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Marc Bloom remembers when cell phones were banned from his hospital. Now, not only are they required, but they must also be turned on. Once a wireless wasteland, hospitals have come a long way. It's not much of a stretch to say we are at the dawn of a golden age of untethered healthcare networks.
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"Our entire hospital communications would collapse without wireless technology," said Bloom, M.D., Ph.D. and director of perioperative technology at the NYU Langone Medical Center in Manhattan, N.Y. Most healthcare facilities, NYU Langone included, have laid the foundation for this new era by building not one but two hospital wireless networks: one for clinical purposes and the other for guests (patients, visitors and medical staff) using their own mobile devices.
On the clinical side, the advent of EHRs and electronic medical images has fueled the need for greater wireless bandwidth. In addition, a growing population of medical devices -- such as glucometers and infusion pumps -- are being enabled for Wi-Fi, an advancement that clears up a confusing and potentially dangerous tangle of wires in patient rooms. "There is a vast array of equipment connected to a patient -- a spaghetti of wires. It would simplify things to make these things wireless," said Sundeep Rangan, associate director of NYU Wireless, the network consortium in which NYU Langone Medical Center participates.
Craig ReiseBoston Medical Center
Clinical Wi-Fi networks and the devices that attach to them must clear a high bar for reliability, so as not to compromise patients' treatment. They must also maintain a high level of security, to protect patient privacy and meet HIPAA regulations. To achieve those two goals, access points must be placed strategically -- taking into account Wi-Fi obstacles like cinderblock construction and lead-lined X-ray rooms -- and Wi-Fi Protected Access 2 encryption must be implemented.
In addition to core clinical functions, hospital Wi-Fi nets are often tapped to transport voice over wireless local area network telephone communications. This is done to ensure secure voice communication between hospital staff and real-time location systems, which use radio frequency identification-enabled electronic badges and tags to pinpoint the location of hospital patients, personnel and equipment.
The guest network is of no less importance. "Guest access is also mobile health. It impacts your loved ones in the hospital," said Ali Youssef, senior network architect at Henry Ford Health System in Detroit and co-author of the book Wi-Fi Enabled Healthcare.
While essential, guest networks must be managed in a completely different way than the clinical nets. "The guest net is slower, and you can't get patient records. You're not supposed to have a health record on a personal device," said Bloom.
Even so, the traffic carried by guest nets can be significant. At Henry Ford Health System, Youssef was faced with the task of building out sufficient access points and bandwidth to support some 24,000 employees, each with two personal wireless devices.
Guest networks keep patients connected with the outside world, including news, sports, friends and well-wishers, and they keep visitors entertained while they wait to see a loved one. However, expectations must be tempered. "People in the waiting room expect to be able to hop onto Netflix and watch 'The Walking Dead,'" said Craig Reise, manager of infrastructure engineering at Boston Medical Center (BMC) in Boston.
To keep a lid on usage, some hospitals prohibit the ability to stream content and place limits on bandwidth. "If you give them the bandwidth, they will use it," said Youssef.
In contrast, the clinical network must deliver all the bandwidth that might be required by medical devices in a highly reliable and secure way. "Your quality-of-service strategy should be to always give medical devices priority," said Youssef.
It's also essential to enforce strict rules about the devices that are permitted. "You have to take a really hard line about what's allowed on the network. You can't use a personal laptop on the medical network," said Reise.
To assure that records never leave the server, even on the clinical network, institutions are finding client virtualization technology effective. BMC uses Citrix client virtualization technology on the PCs that make the rounds on mobile carts. "Citrix helps with security, also availability and performance. You don't have to deal with keeping the clients current on all the patches," said Reise.
All of this is taking place as the curtain rises on 802.11ac, the technology that will provide Wi-Fi bandwidth at speeds of 1 gigabit per second. The 802.11ac standard made a splash in 2013, when it was finalized and the first compliant products were announced. It was hailed as particularly well suited for meeting the sharply increasing bandwidth needs of hospital wireless networks.
Many medical institutions are engineering transitions to the new standard. BMC is in the midst of a year-long upgrade of the approximately 850 access points in its clinical network to 802.11ac equipment from Aruba Networks Inc. The network upgrade is taking place in conjunction with a $300 million redevelopment of BMC's entire hospital campus. The plentiful bandwidth will make for efficient handling of electronic medical records on BMC's recently deployed Epic EMR system. Altogether, the clinical network at BMC handles about 3,000 concurrent devices during the day, less than that on nights and weekends.
Prairie Mountain Health in Brandon, Manitoba, completed an upgrade of its 802.11n network to 802.11ac in January, according to Doug Burch, senior information systems engineer at Prairie Mountain. Although the 802.11n network met the institution's needs, its wireless equipment supplier, Meru Networks, was phasing out 802.11n gear. The situation gave the institution little choice but to upgrade. Soon after the network upgrade, the hospital got its first 802.11ac-ready laptop, Burch said.
The rapid progress that has been made thus far, while impressive, offers only a glimpse of the functionality that tomorrow's hospital wireless networks will be able to deliver.
One of these capabilities is the ability of devices to send information back and forth on their own. "Right now, devices that sit next to each other don't talk to each other," said Bloom. An obvious need, he said, is for bedside monitors to communicate wirelessly with devices that track patient functions. And since medication can change the readings on monitoring equipment, he adds, "When a nurse administers medication, it would be nice if [monitoring] devices knew it was coming."
Although real-time location system tag technology can now track the whereabouts of doctors, the ability to recognize when a specific doctor enters a room and instantly display the information that doctor needs would be a highly desirable enhancement.
Generally speaking, the technologies behind scenarios such as these already exist or are not far off from being commercially available. In addition to Wi-Fi, some of these capabilities will likely be enabled by equipment using Bluetooth Low Energy technology.
Although the 802.11ac Wi-Fi nets that are being installed today are expected to have enough bandwidth for most applications, they could be augmented by 802.11ad, a variant that provides short range (about 10 meters), but high throughput (up to 7 gigabits per second) for bandwidth-intensive activities within a single room.
With technologies like these working in concert, the centerpiece of the golden age of wireless healthcare will be a smart hospital that delivers more efficient, more personalized care in an uncluttered, patient-friendly environment.
About the author:
Stan Gibson is an award-winning editor, writer and speaker who has covered IT for more than 30 years. He can be reached at firstname.lastname@example.org.
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