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Invisible advances

You need to look no further than London Health Sciences Centre and Mount Sinai in Toronto to see that wireless has made huge inroads in the health sector. In the corporate world, motivation for WLAN deployments is strongly dominated by employee demand for greater mobility without sacrificing access to data and phone calls.

July 1, 2005  

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When a hospital is about to become a major diagnostic im- aging regional network hub, its network has to be fast, reliable, resilient and secure. It also has to be capable of quickly, reliably and securely transporting large digital images, such as X-rays, between hospitals so that a specialist at one location can view an image shortly after an X-ray is taken at another location, rather than waiting for a cab to arrive with the film.

By the end of the year, the London Health Sciences Centre (LHSC) in London, Ont. will be the diagnostic imaging and patients record storage and retrieval regional network hub for hospitals and healthcare facilities in Woodstock, Tillsonburg, St. Thomas, Strathroy, Newbury and other towns in southwestern Ontario.

“Our data centre is becoming an ASP model,” says Peter Gilbert, director of IT services, London Health Sciences Centre and St. Joseph’s Health Care. “We’ll use the network connection to those hospitals to acquire images and ship them to appropriate workstations. By the end of the year, we’ll be filmless.”

The digital distribution of diagnostic images between hospitals will save on film, shipping and storage and retrieval costs. It also means patient wait times for diagnoses will decrease and they will wait less time in the X-Ray room, says Gilbert.

In the past, patients had to wait in the sterile X-ray room; sitting on the cold X-ray table while technicians developed and viewed the film. With digital imaging, just as with digital cameras, the technician will know immediately if the image is worth keeping.

Shared IT environment

The LHSC is one of Canada’s largest teaching hospitals, with more than 600,000 outpatient and 130,000 emergency room visits annually. While independent from St. Joseph’s Health Care, the two hospitals have one IT department that provides access to diagnostic imaging services, such as traditional X-rays, fluoroscopy, computer tomography (CAT scan), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine-produce images, for 1.5 million residents over 28,838 square kilometres through 41 community hospital sites in southwestern Ontario.

As the population ages and demand for diagnostic imaging skyrockets, the pool of radiologists cannot keep up.

In fact, 66% of hospital sites have limited radiologist coverage and the situation is becoming more challenging as many radiologists expect to retire over the next few years. So the rapid deployment of images across a network is critical to reducing patient wait times and improving patient care, says Gilbert.

In Canada, the London Health Sciences Centre decided to meet the future on its own terms, deploying a Cisco medical-grade network to extend its reach and increase productivity. “While the existing network had a solid infrastructure, we were looking at future needs, such as IP telephony, high scalability and wireless capabilities,” says Gilbert. “We needed to build a highly scalable infrastructure that would enable us to add new applications without re-architecting the entire network.”

LHSC users, used to ATMs and easy access to the Internet, expected easy access to records, which were often not available in digital format or were not available from all workstations.

The upgraded network needed to allow users to pull up to any workstation anywhere in the hospital and perform their duties. “We had to meet the expectations of staff who don’t have a lot of tolerance for a bank machine being down,” says Gilbert. “If our network isn’t reliable, we will not get them off the paper processes that limit the scope of healthcare improvements.”

Working with Toronto-based Cisco Systems Canada Inc., LHSC upgraded to a medical-grade network. The network provides the hospital with the resiliency, protection and responsiveness required in a 24x7x365 hospital environment.

By the end of the year, radiologists will be able to securely view past and current images in conjunction with patient records to make accurate diagnoses and team effectively with primary care givers at remote locations.

VoIP meets wireless

The Cisco medical grade network is not an industry standard, says Brantz Myers, director of enterprise and voice marketing with Cisco Canada. It is, however, an acknowledgement that healthcare facilities have different needs and priorities than corporations.

“We looked at the medical applications running on hospital networks, and at applications hospitals would like to run on their networks, and created an interactive network that allows for greater information access, improved quality of care and cost management,” he says.

The network includes Voice over IP telephony and a number of wireless applications as well.

“Wireless is important enabler of a medical-grade network,” says Gilbert. Nurse call is a wireless application that is in the pilot project phase at LHSC. In addition to having nurse calls from patients illuminate a light outside the patient’s room and ring at the nursing station, the calls can ring on the pager of the closest nurse or the most appropriate nurse (given the patient’s condition).

Nurses no longer need to be at the workstation, nor do they require line of site to the patient’s room, to know that a patient has called.

This means nurses are more mobile as they can even be on another floor and receive the page.

While it is hard to measure the return on investment in dollars and cents for a project of this nature in a not-for-profit setting, a saving of 150 footsteps per shift would make it “economically viable,” says Myers. The LHSC is achieving that in a pilot test that covers four floors on one campus.

But wireless is not all about improved healthcare services. For instance, wireless networking can be used in conjunction with radio frequency ID (RFID) tags to locate crash carts, wheel chairs and other mobile equipment when they are needed. And it can be used to ensure that security is notified if items pass a certain point on the premises, thus reducing theft.

While visitors are discouraged from using mobile phones in hospitals, Wi-Fi 802.11a and b is safe as the wireless network and wireless devices do not produce a voltage that could have a negative impact on electrodes used during open heart and other surgeries.

