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/ )
(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
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.
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
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
1 comment:
Great presentation- to respond to the question in this section our organization uses wireless technologies in a variety of areas. One example is mobile medication carts- these are a newer version of medication carts that also includes computers. This allows for medication to be provided at the bedside while referencing the electronic health record and Pharmanet to make sure dosage is correct and drug/drug interactions don't occur. We also have basical mobile carts or COWs as we call them (Computers On Wheels). This also enables accessing patient information through our EHR at the point of care. With these technologies we also obviously leverage wireless capabilities of laptops and have just received some pilot "tough" books which are like a laptop but can be dropped from 4 feet, are water resistant and can be wiped down with alcohol for infection control practices. We are about to embark on implementing Vocera so it was great to read more about it hear.
I look forward to what the future brings with wireless but the connectivity can be inconsistant at times in our origanization so we need to find a way to make this more stable before we can deploy these technologies more broadly.
Thanks
Jess
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