The Healthcare and Enterprise Wireless Experience

DAS RFI and RFP Development for Enterprise Deployments for the ROI Business Modeling

Over the past several months I have been contacted by several large IDNS (Integrated Delivery Netowrks) about looking at helping them sort through the jungle of the marketing fluff regarding Distributed Antenna Antenna Systems.

A large part of this is because the technology curve in the GSM/CDMA/Public Safety (3G/4G)space has moved so fast in the wireless world. Any parallel, simply is to look at the adoption of the i-Phone, i-Pad, and Android OS into the healthcare space. It not a evolution, but a revolution that is occuring in this mobility world.

I also feel that now the market is becoming better educated, $$ are scare, and they simply want to(have to) make the right business decision. Oh, yes some of many healthcare organizations simply are now making the decision after the fact; WLAN over DAS simply has not worked; we need to take it off the DAS. Think of the cost savings up front if someone decided through some time and effort to vet this out. Some of the technology players have expressed angst about what I attempting to discuss here. My goal simply is to enable healthcare with the best information available, help them on their technology pathway, while not spending extra $$, when it is not needed.

An independent sounding board, not tainted to "sell something" is perhaps what industry is needing to hear.

Most Healthcare IT organizations are overloaded at best, yet alone sorting through all the variants of 802.11a/b/g/n and who does what from a technology perspective definitely has been a challenge. When you now add stuff like 3G moving to 4G, support of the i-Phone and Public Safety ordinances now happening is becomes real confusing, real fast.

Some DAS infrastructure providers (integrators), make great claims to support 802.11a/b/g/n (MIMO) and yes even WMTS. The question then comes at what price point and who assumes the liability if this does not work? Will they support this in a legal agreement? We can help the IDN sort through the technology landscape, write the correct business plan, and finally draft the correct DAS RFI and RFP to hold the vendor and integrator accountable. This way the CIO will have the ability to now have the tools at hand to make the best informed technological and business decision saving perhaps countless $$ in both the short term and long term.

NFC Android Displacement of Bar Coding another potential revolution

There has always been somewhat a tendency of healthcare to slowly embrace technology, but certainly this has not been the case in the last year. If you take a walk around a hospital today you will not see the following very often. A physician carrying a pager and or 4lb laptop, (they are usually bolted down to cart someplace). But will see them carrying probably a smart phone and probably also an I-Pad. (User interface, portability, just enables every aspect of their patient care process.). Not to knock Apple, but somewhat like Linux, but even more so, Android is beating them to punch. (open source) Also, their is no way I would buy a I-Phone to run on the AT&T horrendous network (GSM), but they are fixing this now. (That is a another blog in detail). I got the DroidX from Motorola. As my son said, it is basically a computer that as a side is a phone.

Now to the interesting part. For years hospitals have tried to adopt bar code scanning (I used to work for Symbol and helped push this early on). Bar coding was cheap, could use unique symbologies, and with CMOS imagers have really lowered the hassle factor of traditional laser scanners. However, it seems that each EMR company, and also IV therapy company, forces the clinician to use their application with their bar code scanner. Hence the clinician at times must feel like a clerk at WalMart. Then also the whole aspect of using active RFID tags to locate equipment.

The latest Android phone (running Gingerbread) (Nexus S), includes a NFC (Near Field Communications chipset). Apple is right around the corner also with the i-Phone next yer swith NFC.

So what does this all mean for healthcare? The jest of NFC for the consumer was to provide contactless payment of credit cards. You could call up an application and look to order and they then can accept payment from the 13.MHz passive RFID in the card. So logically makes sense that you use the same for the point of care. Call up the EMR application with the integrated NFC on your smart phone (not on the I-Pad yet), patient wrist band, medical device, care giver (all have passive RFID). Simply associate all together (right patient, right device, with the right clinician), and the associative integration is dropped into the EMR application. Think that laptops in the hallway with the scanner dangling from it, could be a thing of the past. Would welcome opinions here

www.open-nfc.org

www.code.google.com/android

Merry Christmas and Greatness for 2011. The Healthcare Wireless World is expanding in a rapid fashion.

