1. © 2005 University of Chicago Hospitals Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Todd Hollowell Director, Information Technology University of Chicago Hospitals October 18, 2005

2. © 2005 University of Chicago Hospitals 2 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Discussion Topics »Introduction »Today’s Objectives »Standard Technologies »Leading Edge Approaches and Solutions »The Wireless Utility in Healthcare »Conclusions

3. © 2005 University of Chicago Hospitals 3 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Introduction »The University of Chicago Hospitals –In July’s U.S. News & World Report 2005 "Best Hospitals" issue, the University of Chicago Hospitals (UCH) is ranked 14th nationally overall. This year marked the ninth time UCH made the Honor Roll since 1995. –Closed Staff Model (600 residents, 620 attending faculty) »Key Facts –Bernard A. Mitchell Hospital, the primary adult inpatient care facility –Chicago Lying-in Hospital, a maternity and women's hospital –New Comer Children’s Hospital opened in February 2005 –~28,000 patient admissions annually –~420,000 outpatient visits to the Duchossois Center for Advanced Medicine (DCAM) –Over 80,000 ED visits (Level 1 Peds, Level 2 Adult) –~5,500 employees –Regional Doctors Offices located throughout the Chicagoland area

4. © 2005 University of Chicago Hospitals 4 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Today’s Objectives »Review standard technologies at the “top of mind” with all healthcare providers »Discuss a handful of up-and-coming technologies »Focus on the Wireless Utility for Healthcare –Discuss how UCH has implemented and why it will continue to implement a wireless utility approach –Current vs. Future applications –Benefits gained

5. © 2005 University of Chicago Hospitals 5 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Standard (but ‘hot’) Technologies »Clinical Information Systems –Electronic Medical Records (EMR) –Computerized Physician Order Entry (CPOE) –Electronic Medical Administration Record (eMAR) –Picture Archiving and Communication Systems (PACS) »Business Applications –Enterprise Resource Planning (ERP) –Patient Accounting/Revenue Cycle Management –Enterprise Content Management »Infrastructure –Medical Grade Networks (wired) –Storage, Back Up and Disaster Recovery solutions –High Availability Computing environments –802.11/Wi-Fi infrastructures

6. © 2005 University of Chicago Hospitals 6 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Leading Edge Approaches and Solutions »Medical Device and IT Convergence »Radio Frequency Identification (RFID) and Locator Systems (RFLS) »Robotics (surgery, pharmacy) »Enhanced Medical Imaging Solutions (e.g. 64 slice CT scanner) »Blended Shore/Off Shore delivery models »“The Wireless Utility in Healthcare”

7. © 2005 University of Chicago Hospitals 7 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare History of Wireless in Healthcare »Wireless systems in healthcare are not new –Two-way radios –Voice/text paging systems –Telemetry and wireless portable bedside monitors »New wireless devices and applications are emerging –Voice badges –CPOE –eMAR –RFID/RFLS »The predictable consequences –Multiple uncoordinated, discretely managed, wireless systems –Added risk - quality, safety, and security –Inadaptable infrastructure –High total cost of ownership (TCO)

8. © 2005 University of Chicago Hospitals 8 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Why is the Wireless Utility Important? »Health care organization’s workers are mobile (nurses, physicians, etc.) that need access to their applications and tools…anywhere, anytime »Wireless technologies and applications are proliferating healthcare - requires a coherent IT strategy, plan, and policy around wireless technologies »Benefits for traditional wireless applications for staff communication and IT applications are well documented »Wireless will not replace wired networks – at least in the near term »Life safety and mission critical applications require a ubiquitous and reliable wireless service

9. © 2005 University of Chicago Hospitals 9 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare All IT Infrastructure Should be Virtual »IT Virtualization: (noun) the pooling of IT resources in a way that masks the physical nature and boundaries of those resources from resource users. - Gartner, 2004 TechnologyYesterdayTodayThe Future Computer Hardware Individual standalone processors Blade computers Dynamic computing with auto-load balancing Seamless virtual computing environment Examples IBM On Demand HP Adaptive Enterprise EDS Agile Enterprise Operating Systems A single operating system per box. Multiple operating systems run simultaneously on same box. Data Storage Separate disks Volume managers Storage arrays Storage area networks (SANs) Network attached storage (NAS) Enterprise Networking Multiple infrastructures Protocols –IPX/SPX, TCP/IP, etc. Topologies – Ethernet, token ring, etc. Converged IP networks Grid and mesh networks

10. © 2005 University of Chicago Hospitals 10 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Future Vision for Wireless »Wireless Virtualization –Enables mobile workers to experience seamless communications and information access from any device and from any location –No knowledge of underlying wireless technology or infrastructure required –In buildings, enabled by a ubiquitous common wireless infrastructure »Requires a Wireless Utility! TechnologyYesterdayTodayThe Future Wireless Proprietary technologies Few standards Point solutions Many standards and technologies 802.1x standards Convergence opportunities Seamless mobile environment enabled by virtualization and a Wireless Utility

11. © 2005 University of Chicago Hospitals 11 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Does a Wireless Utility really provide the solution hospitals need? »Questions we asked ourselves as we were assessing our position in UCH’s new Comer Children’s Hospital two years ago: – Should we deploy multiple single-point, in-building wireless systems? – Each requiring its own equipment and distribution infrastructure, technology standards and communication protocols, and maintenance, management and operational overhead OR –Was the technology ready today to build a shared wireless distribution utility? –We chose the latter

12. © 2005 University of Chicago Hospitals 12 Joint Wireless/ICS Meeting Point solutions are more costly and difficult to manage than enterprise solutions. An HVAC analogy… You wouldn’t cool your building with individual window units… … you would build a single HVAC infrastructure – an in- building utility. The Wireless Utility in Healthcare

