Considerations for Consolidation of Pagers, Smart Phones, and VOIP Phones by Anticlue

Way down deep, and probably one of the first installed systems in your facility lays the in-house paging system connected to one or multiple nurse call systems. There is probably even a terminal over by the operators to alert the code groups. On the other spectrum, in your OR the anesthesiologists are beginning to mimic batman with the amount of devices on their belt. There is the Pager, Black Berry or iPhone, and perhaps a VOIP Phone. Obviously all communications are going to one place, but how do you get to one device receiving them all and still maintain the system interoperability?

With the upcoming HIMSS show and marketing campaigns to get us to vendor booths, I have seen several advertisements and whitepapers about consolidations. Additionally there are smartphones out in the vendor ovens which have VOIP embedded and will work with WiMax (IEEE 802.16). So device consolidation has all the pieces and parts in the right place, where it is time to think about it. It will be hard to get budgetary money given the HITECH and ICD10 initiatives.

Having done a replacement of a paging system at two hospitals, implemented a VOIP solution across a hospital, and been accountable for an evaluation at another. I figured it would be helpful to provide a quick guide to the "gotcha's".

Things You Need to Know about Consolidation

• It isn't going to be cheap - In all likelihood, the nurse call systems and paging systems just work. Maintenance has probably been dropped and the systems are fully depreciated and off the general ledger. While it may be getting harder to find Motorola replacement pagers, the ongoing cost of replacing a pager with a VOIP integrated smart phone maybe up to $1000 dollars for a complete kit, and the batteries are a lot more than a AA.
• It isn't going to be easy- Clinical Engineering, Telecommunications and Networking isn't magic. Additionally over the years, the contact information for your employees has been given as either: the pager, the Smart Phone, or the VOIP. Possibly all three are on business cards, so timing will need to be made for colleagues to change the cards and contact information. The pager number is not covered under FDA guidelines for moving with the person if you switch companies like from USA Mobility to AT&T.
• Your nurse call systems maybe really old and not well documented- Nurse call systems over the years have looked a lot like the red-headed Irish step child. They went from being departmentally managed to facilities to clinical engineering to IT. The inner workings are simple, but how it is wired and integrated may be difficult to obtain. Additionally your old in-house pager system maybe connected to disabled systems or live ones. Finally getting information out for who is in what paging group or code group may just not be possible, systematically.
• Investigate email integration through unified messaging- The new exchange 2007 has made some significant improvements in unified messaging, and if your pbx and voice mail system may have some bolt-on components which will offer integration. This avenue is worth investigating.
• Be wary of discontinuing pager agreements for towers- Over the years, physicians who practice at your facility probably have the same paging service for their practice as you do at the facility. It was easier for them to assure paging deliver, since you had an antenna on the roof. Paging companies are a dying breed, and loosing the 1000+ pagers of your hospital will be a big hit on them. Instead of investigating how to maintain the tower, the company may threaten to remove it and your physician groups will be without service. If you proactively manage your vendor, this hardship will not be incurred or a surprise. Additionally investigate if you have leased an antenna on other buildings to improve pager reception range. Within in this aspect, reach out to the credentialing and medical staff office early in the discovery.
• Assure you survey the site for coverage- This should be a just getter done, but have a spectrum audit of the facility ahead of time for wireless (including n) MaxWiFi, cell coverage, and include RFID while you are at it. It will be useful and worth the money later.
• Check out your institutions policy on distributing smart phones- The IRS changed the rule book a while ago, and although rumors abound that they are changing it again. Check out the cell phone distribution criteria. If you are looking for an all encompassing devices, determine how payment and replacement payment will be made. For example, if it is a cell phone stipend, how would that be provided to non-employeed physicians? If it is a pay for personal calls is it really worth it for the clinicians time?
• Investigate Role Based Devices - Have a good discussion with insights from the hospital clinical leadership, hr leadership, and operational leadership, on possibly moving from a single user based determination to a role based determination for device. For example, employeed physicians receive the deluxe and latest combo, while OR nurses get the VOIP device.
• Validate the Nurse Call, PBX and WiFi infrastructure can handle newer technologies- As with the wireless site survey, sometimes the networking and telecom infrastructure is comprised of unsupported legacy assets. The newer technologies may not be compatible.
• Do a pager, voip, and cell phone audit beforehand- Most organizations over the past year nad half have gone through and reduced expenses around telecommunication devices. But an audit and determination of usage will give you insights to how widespread the devices are and how the devices are integrated with business process
• Communicate, Market, Communicate- These device are attached at the hip, so communication and shared understanding of the benefits of this change as it helps improve efficiently will help improve adoption and patience for the blips in the road.

The TakeAway

As with all projects, doing a good assessment and evaluation is worth its weight in platinum when considering consolidating the devices. Plan for at least two to three months of discovery and investigation, which is larger than most assessments.

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