Thanks to the many benefits of wireless networking, hospitals across the nation are moving to the technology—but a note of caution is advised
By Nina Silberstein
According to a 2012 survey on network technology in healthcare conducted by Enterasys Networks (now Extreme Networks), San Jose, Calif,1 many hospitals in the United States are aggressively going wireless. Wireless technology is being used not only for administrative purposes, but also for clinical point of care, patient or guest access, and a wide variety of biomedical devices, from patient monitoring systems and intravenous pumps, to mobile x-ray machines and ultrasound units.
Wireless medical devices and other technologies are improving the way physicians give care and how patients receive it, but to ensure the safe and effective delivery of healthcare services, biomeds and clinical engineers must approach the wireless transition with care. What follows is insight into both the rewards and challenges of wireless technology in the hospital setting.
Incorporating medical devices into the wireless arena has many benefits. For one, it increases patient mobility, such as by eliminating wires that tie a patient to a medical bed. The technology also gives healthcare professionals the ability to program devices remotely and to access and monitor patient data regardless of the location of the patient or physician. These benefits of wireless technology can improve patient outcomes by giving physicians access to real-time data on patients, without having to be physically in the hospital.
High-performance networks have enabled digitized medical records with instant access across disparate facilities, enabling a patient to receive the same level of care and understanding at different hospitals. They can also serve as the foundation for a wireless nurse-call system. Furthermore, the newer networks have software capabilities that provide advantages that aren’t possible with older and outdated networks. Through some systems, IT planners can prioritize and reserve wireless network capacity for healthcare-critical applications and ensure that lower-priority traffic doesn’t get in the way of performance when it’s needed the most.
Baylor Scott & White Health is the largest not-for-profit health care system in Texas and encompasses 43 hospitals, more than 500 patient care sites, more than 6,000 affiliated physicians, and 34,000 employees. For Team Leader – Clinical Technology, Biomedical Technology Services Richard Swim, CLES, MCSE, security comes first. “Security has to be at the top of the list for wireless medical device implementations,” he says. “It’s too easy to overlook effective security which may put an organization at risk for violating the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) requirements.”
In addition, Swim says, using wireless makes sense only where it is truly needed. “Just because a medical device has wireless capabilities does not mean wireless should be used. Wired network communication (when available) is always more effective than wireless.” The industry is stepping up to meet higher security standards by building the technology into the devices. “Healthcare organization information services are working more closely with healthcare technology management (HTM) teams to ensure proper security and effective use of wireless technologies,” Swim adds.
The HTM professional must understand basic networking architecture principles and information security principles in order to manage configuration of connected devices. “This knowledge will also help the HTM professional communicate more effectively with information services team members during clinical system implementations,” he notes.
“A lot of the medical devices in hospitals are being deployed on Wi-Fi networks,” says Tim Gee, connectologist and principal at Medical Connectivity Consulting in Beaverton, Ore. These Wi-Fi networks are intended to be multipurpose, supporting numerous vendors, users, and applications.
First, he says, you need to be sure that your devices can co-exist with other devices and applications on the network.. The challenge is that a Wi-Fi network needs to be designed to support all the specific applications you intend to use it for. “Hospitals add applications to the Wi-Fi network from time to time, and the first inclination is to just deploy them and wait and see how well that works, rather than recognize that the network needs to be designed to support the existing and new applications,” he says.
Gee notes that new applications will probably require changes to the network, which can allow performance to decline, and not just for the new application, but potentially for existing applications as well. “A key factor for biomeds and clinical engineers is knowing that if you’re going to add a new application to the network, particularly a wireless medical device application, you need to get the requirements or specifications for that network from the medical device manufacturer. Then, do a site survey to determine whether or not your network meets those specifications,” Gee stresses. That can be a big hurdle from an implementation standpoint.
When addressing the multipurpose aspect of a network, you also have to consider your environment and potential interference. Inside and outside the hospital, there is other equipment such as metal beds, fluorescent lights, heavy-duty motors—and even brick buildings—that don’t lend themselves very well to wireless data transmission. “You have to be cognizant of how that might affect the reliability of the connection or the range you can get from the devices,” says Vaishali Kamat, head of digital health at Cambridge Consultants, Cambridge, Mass.
“When you’re setting up the wireless infrastructure and the devices connected to that, you have to pay special attention to what protocols are followed and what handshaking happens. You don’t want your data going to the wrong devices, and you want to ensure that it’s always secure and unable to be hacked,” Kamat explains.
