Wireless LANs capitalize on convergence

Wireless LANs capitalize on convergence

Standards, reliability, cost savings prompt hospitals to invest

The increasing drive to make electronic patient records a practical part of the integrated healthcare network and provide access to patient information from any location is pushing healthcare providers large and small to adopt wireless technologies. This growing interest goes hand in hand with product improvements, industry-wide standards implementation, and pilot projects demonstrating the efficacy and efficiency of wireless local area networks in a hospital environment. The result is a huge market potential for wireless-device vendors and their medical-device and computer company partners.

Wireless products, which range from enhanced Palm Pilots and cell phones to cart-based laptops, bring a combination of mobility, flexibility, and real-time access to healthcare providers. In particular, they make clinical, reference, and administrative information accessible from the patient’s bedside, permitting point-of-care updates of electronic patient records. Other standard wireless applications include respiratory care; medication administration; and admitting, discharge, and transfer. And it is expected that still images and even real-time video will be available on wireless networks in the near future.

The success of many wireless installations depends in part on their ability to integrate voice and data over a single IP-enabled pipeline. In fact, some industry observers believe wireless local area networks will be the first true application of voice- over-IP technology in the healthcare field (PNN 7/99).

Just two years ago, most wireless installations in hospitals were pilot projects, and most healthcare providers were wary of the technology. The equipment was large and expensive, the installations clunky, and the service not very reliable. In addition, there were concerns about signal security and radio-frequency interference with existing telemetry devices, particularly in the ER and cardiovascular departments. Industry analysts estimate that, to date, fewer than 5% of the 6000 hospitals in the U.S. have implemented multipoint wireless LAN applications—despite the fact that several large companies, including Proxim, Aironet, 3Com, Symbol, and Lucent Technologies have been actively pursuing this market.

But advances in standards, battery life, user interfaces, transmission speed, and cross-platform compatibility are changing the way healthcare organizations view and use wireless technologies. A report released by market research firm Frost & Sullivan of Mountain View, CA, earlier this year estimates that the market for wireless LANs will grow from $305 million in 1998 to $1.6 billion by 2005, with healthcare accounting for 13% of the wireless LAN market.

“Handheld components have gotten much smaller and lighter, battery life has improved, pricing is coming down, and everything is becoming Web-enabled, which makes the user interfaces simpler and reduces the amount of bandwidth needed,” said Scott Lucas, market development manager for Mountain View, CA-based Proxim, the acknowledged market leader in wireless products and services. “And studies have shown that you can decrease costs and improve quality when care providers have more information available at their fingertips.”

Images and videoThe ability to transmit diagnostic images and do real-time video via wireless is a near-term goal for Duke University Medical Center in Durham, NC, which has been working with Aironet since late 1996 to employ wireless technologies to improve efficiencies, increase access to critical information, and reduce costs and length of patient stays. Although the first wireless applications were pilots, DUMC committed to populating every clinical site on its network with wireless access points. And as the technology has evolved, so have the applications, which today include a wireless laptop drug-ordering and monitoring system that pharmacists use while doing rounds, an updated version of the original wireless respiratory-care system, and a dozen cart-based laptops in the intensive-care unit that enhance mobile access to patient information. But DUMC isn’t stopping there.

DUMC embarked on a pilot program earlier this year involving the use of Palm computing solutions to capture physician charges. Symbol has partnered with Durham-based ClinEffect Systems, a developer of physician charge capture software, to create a customized solution for DUMC.

The palm-sized SPT1500 mobile computing device from Symbol, operating on ClinEffect’s CEDS software platform, enables DUMC’s physicians to scan patient wristbands for identification, view that patient’s profile on screen, select relevant patient care codes, and make clinical notations, all at the point and time of care.

DUMC is also piloting a project designed to look seriously at the viability of wearable computers; primarily head-mounted displays that put information right in front of the user’s face. The goal is to find a device that allows mobile workers to get more display with less weight by bringing the “screen” closer to the eye while leaving the hands free. Eventually, DUMC expects to do even high-bandwidth image-based applications, including interactive video, over these wireless systems.

Standards take chargeStandards have been critical to the healthcare community’s growing acceptance of wireless LAN technologies. The first wireless Ethernet standard (IEEE 802.11) was formally adopted just two years ago, and the first products conforming to this standard were introduced to the market last year. This has made a huge difference in the way end users perceive wireless products and applications, according to Phil Belanger, vice president of marketing for Aironet in Fairlawn, OH.

“Before the standard, wireless applications (in healthcare) were usually deployed on a departmental level for a particular application,” he said. “But when the standard came along, it changed the nature of how (the technology) is deployed. So now, instead of department-based trials, wireless is moving into facility-wide infrastructures.”

An important aspect of the 802.11 standard is that it supports up to 2 Mbps throughput, which until recently had been the standard for most wireless products. But new standards are in the works that will support much faster data transmission, thus opening up the wireless pipeline to a broader spectrum of clinical applications—including, eventually, the transmission of images and even real-time video. The IEEE 802.11 committee is already working on a standard that will support the next generation of wireless products, which are being designed to offer 11 Mbps at 2.4 GHz.

The 802.11b standard will support products with performance of up to 11 Mbps, falling back to 5.5 Mbps if necessary to ensure a reliable connection. Several companies, including Aironet, Symbol, and 3Com, are already shipping 11 Mbps products, and another 11-Mbps standard—802.11a, which specifies transmission in the 5-GHz band, making it faster than 802.11b—is currently in the draft stage, with final approval expected early next year.

Proxim has completely bypassed the 11-Mbps benchmark, however, focusing instead on a 24-Mbps wireless LAN standard and a product line designed to support 24-Mbps data rates and real-time multimedia applications. Proxim has been instrumental in developing the Hiperlan Type 1 wireless standard, which was ratified by the European Telecommunications Standards Institute in 1996. In addition to higher data rates, Hiperlan incorporates specific quality of service parameters that prioritize network traffic and deliver time-sensitive packets first. This will become increasingly important as electronic medical records and related diagnostic and clinical applications become accessible via wireless LANs.

“24 Mbps helps you do everything faster, so it makes it easier to transfer and download bulky images like x-rays,” Proxim’s Lucas said. “It also enables support for multimedia, such as live or streaming video, which helps prioritize traffic, while the high data rate helps speed the transfer of data such as static images.”

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