Can We Fix Wireless in Health Care?

Awareness is growing about the challenges of developing and maintaining safe and effective wireless medical devices. What with IEC80001 moving forward (due to be finalized next year) and the recent series of wireless medical device workshops, people in hospitals and among vendors are asking more of the hard questions about wireless. Amongst the turmoil, participants are jostling for position. This post looks at common problems with Wi-Fi, a report from U.K. alliance ERBI, and some alternatives to Wi-Fi.

Problems with Wireless

Those of us who are old enough, think back to the golden age of wireless medical devices — channelized analog telemetry. These systems were so basic and limited in scope (a couple dozen transmitters typically covering just a single 30 bed unit) that they had few problems and required little maintenance.  Today, larger hospitals are pushing the envelope with a few hundred patient monitors and a thousand or more wireless infusion pumps. These wireless devices are using sophisticated client radio/access point (AP) communications protocols to maximize capacity, whether using Wi-Fi or WMTS. We’ve since left the golden age far in the past.

Radio frequency (RF) spectrum is a shared resource. There’s no getting around that fact, even with “dedicated” spectrum. The ether in which wireless signals move is like gases in the atmosphere or chemicals in water. There are no ways to practically segregate RF signals to specific areas, except for a Faraday cage. In a health care facility, some shielded rooms in Radiology qualify as Faraday cages, but little else. Much of the rest of a health care facility consists of objects and structures that seem to perversely confound and obstruct RF communications in  ways like partially blocking and attenuating signals, creating multipath interference, and radiating both intentional and unintentional interference. Intentional interference is where two or more users of a portion of wireless spectrum get in each others way, disrupting or degrading the communications of one or both parties. When there are problems with two or more wireless devices using the same spectrum, this is intentional interference, often referred to as coexistence problems. Unintentional interference comes from electromechanical devices that accidentally spew RF signals as a consequence of some degradation or failure. Common sources of unintentional interference are florescent light balasts, blow dryers, paper shredders, elevator motors, or faulty microwaves. You can see a bunch of examples of RF interference on a spectrum analyzer (which everyone doing wireless medical devices should have, and know how to use) here.

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GE Healthcare Acquires Agility Healthcare

A unit of GE Healthcares global Diagnostic Imaging Services business acquired Agility Healthcare Solutions today for an undisclosed sum. This is the same group that did the deal with Anywhere several years ago, and most recently signed a distribution deal with CenTrak, which was announced at HIMSS 2008 (press release).

What started as a straight on asset management strategy has grown in scope.

Any hospital administrator knows about the daily headaches caused by the logistical coordination of providing patient care. For each and every patient interaction, patient, clinician, staff, space, assets & supplies must come together at the same time. Agilitys visualization system is the one tool weve found that lets us visualize these interactions to predict and prevent bottlenecks before they occur, said Jeffrey Burke, Vice President and Regional Chief Information Officer, Bon Secours Health System.

The RTLS (real time location system) market’s initial focus was asset management. The industry consensus at the time was that asset management was easy to understand and had an attractive ROI – most hospitals lease some of their equipment that ends up poorly utilized due to hoarding and misplacing equipment. An RTLS can significantly reduce the amount of equipment leased through increased visibility and thus, utilization. Sadly, the hospital market was not sufficiently compelled to adopt this application (regardless of the ROI) at the rate that entrepreneurs and venture capitalists expected.

The founders at Agility, being software guys from McKesson, started with software. After some initial experience in the market they decided to stick with software and resell whatever infrastructure best suited their customer’s application. And the applications the market pulled them to are the kinds of things Bon Secours is doing.

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GE and Sprint Announce Some Kind of Wireless Stuff

GE-logo

Yesterday I came across an eWeek.com story about GE Healthcare and Sprint. There were lots of what marketing folks call “glamor words” but little in the way of substance. After reading another 4 stories here’s what I’ve figured out.

GE Healthcare is taking their proprietary WMTS wireless telemetry, the MobileAccess in-building distributed antenna system (what GE calls CARESCAPE Enterprise Acess), Sprint’s CDMA and iDEN cellular phone services, combined with the customer’s WiFi network, and is providing integrated wireless connectivity engineered (I think) by Sprint’s Custom Network Solutions group. (Here’s the GE press release – by far the most informative source on this announcement.) From the press release:

Uninterrupted communication within a hospital is a requirement for physicians, patients and visitors and is essential to quality care. Sprint (NYSE: S) and GE Healthcare announced today their collaboration to provide in-building wireless communications services to hospitals in North America. Patients, clinicians and hospital visitors will benefit from secure, reliable voice and data communications, supporting an environment conducive to higher levels of patient care. Historically, the use of mobile phones in hospitals has been limited due to unreliable wireless support and the risk of interference between wireless phones and medical equipment. Using the new combined offering, physicians and caregivers will be able to communicate amongst each other and securely access patient information from almost anywhere in the facility.

Motherhood and apple pie. But what’s the announcement?

The new in-building cellular communications network from GE Healthcare and Sprint’s Custom Network Solution (CNS) team leverages GE’s CARESCAPE Enterprise Access, a single, universal wireless platform powered by MobileAccess, and includes Sprint handsets. This solution will provide hospitals with a comprehensive platform for voice and data communications over secure cellular, Wi-Fi and telemetry infrastructure that requires only one installation. Using the combined offering, clinicians, patients and hospital visitors can communicate more efficiently and with ease.

