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01/04/2007Wi-Fi and Healthcare Possibilities Are Endless
Hank Fanberg is with Research & Development Information Management at Christus Health, one of the largest Catholic healthcare systems in the country. Christus Health is partnering with the City of Corpus Christi, Texas, to explore a range of home, community, record-keeping, and emergency response medical applications to be deployed across the city’s broadband-wireless network. The following is adapted from Hank Fanberg’s presentation, "Digital Communities—Health e-Communities,” at the W2i Digital Cities Convention in Los Angeles , May 24–26, 2006.
 Christus Health is partnering with the City of Corpus Christi, Texas, which has made an investment to develop a citywide wi-Fi network across 150 square miles. The city is trying to use the network to deliver better services to all citizens as well as to spur some economic development.
Christus Health has about 30 hospitals throughout Texas and Louisiana and five in Mexico, and it’s the largest healthcare provider in Corpus Christi. It has three hospitals in the city itself, and three in surrounding rural areas. The ambulance service is owned and operated by they city, and about 60 percent of runs end up at a Christus hospital.
When the city asked what could be done with its network, Christus Health saw an opportunity. Much of the healthcare provided to people without health insurance and to the indigent is not compensated for, and about 30,000 people in Corpus Christi have no insurance, and the hospital district pays for their care with tax dollars. We are all paying for healthcare for people in our communities who can’t afford to pay for it themselves. If we can give them better care, hopefully we can drive down costs, and make people healthier than they are today. Most of the time, apart for paying for the indigent, municipalities don’t spend a lot of time thinking about what they might be able to do with healthcare delivery. But the city asked, what can we do?
Phase 1: Emergency ResponseChristus decided to work with emergency response to create a linkage to the paramedics in the field who can access individuals’ information from the scene of an incident. Very simply, if you’re walking around Corpus Christi and get hit by a car, the ambulance team executes the standard protocols. But if it has specific information about you—blood type, allergies, medications—it provides the opportunity to give best and most accurate care right at the scene.
Christus is pretty early in the phases of the project. Paramedics can access the hospital’s database, but this hasn’t been tested yet in a live situation. Nine ambulances in Corpus Christi have an EKG machine, and the wireless network will be used to transmit the EKG readings from the ambulance to the cardiologists.
The cardiologists are excited about this because time is critical. If someone is having a heart attack, the faster you can get them into the catheter lab to clear out the artery, the better the outcome is going to be. Clinical studies show that if you don’t get someone into the cath lab within 90 minutes, chances of damage to the hearth muscle increase dramatically, along with chances of a truly negative outcome leading to death. Even if it’s only five minutes earlier, doctors can make the determination to get the person into the cath lab. They can call the cath lab, have it prepped, and be ready and waiting as soon as the ambulance hits the doc in the ED. If the patient is stable, you can move them right into the lab.
Phase 2: Personal Health RecordCorpus Christi has a program in place called the Vile of Life, a paper-based program in which people are supposed to write down their important health information and put it in a device that looks like a syringe and then place that in their refrigerator. Paramedics on a call go to a house to respond to someone having a medical emergency, and the first thing they’re supposed to do is go to the refrigerator and look for this syringe-like vile, open it up, and get the information. But who knows how old the information is? Who knows when it was put on the paper and into the refrigerator?
The city wants to develop a Personal Health Record that goes beyond the hospital database—a database for everyone in the city. Because the city is on the Gulf of Mexico, a large population from the Midwest comes down and spends its winters in the area. They may not have the primary physician relationship down there, so, in Phase 2, a separate database would be linked to the city’s CAD system. This is still under discussion.
Privacy and confidentiality are very important, and creation of the Personal Health Record would be on a voluntary basis. (For example, at the Veterans Administration, someone took a computer with a disc filled with information for tens of thousands of veterans.) If individuals see value in the record, they will participate. They will be able to create their own personal health information and input the data with their permission from the hospital database.
Phase 3: Home HealthThe third phase includes people who are bound to the home because of some situation that limits their ability. A nurse may visit the home from time to time, but this is a manual process, and the records are all on paper files. Why can’t we equip the nurses with a laptop or PDA device where they can access the person’s record via the wireless network that’s in place, put whatever information they need right into the system, and transmit it via the wireless network back to the database? Further, because nurses can’t prescribe, they can begin an e-prescription process to notify the doctor that they’ve been to the patient and seen the situation. Here is all the information to refill these meds; can we go ahead?
A lot of medical equipment companies are making monitoring machines to be placed in the home. They take blood pressure, temperature, and weight, and the information is uploaded. These machines will be distributed to people within the community, and the data will be delivered using the wireless network that’s in place.
Phase 4: The Healthy CommunityThe fourth phase includes distributing access to healthcare across the entire community. We don’t mean doctors in the hospitals, but kiosks around the community in whatever locations are important—churches, shopping malls, beauty parlors, colleges, libraries, grade schools, etc. We want to give people access wherever they happen to be. These sites become the Healthy Community Network.
People will be issued a card—modeled after a smart card—to authenticate your ability to get into the network. While some of the technology and how to do this is still being debated, people will eventually have a method to find their health information and ask questions. The entire community gets blanketed, and this begins raising peoples’ awareness about their behavior, which is drives people to change what they do and creates a healthier community.
Can we send people messages that are specific to them, and link them to the wireless network? If someone has a blood test done, and if their values are out of whack, why can’t we send a message to them: You may want to go to your healthcare provider to make sure this doesn’t get more serious.
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