Wireless Strategies for Healthcare Provider Organizations
Washington D.C. 28 January 2006
As the American population increasingly carries portable telephones and personal computer devices, Federal agencies are continually seeking new cost-effective ways to bring Government to the people instead of making people come to "fixed" government offices during normal "business hours". Whether it involves using mobile van offices at shopping centres or setting up additional government portals for citizens to use on the Internet, wireless communications will play a key role in providing improved services to citizens across the country in the coming decade.
The scope of wireless and/or mobile computing is expanding daily. It is no longer enough to just know about available mobile devices and applications to gear up an organization's wireless strategy. One must now be aware of the wireless architecture, wireless standards, special security needs for wireless devices, the growing range of application choices, and the unique support and maintenance requirements needed for wireless systems and users of mobile devices.
The use of wireless modalities in settings such as hospitals, clinics, long-term care facilities, and home care is becoming well established. The proliferation of software applications and use of mobile computing devices in health care settings indicates that the wireless landscape is finding a secure place within our health care settings. This specifically holds true for any major health care organization.
One of the greatest risks related to the acquisition and implementation of wireless technologies is to focus on technical features before addressing the issues of privacy and security. Privacy and security of transmissions of sensitive patient information within the health care setting must remain a high priority to prevent any breach of patient confidentiality and leakage of data about any individual's health condition.
It is essential that stakeholders across the health care arena become fully aware of the wireless architecture, mobile computing devices, mobile computing applications, the scope of benefits and limitations, alternative solutions available for different health care settings, security risks, guidelines for implementation success, and the end-user experience. Becoming more knowledgeable is essential before a health care organization takes any major steps forward towards acquiring and implementing wireless solutions.
The Department of Veterans Affairs (VA) in support of their health care facilities nationwide has already taken initial key steps in supporting medical services at the point of care through the use of wireless technology and the adoption of appropriate mobile computing devices and applications. For example, staff from the Veterans Health Administration (VHA) Office of Information (OI) national Bar Code Medication Administration (BCMA) Joint Program Office were selected by the Security of Mobile and Wireless Business Applications in Government II Conference Awards Committee to receive the award for Outstanding Accomplishment in the category of Enterprise-wide Applications of Mobile and Wireless Security. The award was given for their work on deploying VHA's Bar Code Medication Administration (BCMA) software over secure wireless data networks throughout VHA medical facilities. The system ensures VHA's network and patient information are secure from unauthorized access and meet HIPAA privacy guidelines for the health care industry.
What is Wireless Communications?
Wireless communication is currently one of the fastest growing technologies in the information technology (IT) industry. Wireless communications can be further divided into two major categories: wireless voice and wireless data. Wireless voice includes cordless/cellular telephones and mobile phones. Wireless data includes cellular digital packet data (CDPD) and Wireless Local Area Networks (WLAN).
Background on the Wireless Sector
The whole wireless sector is under close scrutiny from research agencies, analysts, consultants, and enterprises keen to implement some sort of wireless solutions. While the discussion related to Return-On-Investment (ROI) continues, it now appears that wireless technology will deliver on its promises over time. The technology will solve a lot of problems over the long term once sufficient infrastructure is present and products reach the same level of maturity found in other commonly used electrical appliances produced by industry.
Many companies have already chosen to move forward and are using wireless networks to connect portable computing devices to enterprise applications. These are the companies that have examined the business processes of their customer-facing employees and identified areas where today's technology can improve those business processes. Possible business process improvements exist in the following areas:
Cost reduction. Activities and resources can be removed from existing processes.
Cycle time reduction. Sales, service, expense, and billing cycles can be reduced.
Increased revenue. It can introduce revenue-generating activities that wouldn't otherwise be possible.
Optimal use of time. At points in a business process where there is a wait state, workers can perform other useful tasks.
Increased customer satisfaction. The quality of the service to the customer is maximized.
Increased employee satisfaction. It can reduce tedium, unnecessary trips to the office, and paperwork.
Mobile Health Applications Software
Most technology tools available to physicians today are complicated and cumbersome and do not yet fit easily into the flow of patient care. However, a new generation of information systems and technologies are changing the way physicians practice. For example, physicians today can acquire a mobile practice companion, or PDA device, that offers immediate and secure access to critical clinical information no matter where or when physicians need it to help them provide patient care. Just as important, these types of portable wireless tools should improve practice efficiency and may potentially increase patient satisfaction.