13. © 2005 University of Chicago Hospitals 13 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare In determining what we wanted out of a Wireless Utility, the UCH IS team established the following technical goals: »Build a shared, broadband wireless infrastructure »Provide consistent, reliable radio frequency (RF) coverage »Minimize interference potential with hospital biomedical equipment »Ensure the utility is managed and secure »Guarantee predictable, low total cost of ownership »Provide flexibility for new services and applications »Ensure it is open…make it protocol and service provider independent

14. © 2005 University of Chicago Hospitals 14 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare UCH Wireless Utility Design »Reliable wireless communications (designed for > 95% coverage) using a single infrastructure that will support current, as well as future, wireless voice and data services »Ability for 2-way radio (450 MHz), Paging (900 MHz) and PCS/Cellular Carriers (800 and/or 1900 MHz) to distribute their wireless services at their licensed frequencies throughout the facility »Provide uniform coverage for wireless LANs (802.11) for immediate and future installations »Ability for UCH to add capacity at any time without modification to the system »Ability to operate the system with little maintenance, due to the passive design »Ability to add any current and anticipated frequency between 400 MHz and 5 GHz

15. © 2005 University of Chicago Hospitals 15 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare What is it? »InnerWireless ® solution »Universal broadband RF access »Passive design/no electronics »Multiple services today including WiFi, cellular (from multiple carriers), paging, two-way radios »Insertion of new services (First Responders, Wireless Medical Technology Service, Building Automation Controls) as needed and available

16. © 2005 University of Chicago Hospitals 16 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Excellent performance Threshold performance Intentionally below threshold Comer Hospital Floor Plate Engineered Coverage is Essential

17. © 2005 University of Chicago Hospitals 17 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Expandable to any size

18. © 2005 University of Chicago Hospitals 18 Joint Wireless/ICS Meeting Wireless Utility The Wireless Utility in Healthcare

19. © 2005 University of Chicago Hospitals 19 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare The Future Role of Next Generation Cellular (3G) in the Enterprise

20. © 2005 University of Chicago Hospitals 20 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Wireless Utility – Comer Results: »Greater than ninety-five percent coverage, including elevators/stairways –Load balanced –100% redundancy –70 to 80% reduction in network access points »50 to 1 improvement in exterior RF security over other typical installations »Improved physical security –Access points in controlled equipment closets –Hidden antennas and coax distribution environment »“Utility Grade” reliability –Less Access Points = less points of failure »Lower maintenance costs –No periodic maintenance required…system is passive –Fewer access points to procure and maintain »Low cost evolution –Update few centralized access points

21. © 2005 University of Chicago Hospitals 21 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Security and Coordination  Two-way radio  Paging Building Control  HVAC/Energy  Security cameras  Monitoring devices  RFID/RFLS Personal Communications  Cellular/PCS  Paging  Blackberry and PDAs  WiFi/802.11, including Wireless VoIP  Wireless Medical Telemetry Service (WMTS)  Sensors Medical Data UCH Wireless Utility Applications Today and in the Future

22. © 2005 University of Chicago Hospitals 22 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Wireless Utility – Other Results and Plans »Wireless telephones are integrated with the nurse call system and the Philips monitors and has had several positive impacts –Lower noise level on floors with nurse call alerts coming through telephones vs being broadcast throughout the floor –Nurses are able to be connected via the wireless telephone anywhere in the building reducing cycle time –Sense of nurses being very satisfied with these new tools and feeling that it helps them do their jobs better »Paging and two-way radio systems have worked flawlessly using the Wireless Utility »Cellular providers are connecting to the environment currently (Cingular is on; Nextel, T-mobile, and Verizon are coming) »RFLS solution will be in beta test mode within 60 days »Proximity locators should be in place within the next 12-18 months »UCH is retrofitting its legacy facilities with the Wireless Utility

23. © 2005 University of Chicago Hospitals 23 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Partnership with InnerWireless/JCI »Entire Comer Children’s facility covered, including stairwells and elevator shafts »Incremental capital costs mitigated by integrating with the JCI portion of the construction program »Early adopter status provides additional discounts and attention to implementation »Early estimates are that it will be expensive to retrofit current adult hospital and outpatient building, but we will do this in preparation for our new clinical system rollout »May have revenue opportunities with cellular providers »Have uptime warranty and performance warranties »Guarantees for coverage (and leakage) »Commitments to work with Cisco and other vendors (RFID) »Representative list of current healthcare customers –Barnes-Jewish –Baylor Healthcare –St. Luke’s Health System (Kansas City) –Mass General –Children’s Memorial

24. © 2005 University of Chicago Hospitals 24 Joint Wireless/ICS Meeting The Wireless Utility in Healthcare Conclusions… »The Wireless Utility is here and is a critical convergence opportunity that helps to manage costs and speed implementation of new applications »UCH Results –System installed and tested to specifications in Comer Children’s Hospital –System live in production and supporting patient care (e.g. wireless telephone integrated with monitors and nurse call system have resulted in quicker response to patient needs) –Cost effective convergence opportunity; avoided costs for distribution systems for other wireless technologies (paging, two way radio, cellular, etc.) –Provides ability to manage and secure the wireless infrastructure –Well-positioned to integrate future wireless technologies (e.g., RFID/RF locator systems, medical equipment, etc.) –Vendor committed to our success and delivered »Next Steps include… –Estimating costs and planning the implementation of the wireless utility into existing hospital spaces in preparation for new clinical system and other wireless applications –Working with medical device manufactures to validate compatibility and speed industry adoption