The Wireless Way

We begin this presentation with a question of reality. Please read the following statement and think about what it means.

"A microchip that can be implanted under the skin to give doctors instant access to a patient's records yesterday won government approval, a step that could transform medical care…"

Is this statement true? If so, what are the implications of this device? How could it be useful? How could it be harmful? How could it be adapted to other uses?

Although this statement sounds like a line from a James Bond movie, if you answered "true" you are correct.


Please view the following video for a more detailed look at this wireless device.
http://www.youtube.com/watch?v=jL7dPN9l6EI
Link to the remainder of the Washington Post article from which the excerpt was taken.
http://www.washingtonpost.com/wp-dyn/articles/A29954-2004Oct13.html

Although this example may not be the first to come to mind when one thinks of wireless technology in healthcare, it is a prime example of the diversity of wireless applications entering the realm of human health. A statement by Eric J. Topol, M.D., Director of the Scripps Translational Science Institute and the Chief Academic Officer of Scripps Health in reference to wireless technology in healthcare is both powerful and to the point:

“While the top five life-changers are currently the Internet, PCs and laptops, mobile phones, email, and DNA testing and sequencing, by 2015, it will be wireless medicine.”

Wireless technology is revolutionizing healthcare. From implantable data devices and hand-held computers, to hands-free voice-activated communicators, wireless technology is changing the way that healthcare is delivered. But what is wireless technology, why is it useful and what are its limitations and risks in the healthcare setting?

For more of Eric J. Topol’s thoughts on wireless technology please follow the link.
http://www.mobilemarketer.com/cms/news/software-technology/2971.html

Our Goal

The goal of this presentation is to enhance your understanding of wireless technologies and their applications and implications in the healthcare setting.

To achieve this goal we have set the following objectives:

1. to describe the basic function of wireless technologies

2. to provide the reader with a foundational understanding of the types, uses, and benefits of
wireless technology in healthcare

3. to describe the security considerations of wireless technologies in healthcare

4. to present a detailed description of a wireless communications device emerging in the
Canadian healthcare setting

5. to describe the future applications of wireless technologies in healthcare

We hope that your journey through this presentation stimulates some thoughts and questions that you can share in the forum.

Now that we have your attention and you know where you’re headed, let’s begin!

What is Wireless?

Wireless technology has come a long way since Guglielmo Marconi sent the first wireless transatlantic radio message on December 17, 1902 (Wikipedia, 2009). Today, wireless technology is used in almost every society around the globe. As wireless technology is not new to the world, nor is it new to healthcare. Cardiac telemetry systems of the 1970’s used wireless technology to measure electrocardiographs (Medical Connectivity, 2008). Although the use of wireless technology in healthcare is not new, we are currently witnessing a technical revolution in terms of the applications of wireless technologies within the healthcare sector. The old saying, “the sky is the limit”, truly applies to wireless technology in healthcare.

So what is wireless?

The term wireless implies that a system or device is continually connected without a direct physical connection. The connection may be to a server with data, the Internet, a network or a mobile communications system. Without cables, wireless systems use air as the medium for transporting data. Like wired systems, wireless data is available in “real time”, although wireless technologies limit the confines of space and distance. Wireless systems allow data to be shared between wireless and wired devices. The type of wireless system dictates how, when and where a wireless user may use the specific system.

Wireless systems use radio waves to send signals (Wifinotes, 2009). Modern wireless technology began with the invention of wireless local area networks (WLANs). These networks were refined in the late 1990’s to increase their speeds, security and ability to carry data. The term WiFi is used to describe a wireless network. A wireless connection can be between two or more devices. Personal computers, cameras and printers use this system. Wifi may also transmit data to larger systems for a business or geographical purpose. WiMax is the term used to describe metropolitan area networks. Global systems also use wireless technology and are often referred to as mobile communication systems or GSMs. Cell phones, pagers and global positioning systems (GPS) use GSMs. Bluetooth devices use wireless technology but over much shorter distances. Bluetooth may support up to 8 devices within a distance of 100 meters. In healthcare, this technology is often used during procedures with instruments sending a signal to a main terminal. An endoscopy exam is one example.

(Information retrieved from Wifinotes at Website http://wifinotes.com/ )

WLAN

A wireless local area network (WLAN) works in much the same way as a wired local area network, but a WLAN allows devices to be connected without a wire.

Each device in a WLAN (desktop PC, PDA, laptop) is fitted with a radio transceiver (often called a LAN card or ethernet adapter). The transceiver sends and receives radio signals. Each transceiver has a permanent and unique identifier that serves as the device address; thus each wireless device has a unique address.

Data sent through a WLAN is carried in packets. These data packets contain:
1. the address of the sender
2. the address of the receiver
3. data

Data carried via a WLAN is not sent continuously; it is only sent when the transceiver detects an opening in the WLAN. Communication between WLAN devices falls into two types; peer-to-peer communication and infrastructure communication.