Currently these mobile applications focus primarily on tasks at the point of care and do not require a sophisticated data transfer infrastructure back to the organization's main computer system. Using these mobile applications in conjunction with wireless technologies, the following benefits have been realized within the health care setting:
- Convenient access to patient data
- Accurate and timely entry of data
- Cheaper installations than wired networks
- More efficient utilization of provider time
- Reduced medical errors
- Eliminating duplicate data entry
- Improved patient care
- Decreased operating cost
- Improved work flow
- Decreased patient and clinician wait times
Some of the most widely noted drivers in the growth of enterprise mobile computing are:
- The need for faster, decentralized decision making
- The need to be closer to beneficiary population
- The availability of better mobile computing technology
- Increased responsiveness to beneficiary service needs
- The need for real time medical decision making
- The need to decrease medical errors
- The need for bedside standardized protocol
- Increased industry pressure for better data quality and efficiency
One of the biggest challenges for mobile computing vendors is to provide deeper and broader functionality. Expect mobile computing vendors to continue to expand their functional capability from solely prescription writing into clinical documentation or charge capture in the coming years especially as they merge with or acquire other mobile computing application vendors.
Despite the economic situation and recent world events, the basic drivers of growth in mobile computing are as strong as ever. In fact, health care is re-engineering its workplace and provision of care utilizing wireless information technology to achieve many of its business objectives. Optimal to its success is the priority of securing the infrastructure and data stream. Any wireless strategy must understand how every decision impacts the security of the enterprise and yet implement devices and applications that provide great value. The landscape changes everyday and remaining mindful of the advancements is the first step toward an efficient, secure, and tangible wireless enterprise.
High-speed Internet and portal technologies will dramatically transform the delivery of health care. Portals will be accessed ubiquitously via computers, wireless devices, and telephone (using voice recognition and speech synthesis applications). Patients and providers will have the capability to collaborate in real time, search, publish/subscribe, or even obtain personal information. Portal infrastructures will also enable an environment that promotes customer service. They will provide common access to accurate, consistent, and reliable information across business lines.
Life Span of Wireless Solutions
Mobile computing using wireless technology involves a range of solutions that enable users to obtain access to data from almost any location, at any time. Currently, there is a wide array of mobile computing device options ranging from cellular phones to full function wireless laptops. Before proceeding with the selection of mobile solutions, it is important to consider the 1) Infrastructure requirements, 2) Mobile computing device capabilities, and 3) Integration with existing systems.
The expected life span of wireless technology is currently about two to four years. While the equipment itself may last much longer, the increasing network requirements of new health care software (e.g. Wireless EHR and Pocket Rx) may force an accelerated replacement schedule. Network is an issue as well. As a rule, plan to begin replacement of existing wireless technologies within two years of installation and anticipate completing the replacement within four years.
Business needs are evolving daily as are the solutions within the wireless landscape. Knowing the business needs of one's organization will help tailor the recommendations that are essential to the success of any wireless technology implementation effort. During implementation and deployment, security issues and concerns must remain visible. Every decision must address how it will affect the security integrity of the enterprise. The following is a list of basic recommendations:
- Standardize on a single mobile infrastructure platform
- Standardize wireless devices and application solutions whenever possible
- Maintain a comprehensive security protocol
- Enable connectivity to the intranet and legacy systems
- Look for new applications that can improve existing processes
- Purchase products centrally to secure volume pricing
- Deploy wireless systems management tools from the outset
- Begin to build key skills now with pilot deployments in the field
- Document procedures for testing and design of wireless infrastructure and applications
- Ensure your enterprise Help Desk can respond to wireless technology questions
Training is a valuable tool to use for the organization's non-engineering professionals who provide invaluable expertise to the operational network. An organization without a focus on training personnel in such a technologically changing environment runs the risk of rendering their networks liable for breaches in security, inappropriate network design, and future technological problems.