Although devices operating in two different frequency bands (spectrum) can coexist and not corrupt each other, interference can occur if they are not designed carefully, potentially compromising reliable operation. In addition, sometimes a band gets too crowded because there are a lot of devices talking in the spectrum, such as patients’ devices, smartphones, and the like. “They’re all talking in the same spectrum where the hospital’s managed devices are [communicating],” Kamat says. “You must be aware that this issue exists, so the network must either be set up to accommodate multipurpose use or allow only authorized devices.”
A facility might have a number of doctors, clinicians, administrators, and others who have authorized devices that it wants on the network. At the same time, it may not want to grant access to visitors or others. That difference needs to be addressed when establishing security and access-control policies.
Keep in mind that interference affects not only the data stream but also patient safety. A random microwave, for example, can interrupt wireless transmissions and affect the hospital’s equipment.
Reliability of the network is another aspect. “When I’m sending my data from one end to the other, I want to make sure it gets there and isn’t dropped in the middle [of transmission],” Kamat says. A good example of addressing this problem was a wireless station monitor Cambridge Consultants designed some years ago for Philips Healthcare. It was meant for the cardiac monitoring of patients who should be moving about rather than restricted to their beds. “A wireless monitor is hooked to patients so that they are monitored as they walk around in the hospital,” Kamat explains. The data that is received as a result of this has to be continuous and accurate, and reach the nurses’ station without being dropped in the middle of transmission. “You have to have the confidence that your network is up all the time and your data is going to get there,” she says. “We designed the wireless protocol for these devices to be fault tolerant and able to support multiple patients (up to 1,000) at one receiving station.”
All stakeholders using the network need to be in the loop, ideally before implementation, Kamat advises. “If you only have the administrative staff involved in making these decisions or policies, they might not appreciate what happens on the floor—for example, the nurse who’s attending to a patient and needs access to her data, or someone who’s running from one place to another with a mobile device in hand and needs to see the data,” Kamat says. A surgeon in the operating room and a physician at the bedside of a patient may have different needs. “We recommend that requirements from all users are considered when setting up policies or the infrastructure. Equally, you need technology experts who understand how these requirements can be incorporated into the system design,” Kamat says.
“We’ve been pushing for hospital-wide wireless policies as a standard,” says Mark Gibson, director of business development at Comsearch, Ashburn, Va. Gibson also recommends creating a database that includes every device that operates in the hospital’s wireless spectrum. “Know your spectrum, know what bands you’re operating in, and know what’s operating in them,” he says.
Gibson notes that the Association for the Advancement of Medical Instrumentation (AAMI) has developed a wireless strategy task force to establish best practices that address wireless challenges in healthcare. According to AAMI, “priorities include clarifying roles and responsibilities in the wireless arena, managing spectrum to improve safety and security, designing wireless infrastructure for high reliability, learning from other industries, and managing risk and preventing failure.”2
Some hospitals have a “bring your own device” (BYOD) policy, and are allowing employees to bring their own mobile devices into the hospital. IT departments then connect the devices to the network, although there are concerns about doing this. “Some hospitals would rather issue controlled devices to the staff that are centrally managed and configured,” Kamat says. “Both have their merit and challenges in terms of management, access control, and ensuring patient privacy, but these have to be handled from an organizational standpoint.”
In the BYOD environment, users could possibly leverage the hospital’s wireless network to access illegal or controversial content, or inadvertently download malware that could infect the network and retrieve sensitive data. Malware can enter the network and imperil sensitive patient and lab data that biomed and clinical engineers rely on for testing and research purposes.
Hospitals that want to implement a wireless network should be working on a comprehensive risk management policy or program for how they’re going to use this technology. An essential document in this effort is the 80001 standard, “Managing Medical IT Networks,” available from AAMI.
It’s recommended to ensure that the facility’s wireless communication solution provider has carried out extensive interoperability testing and produced deployment guidelines for their products. These deployment guidelines have typically been used by successful technology teams to make certain that best practices are implemented. The guidelines have been built up through years of feedback from the field, evolution in the technology, and from living documents that, if adhered to, can deliver high levels of reliability.
“Education in information technology is a must for the biomed or clinical engineer,” Swim says. “Don’t stop at the medical device itself for considering support responsibility. One must consider the management of data flow from that medical device to clinical systems as well,” he concludes.
1. Enterasys survey. Preliminary survey results show US leading in wireless healthcare connectivity. Extreme Networks. 2012.
2. About us. In: Going wireless: A special compilation of AAMI wireless articles and resources. Association for the Advancement of Medical Instrumentation. Arlington, Va. 2013. Accessed March 6, 2014.