Wireless networks are an emerging technology in business, government and healthcare, says Ina Sebastian, associate analyst with Jupiter Research in San Francisco, Calif. Motivation for WLAN deployments is strongly dominated by employee demand for greater mobility without sacrificing access to data and phone calls, she says.

“Companies are gaining confidence around the advantages of WLANs,” generally used as an extension of the wired network in the office environment and in the technology’s status as a cost-effective, quicker alternative to wired LANs, she says.

Usage at all-time high

The use of wireless networks in the enterprise is at an all time high, says Lisa Pierce, vice president with Forrester Research. According to Forrester, currently, 56% of North American enterprises have installed wireless LANs, 11% use wireless hotspots and 30% use wireless 2.5/3G services, according to a recent Forrester Research report, Forrester’s Business Technographics May 2005 North American Network and Telecommunications Benchmark Study.

Last August, Mount Sinai Hospital in Toronto opened a centre devoted to working with technology partners to use new information and communication technologies in the hospital setting. Even though the Informatics Technovision Unit (ITU) brought 70 staff people who had been dispersed over the hospital together in one department, wireless was a major component of the network.

The department has technology, clinical and academic partners working to identify information and communication technology solutions that will support and enhance health care delivery, said Steve Noyes, director, information and communication technology with Mount Sinai. In addition, the wireless component of the Nortel network ensures that ITU members can roam anywhere and yet have access to data on the network and be accessible by wireless VoIP phone.

While wireless is critical to the success of the ITU, the workstations in the department are hardwired so ITU members do not use up wireless bandwidth when in the office.

The ITU is testing both wireless and wired applications. For example, many healthcare professionals work at more than one healthcare site. At the same time, teaching hospitals like Mount Sinai, a University of Toronto affiliated patient care, teaching and research centre, tend to use a myriad of IT platforms to support clinical care. ITU software developers are working to design a physicians’ portal solution that will bring consistency to the user interface no matter what a hospital’s proprietary system might be.

Mount Sinai is also actively involved in extending its wireless infrastructure throughout the hospital. Clinicians will be able to update, and have easy access to the most up-to-date, clinical information no matter where they are in the hospital, said Noyes.

The hospital’s wireless strategy also includes the installation and integration of a VoIP network by Telus using equipment from Nortel. Wired VoIP, is at long last coming of age in business but Noyes did not feel the hospital was taking a chance on rolling out wireless VoIP.

“Absolutely this works,” he says of a technology that several years ago was echoed and distorted. It’s rock solid,” In addition, VoIP means hospital staff can move, as they often do, and keep their extensions without anyone having to pull cables.

Freedom to roam while being accessible is important in healthcare and the Mount Sinai network strategy involving Nortel and Telus, is delivering on that.

Beyond the healthcare applications, there is a significant cost savings when networks can be extended without stringing cables, Noyes says.

Cutting the cords that bind

When it comes to cutting cords that bind networks, there are great opportunities for savings, says Barry Lewis, president of Brampton, Ontario-based of Cerberus ISC Inc., an information security consulting company, and co-author of Wireless Networks For Dummies. “Wireless can exist with no wires. Conversely, if you have a network, it can be enhanced and extended with wireless.”

The wireless network needs no cables, other than to be connected to the backbone — such as a LAN — or out to the Internet. Wireless 802.11b access points can be set up to cover a building, a campus or even a city, he says.

Connect the wireless network to a T1 backbone to the Internet and users will not notice a difference for e-mail, Web surfing and typical data applications. While there are limits — about 300 feet — as to how far a user can be from the wireless network access point, access points can be setup within 200 feet of each other giving cellular network like coverage to a building, campus or city, Lewis says.

“You can expand the wired network quickly by adding access points and no cables,” he adds, which is a cost-effective and gentle way to bring networking capabilities to a heritage building or to retrofit an existing office.

While there are security concerns around wireless networks, Lewis points out that “wired networks are generally, not secure at all, generally.” The limitation of the physical environment makes them seem secure, unless a hacker rides in on the Internet, and networks were set up for sharing, not keeping people at bay, he says.

Properly set up, wireless networks are more secure than wired one as all data can be encrypted. However, a hacker only has to be within access distance before attempting to crack the network. Too many organizations leave their wireless network guards down, making it all to easy for hackers to go joy riding.

However, Lewis is quick to point out that if an organization has enough of a concern, coupled with enough money, they can make their networks “secure within limitations of risk, absolutely.”

While the proliferation of private and public wired and wireless networks has not yet led to ubiquitous network coverage, we are getting close, says Chris Bogdon, chief technical strategist with Padcom Inc. in Bethlehem, Penn.

Padcom has developed wireless software, TotalRoam, for continuous and seamless access, across different communication protocols, to critical information on enterprise networks. TotalRoam detects the network that the user is covered by, which can sometimes be more than one network.

Then, based on business rules, it determines the most appropriate network to use and ensures keeps the roaming mobile worker is online. It does this while maintaining network authentication and security standards, including encryption.

Currently, the technology is used primarily by public safety and utilities markets, but as more employees from more verticals roam greater distances across disparate networks, the company expects to expand its base.

Perhaps one day doctors will be able to use wireless devices to view images and make diagnosis while on their way to conferences or cottages, further enhancing patient care and reducing wait times by allowing the right medical expert to view the right images and documents in a timely manner, from any location.

Paul Lima is a Toronto-based freelance writer. He can be reached online at