There is a need for all health care organizations to do a resource analysis prior to undertaking any major project to implement wireless solutions in order to determine:
- what resources you will need to aggressively pursue wireless communication opportunities;
- which Internet and intranet communication, document management and work flow procedures need to be put in place;
- what type of staff or vendors you may need to bring on board to help implement your wireless applications; and
- how to use your existing resources to get up and running quickly with wireless tactics.
Trends and Future Direction
For the foreseeable future, wireless technology will complement wired computing in enterprise environments. Even new buildings will continue to incorporate wired LANs. The primary reason is that wired networking remains less expensive than wireless, although wireless has decreased support costs. In addition, wired networks offer greater bandwidth, allowing for future applications that may be beyond the capability of today's wireless systems.
The complexity of mobile and wireless applications, combined with a lack of standards, will continue to make mobile and wireless an area of overdue innovation. Risk remains, e.g. more than 50 percent of mobile applications deployed at the start of 2005 will be obsolete by the end of 2005. The lack of sufficiently useful and usable applications will be the biggest barrier to "always-on" consumer acceptance in the near term. The real question about the future of the wireless enterprise network is not whether it is here to stay but rather the extent to which we have the foresight to fully exploit it while preserving the privacy and security of the individual's health information.
Although the implementation of wireless computing can potentially provide enticing dividends, its full value cannot be recognized without proper planning and extensive forethought on the wireless enterprise design. The goal is to be better able to define, implement, deploy, and evolve state-of-the-art wireless solutions that meet the needs of the evolving business environment. The clinical care initiatives that many major health care provider organizations are currently working on lend themselves concretely to a proactive wireless strategy. However, critical questions do need to be asked prior to making any implementation decisions.
1. Understand clearly the organization's business objectives and business processes. Health care organizations should consider wireless applications in the context of a larger business process reengineering and enterprise-wide IT effort.
2. Establish an enterprise wireless working group to develop a long range strategy and plan.
3. Conduct an enterprise technology assessment. Complete a thorough technical analysis on which to base the decision to install wireless solutions. Avoid choosing a technology that fails to meet your organization's business and clinical needs.
4. Identify the type of data to be transmitted. Determine whether it is text intensive, graphics-intensive; determine physical parameters of the proposed installations as wireless networks are limited in range; note the span and throughput of wireless networks offered by competing manufacturers.
5. Conduct detailed on-site analyses of critical physical and clinical problems at health care facilities to determine if wireless computing offers the right answers.
6. Ensure the design of wireless infrastructure products and components chosen to be implemented comply with your Enterprise IT Architecture and Standards.
7. Choose the right vendor. In addition to their product line the chosen wireless product vendors need to be able to provide training and support to the organization over time.
8. Lay the groundwork for a shift in mindset and the work environment when wireless solutions take hold. Provide orientation and training needed to help management and employees embrace the new world of mobility and increase autonomy of the organization's workforce.
9. Secure data everywhere. Wrap security around the information, internally and externally, regardless of when, where or how it is created, stored, processed or transmitted. Be mindful of ever-occurring security threats and create centralized policies.
10. Check on how the stations communicate with different internal and external Access Points (AP) in order to assess to which AP they should currently belong.
11. Develop a device management strategy and approach to control hardware and software purchases, inventory management, back up, training, and help desk support.
12. Consider acquiring and deploying an enterprise-wide "mobile infrastructure" solution. Deploying one integrated mobile computing suite across the enterprise will provide a range of benefits, e.g. one vendor, one contract, less training, simplified architecture, and lower support costs.
13. Determine how to quickly and cost-effectively integrate wireless technology into your current environment - and achieve the most positive impact on your business.
- Determine which wireless solutions will deliver the greatest business value
- Conduct pilot tests of various solutions
- Prioritize planned acquisition and implementation of wireless solutions.
List of Potential Wireless Solutions
- Wireless Phone Switch (PBX)
- Wireless Data Networks
- Wireless Internet/Intranet
- Wireless Web-based Reference Sites
- Wireless/Mobile Enterprise Computing Devices
- Cellular Phones
- Handheld Personal Digital Assistants (PDA)
- Laptop Portable PC
- "Wearable" Computing Systems
- Wireless/Mobile Enterprise Health care Applications
- Clinical Documentation
- Alert Messaging
- Electronic Health Records (EHR)
- Bar Code Medication Administration (BCMA)
Peter Groen and Marc Wine
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