Preparing network infrastructure for hospital iPad use

Hospital network infrastructure usually supports both wired and wireless access. When staff start using iPads to access patient data, networks must meet additional requirements.

As hospital iPad use continues to grow, network infrastructure must change to meet bandwidth demands. This tip

describes two types of iPad deployments in health care and examines the impact that such a deployment will have on a hospital's network resources.

The Ottawa (Ontario) Hospital is the largest acute care hospital in Canada, with 1,163 beds and 11,967 staff members, among them 1,159 attending physicians and 3,886 registered nurses. The hospital announced in December that it will use Aruba Networks Inc.'s WiFi Mobile Virtual Enterprise (MOVE) system to connect 3,000 Apple devices -- including iPads, iPhones and iPod Touch units -- at the medical facility. The MOVE system serves wired laptops and desktops as well as wireless devices. The hospital needed doctors and nurses to be able to walk around the hospital with iPads so they could access the electronic health record (EHR) and computerized physician order entry (CPOE) applications.

Meanwhile, Children's Hospital Central California plans to deploy iPads in a different way. The Madera-based hospital, one of the 10 largest pediatric hospitals in the country, is rolling out VMware Inc.'s VMware View Client on iPads so clinicians and staff can stay connected to virtual Windows desktops anywhere in the building. The VMware View client is designed to emulate the multi-touch user interface of the iPad, but the applications are the same as what one would access on a desktop in building.

While the above case studies show that the underlying software architecture of iPad deployments can differ, hospital network architecture nonetheless needs to meet some basic requirements. The following 11 requirements are common for all hospital iPad use cases.

Unified wired/wireless access. Many hospitals may be already using desktops or laptops for doctors and nurses to access EHR, CPOE and other applications. Hospital iPad use for these apps may not be far behind. Laptops could be used in wired mode at someone's office, but users may need wireless access if they are in a conference room in the hospital. The same network infrastructure needs to support both wired and wireless access seamlessly.

Policy redeployment for mobile devices. Use of applications such as Epocrates is already widespread in many hospitals with iPhones and iPods. For these, and other basic applications such as email, hospitals may already be providing basic wireless network access, with some minimal secure access. Until now, mobile devices may not have had access to hospital applications. When network infrastructure is rolled out and includes access to hospital applications, new policies may be needed for these legacy devices.

Adding network access points. Hospitals may vary in size from a few hundred thousand square feet to campuses with multiple buildings running into millions of square feet. Pilot deployments and phased rollouts in select areas of the hospital are pretty common. Usage may increase over time. Increasing network traffic needs monitoring and modular scaling of additional network access points as necessary.

Network load and quality of service (QoS) balancing. When the same network infrastructure serves wired and wireless devices, those different devices may need different Quality of Service (QoS) levels. It may be necessary to monitor QoS on wireless devices at various locations within the hospital and to make adjustments, both when applications requiring vastly different bandwidth are in use -- text messaging vs. downloading and viewing an X-ray -- and when mobile device users move from areas of high to low connectivity within the building. In addition, emergency departments may need network traffic priority over other departments.

Device fingerprinting. On the network side, device fingerprinting, which assesses a device's hardware and software settings, can recognize whether a device that needs a connection is a mobile device or a wired device. This information may be needed for appropriately ensuring QoS levels for all devices.

Authentication services. In addition, devices may need to be registered with the network infrastructure to ensure that a mobile device is really the mobile device it says it is. Mobile device authentication services must prevent unauthorized access to the network, to applications and, most importantly, to medical data. HIPAA privacy violations are penalized severely.   

Remote wipe capability. Many hospital iPad deployments provide access to applications and data only within the hospital campus. In addition, they do not allow local persistent storage of medical data on the iPad. Hospital network infrastructure may need behind-the-scenes data streaming -- that way, when an iPad is on, data is available, when the iPad is switched off, or travels off campus, data can be remotely wiped from the iPad.

To support hospital iPad use, network infrastructure needs comprehensive network monitoring and logging.

Multicast video conferencing capability. The iPad's built-in camera, combined with mobile video conferencing platforms from vendors such as Polycom Inc. and Vidyo Inc., makes it a prime candidate for videoconferencing and other telemedicine initiatives. To make this possible, network infrastructure should support multicast communication between one sender and several recipients.

Patient video monitoring support. Video applications, especially on mobile devices like the iPad, are bandwidth intensive. This includes videoconferencing as well as video monitoring, which hospital personnel can use to keep an eye on patients from afar. To accommodate such applications, network infrastructure may need additional bandwidth.

Uninterrupted power. As hospital iPad use becomes increasingly mission critical, especially in situations such as a power failure, providing uninterrupted power for the network gains importance.

Network monitoring system and logging. To support hospital iPad use, network infrastructure needs comprehensive network monitoring and logging that records the exact device, the applications and the data it accesses, and the timestamps. While applications may have their own logging, tracking access from specific iPads may be needed for additional security and audit purposes.

Hospital networks are playing an important role in health care delivery. Hospital iPad use could improve patient care and drive down spiraling health care costs. However, device deployment introduces additional requirements, since mobile devices and wired devices are now mixing.

Extending access with iPad EHR systems and other hospital applications introduce additional network infrastructure requirements. However, once these requirements are addressed systematically, hospitals can see successful iPad deployments. Caregiver and patient mobility are enhanced, which leads to better patient outcomes, efficiency and effectiveness.

About the author:
Nari Kannan is currently the Chief Executive Officer of appsparq Inc., a Louisville, Kentucky-based mobile applications consulting company. Nari has over 20 years of experience in information technology. He can be reached at nari@appsparq.com. You can also contact @SearchHealthIT on Twitter.

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This was first published in January 2012

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