Subject: [NEXTEL-1] Speeding Up Tennessee Medicine

From: [email-masked]
Date: Wed, 03 Sep 2003 13:28:07 -0400

Speeding Up Tennessee Medicine

By Gerry Blackwell 

When a patient comes into any one of the four Baptist Health System of East
Tennessee  hospitals in Knoxville, Tenn., doctors, nurses, pharmacists and clerks
can instantly get access to everything about that patient -- records of past
visits, allergies, x-rays, MRI scans, medication, clinical notes. 

Even better, they can get the information wherever they are in the hospital --
wirelessly. 

Baptist is one of the first hospitals in the country to provide comprehensive
wireless coverage with both 802.11b for text and business-related applications and
802.11a for mainly clinical applications, especially medical imaging which
requires the higher speeds of 11a (54Mbps vs. 11Mbps). 

The hospital has deployed over 350 access points of various flavors to support a
similar but growing number of terminal devices. 

Wireless networking in hospitals is no longer news, of course. In the last couple
of years health care facilities across the continent have begun to get the message
about the benefits in time savings and efficiency from giving clinical staff
wireless access to patient records wherever they wander. 

Those time savings sometimes translate into life savings, and almost always into
better patient care -- quicker response to patient calls, faster response on calls
to physicians, and quicker turn-around on medical imaging and imaging-based
diagnoses. 

It also means clinicians work from more accurate, up to date and comprehensive
information, and the system provides a complete clinical audit trail on each
patient. 

Baptist Hospital was a wireless pioneer. It started back in 1996, the WLAN dark
ages, installing pre-standard 2.4GHz gear from Proxim. This was Proxim's
frequency-hopping 1.6 Kbps OpenAir network system. It's still doing yeoman service
in some areas of the main downtown facility, though all will be systematically
upgraded over the next several months. 

Before that, data networking at Baptist was virtually non-existent. 

"The first application was clinical documentation," explains senior systems
specialist Rick Simpson. It's still one of the most important. 

"Now it's a complete electronic record -- it includes everything the patient has
seen, signed, touched or been touched by," Simpson says. "All of that is now
readily available to physicians and nurses everywhere in the clinical areas of the
hospitals." 

Baptist Hospital came to wireless originally almost by a process of elimination.
Going wireless meant the hospital could avoid breaking into the cinder block walls
to install Category-5 Ethernet cabling -- a traditional cost justification for
wireless. That was certainly one factor. 

Baptist could not cost justify putting a computer in every patient room. That
meant the PCs used by nursing staff would have to be mobile. Mobile computers that
had to be connected to an Ethernet wall jack each time they were moved was not
practical. The only solution: wireless. 

There were clearly additional benefits to going mobile -- nurses can be located
and signaled more easily over the wireless network. Ditto for physicians. 

Terminal devices used on the network have evolved over the years. Initially they
were notebooks on trolleys that had to be plugged in to electrical sockets. Nurses
used early tablet PCs for a time before moving back to notebooks. The notebooks
are now fitted with additional batteries that last a whole shift before being
replaced with freshly charged batteries. 

In recent months, more and more physicians have started using PDAs, allowing
doctors to take notes electronically while on rounds and save them to network
storage. 

The decision to upgrade from the early Proxim gear and go with dual-mode 802.11a/b
infrastructure started with the decision to build two new facilities in the west
end of the city. Baptist Hospital West and Baptist Hospital for Women opened July
2003, joining the main downtown campus and a fourth facility in suburban Cocke
County. 

That the new facilities would be equipped with wireless networks was never in
question. The benefits of mobility had long since been proven at Baptist. The only
questions were which technology and which vendor? 

One concern was that with the widespread adoption of Picture Archiving and
Communications System (PACS) technology for electronically storing and
transmitting medical imaging data, 802.11b would be a bottle neck when physicians
needed to download images quickly. Medical imaging files can be up to 20 MB, not
huge by the standards of some applications, but certainly big enough to benefit
from a higher-speed network. Faster 54-Mbps 802.11a technology was one answer, but
it would be overkill for most other applications. 

Dual-mode 802.11a/b technology -- available from most corporate WLAN equipment
vendors -- offered an ideal compromise. The architecture of the Proxim gear
Baptist ended up buying also left open the option of upgrading to all 11a or 11a/g
in the future. 

The 11a infrastructure could be used for clinical applications where speed was of
the essence. The 11b infrastructure would be perfectly adequate for clerical and
e-commerce applications -- such as food trolleys from the cafeteria selling snacks
in patient rooms and needing to swipe a credit card for payment. 

Although Baptist had a long history with Proxim, it did look at other vendors,
including Cisco, 3Com and others. "We stuck with Proxim because of the reliability
we'd always enjoyed [with their equipment]," Simpson says. "But you have to test
other vendors to see which [equipment] works best in your facility." 

Security, never a concern with the proprietary OpenAir protocol of the
pre-standard Proxim gear, became a significant issue with the move to Wi-Fi.
"Security was one of our biggest concerns to be quite honest," Simpson says. 

The hospital implemented WEP (Wired Equivalent Protocol) Plus security features on
the Proxim ORiNOCO equipment. WEP Plus, which works only on ORiNOCO-to-ORiNOCO
transactions -- the majority in this network -- rotates encryption keys to make
them less vulnerable to brute force hacking attacks. 

Baptist also uses MAC (Media Access Control) authentication, but opted not to
tighten security any further. 

"We thought about doing a whole bunch of stuff with RADIUS (Remote Authentication
Dial-In User Service)," Simpson says. "The problem is if we had to ask clinical
staff to log on five times a day, it would seriously reduce the productivity gains
wireless gives us." 

Once the decision was taken to go with 11a/b in the new facilities, it made sense
to upgrade the infrastructure at the existing hospitals to match. Baptist
physicians move from hospital to hospital through the day, Simpson points out.
Expecting them to switch network devices in their PDAs or laptops as they moved
about did not make sense. 

Will other health care facilities follow in Baptist's footsteps and install
dual-mode or single-mode high-speed Wi-Fi networks? We're betting they will. 

Given the long-term cost savings of PACS and the efficiency and speed promised by
filmless, hard copy-free medical imaging, even broader acceptance of the
technology is inevitable.

http://www.wi-fiplanet.com/columns/article.php/3071181

http://www.bhset.org

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