DALLAS — The ability for VA hospitals to remotely track the vital signs of patients has been around for longer than a decade, but it always has been limited by cost and technology.
Patients who need remote monitoring were relegated to specific areas of the hospital where that service was available. But a new system recently employed at the Dallas VAMC may mean that the hospital will be able to track patients throughout an entire facility using the hospital’s existing wireless Internet network.
Existing patient-worn monitoring technology at VA hospitals requires a dedicated wireless medical telemetry system (WMTS) band — a proprietary medical band controlled by an antennae system installed wherever a hospital wants to monitor patients.
According to Rick Sullivan, vice president of Draeger Medical — the company installing the new system at the Dallas VAMC — this older technology was tedious to install and expensive to maintain.
“Most hospitals only have one or two wards equipped for this kind of monitoring. It limits them,” Sullivan said. “For instance, if you have an oncology patient but they have a cardiac issue, they’re OK to be discharged from the ICU, but they still need to be monitored. Traditionally, they would have to go to a dedicated telemetry ward, whether it was the oncology specialty ward or not.”
As hospitals have maintained this monitoring system, Wi-Fi technology has grown around it — a much simpler and cheaper way of wirelessly gathering data.
“We are now able to do this kind of patient monitoring using Wi-Fi,” Sullivan said. “Most hospitals have Wi-Fi installed throughout their facilities. That means you can do wireless patient monitoring anywhere in the hospital. There’s an advantage to that, especially in places like VA who are bursting at the seams with patient load.”
Monitor Patients Anywhere
Patients no longer will have to wait in the emergency department until a bed in a telemetry ward opens up, Sullivan said. “The same is true of the ICU. You can get patients out of the ICU and monitor them anywhere. Before, patients ended up with longer ICU stays than should be normal.”
Older telemetry systems are little more than “a dumb box,” Sullivan said. “With traditional telemetry, it’s just a transmitter, a little box about the size of a cigarette pack, and there’s no display at all. There’s no waveform or anything. It’s just picking up the signal off the patient’s ECG and sending it back to a central station, and there’s a technician there monitoring the feeds for all the patients.”
The Draeger Infinity M300 — the device worn by patients in Dallas — has a screen displaying the waveform. “So, if a nurse is caring for a patient on the ward, and they want to see what’s going on with the patient from a cardiac standpoint, they can look on the screen. It’s not just telemetry. It’s actual patient-worn monitoring.”
The system also is cheaper to maintain and install. The previous system at Dallas went through batteries on the patient-worn devices every eight hours or so, while the Draeger system uses rechargables. “It’s better for the environment and cost savings for the hospital,” Sullivan said.
The rollout of the Draeger technology at the Dallas VAMC hit a major security road bump midway through the process.
To transfer data over a wireless Internet system, the government requires a special data encryption called Federal Information Processing Standard (FIPS) 140-2. The Dallas VAMC had purchased the monitoring system but was delayed because the system was not FIPS-compliant. Dallas applied for a waiver, but there was no immediate response.
Then it was announced that Roger Baker, VA’s chief information officer, was allowing VA employees to use iPads and iPhones to access patient data. The decision was met with some controversy, but an investigation by the Government Accountability Office found that, despite the technology not being FIPS-compliant, it was safe.
“We went back to them and said, ‘This is a VA-controlled medical device. It’s far safer than an iPad,’” Sullivan said. “So they granted us a waiver that’s applicable nationally.”Dallas VAMC Tests Wireless Monitoring of Vital Signs; Rollout to Full VA Possible
Retrofitting VA Technology
Draeger is working with the manufacturer of its wireless radio to build a FIPS-compliant chip that will be available in late 2013, after which they will go back and retrofit all the technology installed in VA.
How many that will be in 2013 depends on the success of the Dallas VAMC rollout. According to Kurt Finke, VA’s director of healthcare technology, VA will be looking at how the system works over the long term. Not only will Draeger need to prove that the technology can be made FIPS-compliant by late 2013, but the system needs to be shown to be stable and reliable over the long term.
“It’s very important that the Wi-Fi network be very reliable,” Finke said. “Gaps in coverage or bringing down the system for maintenance for an hour or even for 15 minutes was tolerated for nonessential things. But when it’s supporting medical telemetry equipment, that can’t happen.”
According to Finke, VA will be watching how the system works at the Dallas VAMC for at least a year, if not longer, before installing the technology at other sites. Of the 152 VAMCs, 60 have robust enough Wi-Fi systems to use the technology, and 24 are expected to be upgraded soon. The technology is already in use at some military healthcare facilities, including Brooke Army Medical Center in San Antonio and the David Grant USAF Medical Center in Fairfield, CA.
“It’s not necessarily true that this is the way we’re going to go in the future. But we’re watching carefully how things go in Dallas and see how that works,” Finke said.
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