Some Things You Need to Know About WLANs in Healthcare
Airwave is a best of breed WLAN management vendor that is infrastructure vendor agnostic. They have a new white paper titled, 5 Things You Need to Know About Managing a Wireless Network in Healthcare. Let's go down the list, shall we?
- You cannot manage what you cannot see. The demanding nature of both users and applications requires rapid problem resolution. Airewave provides what they call “real-time network visibility” that shows all users, which access point (AP) they're associated with, and network performance. Data includes RF heatmaps, usage reports, detailed user roaming histories, and more.
- Your HIPAA compliance officer will require regular configuration audits of your Wi-Fi infrastructure. Well, maybe if IT tells them they should. While this is a shameless play to a health care specific need, what they describe is really useful – more useful in reality than their scary HIPAA compliance benefit. Airwave can apply enterprise wide configurations and security settings to all your APs, and continue to monitor those settings once they're set. The alternative here is getting out your ladder and visiting each and every AP yourself – or the poor guy you send off to do it.
- The most likely location for a rogue AP is far from your wireless sensors and existing APs. This one seems a bit weak. Most WLANs nowadays monitor for rogue APs and automatically keep them from associating with any wireless devices. I suppose there's some value here in having this integrated with the rest of your management capabilities, or if you had an old infrastructure that didn't support this.
- One network engineer can't manage a wireless LAN by himself. The point here is that their WLAN management console can be accessed by multiple users (e.g., the helpdesk) and remotely via the web interface. This is not earth shattering, but at least they appreciate how thin a lot of hospital IT shops can be.
- Your wireless network will only get larger and more diverse over time. They've got that right! As much as we try, we live in a heterogeneous world. Now is the time to get ahead of the curve.
That was a nice list of issues, given their perspective. I would add a few more things. Here are the Connectologist's 5 things you need to know.
- Quality of service (QoS). Many folks think of wireless VoIP at the mention of QoS – I think of wireless medical devices with continuous data streams and life threatening alarms. “What about WMTS for this,” you say? WMTS is presently used by some patient monitoring vendors. I am not aware of any IV pump, ventilator or point of care testing vendor who is contemplating WMTS over 802.11a/b/g. Medical devices will be on your network, and they will be life critical, and you must ensure their QoS.
- Roaming. Some health care users like discharge planners or social workers are “mobile” in that they go all over the hospital working in various places. Other users are truly mobile – they actually move while communicating with the network. Examples include patients on a smart pump or patient monitor who are ambulating or are taken down to radiology or some other department. These types of users will cross subnets and they will not take kindly to having to login in or reestablishing patient context every time they cross a subnet.
- Capacity. Everyone is mental for coverage, and rightly so. But just as important is capacity, the number of devices that must be supported within a confined area. In the not too distant future, every nurse and physician will have at least one wireless device they carry. Add to this computers on wheels (COWs), wireless medical devices and perhaps active RFID tags, and you've potentially got a lot of devices in one area. Imagine two acute patients in adjoining rooms and one codes – you could have 15 or 20 devices associating with one AP – what is that going to do to latency?
- Security. You need more than WEP. At one hospital I know, a team testing WEP cracked a rogue AP running WEP in 3 days (that included finding the rogue AP) – and that was using AirSnort and other publicly available tools. Oh, and don't expect device vendors with embedded radios to support proprietary security schemes (I'm thinking Cisco here).
- Site surveys. Different WLAN applications require different site surveys because of different performance requirements. Plan on doing site surveys a number of times as you add capabilities to your WLAN. Site survey tools help approximate coverage and provide a starting point for AP deployment, they are not the final answer – you are. Oh, and don't just take your vendor's recommendation and slap up a 150 milliwatt AP every 100 meters.
UPDATE: Okay, I admit it. I came up with a fifth item for my list so I'd have as many as Airwave…
Cardiovascular Information Systems: Planning for Success
I came across this story a few weeks ago (it's been a slow news day) about planning for PACS. While we're on the back side of the bell curve for PACS adoption, the adoption of multi modality cardiovascular information systems (CVIS) is just taking off. This article provides a nice outline for some of the key things accounts can do to ensure success in adopting CVIS (with a few obvious twists).
Global RFID Forecast – $3 Billion by 2010
In 2005 RFID spending was $504 million, a 39% increase over 2004, according to Gartner (registration required). Their estimate for 2006 is $751 million. Garner's study reports that RFID will not replace bar coding (which is cheaper), but will be used in applications that bar coding can't support.
structured and engineered processes, such as warehouses, and this will
likely continue for the next five to seven years,” Mr. Woods said.
