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Implementing a House-wide Digital Telemetry System with Central Monitoring Room. Alan Lipschultz Director, Clinical Engineering Christiana Care Health Services Newark, Delaware. Overall Outline. Why we embarked on project What changed Brief overview of system Decision Process

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implementing a house wide digital telemetry system with central monitoring room

Implementing a House-wide Digital Telemetry System with Central Monitoring Room

Alan Lipschultz

Director, Clinical Engineering

Christiana Care Health Services

Newark, Delaware

overall outline
Overall Outline
  • Why we embarked on project
  • What changed
  • Brief overview of system
  • Decision Process
  • WMTS vs 801.11
  • IS Backbone vs stand alone network
  • Layers of system backup
  • Technical cooperation & Service Roles
christiana care health services
Christiana Care Health Services
  • 1000 bed, tertiary care, 2 campus system
  • Historically – Islands of telemetry for selected patient areas. No dedicated staff for watching monitors.
  • Currently – All telemetry (300 channels) monitored from Central Monitoring Room with dedicated monitor watchers
why we embarked on project
Why we embarked on project
  • Frequent alarms, paper ran into waste basket
  • Nurses tended to ignore low level alarms
  • Two sentinel events – low level alarm ignored & patient expired
  • Severe bed crunch with ED diverts
  • No more UHF channels available
what changed
What Changed
  • Central Monitoring Room (CMR) remote from clinical units
  • monitor watchers, not nurses
  • CMR staff delivers, applies and retrieves telemetry boxes
  • Almost any Non-ICU bed can become a telemetry bed
  • Major culture change for nurses and physicians
  • System onto IS network backbone
brief overview of system
Brief overview of system
  • 328 channels of telemetry
  • 802.11 protocol in 2.4 GHz ISM band
  • System resides on main hospital backbone using virtual LAN
  • Full two way communication between network and telemetry units
  • Access points provide “cellular-like” communications with telemetry units
  • Telemetry units have ECG display on front of unit. Works independent of network.
overall process
Overall Process
  • Clinical/political decision to implement centralized system
  • Search for best vendor to meet goals of clinicians
  • Decision to put system on IS network backbone
  • Implementation
decision process
Decision Process
  • Clinical vision established first
  • Wanted extremely flexible system
  • Early on - decided to utilize IS backbone
  • When we were looking (late 2000), technology was cutting edge
  • Different market today
  • Much uncertainty in market (WMTS vs ISM band)
wmts vs ism 802 11 system
WMTS vs ISM 802.11 system
  • Did not feel WMTS was good option
    • Bandwidth too limiting
    • Proprietary, no standards
    • one way communications
    • at the time we were making decision, most systems were identical to conventional telemetry system we were replacing.
wmts vs ism 802 11 system1
WMTS vs ISM 802.11 system
  • 802.11 industry standard for all sorts of devices
    • Inter-connectivity w/non-medical & medical devices
    • Lower cost
    • infrastructure can be reused
  • Concerns about sharing ISM Band
    • If “rogue” device were to come into institution, would not be able to connect to anything without proper codes
    • Frequency hopping was originally designed to hop around any interference that does occur
    • No issue coexisting with 802.11b applications
is backbone vs stand alone network
IS Backbone vs Stand Alone Network
  • Fully switched IS network with VLAN technology
  • Knew that system would be all over institution. Access Points, terminals, printers
  • Some floors only had a few Access Points
  • Closet space extremely tight
is backbone vs stand alone network cont
IS Backbone vs Stand Alone Network (cont)
  • Utilize existing infrastructure (cost)
  • Good cooperation between Clinical Engineering and Information Services
  • IS really set up for complex network management
  • UDP Packets
  • VLAN technology didn’t initially provide quality of service
layers of system backup
Layers of System Backup
  • High Availability (HA) servers with RAID. (“A” and “B”) Physically separated in different rooms
  • Redundant network switches – one for “A” and one for “B” set of servers
  • Any telemetry device can be used anywhere in system
  • Redundant coverage for Access Points
  • Redundant telephone switch
  • Two way communication between telemetry devices and rest of system
  • If communications lost, telemetry device automatically reverts to local mode with ECG display on face
implementation
Implementation
  • Process/cultural changes much more difficult than technical implementation
  • First CMR adjacent to nursing unit
couldn t work w o close technical cooperation
Couldn’t work w/o close technical cooperation
  • Vendor - hardware, software & 24x7 technical support
  • Information Services group - network infrastructure, network printers, UPS units, 24x7 network monitoring
  • CE – front line repairs, bridge between technical and clinical world, IS & vendor & clinicians, installation coordination
definition of service roles
Definition of service roles
  • How is problem noticed
    • User
    • LAN notification
    • System notification
  • CE primarily responsible. Initially most issues were IS or vendor
  • IS handles network issues
  • Vendor plays an integral service role
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