Peer-to-Peer WLAN
- data is broadcasted and received by all wireless devices within 300 feet of each other
- devices are constantly listening for signals and when one is detected a network is created
- there is no central access point

Infrastructure WLAN
- each device sends data to and receives data from a central access point (wall or ceiling mounted)
- data received by the central access point is resent to devices within a greater range

The majority of WLANs in the healthcare setting are of the infrastructure type.

Specifics

Technical Needs

Very little is needed for a wireless system to work. All you need is a wireless adaptor, a repeater, a network hub and a modem.
(photo retrieved from http://www.health.gateway_process_homecare/ )

Types of Wireless Devices

There are a wide range of wireless products on the market today. They include Personal Digital Assistants (PDAs), tablets, mini-laptops, handhelds, handsets, pagers and mobile phones to name a few. Printers, scanners, computer mice and mp3s may be wireless as well. In the healthcare sector telemetric monitoring, lab work such as glucose monitoring, patient identification, paramedic patching to base and communication tools may be wireless.

The list of products seems endless for the novice user. Choosing the right product for specific clinical applications is extremely important. Numerous studies (Chen, Mendoca, McKnight, Stetson, Lei, and Cimino, 2004, and Leon, Fontelo, Green, Ackerman, & Liu, 2007) regarding the integration of new technology have illustrated that technology is often advancing faster than implementation. It is therefore important to ensure the most up-to-date and useful product is chosen for a particular application.

Some of the Implications of Wireless Technology in Healthcare

It is hoped that wireless technology enables healthcare providers to improve decision making, enhance work environments and improve health outcomes for patients.
Medication error reduction (Chinn & Cimino, 2004), patient tracking (Quinn & Curski, 2004), use of clinical practice guidelines ( Bullard, Meurer, Colman, Holroyd & Rowe, 2004) and clinical documentation (Briggs, 2004) are some of the reasons wireless technology is integrated into the healthcare work place today.

Wireless technology allows for real-time entry of patient information into an electronic health record, information that can be accessed wirelessly and kept up to date.
With wireless access, individual care providers have the ability view information without the constraints of finding an accessible desktop computer or chart. Lab results, medications and treatments are immediately recorded. Smart phones have been used in clinical settings to access web-based information resources with the hope that real-time access would provide more timely care. This all sounds great, but does it really make a difference in patient care?

The convenience and usefulness of immediate access to information was evaluated and found to promote evidence-based practice (Leon, Fontelo, Green, Ackerman, & Liu, 2007). Smart phone communication systems have been used in many healthcare centres, where interdisciplinary teamwork and complex communication issues constantly challenge the provision of best patient care. Time savings and workflow improvements were demonstrated by Breslin, Greskovich and Turisco (2004) in a study of the wireless Vocera Communication System.

This article provides a brief overview of one-way wireless technology used within the hospital setting.
http://0-proquest.umi.com.aupac.lib.athabascau.ca/pqdweb?did=236491631&sid=4&Fmt=4&clientId=12302&RQT=309&VName=PQD

Cell Phones Manage Diabetes (link to article and short video)
http://www.sciencedaily.com/videos/2008/0902-cell_phones_manage_diabetes.htm

General Considerations

There are many issues to consider when implementing wireless technology. The first questions usually relate to the cost and the actual benefits of implementing wireless technology. A study by Leonard, Comm, Sittig, (2007) identified the indicators of information technology (IT) costs, IT infusion and health performance to be used to examine the existence, timing and level of improvements in health outcomes that can be derived from IT investment. The initial studies have demonstrated improved patient outcomes and financial benefits in institutions using electronic health records, real time data entry and retrieval, and wireless communication tools.
Choosing appropriate sites to set up transmission bases through a site survey must be done when wireless technology is implemented (Briggs, 2004).
Globalization of standards of documentation, systems to use and security and privacy measures should be considered with wireless implementation (Varshney, 2006).
Staff education, project evaluation and ongoing management must also be addressed.

Consider your clinical experience. Is wireless technology used in your workplace? Think about how it may be used to benefit healthcare in your workplace.

Security

Wireless technology use must meet the security standards set by Canadian Government and the professional bodies involved in the healthcare system. The Canadian Personal Information Protection and Electronic Documents Act describes the general principles of consent, data minimization, use, retention, disclosure and safeguards. (Cavoukian, 2004). Provincial laws such as the Ontario Personal Health Information Protection Act, address access, collection, use, disclosure and protection of patient information.

The Canada Health Infoway Privacy and Security Overview (2006) details the need for reasonable steps to be taken to ensure personal heath information is protected from loss, theft, unauthorized use or disclosure.

The overview outlines ten components that are critical to the privacy and security of electronic health information:

User identity management
User authentication
Access control
Informed consent
Identity protection
Anonymization services
Encryption
Digital signature services
Secure audit services
General security services

These components serve as guidelines for hardware and software developers and the users electronic health systems.