“Sprint CNS provides scalable coverage and a high-capacity platform for wireless voice and data services on the Sprint National Network and Nextel National Network, enhancing the mobility and productivity of staff at hospitals and other businesses,” says Darlene Braunschweig, vice president of CNS at Sprint. “We are very excited to partner with GE Healthcare to provide differentiated and innovative mobile solutions that are critical for every business. This new solution facilitates constant communication of secure information amongst hospital staff; an aspect very critical to patient care.”

So it seems that Sprint will pipe their cellular network into hospitals to run on the MobileAccess DAS. This is something that MobileAccess can already to – with any carrier. It is not clear how (or if) Sprint’s offering will be differentiated from other carriers. Nor is it clear if CDMA, iDEN or both networks will be supported. For that matter, what about the new WiMax wireless network that Sprint’s building? The fact that a Sprint handset is required is also confusing. Since US carriers lock their phones to their networks, of course you must use a Sprint phone on their network. Or does the Sprint handset provide some special features? Oh, and the bit about “secure cellular” – all cellular networks are secure, especially the air link which is encrypted.

Does the announcement also include WAN networking on Sprint’s backbone? This is also not clear, though it could be a nice feature if there was a nice bundled (i.e., reduced) price, or there were other hospital trading partners on the WAN.

The downside of this announcement is that Sprint is a second tier mobile carrier at best (52 million subscribers), behind both AT&T (58.7 million subscribers) and Verizon (54 million subscribers). They are also the only carrier with the iDEN network (they bought Nextel). Hospitals that only offer Sprint in building coverage will meet the needs of less than a third of potential users. Hospitals need carrier agnostic solutions that allow users to connect, regardless of carrier. Maybe GE is working on announcements with AT&T and Verizon too.

Unless someone can explain it to us, this seems this is a non event.

In other news, the Chair, President and CEO of Sprint, Gary Forsee, beat a hasty retreat. It seems that, “Sprint decided it was time to put new leadership in place to move the
company forward in improving its performance and realizing corporate
objectives.”

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HIMSS 06 Wrap Up

Arnaud-Houette-Brian-McAlpine

Yesterday I was asked for some quick impressions of this year’s HIMSS. Now that I’ve had a bit of time to digest the event, here’s what I came up with. First, this show was much more of a business development/business alliance oriented show. Many vendors were openly partnering and had products in each other’s booths, brought together by their efforts to bring to market broader solutions that meet market requirements. These alliances frequently revolved around connectivity.

  • First Vocera came to market (a few years ago) on the strength of a health care targeted wireless communicator, and has done well. This year Ascom was the first established phone company to take that step with an almost full blown point of care system integrating wireless phones with nurse call, medical devices and more. Ascom now represents a competitor to both Emergin and their wireless phone competitors.
  • Two new wireless patient monitors were introduced at HIMSS using 802.11b (the GE Dash and Spacelabs SL2400). The adoption of ISM/Wi-Fi over WMTS for wireless patient monitoring is significant, and reinforces the trend away from that proprietary narrow band.
  • GE showed near real time fetal monitor surveillance (AirStrip OB) on smart phones – with a 510(k), no less! (check this photo)
  • PDAs and tablets lost much of their cache this year – there were lots of laptops and integrated computers on COWs (computers on wheels), AirStrip OB on smart phones, and while not an exhibitor, there was buzz about the OQO handheld computer. (check this photo)
  • Welch Allyn was the first major vital signs monitor vendor to release a wireless vital signs monitor for data integration into EMRs (the new Spot) – a couple years behind Stinger Medical. Also of note, Welch Allyn licensed Wellogic’s server software for their wireless vital signs monitor. Clinical servers are neither rocket science nor a trivial effort, what with role based access support, CCOW, RADIUS/LDAP integration, HL7, remote access (i.e., a web server), data storage and high availability. So far, not a single medical device vendor has launched a decent server – until now.
  • Integration middleware vendor Emergin was in over a dozen booths – most of the smart pump vendors, patient monitoring, nurse call and wireless phone vendors, and a few HIT vendors.
  • This was also a year for refining product strategies for patient flow application vendors – in particular, StatCom and Awarix have moved beyond (and in different directions from) bed management to help out more broadly with hospital care delivery.
  • On the imaging front, this was (if not the first) the largest presence of cardiovascular information systems (CVIS) shown at HIMSS. Agfa/Heartlab, Witt Biomedical, McKesson/Medcon, ScImage were all there – and maybe a couple I missed.
  • All the smart pump vendors (Cardinal/Alaris, Hospira, Baxter, B Braun) showed progress in moving past the first generation of wireless features.
  • RFID was hot hot hot at HIMSS this year. In apparent agreement with my post that RFID is not a product, many RFID vendors introduced software applications – mostly basic patient flow apps. RFID also presents an interesting issue for device vendors – for the slackers who don’t embed a Wi-Fi radio into their device, should they embed some kind of tag technology?
  • Finally on a related topic, wireless network infrastructure also got some buzz. GE formally introduced their deal with MobileAccess, InnerWireless repositioned themselves at the show (rolling out their RFID solution and dropping the “leaky coax” part of their solution), and lots of wireless LAN vendors – Cisco, Aruba, Trapeze, Symbol and Meru.

Whew. Pictured above right are two of the Godfathers of Connectivity: Arnaud Houette of Capsule Technologie, and Brian McAlpine with Emergin.

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