BMET RESOURCE FILE

Ban or Bandwidth? Has Your Hospital Changed Its Cell Phone Policy?
Colleen Diez

or several years now, the use of cell phones and other electronic devices in hospitals has been cause for debate. Concerns over what equipment is susceptible to radiofrequency energy (RF) seem to have diminished, only to resurface again as those in the biomedical profession discover new equipment that is affected by wireless phone usage. Surprisingly, as the debate grows, more hospitals are removing the ban on cell phone use. In January 2003, a survey on currentpath.com a BMET-oriented Web site showed that only 13 percent of hospitals that participated allowed unrestricted cell phone use. Ten months later, that number has now jumped to 39 percent. Frank Magnarelli, Director of Clinical Engineering, at Miami Childrens Hospital, agrees with his hospitals decision not to have a cell phone policy. As a Childrens Hospital, we have to think of parents and their children, said Magnarelli. What youve heard is mostly hype from the news media, as opposed to good science. Parents need cell phones to communicate with their families outside the hospital, he added. We have a temporary ban on cell phones in the presence of one manufacturers ventilators, explained Magnarelli. The manufacturer alerted us 3 months ago, and thats our only piece of equipment thats affected, he said. In response to the manufacturers warning, Miami Childrens has printed up 5 x 5 stickers to place on the 30 ventilators affected by cell phones. Apart from those, we had had no previous problems, said Magnarelli. Other hospitals refuse to wait for notification from equipment manufacturers. Early last year, a study led by Cheryl Shaw, clinical
Colleen Diez is a Staff Writer for AAMI. Biomedical Instrumentation & Technology

engineer in the Biomedical Engineering department at Massachusetts General Hospital (MGH, Partners Healthcare) and Rick Hampton, Wireless Communications Manager for Partners Healthcare, identified susceptibility to electromagnetic interference (EMI) on one model of patient ventilators from a manufacturer. We did ad hoc testing on several pieces of equipment, said Shaw, and we deployed cell phones into the intensive care unit [ICU]. The tests were conducted on a variety of devices such as defibrillators, infusion pumps, dopplers, and ventilators. Cell phones were held 30 centimeters (about one foot) from the equipment. People were confused, recalled Hampton, because cell phones and other hand-held devices were being used by staff anywhere, but were prohibited for patients and visitors. Even though one ventilator was particularly susceptible to EMI, the hospital decided to allow cell phone use everywhere, for patient benefit. The ventilator in question was upgraded by the manufacturer, and according to Shaw, there have been no recent problems. Warning people not to use cell phones within 3 feet of ventilators has been left up to the ICUs of Massachusetts General. They put up signs that discourage cell phone use, said Hampton. Good Samaritan Hospital, located 30 miles south of Seattle in Puyallup, WA, recently conducted cell phone testing to determine the level of risk to many types of patient care equipment. Our current policy was drafted in the mid-1990s, said Jim Kenyon, Supervisor of Biomedical Engineering at Good Samaritan. It restricts the use of cell phones in 10 distinct patient care areas such as emergency rooms, cath laboratories, operation rooms, and ICU. Good Samaritans testing will deter437

BMET RESOURCE FILE

Ban or Bandwidth? Has Your Hospital Changed Its Cell Phone Policy?

mine if this policy should be reassessed, as there is demand from patient families to communicate in OB and Post Partum. Several years ago, cell phones operated at much higher power levels [up to 3 watts] and testing showed a considerable amount of interference on many types of patient care equipment including telemetry systems, blood warmers, incubators/isolettes and ventilators, said Kenyon. Todays cell phones operate at less than 600 milliwatts and manufacturers design most patient care equipment to withstand higher levels of radiated power, he said. The Biomed department of Good Samaritan, part of the hospitals Information Technology (IT) team, conducted testing by procuring 3 types of cell phones from AT&T, Verizon and Nextel. Phones were held at varying distances from devices, ranging from 20 feet to right next to the devices. The devices used were identified as clinically significant, said Kenyon, and included patient and fetal monitors, telemetry, vital signs monitors, infant blood warmers and blood warmers, among others. Each piece of equipment was tested 4 to 5 times in different locations. Our testing showed no adverse effects, said Kenyon, and indicated that the ban would probably be lifted. Another hospitals policy continues to prohibit all use of cell phones in the hospital. A collaborative study by Biomedical Engineering and Nursing Service at Texas Childrens Hospital, along with Baylor College of Medicine, Motorola, and Cisco intends to reassess the potential dangers and effects of cell phone use. We are conducting clinical site testing of the impact of cellular telephone operation on medical devices in patient care locations, said Yadin David, PhD at Texas Childrens Hospital. At present, we operate under a policy that prohibits the use of cellular telephones within the hospital, he said. Currently, a technical information report on the guidance of electromagnetic compatibility of medical devices for clinical/biomedical engineers is available through AAMI. The TIR18:1997 document provides information on radiated radio-frequency electromagnetic energy, cell phones, and ad hoc testing. The AAMI EMC Committee started work in June 2003 on a second edition. A task group was formed to develop a work proposal for presentation to the full committee, said Jeff Silberberg, Senior Electronics Engineer, FDA Center for Devices and Radiological Health, and co438

chair of the AAMI EMC Committee. David predicted that the use of wireless communications devices only will expand. The benefits from rapid communications between healthcare providers anywhere anytime are important, said David, thus, the use of wireless tools will continue to increase, and together we need to find a way to facilitate this. How can hospitals communicate rapidly and combat cell phone interference? Were about to launch an in-house cellular network, said Frank Magnarelli. Rick Hampton concurred. Were putting in a distributed antenna system, he said. The antenna system would operate at very low power, and provide coverage for any cell phone from any manufacturer. Once installed, anyone can use their cell phone anywhere in the hospital, he said. Problems with cell phone interference, however, may arise from medical telemetry in hospitals. One vendor we looked at had a system that would re-radiate nearby signals throughout the whole facility, said Hampton, and this could cause potential interference problems with telemetry receivers. Good Samaritan Hospital has already faced telemetry problems. Weve significantly expanded our telemetry coverage throughout the hospital, said Jim Kenyon, and weve confirmed that cell phones used within one foot of the telemetry transmitterwhat the patient wearscan cause their waveforms to be distorted. Because of this, the hospital will institute a policy that cell phones must remain a specific distance away from patients. In response, Kenyons department has provided small signs that can be posted at a patients door with a No cell phones allowed message that are available to any department. The hospitals current cell phone policy will soon be updated to reflect the extension of their telemetry system. Could the upgrading of wireless telemetry systems have an unforeseen effect on cell phones in hospitals? I dont know that its ever been the hospitals sole responsibility to fix these problems, said Hampton. It will take a cooperative effort between the hospital, FDA, and the medical and communication device manufacturers, he suggested. Magnarelli disagreed. Were supposed to be the voice of sanity, he said, and I dont think we took the lead.
November/December 2003