“However, RFID tags will be used for data collection of mobile assets
and in largely chaotic or unstructured business processes, ranging from
retail environments to hospitals, enabling these environments that lack
sophisticated process engineering or controls to be systematically
managed.”
They even have something to say about how RFID adoption is evolving in hospitals:
controlled by an incumbent business application,” Mr. Woods said.
“Contrary to the notion that companies will need to “integrate” RFID
data into established transactional applications, companies will likely
need to develop new business applications if they want to put RFID at
the centre of a process. In this, the opportunity for real process
innovation exists.”
This jibes with my position that RFID is not a product but an enabling technology for new applications, like infant security, hospital wide patient flow, and departmental throughput applications (especially in the ED and operating rooms).
Gartner has published a series of reports that provide detailed analysis on the future of the RFID. The 78-page report 'RFID Enables Sensory Network Strategies to Transform Industries'
examines the factors affecting RFID adoption, as well as the impact
RFID has on vertical industries. Gartner has also released its
inaugural RFID market size, share and forecast report entitled 'Market Share and Forecast: Radio Frequency Identification, Worldwide, 2004-2010'. Both reports can be obtained from Gartner.
Trends in Nursing Units Impact Patient Care and Technology
Research has shown that good design can impact length of stay (LOS), patient safety, and outcomes. Health Facilities Management published a round table discussion on Nursing Unit Planning and Design. Much of the discussion centered on traditional nursing units and how they’re crowded, noisy and chaotic. In response to this there is a trend to moving caregivers closer to the patients. A number of the participants also indicated that their hospitals were moving to in-room computers.
We have found success combining centralized and decentralized design. The centralized area is what we often refer to as the work and care area. It’s a place for physicians to talk with patients. It’s a place for the unit clerk, the social workers and the case managers, and it’s a place for folks to coordinate their care of patients. It’s the social aspect of what oftentimes the nurses and the physicians need to ensure proper communication.
Certainly, the decentralized area ensures that the nurses are not walking as far to fetch various things. They’re closer to their assignment areas, and getting away from stress, which is what we’re trying to mitigate in our architecture for the nurses, the patient and families, and the physicians.
So how do we do that? How do we mitigate the noise issue? In design, I struggle with how to balance that. I struggle with getting things close or farther away. I struggle with noise, equipment, beds that are moving around, things coming up on the floor. It’s a balance of doing both centralized and decentralized.
It seems that technology could greatly reduce nursing unit noise. Wireless communications devices like phones or Vocera badges would eliminate much of the overhead pages and shouting down the hall that occurs now. A nurse carried alarm notification device would minimize device alarm noise at the central station central station and remote annunciators.
These changes in work patterns will have a major impact on medical device design, especially central stations. If nurses spend much less time at the nurses station, the operating costs for central stations will go up as monitor techs are hired to cover for absent caregivers.
Mobile Phones Don't Interfere, Can Improve Patient Safety
First it was the Mayo Clinic, now it's Tan Tock Seng Hospital (TTSH) in Singapore who has published a study on the safety of cell phones in hospitals. Phones can be used anywhere in the hospital as long as they're at least 2 meters from a medical device.
TTSH's study found that doctors spend an average of 80 minutes a day
making return calls. Nurses spent between 40 and 200 minutes paging
doctors daily.
Nursing officer Abdul Kahar Sulong, 42, said he used to stand by the phone waiting for a doctor to call back after paging.
'Now, it's easier for the doctors and us,' he told the newspaper.
'Also if there's an emergency, we can call the doctor directly.'
Doctors will be informed automatically when patients' laboratory test results are ready later this year.
In another study published in Anesthesia & Analgesia, investigators showed that using mobile phones actually reduced errors by facilitating improved communications.
reported using pagers as their primary mode of communications and 17
percent said they used cellular telephones. Forty percent of
respondents who use pagers reported delays in communications, compared
to 31 percent of cellular telephone users.
He said the reported 2.4 percent prevalence of electronic interference
with life support devices such as ventilators, intravenous infusion
pumps, and monitoring equipment is much lower than the 14.9 percent
risk of observed medical error or injury due to a delay in
communication.
Interesting statistics. This is the first ever study on the potentially beneficial impact mobile phones have on patient safety. Let's hope more follow soon.
