on the feedback when they’re working in these mockup rooms. It’s been a great, fun activity to be involved with these last two years.