There are particular issues of security and privacy for wireless systems. These include storage of wireless data and devices, reliability of data, tracking or auditing of users, device theft and data hacking during transmission (Retterer, 2004). The Information and Privacy Commissioner of Ontario (2009) suggests the use of a privacy impact and threat risk assessment to confirm that the wireless devices are secure and data will be transmitted, accessed and stored in a secure manner. Further safeguards include institutional policies around password protection, key card administration, timeouts and data erasing. Some wireless devices are equipped with phone home capabilities so they may be located or locked out if lost or stolen.

Human failure is one of the most common reasons noted when security and privacy systems fail (Varshney, 2006). Loss of devices or failure to follow security protocols reinforces the need for education and enforcement of policies and procedures related to wireless healthcare devices.
Technology is changing quickly. There is a need for standards to ensure interoperability, interconnection, reliability, quality and security of medical data, images and video transmitted over the internet.

The following link details a report by the ehealth Vulnerability Reporting Program. This report details some interesting facts regarding the vulnerability of electronic health information.

eHealth Vulnerability Program Report (2007). Retrieved July 14, 2009 from
http://www.vermontmanagedcare.org/Contribution/Providers/EHR/EHR_PDFs/2007%2009%20eHealth%20Vuln.pdf

The Future of Wireless Technology in Healthcare

Wireless technology has the potential to transform healthcare. The tools used to deliver care and the way care is delivered will be influenced greatly by wireless technology.
The microchip described at the beginning of the presentation provides healthcare workers with almost immediate access to the medical records of their patients.
Wireless transmission of patient data to and from electronic patient records, labs, therapists and data bases maximizes communication within the patients’ circle of care.
Telehealth, which involves the treatment of patients as well as the education of healthcare providers over wireless networks provides services which were unavailable in the past.
The following presentation (link below) by Lionel Tarassenko (2008), describes how wireless technology may empower patients to take more responsibility over their health management. Wireless techniques for monitoring patients with diabetes, hypertension, asthma and chronic obstructive pulmonary disease are described. These self management programs reduce hospital admission rates and decrease healthcare costs, and through prevention improve health outcomes.

http://www.raeng.org.uk/events/pdf/Engineering_Better_Health/Lionel_Tarassenko.pdf
If you would like to follow the latest advances in wireless technology tune into 3G and 4G Wireless Blog website (Ghadialy and Sharma, 2009) at blogspot.com

http://3g4g.blogspot.com/2009/04/mobile-healthcare-more-on-telehealth.html

Vocera - an emerging wireless technology in Canadian healthcare

According to the company website, "the Vocera® communications system is a breakthrough wireless platform that provides hands-free, instant, voice communication throughout a networked building or campus." (Vocera, 2009). The Vocera communications system consists of two key components: 1. Vocera system software which controls and manages call activity; and 2. The mobile, lightweight Vocera B2000 communications badge which allow users to converse over a wireless LAN.

Phoenix Children's Hospital - Staff Experience with Vocera (youtube video)
http://www.youtube.com/watch?v=lbN5lLEeVNA

The Vocera device communicates through WLAN. With the push of a button and a spoken command (for example, "Call Dr. Smith"), Dr. Smith's personal Vocera will audibly ring and visually display incoming caller information. At this point, the call can be answered and immediate hands free person-to-person communication can commence. Additional software also allows users to make and receive telephone calls. Missed and received calls are stored in sequence and accessible through a small scrollable LCD screen. With additional software the Vocera device can communicate with patient monitors and nurse call systems, providing users with real-time clinical information while away from the patient bedside.

Link to Vocera Badge Data Sheet
http://www.vocera.com/downloads/Hardware_ds.pdf

A Toronto hospital recently implemented the Vocera system in an effort to promote staff safety. A panic feature connected directly to protection services has reduced response time during a Code White (violent person) by 50%.

Although this device clearly has its benefits, do you see any possible challenges implementing or using such a device in your workplace?

Press play to view a video of the Vocera communications device.

Conclusion

Wireless technologies are neither new to the world nor to healthcare. However, technological advancements and the growing complexity of healthcare have combined to promote the advancement of wireless applications and functions in providing better patient care. The benefits of wireless technology in healthcare are vast and becoming more apparent, however, like all good things it comes with a price. Without hard wires to protect data, securing wireless information is a challenge, as those with the know-how can now intercept information simply travelling through thin air. In terms of potential consequences, the security of personal health information could not be more sacred. As the future brings new and exciting advances in wireless devices and applications, tomorrow’s healthcare leaders must stay informed and aware of how these devices work, how they are of benefit, and most importantly how they could be used for harm. As Hippocrates so famously ascribed; first, do no harm.

Comic courtesy of and created by Sean Martin.

Reference List may also be viewed at web site
http://www.scribd.com/doc/17448280/Wireless-Way-Reference-List