Prescription for success: at Hackensack University Medical Center, an unlikely branch of technology is playing a major role in helping doctors and nurses provide better patient care

Communications News, May, 2004

When someone mentions technology that is improving medical care and has the potential to save lives, most people think of a new diagnostic test or a state-of-the-art surgical technique. At facilities like Hackensack University Medical Center (HUMC) in New Jersey, however, an unlikely branch of technology--IT--is playing a major role in helping doctors and nurses provide better patient care.

Specifically, real-time, wireless access to patient information and clinical applications, such as computerized physician order entry (CPOE) deployed across the medical center campus, is allowing HUMC's peripatetic physicians, nurses and other staff members to improve decision-making, speed treatment and help ensure patient safety--with the desirable side effect of cost savings.

The move to computerized clinical information systems (CIS), which encompass electronic medical records (EMR), CPOE, medical documentation, orders/results and other processes, is a major healthcare topic today. The goal is to have comprehensive, up-to-date medical data for each patient available electronically at the bedside, instead of stuffed into a manila folder.

Some healthcare organizations are adopting CPOE, which enables physicians to input orders for medications, diagnostic tests and treatments directly into the computer instead of handwriting them, to improve accuracy and reduce medication errors. Converting from a paper-based to a computerized system, however, is a complex project--with many challenges and, potentially, high costs.

HUMC is a major research and teaching hospital and New Jersey's largest provider of inpatient and outpatient services. With technological innovation playing a key role in the healthcare provider's high-quality care, HUMC implemented a CIS that would ultimately deliver EMRs, CPOE and other capabilities. Part of this multiphase project was the deployment of several modules of IDX LastWord, a clinical software solution, over a wireless LAN using access infrastructure software from Citrix Systems.

"Our goal is to provide real-time access at the point of care to the complete patient record for our caregivers," says Gerard Burns, M.D., director of medical informatics at HUMC and a member of the medical staff. "The ability to view and input all types of information immediately, using one centralized computer system, allows physicians, nurses and other staff to make informed decisions and enable the best outcomes for our patients."

WIRELESS CONCERNS ADDRESSED

HUMC sought the best strategy for delivering the CIS system and other applications at the point of care to its highly mobile physicians, who needed access within the hospital campus and at remote locations, and to three shifts of nurses, who needed access at the patient's bedside. To Benjamin Bordonaro, HUMC's director of applications development and support, wireless access offered the mobility these caregivers required.

Bordonaro, however, had security, performance, administration and cost concerns about implementing a wireless system. Specifically, he worried that installing applications on wireless devices would put confidential patient information at risk in case a machine was lost or stolen, and that tracking down each device for application updates and maintenance would overtax his IT team.

There was additional concern around the slow performance of data-intensive applications over a wireless LAN. In addition, Bordonaro wanted to leverage as much of the current HUMC infrastructure as possible to keep expenditures down.

He found a solution by turning to HUMe's existing implementation of Citrix access infrastructure software, which was providing employees on a variety of devices with wired access to centralized applications. Citrix MetaFrame Presentation Server offered the ability to extend this implementation to support wireless access, without the need to rewrite applications.

Citrix access infrastructure separates an application's logic from its user interface, centralizing installation, processing, administration and deployment on the server or server farm. Users access the application on any device, over any network connection, sending keystrokes and mouse dicks to the server and receiving screen refreshes. The access infrastructure offers greater IT efficiency from centralized application rollouts, updates and support, high application performance over bandwidth-constrained networks and inherent data security by housing applications on the server rather than each device.

To further enhance the planned wireless-access project, Bordonaro decided to upgrade to Citrix MetaFrame XP Presentation Server software. This version of the product offers application performance and Web-enabling capabilities, in addition to more robust security and administration, to address wired and wireless application-access challenges.

THE NETWORK IMPLEMENTATION

To accelerate the wireless access project, Bordonaro and his team had Citrix's consulting group, Citrix Consulting Services (CCS) provide an analysis of the existing MetaFrame 1.8 architecture and assist in the design and configuration of the MetaFrame Presentation Server implementation. CCS also performed a subset of application testing to ensure the new configuration would work in the fast-paced healthcare environment.