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Successful wireless network implementation mixes policy, technology

Hardware is key to any wireless network implementation. In hospitals, anything that can drop a signal -- including pipes, bathrooms and microwave ovens -- also matters.

For hospitals, a wireless network implementation or upgrade features all the task's trials and tribulations with which CIOs in other industries are familiar: namely, overcoming low-signal areas, solving spectrum issue and guarding against rogue access points. The objective on the back end is the same too: maintaining a consistent signal without dead spots that makes it easy to switch from one access point to another and as a result, reduces the time spent troubleshooting.

On top of that are two challenges unique to health care. There's the constant proliferation of medical devices transmitting wireless signals: That causes bandwidth and spectrum issues in some areas, especially the emergency department. There's also strong security and privacy regulation; noncompliance means a financial penalty running into the millions and a public listing on a government website, both of which can cause immeasurable damage to a facility's reputation.

Done right, though, a wireless network implementation can be a game-changer.

"Wireless enables a lot more than mobility in health care," said Patrick Hale, chief technology officer at Sparrow Health System in Lansing. Mich., which set up a new enterprise wireless network in a new hospital tower three years ago. "We're still learning the true impact of that, and [it's already] had a tremendous impact -- everything from our emergency department being mobile and achieving better patient care scores, to our food service department being able to turn on concierge service."

Hale and Jason Loznak, Sparrow Health's network manager, are applying the tower's wireless topology to satellite facilities on multiple campuses, where they are ripping and replacing the existing network to support a new rollout of Epic Systems Corp.'s electronic health record (EHR) system. Sparrow anticipates caregivers will use Epic heavily on wireless devices. In the new tower already, wireless is improving Sparrow's patient experience in a number of ways:  Physicians access the EHR system on tablets, patients order meals from their beds and nurses admit patients at the bedside.

Build a wireless network implementation plan

Setting up a hospital wireless network starts with a strong implementation plan. The first thing to do is select a hardware vendor, Loznak said. Sparrow Health ultimately used Meru Networks Inc. Other vendors to consider include Cisco Systems Inc. and Aruba Networks Inc.

Determining the best fit involves more than listening to sales pitches. Loznak recommended testing a vendor's gear to get a feel for how well it works in your environment and with the devices your hospital network supports, be they laptops and tablets, or wireless patient diagnostic tools or infusion pumps.

"Every vendor will come in and tell you they're device-agnostic, everything will work on their product. It's just flat not the case," Loznak said. "Some things are going to work much, much better than others. You really want to battle-test your current client environment against the product, in a live environment, to find what kind of issues you're going to be dealing with after go-live."

In addition, get a feel for a vendor's wireless network management tools. In Hale's view, this is a key differentiator. These tools have improved significantly during the past few years, from rudimentary dashboards to more sophisticated utilities, he said, but even the best in class could use some improvement.

Before a wireless network implementation, heed site considerations

Once you have decided which vendor will supply your wireless network, plan for its implementation. Determine the areas of the facility it will cover, and what the workflow inside those areas looks like. Key considerations include which devices staff will use, how mobile the staff is, and whether interference from anything, such as a radiology lab, will be a concern.

"If this is your first install, I would highly recommend spending the money to bring somebody in that's got the back-end experience at many, many other locations, who has seen a lot of gotchas you aren't prepared for," Loznak said. It comes down to "yourself vs. someone who's done several hundred of these."

Even the best wireless networks will drop you. It doesn't mean there's anything wrong. It just means that's the price you pay for mobility.

Patrick Hale, CTO, Sparrow Health System

Issue a request for proposals (RFP) and collect responses as you would for other network projects. Nevertheless,  talk to your peers about the integrators who respond, and ask for their experience and opinion.

You should be "very particular" about integrator selection, Loznak said. "You want to not only focus on their technical prowess and capabilities, but you also want to put some keen focus on their project management capabilities."

Wireless network integrators who are organized and deadline-driven will help you meet your timelines, recover from the challenges and roadblocks that inevitably arise during the implementation process, and work with manufacturers when defective or malfunctioning hardware comes in.

Part of evaluating an integrator is considering how the company does a site survey. Loznak recommends avoiding computer models of your site, except for "ballparking" costs. These models fail to take into account the impediments that might weaken wireless signals or (as Loznak described them in referring to his room-by-room physical site survey) "weird areas." Such areas include medical records rooms filled with 3-feet-thick walls of paper-filled boxes and other bookcases, pipes not shown in the building schematics, and bathrooms on top of bathrooms on multiple floors.

Consult every department when placing wireless access points

A spot that would provide a strong wireless signal might not be ideal for other reasons, however. If, for example, a wireless access point malfunctions in a room where infection control precautions are in effect, how do you fix it? Where can you situate a router so that it optimizes signals from within a high-efficiency particulate air tent, and is simple to replace or repair? These are questions only your infection control office can answer.

Safety managers will have their concerns too, and the facilities manager will have tips for protecting gear from air-handling units. You will spend a lot of time determining where to place wireless access points and their power supplies so that they are easy to maintain but at the same time don't interfere with heating and air conditioning, as well as with patient care.

It's an arduous but necessary process, best accomplished with all stakeholders at the same table, Loznak said. That way, physicians in, say, the neonatal intensive care unit or the post-anesthesia care unit "understand exactly what you're doing" and why it's important.

Hale concurred: "It's critical. It's just dangerous if you don't take those steps."

In a successful wireless network implementation, technology, policy work together

Spending money, unfortunately, is part of getting a hospital wireless network ready for an EHR system, Hale said. Although it's a tough sell, it's important to convince the hospital board of directors to invest in a solid wireless infrastructure and support it from the beginning -- either that, or suffer a painful outage later when patients' lives are on the line.

Even after the upgraded network in Sparrow Health's hospital tower went online, problems cropped up and continue to do so. That which leads to another piece of advice from Hale and Loznak: Plan for wireless network implementation to be an ongoing process. You may have to move or add a wireless access point around a high-traffic area, such as the emergency department, so signals don't drop as harried nurses carry their tablets from one room to another.

In addition, diagnose and work around persistent problems that cause service call after service call. This isn't always easy. Monitoring tools can't recreate what was happening in a room when a problem was reported -- and by the time IT staff arrives, things can have reverted to normal.

For Hale and Loznak, the problem was "microwave alley," a group of five employees who all have microwave ovens at their desks that, it turned out, negatively affect the wireless network around lunchtime.

"We went in there with [radio frequency] studies, [and] it was fine," Hale said. "It was one of those really frustrating, intermittent -- but when it happened, really serious -- wireless problems."

Eventually, with some outside help, they traced the problem to the microwaves. Diagnosing the problem was one thing, but solving it has been a different matter: "We're still fighting the battle to get rid of those microwaves," Hale said with a laugh.

That brought him to one final tip for a successful hospital wireless implementation: Give users a realistic explanation of what to expect in a new wireless network. Performance -- and experience -- will vary.

"Tell them [that], from time to time, even the best wireless networks will drop you," Hale said. "It doesn't mean there's anything wrong. It just means that's the price you pay for mobility. There's no truly, completely bulletproof wireless network."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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