Healthcare Wireless and Device Connectivity

What are the Business Models for In-Building Coverage for Healthcare - Why look at them now?

http://solidtechusa.com/blog/

We propose that the integrated delivery network own the technology and or DAS solution. This has several advantages.

1. This will allow the healthcare system look to the carriers for participation in the funding of the system.

2. The healthcare system now has the ability to actually look to the best technology out in this space, versus settling for either what the carrier proposes, and/or outside leasing company.

3. The cellular technology evolution is not static…it is constantly moving forward. For example two years ago 4G or LTE was not even being discussed. If a carrier or an outside entity that “owned” the DAS implemented the proposed in-building coverage solution, how could the healthcare system be ensured that the proposed DAS solution would meet their future requirements?

Overall Cost of Ownership and why this is important to look at?

• As in the aforementioned, when the healthcare system actually “owns” the in-building coverage system; the overall total cost of ownership over the life of the system is actually much lower.

However there are other costs that need to be considered both from a capital expenditure and operational expenditure side.

The vast majority of in-building coverage systems utilize a combination of fiber optic cable and coaxial cable distribution. As said, it is important to look at the capital expenditure cost to implement these systems. The following areas should be looked at.

1. How much fiber optic cable or strands are required from the MDF (Main Distribution Frame) to the IDF (Intermediate Distribution Frame)?

2. How many remote units are required to convert the RF over fiber signal to RF on the coaxial cable infrastructure? More remote units, higher capital expenditure costs.

3. What is the total cost to support all carriers as well as public safety coverage?

4. We do not recommend supporting the use model of combining WLAN (Wireless LAN) with a DAS or WMTS (Wireless Medical Telemetry Service) with a DAS. However if an integrator proposes this; then what is the cost of WLAN and/or WMTS combined with a DAS, versus a separate discrete WLAN and a discrete DAS? Will the WLAN provider if combined with a DAS provide the appropriate warranty support?

Looking at the overall cost of operational expenditures as well as potential liability, one should also take into account the following.

1. Are the remote units in the IDF capable of being locked and sealed from water ingress? This is important because the in-building coverage system has now become a very important communication system in the healthcare enterprise. There should be no way for any outside person to potentially cut cable and or the fire department in the event of a fire to cause damage to the electronics with water.

2.How modular is the system for upgrades to new technology? This is also important because some designs require the replacement of the “remote unit” to upgrade to new technology offerings, or do not allow future expansion?

3. Upgrading and MTBF. What is the calculated mean-time between failure of the system components? Can the system components be hot swappable without taking the system down both in terms of upgrade and replacement?

Recommendation and Rationale

In evaluating in-building coverage system and requirements the market has evolved from a single carrier coverage system to a multi-carrier business model in healthcare. As a result of this there are several business models that need to be evaluated and it is our premise that the owner operated business model provides the best total cost of ownership and protection of the technology investment. From a total cost of ownership many factors need to be looked at that will reduce the initial capital equipment expenditures as well as operational expenditures.

WLAN on a DAS...Really..Again

I heard about this again today...not again. OK, like anything else if you through enough $$ at something, custom re-engineer something for what it was not intended, make it proprietary as all get out, and create barriers to the evolution for new wireless LAN technology...then I guess maybe you could make it work. But will it work that well? At this point trying to combine these architectures has certain compromises..never intended to work together. Sounds good on the surface. (marketing and good salesmanship) A well designed wireless LAN (and let me state well designed), on it's own works fine. Some WLAN(s) have not been designed that well as different integrators (well they have different skill sets).

Now to the financial part of things. Go get a quote for WLAN coverage for 1M square feet. Get a quote for a multi-carrier DAS for 1M square feet. Now get a quote for 1M square feet with a DAS to support 802.11n. Compare the costs! Finally, when you hear of now adding WMTS, add this into the equation. It is far less expensive to install a separate DAS, a separate (discrete WLAN), (and it is totally supported by the WLAN companies), than trying to combine everything. I intend to say no more about this, as it makes no technical or financial sense to keep trying to force a round peg into a square hole.

Validation and Verificaton & Risk Analysis - Networks for Healthcare

It is still alarming to me to hear that certain entities are promoting that a "type of network is termed "medical grade utility", or that a network needs some sort of certain regulatory approval.

This is not true in my opinion, in fact it could be construed as mis-leading. What is true, is that the medical device company if they decide incorporate their wired/or wireless medical device as a part of any infrastructure and/or design does need to test, validate, and verify that the product works as per the intended use. It all in the minds of the regulatory agency reviewer about risk analysis. Example: Would be a patient monitoring company. The patient monitoring company decides to not have a closed network, but actually make their WLAN network a part of the enterprise wired and wired network. Then the patient monitoring company needs to work with what ever provider of say WLAN infrastructure, or other and provide validation testing both in the lab and in an actual clinical site. They need to demonstrate in the case of other application traffic, (data, voice, and video), that their application works as intended in a safe, reliable, and repeatedable manner based upon the best of industry practices. In the case of patient monitoring which is a real time application, then this means the right persistence of waveform data from the patient monitor to the central station, the right annunciation of alarms, and the correct and timely recordings. This also needs to show how this is scaled, i.e. adding more devices and traffic will not effect the operation of the application as intended. If say that design changes in the future (for instance another manufacture of access points), then the medical device manufacture does need to also test on this,(to the same level as described) but then this becomes an internal letter to file.

I am speaking from experience going through this process several times.

