Practical wireless: Is there such a thing?

"Wireless integration," sometimes promoted as the most promising new development in healthcare since penicillin, may have trouble living up to the hype, according to speakers at a HIMSS education session Tuesday afternoon.

"Cellular systems have a long way to go before they're viable alternatives for in-building wireless applications," said Mats Fridlund, CEO, Ascom Wireless Solutions, Morrisville, NC. "We don't know if cellular technology will become a viable alternative. What we are sure of are the challenges."

When St. Thomas Hospital in London became the first "wireless hospital" in 1958, it experienced three technical restrictions in its simple peep-tone wireless on-site paging system: battery capacity, reliability, and durability. Forty years later, these same limitations remain to various degrees, even though 400,000 wireless in-building systems have since been installed in the U.S. and Europe.

In the mid-1970s, second-generation paging systems appeared that were capable of interfacing with telephone PBX systems, and customers began to build larger systems, Fridlund said. Then, in the early 1980s, alpha-numeric display pagers began the transition from paging to messaging. By the mid-1980s, on-site paging systems included a combination of voice, messaging, and alarm features.

Wireless telephones emerged in 1984, although it was another 10 years before wireless in-house manufacturers introduced add-on mobility solutions for PBXs, including analog and digital connectivity, which yielded greater possibility for customization. In 1998, PBX makers began to offer integrated wireless mobility.

Fridlund cited several obstacles cellular technology must deal with to be considered an agreeable option for in-house wireless applications:
- Today's cellular systems are designed primarily for voice, although messaging is now becoming available.
- Risk of interference is a factor - today's high-powered solutions generate from 600mW up to 2W. Cell phones are banned in most healthcare facilities due to their potential to interfere with sensitive equipment such as biomedical telemetry and computer monitors.

"Cellular technology allows limited potential for customized solutions, primarily because this is part of the cellular operator's business realm," Fridlund said. "The operator owns the infrastructure and as a result they define the coverage area and monthly charges."

Depending on the coverage area, it is possible for an institution to be forced to deal with more than one operator to coordinate focus and activities, resolve interference issues, and customize solutions to meet client needs of such details as return on investment and invoicing.

While many telephone companies are struggling to survive in a deregulated market, some new players are attempting to offer integrated solutions.

"The operators will decide a lot in the future, especially cellular companies specializing in cellular nets," Fridlund said. "A handful of companies, maybe 20, will produce handsets. You can expect to see the operator focus on value where return is greatest - residential."

Priority number two will be businesspeople, including those in healthcare, which means the operator will give exceptional wide-area but poor in-building solutions.

"I expect it will be five years before we have in-building cellular systems good enough to support voice and data simultaneously," Fridlund said.