Stock brokers and corporate types may get all the credit for having high-pressure jobs, but holding a position in the healthcare sector is arguably one of the most stressful posts around. Working under constant budgetary constraints, healthcare professionals are forced to do more with less—and deliver results that comply with the regulatory codes upon which their procedures are based.
In an effort to address these concerns, an increasing number of hospitals and healthcare centers are implementing wireless networking technologies that enable doctors, nurses and technicians to access data and communicate with one another on the fly. Sleek PDAs and sophisticated tablets are no longer reserved for those who report to work wearing expensive Italian suits; those wearing lab coats are making good use of these technologies, too.
“There are a lot of benefits that come from mobility, including efficiencies of skill and cost efficiencies,” observes Rohit Mehra, director of product marketing at Bluesocket, a developer of Wi-Fi control and security technologies based in Burlington, Mass. “The entire healthcare sector has been under cost pressures for a long time. And there is pressure to do a better job of providing more cost-effective healthcare to the American population. With all of these pressures, healthcare professionals must become more efficient, which will increase the demand for mobility.”
Mehra divides wireless use among hospitals into two main categories: data management and voice communications. “On the data side, doctors and other healthcare workers use notebooks and handheld devices such as PDAs and tablet PCs, providing them with instant access to all of their information and applications, wherever they are—whether it’s an electronic medical record, patient database or administrative database,” he explains. Barcode scanners and RFID tags are used to track medications, equipment and even patients.
For voice communications, hospitals are making use of Voice over IP (VoIP) through the application of VoIP phones—similar to traditional cell phones—and badges that are not unlike the communicators worn by Federation members on Star Trek.
Fletcher Allen Healthcare, which operates out of five Vermont-based campuses, is among those organizations that have adopted this technology wholeheartedly. “It was becoming more and more evident that portability was what we needed—especially in our emergency department,” reflects Wes Daum, a network engineer at Fletcher Allen. “Doctors were going in and out of the exam rooms and needed some kind of device so they didn’t have to look for a free PC at a nurse’s station where they could input data after meeting with a patient. They needed something that was real-time.” Currently, doctors use tablet PCs, while nurses input data into laptops that accompany them from room to room on carts.
Over the past two years, the IT staff at Beth Israel Deaconess Medical Center in Boston, Mass., rolled out an enterprise-wide wireless network that enables doctors and support staff to access and input information wirelessly. The result: 100 percent of the doctors’ orders are now processed via the Internet and approximately 20 to 30 percent of that information is generated on a wireless network. Four thousand PCs and 500 wireless devices are required for the task.
“At Beth Israel Deaconess, we realized that there was a great utility in wireless data,” says John Halamka, M.D., CIO at Beth Israel Deaconess (and Harvard Medical School). “We wanted doctors to be able to wander through various parts of the hospital, place orders for their patients, look up test results and look at X-rays. Wireless provides that ubiquitous access to the Web, and if 100 percent of your clinical systems are Web-enabled, this is something that is very empowering to the doctors.”
The network at Beth Israel Deaconess is made up of 216 access points covering the 2 million square foot facility. “This was no trivial task, because we were dealing with buildings that were nine stories high and that feature an odd topology. You must think about the floor above and the floor below, and all of the different, conflicting signals that might occur.”
For communications, the professionals at Beth Israel Deaconess are using VoIP technology by Vocera. Doctors and nurses wear devices on their lapels and, with the press of a button, have instant access to one another. For what Halamka refers to as “geo-location,” the hospital partnered with Pango Networks to outfit patient wristbands and equipment with RFID tags. “We can now figure out where people, ventilators, EKG devices and IV pumps are located, and no redundant infrastructure was required,” Halamka explains. “It’s all done over the Wi-Fi network.” Patients are also able to access the Internet from their hospital beds, making it a little bit easier to pass the time.
The most significant concern for institutions using this technology is security. “Within security there is compliance, because there are strict HIPAA rules that mandate what security protocols need to be in place before you can deploy any of these networking technologies,” Mehra explains. “Beyond compliance, there is the actual security and safety of the hospitals’ own networks.” Factors such as the protection of applications, patient information and financial records are all taken into account. “Security is end-to-end, from the time the data leaves the computing device, all the way over the network until it is received.”
At Beth Israel Deaconess, hackers attack the network every seven seconds. The trick was to create a system that was airtight, while still enabling absolute mobility.
“One of the things that is very bad to do in networking is bridging networks together,” Halamka notes. “If there is someone hacking into your system, you want it to affect a very small portion of your network, so you would rather isolate each floor of the hospital.”
The problem is, doctors seldom work on just one floor of any institution. “If you want to isolate floors, you don’t want to have the doctors logging on and off the system as they go from floor to floor.”
To get around this, Beth Israel Deaconess is outfitted with Layer 3 Roaming technology by Cisco Systems. “Layer 3 Roaming allows us to use routers,” Halamka explains. “A doctor can walk through the hospital and use his or her mobile device anywhere—it’s like roaming between cell sites, where you can go from one place to another without having your signal cut out.” Because the signals travel through routers, if there is an intrusion on the network, it remains isolated.
Halamka concedes that while it’s possible to build an extremely secure network, some compromises must be made in the process. “The challenge with security is that there is a trade-off between highly secure, bulletproof technology and easy-to-use technology,” he says. “With our network, it’s good because no one can break into it, but it’s bad because it requires extra configuration and extra support to maintain all of these protocols.”
Which points to another challenge: interoperability. These systems must support different types of PDAs, scanners, tablet PCs and laptops while still maintaining a high level of security. This challenge is exacerbated by the fact that many of these technologies are proprietary. “Obviously, we didn’t choose proprietary protocols—it’s just that the industry is still evolving,” says Halamka. “When there are non-proprietary, industry-wide security protocols that deal with authentication, the appropriate blocking and encryption and all of the rest, then of course we will use them.”
While hospitals and other healthcare facilities are embracing wireless networking and all of the flexibility that it provides, the industry has just scratched the surface in terms of the applications that are
possible today—and in the near future. Halamka is attempting to push the limit, using himself as a test patient: He recently had an RFID chip by VeriChip implanted in his body to analyze the effects of implantable RFID technology on humans. “Now I have an implanted, 16-digit identifier, so that whenever I walk into a room, you know where I am and who I am.”
The VeriChip Health Information Microtransponder System, which is about the size of a grain of rice, features a secure database that stores patient-approved healthcare information and received clearance by the U.S. Food and Drug Administration during the fall of 2004. While advocates of privacy may take issue with the technology, the benefit to the healthcare profession is clear: With this
system, there is no guessing—especially in emergency situations. With the VeriChip, victims of natural disasters, sporting accidents and other traumatic events are able to provide their medical history, allergies and other important statistics without even being conscious.
RFID, however, will also soon provide less futuristic advantages: Once patients, medication bottles and nurses’ badges are all equipped with RFID tags, tracking drug administration becomes easier, and the potential for error decreases considerably. “This could trigger an analysis of whether the right medication is being given to the right patient at the right time,” Halamka illustrates. “There are a lot of interesting applications based on medical error, decision support and patient safety that are coming down the road.”