PAN (Personal Area Network Space)

Well Zigbee has ruled the mesh space here, as well as ANT for very low powered links. It looks the adoption of Bluetooth Low Energy (BLE), that this will change the game. Apple has recently announced the adoption of BLE in all of it's I-Phones forthcoming. Devices using Bluetooth low energy wireless technology are expected to consume a fraction of the power of Classic Bluetooth enabled products for Bluetooth communications. Low duty cycles will greatly extend battery life..up to a year on a coin cell battery. Bit rates are 200kbits/sec, versus 1-3 Mbits with Bluetooth V2.1. Set up time is also drastically improved <3ms versus <6s with Bluetooth V2.1. I do believe that this will change the landscape of medical device connectivity. Now your I-Phone or Android device can be used as a simple gateway to the cloud.

Search Engine Ranking for DAS - Integra Systems Ranks 1rst

My long time friend Eric who does my SEO (Search Engine Optimization), pointed out to me that if you type into Google...."Distributed Antenna Systems for Healthcare" Integra Systems, comes up first and dominates. The grayed areas are ads. We even come ahead of Graybar...and they probably had to pay to get there.

Integra Systems M to M Development Program

In the past two years we have developed solutions for a medical device company that wanted remote connectivity. The prototype was built in record time. We are now embarking upon the actual application development to M to M solutions for a variety of vertical markets. M to M stands for machine to machine from the non-intelligent device to cellular to the cloud. We also will providing complete end to end Android and I-Phone application development for these solutions as well as back end management for kitting and deployment. Stay tuned for further developments.

The Bandwidth Pipe Requirement it is real and coming fast

Had an interesting conversation with one of the smartest guys that I know in the cellular and optical industry. Apparently one of the larger (will leave out names..let you guess)networking companies is going down the path of supposedly integrating components of DAS into their WLAN infrastructure. At to this, it is analog. They evidently see that providing Gigbit Ethernet with 802.11ac and cellular capabilities is perfectly fine. I am sorry but this is like building a two lane road in the middle of Los Angeles when you actually need ten. In my previous blog I mentioned LTE and LTE Advanced. The question comes up how will you handle a hundred, (conservative number), smart phones downloading live video at 1 Gbit/sec, with 1Gigibit Ethernet? You won't..oh you say..just add another strand of Giga Ethernet. You will need so much Ethernet it is not funny. This is where the revolution is coming in optical...fiber. You need the back haul to provide the pipe. Imagine over one strand of fiber (use patented optical laser and WDM (wavelength division multiplexing), that can deliver 16 independent channels of traffic, with each channel capable of carrying GbE, SONET, up to OC-48, EPON, GPON, or CPRI up to 3.07Gbps.

Advanced LTE Changes the Game...again - The Need for Speed

There is definitely a battle going on, i.e. LTE Advanced versus 802.1ac. Going from outside on LTE then I want LTE inside the building. But think of the use model. I have the Motorola 4G Droid Razer and it is my world. Still have to use a desktop and laptop..but with 4G..unreal.

Even though I have WiFi on my Droid, I do not associate an AP..even in my house..how many others do? Now this is changing again (once people get used to this type of bandwidth...everywhere they want more.

Traditional LTE has Peak Download of 100Mbits/s with Peak Upload of 50 Mbits/s. Still WAY better than 3G. LTE Advanced now will provide Peak Download of 1 Gbits/sec and Peak Upload of 500Mbit/s. LTE Advanced is an enhancement to LTE. LTE Advanced is similar to the upgrade path from WCDMA to HSPA. Additional spectrum and multiplexing will allow higher data speeds while coordinated multi-point transmission will allow for more system capacity to help handle the enhanced data speeds

Fallacy of WMTS and WMTS on a DAS

I got an interesting call this week from a major healthcare system (not to be identified). Question was...are their Quality of Service Requirements or latency issues for WMTS? Well, no. However I probed further and found out what the real issue was.

Apparently one of the installed (not to be named..but lets' say real large companies) WMTS in 608-614Mhz was actually having delays of up to 4-8 seconds from the transmitter to central station waveform display. (Very clinically unacceptable), every few hours. My read is it probably had to do with "drop-out". (The companies (manufacturing this)...apparently threw up their hands!)

So how do you trouble shoot this?...send people out and use a spectrum analyzer and then step by step look through all aspects of the coaxial antenna system. How do I know this...because been there and done that years ago. The point of this, (if the companies..which we know about), actually used WiFi; it would at least be a different story. You could remotely troubleshoot, but also ensure enterprise grade Quality of Service...and the IEEE standards.

Now moving on the issue of WMTS on DAS. Well looking at my crystal ball and what I know, the big companies that we know all have skunk work projects to figure out probably to exchange the 608-614Mhz and 1.4GHz radio with WLAN (probably 802.11n..as silicon gets smaller and more efficient. So this is where it gets interesting. One company is promoting how great it is to combine WMTS with a DAS, (at 1.4GHz). Another quote is obtained from a competitive WMTS company (at 1.4GHz). Discrete WMTS at 1.4GHz Combining it with a DAS cost $900,000.00 (more)..yes more. Oh yes how would you like an antenna element spaced every 15 feet down the hallway!

Integra Systems, Inc. and HIMSS 2012

The principal of Integra Systems, Inc. has been attending HIMSS since 1997. Previous to 1997, the AHA since attending from 1983 gathered the most attention. It is interesting to see the change in the HIMSS attendees and companies. Definitely there is the move from software (Cerner dropped out...we all know), to a lot of very forward looking companies in the wireless and mobility space front and center. In fact I would strongly agree that 2012 is another break out year for the wireless, mobility, and smart phone application space. The big iron networking or what we consider as this era..well, think of the desktop..what is their messaging and value proposition? Integra Systems, Inc. is working with many companies during this week...it should be a 24x7 week as always. Stay tuned for more concentrated blogs leading up.