• July 2008 FEATURE ARTICLES •
Wireless/Mobile Computing
Wireless is More
A comprehensive network strategy can trump wireless challenges for healthcare enterprises.
By Cathy Zatloukal
There has never been a better time to take
advantage of wireless connectivity in healthcare. Technologies
have matured, carriers value their highly mobile healthcare
customers, and the demand to untether caregiving is high. The
time is right for hospitals to forge ahead and adopt next
generation wireless technology, placing mobile applications
within reach.
Today, the pressure to enable mobility in
healthcare is as great as the potential to improve healthcare
with wireless technology. Just five years ago, hospital
administrators banned the use of cell phones, fearing that Wi-Fi
and cellular connections would interfere with medical equipment
ranging from ventilators to pumps. Today, such a ban would be
unimaginable, as wireless has become a priority for IT
departments, clinicians and engineers alike.
What was once uncharted territory for
hospitals has now materialized into real workflow gains.
Caregiver productivity has increased and wireless access has
become an indispensible tool. By deploying more wireless
monitoring gear bedside, patients are more ambulatory and nurses
can cover more ground, thus improving both the patient
experience and optimizing care delivery. Beyond telemetry
applications, untethering caregivers helps hospitals to maximize
the use of limited resources while serving growing patient
populations and making better use of fewer beds and staff.
Hospitals also realize that care can be
delivered from anywhere when wireless access is available
everywhere. Without wires, mission-critical tools are at
caregivers’ fingertips. The new definition of mobility has come
to mean marrying a physician’s location with other staff
expertise, the patient’s medical records, internal databases and
the location of available equipment, thus transforming disparate
data into a web of actionable knowledge. This high level of
connectivity has resulted in customized care tailored to each
patient’s needs. Hospital administrators also reap the benefits
of location-based wireless technologies with improved asset
utilization and cost savings across the board.
The wireless world never sits still,
so a good design means future-proofing the system, so expansion is as seamless and cost-effective as possible.
In the long-term, wireless connectivity could
even improve how hospitals treat patients. When a patient isn’t
in the ICU or the ED, the hospital can continue to capture the
patient’s vital signs with wireless patient telemetry solutions
throughout the care continuum — even from as far away as the
patient’s own home. Over time, this capture of minute-by-minute
medical data can be analyzed and used to transform the very
nature of care itself, changing how hospitals administer
treatment. Before the vision of a completely integrated mobile
experience becomes reality, hospitals will need the tools to
make it happen.
Addressing Interference
As technology matured and antenna management
evolved, interference fears have proven to be unfounded. Lacking
vital wireless coverage indoors is actually the bigger concern
for IT departments, clinicians and engineers alike.
As staff complaints mount, hospitals turn
their attention to the structural causes of "dead-spots" or
coverage gaps inside their facilities. Dense concrete, steel and
shielded glass materials absorb outside RF signals, or degrade
them, creating poor or nonexistent cellular reception inside the
hospital. As a result, wireless coverage is unpredictable,
location-dependent and sensitive to floor plan changes. Thus,
many hospitals must add antenna systems indoors so that
caregivers, patients and visitors can use their mobile devices
to communicate throughout the hospital.
It actually takes a structured system of
antennas and cabling to make indoor wireless work. An element of
a distributed antenna solution is to prevent interference by
mitigating it through proper antenna placement and design as
well as filters, which clean signals from the outside. Lowering
RF power indoors is another mechanism used to ensure "dirty"
high power signals are not unevenly distributed inside
buildings, exacerbating the interference problem. Current
solutions on the market aim to create broad wireless coverage
that enables multiple services without sacrificing signal
quality.
In addition, with multiple radio frequencies
in place, a single hospital will need to support a variety of
wireless operators, devices and wireless services including
cellular voice and data, Wi-Fi, public safety radio and wireless
medical telemetry services. This requires a comprehensive
wireless network infrastructure.
Multiple Stakeholders
Another challenge stems from the way
healthcare entities are organized, as hospitals are not typical
enterprise environments. While many are considered large
corporations, they have become a collection of different
corporate groups where physicians are employed by their practice
groups; laboratories are their own entities; and, clinics
operate off-campus but continue leveraging central facilities
for analysis and laboratory services. This decentralized
structure often complicates IT departments’ plans to centralize
control over wireless application, frequency or mobile device
decisions. Each entity may even have its own IT budget and
separate funding source for computing equipment and
infrastructure investments since requests can come from any
practice group or department.
Over time, separate requests for technology
have meant that the average hospital has multiple mobile
applications running on different floors, often unrelated to one
another. For example, patient records and medication inventory
management are accessed on separate systems, and physician and
nurse paging applications are on another system. Some medical
data is stored digitally and some still as analog copies that
need to be shared among the physician’s practice, the insurance
carrier, and other entities — all while protecting patient
privacy. It is a tall order for any integrator that must
implement a new kind of network to link all of this together.
