Healthcare Wireless and Device Connectivity

802.11n and Transmit Beamforming Cisco ClientLink

802.11n provides remarkable performance improvements in the areas of throughput, link reliability, and predictability. The move to 802.11n provides significant benefits, but most hospitals will move forward in a transition strategy. Most 802.11n solutions offer improvements in the up-link communications from the access point. Cisco ClientLink technology is unique in that it offers improvements as well as downlink communications from the access point to the client. Cisco has also added advanced signal processing into the Wi-Fi chipset. Multiple transmit antennas are used to focus transmissions in the direction of the 802.11a/g client, increasing the downlink signal to noise ratio and the data rate over range, thereby reducing coverage holes and enhancing the overall system performance. This essentially learns to optimize a way to combine the signal received from the client, and then uses that information to send packets in an optimum way back to the client.

The radio signal in a healthcare environment rarely takes the most direct or shortest path from the transmitter to receiver because walls, doors, or other structures obscure the line of site. That is why telemetry systems use diversity. 802.11n takes advantage of multipath by sendintg radio signals at the same time. 802.11n also specifies how MIMO technology can be used to improve the SNR at the receiver by using transmit beamforming. Transmit beamforming as specified in the 802.11n standard requires cooperation from both the receiver to feedback training and/or channel information about the received signal to the transmitter - so both the AP and client need to support this capability. Due to the complexity issues, the first generation of mainstream 802.11n chipsets neither the AP nor client chipsets implemented 802.11 transmit beamforming.

Cisco realized that for many networks the performance of the installed 802.11a/g client base would be a limiting factor on the network. To take advantage of capacity in the second transmit path for 802.11a/g clients, and to enhance overall network capacity by bringing 802.11a/g clients up to a higher performance level; Cisco created an innovation in transmit beamforming technology called ClientLink.  ClientLink uses advanced signal processing techniques and multiple transmit paths to optimize the signal received by 802.11a/g clients in the downlink direction without requiring feedback. Since it does not require any special feedback, it works with all existing 802.11a/g clients.  Another step is taken to improve performance in the downlink direction, making the client better able to hear the access point. The Wi-Fi  channel is reciprocal, meaning the transmissions between access points and clients happen on the same frequency and use the same antennas. Thus, the access point can use the adjustments calculated by the MRC (maximal radio combining algorithm), to optimize the reciprocal signal transmitted back to that specific client using the APs two transmit antennas.  These enhancements are made in hardware with minimal overhead on the AP platform and no performance is lost due to signal processing.  ClientLink effectively enables the access point to optimize the SNR (signal to noise ratio), exactly at the position where the client is place. Improved SNR has benefits such as reducing the number or retries, provides higher data rates, and increases the overall capacity of the system.  Several companies will be talking about "beamforming" in the next few months.  Here are some interesting test results for review. Any questions or feedback about this would be welcome. The world of Wi-Fi with 802.11n and beamforming is going to get quite interesting in 2010.

 
 

Download Miercom_Test_Report_Cisco_ClientLink

Download FarpointWLAN_strategies_wp
 

Integra Systems Inc as a Healthcare Visionary for Point of Care Connectivity

Integra Systems, Inc. www.integrasystems.org is a forward looking visionary boutique firm firmly implanted in the wireless and medical device space that is based upon two decades of field integration experience. 

 
That will not stop us at nothing to advance the quality of the modern wireless healthcare delivery model.  We have been instrumental at driving this forward looking with vision over five years ago with Anyware Network Solutions, of which now is a part of www.gtri.com. Our original out of the box model was demonstrated with www.draeger.com and OneNet. This is our passion and mission of which is always pushing the envelope to take current technology offerings and to wrap them around perhaps non-proprietary solutions to move decision makers to the next level with the goal to save costs and manage risk.  From this mission as described it is coupled and tested to ensure that all caregivers have the best user experience for the patients and their families. This is as described also saves huge costs and decreases overall risk at the point of care and with medical devices on a wireless or wired network. Separate proprietary medical device networks are legacy. Go to www.linkendin.com for  our full profile. We have completed consulting and design work on a global basis with the leading medical device companies. (patient monitoring, infusion therapy, ventilation/anesthesia) whereby Integra Systems, Inc has been front and center in 2008 and 2009.  www.integrasystems.org  Download Edit Post - Healthcare Wireless and Device Connectivity TypePad Patents pending on RFID and wireless integration point of care devices of which are pending clinical trials will define the new avenue in the point of care space.  Just some messaging to put things into perspective will follow. We certainly can help in this perspective.  www.capsuletech.com of which we (David H. Hoglund) share a combined IP through a licensing agreement.

