Posted by: Jenny Laurello
EMR, Medical devices, mHealth, Mobile devices and telehealth, mobile health, UHF, Wi-Fi, Wireless, Wireless Medical Telemetry Service, WMTS
Guest post co-authored by: Chris Bolinger, Product Director of Embedded Wireless Solutions and Natalie Sheerer, Marketing Specialist of Embedded Wireless Solutions, Laird Technologies
Using Wi-Fi for medical device connectivity to a hospital network brings many benefits to caregivers, device administrators, and even those on the business side of the hospital. Benefits affect many technologies, including:
- EMRs: Once a medical device is associated to a patient, medical device data can be stored in the patient’s electronic medical records (EMRs). More complete data on a patient leads to better patient care because doctors will have constant access to important information such as patient blood type, prescribed drugs, medical conditions and other aspects of the patient’s medical history. Healthcare providers improve their ability to make well-informed treatment decisions with more complete patient information. This also decreases the likelihood of doctors ordering repeat tests, which waste time and money.
- Monitoring: A network-connected device can be monitored from a central point of control, such as a nurse’s station. This enables nurses to monitor the health of many patients without constantly moving from one patient room to the next. It also can give nurses visual alerts of potential issues with patients, augmenting an audible alarm that a nurse may not hear.
- Device management: Another example of the benefits of a centrally monitored device is if a network-connected infusion pump needs a new drug library, the network can be leveraged to download the library to the pump, where an application can install the library on the pump.
One might think the majority of medical devices in hospitals are connected to hospital networks via Wi-Fi because of all the benefits they supply. In reality, most hospital medical devices do not use Wi-Fi. Phil Raymond, wireless architect & product manager for Philips Patient Care and clinical informatics, and chair of the Wi-Fi Alliance Healthcare Marketing Task Group, shared why many hospitals don’t connect their devices to Wi-Fi.
Wireless and patient monitors
Philips is a market leader in patient monitors for hospitals. Patient monitors, like most medical devices, were originally designed to operate in standalone fashion, without a connection to a hospital’s network. The first network connections for patient monitors were wired connections.
Philips has offered Wi-Fi connectivity as an option on its patient monitoring product line for over a decade, according to Raymond. Few hospitals used the option until a few years ago, but adoption of Wi-Fi on patient monitors is beginning to climb, and Raymond expects adoption to accelerate once hospitals overcome certain challenges presented by Wi-Fi.
“The value of enabling enterprise devices wirelessly is well documented,” said Raymond. “The challenges lie in the design and management of a network that requires 24/7/365 operation for high-bandwidth applications and real-time streaming traffic. And some of this traffic may be remote surveillance of ambulatory (mobile) acute-care patients. When you combine the challenge of maintaining a persistent connection in unlicensed spectrum with a patient that is ambulating, there may not be the resources to design and manage such a high performance network.”
Many hospitals in the U.S. use an alternative to Wi-Fi called WMTS (Wireless Medical Telemetry Service). While Wi-Fi operates in the unlicensed 2.4 (gigahertz) GHz and 5 GHz bands of the radio frequency spectrum, WMTS operates primarily in the ultra-high frequency (UHF) bands, where the Federal Communications Commission (FCC) has allocated some spectrum for WMTS. It was allocated in 2000 in response to interference issues related to the establishment of digital television. WMTS is the only frequency spectrum designated exclusively for medical telemetry systems. WMTS networks are dedicated networks, and only patient monitors connect using WMTS.
The FCC designated the American Society for Healthcare Engineering (ASHE) as its medical telemetry frequency coordinator and requires all transmitters operating in the WMTS bands be registered with ASHE to ensure interference-free operation. ASHE maintains a database of WMTS transmitters and is responsible for notifying users of potential frequency conflicts. Although some vendors support Wi-Fi or Bluetooth for wireless medical telemetry devices, both the FCC and the Food and Drug Administration (FDA) encourage the use of WMTS.
One of the downsides of WMTS is the use of these bands has not been internationally agreed upon, so in most cases devices cannot be marketed or used freely in other countries. The fact that WMTS frequency bands are not contiguous (608-614 megahertz (MHz), 1,395-1,400 MHz, and 1,429-1,432 MHz) can add to the cost and complexity of developing and deploying devices using WMTS. Furthermore, the bandwidth available is only 13 MHz, which according to a blog post by Tim Gee (a Principal Consultant with Santa Rosa Consulting) is barely enough to deploy a few hundred patient monitors in a large hospital. Finally, the WMTS band specifies frequency only, and the WMTS rules contain no recourse for institutions that suffer interference or coexistence problems.
The FCC is evaluating the relocation of one of the WMTS bands, 608-614 MHz. The FCC and ASHE will determine the full impact of moving thousands of medical telemetry transmitters to other suitable spectrums.
If the use of WMTS declines, will patient monitors move to Wi-Fi? The use of Wi-Fi is promoted by the Wi-Fi Alliance, an international trade association with certification programs that ensure Wi-Fi products from different manufacturers work together. One of the Alliance’s 16 active task groups is the Healthcare Marketing Task Group.
“The Wi-Fi Alliance healthcare task group has created educational material regarding security and best practices in connecting medical devices to hospital 802.11 networks,” said Raymond. “We are seeing an increased awareness among hospital IT managers about the challenges and requirements of connecting medical devices to Wi-Fi networks.”
Raymond expects the use of Wi-Fi on hospital medical devices to increase significantly in the next few years. Why? “Caregivers are mobile, patients are encouraged to be mobile, and medical devices are getting smaller and more sophisticated,” he explained. “The question is not if wireless will or will not be utilized, but rather what frequency band and technology is the most appropriate for the clinical application.”
Hospitals are highly risk-averse, continued Raymond, and so applications that don’t carry a higher degree of patient safety risk will move to Wi-Fi faster than others. To mitigate risk as it expands its use of Wi-Fi, a hospital should get very familiar with IEC 80001-1 and 80001-2-3. IEC 80001 is an international standard of risk management for IT networks that incorporate medical devices. IEC 80001 aims to ensure both the delivery of safe, high quality of healthcare, and the security and privacy of patient data that is communicated over hospital networks. This standard applies to medical devices that have already been purchased by a healthcare organization and is candidate for incorporation into an IT network.
“Hospitals will be in a much better position to enable medical devices on their Wi-Fi networks if they adopt a risk management approach leveraging IEC 80001-1 and 80001-2-3,” said Raymond. “There are also the healthcare task group’s white papers offering valuable guidance in terms of best practices. The next few years will be quite interesting to see how hospitals respond to the changing demands of wireless connectivity and the implications to patient care.”