Ultimately, the IT department can’t prescribe
a "one-size-fits-all" wireless solution or practice single
device enforcement for everyone onsite. Consequently, a
hospital’s wireless infrastructure will need to be flexible in
order to provide wireless coverage for a variety of changing
mission-critical applications, an assortment of mobile devices,
new and existing frequencies, multiple operators and a variety
of user needs. The same system will also need to adapt as
hospital floor plans change, new buildings are constructed and
as progressive new applications are needed to support
cutting-edge medicine.
Universal Platform
The days of a single wireless network that
supports services from just one wireless operator are clearly
over. There are different frequency bands for medical devices,
cellular and Wi-Fi. In addition, there are different subspecies,
applications and protocols within these frequency bands that
make for a very convoluted collection of radios running inside a
hospital. Running 10 or more different wireless applications and
services is the typical scenario at many hospitals.
Consequently, forcing standardization on a single application or
technology is nearly impossible.
Consider the situation of providing better
indoor cellular coverage for voice applications, as an example.
The IT department can’t choose a single cellular operator
because caregivers prefer to use their own cell phones and will
have a variety of providers and plans. In addition, medical
technology providers have recognized that there is a growing
demand to mobilize applications so that they are PDA- and
phone-ready. As a result, most hospitals today support three or
more of the major wireless carriers as they deploy indoor
cellular coverage solutions.
The same is true for WLAN, as today’s
hospitals must support all varieties of Wi-Fi, now that there
are wireless devices operating across the 802.11b/g and 802.11a
standards. Again, this support is complex, since Wi-Fi frequency
bands get used for more than just sending computer data. They’re
also used for voice over IP and video streaming applications.
In some cases, hospitals are finding that
existing Wi-Fi applications are rapidly consuming their Wi-Fi
capacity, so they’re now looking to other licensed frequencies
such as cellular and WiMAX to carry more of their data traffic.
Wireless is no longer a single domain, a single technology or
frequency or even a single protocol. Hospitals need a universal
wireless platform that can handle the broad range of
applications currently available with the scalability to
accommodate future applications.
Wiring for Wireless
Ironically, any indoor wireless solution is
going to require wiring, such as a cabling and antenna
infrastructure, to distribute signals. There are really two
distinct architectural approaches for delivering a mix of
wireless services: 1) multiple parallel networks or 2) a
universal, multi-service network.
The first approach requires a separate
antenna system for each wireless service that needs to be
supported in the hospital. Each wireless service has its own
dedicated cabling infrastructure to bring each radio signal from
its external source through to ceiling-mounted antennas
distributed throughout the building, resulting in multiple
separate and parallel networks. With this solution, Wi-Fi is
deployed as a separate network from the cellular or any other
wireless services.
The universal solution uses a single cabling
and antenna system that supports multiple wireless services
simultaneously. This approach relies on broadband fiber optic
and coaxial cabling to deliver radio signals from multiple
external sources to the multi-service antennas located in the
ceilings. With this type of solution, Wi-Fi signals are
supported over the same cables and antennas used to deliver all
other wireless services.
With the universal approach, Wi-Fi access
points are kept in secure, yet accessible wiring closets and
Wi-Fi signals are combined with the other wireless services so
that all signals run over a single cable to a single set of
broadband antennas. This has the advantage of keeping IT
infrastructure in ceilings to a minimum and in more centralized
areas that can be protected and more easily maintained. This
approach also removes equipment from locations in high-traffic
patient areas, allowing equipment to be accessed without
invoking time-consuming and expensive infection control
procedures.
Current solutions on the market aim to create broad wireless coverage that enables multiple services without sacrificing signal quality.
In hospitals especially, one of the most
significant cost components of any antenna installation is the
final few yards of cabling that go from the closet to where
end-users are located. In addition to the labor costs of
installing cable in the ceilings, hospitals must absorb the
expenses associated with the infection control procedures and
regulatory compliance issues that surround installation work in
sensitive hospital areas.
However, with a universal wireless solution,
hospitals can keep cabling costs and operational expenses
contained. A single installation can accommodate all of the
hospital’s current and future wireless requirements. And, by
moving managed network elements to wiring closets, new services
can be added at any time without the disruption and cost of
penetrating the ceilings. The wireless world never sits still,
so a good design means future-proofing the system, so expansion
is as seamless and cost-effective as possible.
Conclusion
Today’s healthcare decision makers have at
their disposal, a broad range of wireless applications that
promise to boost productivity, enhance the patient experience,
and provide a competitive advantage. However, getting there
isn’t easy. To support these applications, hospitals will need
to provide facilitywide coverage for an increasingly complex
array of wireless services operating across multiple frequency
bands.
At the same time, the wireless industry is
growing exponentially, with many new technology options emerging
over the next five years. To thrive in, and fully take advantage
of this dynamic environment, healthcare IT organizations must
develop proactive wireless strategies and invest in future-proof
wireless infrastructure solutions.
Cathy Zatloukal is CEO of MobileAccess in
Vienna, Va. Contact her at
czatloukal@mobileaccess.com.