" The Pain in life Happens. It may last a minute, or an hour, or a day, or a year, but eventually  it will subside and something else will take it's place. If I quit, it lasts forever." Lance Armstrong. http://www.lssmn.org/

The message is:  "Just keep on a going"

What do you think is at present and forward looking; do you think that the days of proprietary medical device networks are over..why or why not?

Why should a hospital install a separate WMTS telemetry system, a separate stand alone patient monitoring network?  Why not converge them onto a single enterprise designed and managed WLAN?

How is the risk lowered by using enterprise tools for design and management?

Who is going to be responsible for the management of a life critical network if enterprise management tools cannot be used?

A goal here as described is to provide and enable the healthcare enterprise to provide the quality of healthcare wireless experience in a proactive fashion for 2009 and beyond that everybody needs.

Medical Device Connectivity and What is the Right Strategy?

It seems that these days everybody is jumping into the medical connectivity space; however there are a lot of issue to look at. This will simply explore a bit what needs to be front and center - that is the core business model.

Overall Design -First determine if the connectivity solution is patient centric. Second, how does this actually help the care giver, or does this just add more layers of "things to do" for the nurse at the bedside.  The reason I bring this up is when I was at Symbol Technologies (now Motorola), caregivers had initially a lot of push back on the use of hand-held scanners, but mostly surrounding PDA(s). Application specific PDA(s), seemed to wane and hunting and pecking on a tiny screen added a lot of frustration. Caregivers, simply want technology solutions that work. Several companies in this space have taken different approaches and are pursuing various business models. Not all of these make sense - let me know if you agree here?

Cerner - Cerner a software company by definition has chosen to enter the medical device connectivity space with CareAware and MDBus to add to their portfolio of other solutions to include iCommand, among other previous acquisitions as Bridge Medical.  Why move away from their core business?  It is going to take a tremendous amount of work and effort to keep these connectivity solutions going and supported. Meanwhile, I do not feel that hospitals want a medical device connectivity solution that is tied to a specific vendors EMR application. Most hospitals have multiple EMR solutions, so it is not quite clear how open other competitive EMR solutions will be playing with Cerner and MDBus.  Any contextual patient connectivity needs to be a part of the patients continuum of care.

Hill-Rom - Navicare Bed as a Hub. Driving efficiency at the Point of Care with Navicare Device Connectivity. It is not quite clear how this fits in with Hill-Roms core business which is hospital beds and nurse call. You have to ask yourself if making your hospital bed a medical device integration hub is the right approach?  What if you hospital does not have all Hill-Rom beds?  And what if your hospital decides to switch from Hill-Rom to Stryker beds?  it would appear that you would also have to re-assess your hospital's medical device connectivity strategy at the same time - which makes no practical sense to me. Finally, is this solution able to be patient centric and follow the patient throughout the continium of care?

How much more R&D money does Cerner and Hill-Rom want to throw at "medical device connectivity", when this is not centric to their core business?

Capsule Technologies - The business model that makes the most sense to me is vendor-neutral. A company like Capsule does not make medical devices, hospital beds, a nurse call system, or an EMR application. Medical device connectivity is their core focus and they have been at this for over 12 years. In this space, I believe experience counts for a lot. Capsule does not care what bed, monitor, or ventilator is in the room and can connect all of those to any EMR on the market.  This advantge for the hospital is that they can switch out any of their medical devices and even change EMR's - without having to redesign their MDC strategy.

Also regarding a patient centric approach for connectivity, their new Neuron platform will automate the association and disassociation of medical devices to the patient - which is really the right model for data identification. It also does not create extra workload for the caregiver. Finally, by moving away from room centric or bed centric, it provides a platform that is enterprise enabled for the patient's total continuum of care.

Let me know what you think?  Are their advantages to any of these business models that I am missing?  What models have you seen  - good or bad?

 

 

 

 
 

Motorola and Aruba Networks Announce Collaboration on the All Wireless Enterprise and Resolution of Patent Dispute

This definitely shows how far the wireless industry has come. 

Aruba Networks and Motorola Inc, together with it's subsidiaries Symbol Technologies, Wireless Valley Communications, Inc. and AirDefense decided on November 06 to settle all outstanding intellectual property disputes between the two companies.

 Additionally they are actively exploring technical and business opportunities of mutual interest associated with the all-wireless enterprise. It is interesting to see the market converge in the WLAN space. Aruba Networks is definitely the number #2 player.

 Motorola with the acquisition of Symbol Technologies has a commanding lead in the mobile computing and Auto-ID industry. I joined Symbol in 1999 and rode the wave of 802.11b becoming real with the healthcare application convergence as well as the use of bar-code scanning at the point of care. Several good companies were formed in the WLAN space that did not manufacture (APs, or controllers).  Wireless Valley is considered one of the gold standards for WLAN planning, while AirDefense provided a comprehensive enterprise approach to IDS 24/x7x365 monitoring. The other gold standard AirMagnet, was most recently acquired by Fluke Networks.  Motorola then acquired Symbol then both Wireless Valley and AirDefense. In a similar fashion, Aruba Networks made a brilliant move to acquire AirWave. AirWave provided the industry a standard management platform that allowed for a true multi-vendor approach to WLAN management. I think that this could have a very positive approach for healthcare in general and may really force hard competitive price pressures.  First on the Motorola side, they have with the acquisition of Symbol, the mobile computing and Auto-ID (bar code), situation (BCMA), covered. With Wireless Valley and AirDefense, a comprehensive planning and IDS strategy can be provided. Oh, yes forgot they (Motorola) too have WLAN controllers, APs, indoor/outdoor, point to point, etc., two way radios, etc. of which Motorola has a huge heritage.  Second on the Aruba Networks side, AirWave can provide a true enterprise management platform for the management of legacy 802.11a/b/g from Cisco, Symbol, HP ProCurve, Trapeeze, (which was purchased by Belden) you name it together with Aruba Networks and provide a comprehensive management strategy for QoS and security. Finally, a lot of medical device manufactures like Aruba because of it's patented quality of service on a packet by packet level, without a need of implementing any specific proprietary extensions. Sounds like these two companies have resolved things and are combining forces; which makes good business sense. All the win for healthcare.  My web based event on 802.11n for Aruba Networks in case it was missed, is now posted on www.arubanetworks.com 

How will these two major players teaming together in the wireless space effect both the "largest player" and whole slew of minor players in the WLAN space?

   

Saving Costs on Networks and Medical Device Connectivity

With the advent of 802.11n it does not make sense to "wire up" or run ethernet anymore.  Actually, I would say that 30-40% of wired ports are not being used anymore.  So maybe the network could be right-sized and an overall switch count could go down. Since "patient worn" telemetry is now moving away from WMTS and going down the Wi-Fi route, it makes also good business and financial sense to not move forward with an expensive whole-house WMTS coverage. Just limiting WMTS to one area, may not give you the true overall business and clinical advantages. When looking to improve cellular and public safety coverage it also is more economical to implement a stand-alone DAS. So in summation, the move from the wired side to the wireless side, has eliminated the need for some of the wired ports, WMTS has become legacy as patient monitoring has been proven over years to work on Wi-Fi, 802.11n is negating the need for running ethernet, and in-building coverage for cellular is much more economical if the DAS is kept stand alone. 

Enterprise Wireless Mobility versus Departmental

Years ago when I worked for VitalCom (now a part of General Electric), I designed VHF antenna systems to cover the entire hospital. This was a radical departure from antenna coverage just in "limited" step down areas for telemetry coverage. The idea was to provide "flexible patient monitoring" where the patient was. It also allowed capabilities for moving the patient out of costly ICU beds, allowed real time monitoring throughout transport and helped decrease ER diversions. The only issue was the cost involved with the antenna infrastructure and to think of "not unit" based patient monitoring, but enterprise patient monitoring. Now we have moved from VHF/UHF to WMTS. So in reality it makes good sense to provide WMTS antenna coverage across the entire hospital. The same business issues for improving care are present and this provides a better quality of patient monitoring. However as stated, there are costs of the infrastructure, that is whole house WMTS antenna coverage. It is even more complex and costly if you try to provide WMTS whole house coverage with a DAS, the costs at least go up by a factor of 3. So, the solution is present today. Use 802.11a/b/g "whole house" coverage. Today it just makes sense to provide complete Wi-Fi throughout the entire hospital as you can use this for not only data, but voice (voice over IP), and medical devices. Both Draeger Medical and WelchAllyn have 'traditional telemetry, now the term "patient worn monitoring", but do not use WMTS, but 802.11a/b/g.  So when you converge this on the existing Wi-Fi network you save huge costs involved in not having a separate WMTS infrastructure. Enterprise tools are available for the design and management of this Wi-Fi infrastructure, but nothing is available for WMTS. WTMS was often promoted as "safe" spectrum, but in essence it is still RF and drop-out is drop out. A properly designed Wi-Fi network especially with 802.11n coming out works just fine.