As one who has served in the military as both enlisted as an officer; I have the utmost respect for those that venture off into the business world combining the professional experience gained while serving their country. However, it has to be metered with a humble nature and real valuation of what is brought to the table. Seen a lot of former officer egos get in the way of common ground roots business, thus blowing away many opportunities. Met a former USN SEAL, in Philadelphia in the train station on a Sunday and wanted to give his company the exposure. (see here) Anybody that has gone through this program (yet alone made it through) and had the fortitude to develop their business, they should be respected at the highest level in all areas of ethics and integrity. This is the type of business person that will lead the United States and our global competitive business challenge, versus others how they perhaps line their portfolio. (Hence egos getting away of common business sense). Although a lot of their work is CLASSIFIED, what they do, could have great value to healthcare. Thus why I trying to schedule a meeting in Philadelphia or Washington D.C.

http://www.whitecanvasgroup.com

The same for www.avtech.com,

http://www.avtech.com

Whereby Integra Systemns is working with them to develop the next evolution of software and hardware developement to improve patient care in telemedicine. Reach out to these guys, as integrity, ethics, and hard work, is their value in total fashion. No smoke and mirrors or PT Barnum here regarding how to get VC money, but just basic honor, hard work, and making things happen...daily.

Integra Systems Recap for 2010

This is a basic recap of 2010 for Integra Systems, www.integrasystem.org...it has been a very busy year!. On a media and publishing standpoint we have completed four separate white papers. These have ranged from a paper on RTLS to 802.11n and the nuances of beamforming, to the latest advances in distributed antenna systems as well as a web based event on converged medical devices on a WLAN. Our travels have taken us all over the United States, as well as a speaking enagement in San Paulo, Brazil and a business meeting in Paris, France. We have created test plans and protocols for several medical device companies to test their wireless products in anticipation of a FDA 510k approval. In light of this, we have also helped one company define an embedded radio strategy for point to point, and designed a solution for a medical device company using Zigbee, an embedded web server, OS, GSM modem, and control interface via the web. We have finalized the in-building DAS design for one of the most prestigeous cancer hospitals in the United States. Dave Hoglund the founder of Integra Systems has received his first patent on 23 November 2010. This is currently cross licensed to www.capsuletech.com. No doubt 2011 will be as busy and lot more intense as the adoption of the i-Pad into healthcare is taking off like a rocket. 802.11n will continue to provided read added value and the move toward 4G will drive further the right in-building wireless strategy for broadband services.

Smiths Medical Introduces Wireless Version of of the Medfusion Syringe Infusion System

St. Paul, Minn., December 14, 2010 - Smiths Medical, www.smiths.com a leading global medical device manufacture, announced today that it received a license from Health Canada and launched its Medfusion 4000 syringe infusion pump with the PharmGuard software suite in Canada.  The new customizable system allows healthcare providers to send and receive medication delivery information more efficiently, helping to prevent medication errors.  I consider this very cool as last year (2009) Integra Systems www.integrasystems.org  partnered in a relationship with GTRI, www.gtri.com that helped their internal R&D group vet out the wireless and networking functionality for the planned FDA 510k submittal in the MedFusion 4000 syringe pump. While the FDA approval process for actual infusion pumps (not wireless), has grown more complex since last year, it good to see that Smiths Medical  can get this important "wireless" solution into hospitals and help save lives.  Add to their recent partnership with www.hospira.com and this is a pretty unique combination of one company having a solid volumetric pump, and the other pretty much the leader in in pediatric and neonatal syringe pumps. Now the next step is to drive this it seems in North America and other countries.

 

 

Verizon 4G LTE what does this mean to healthcare?

Verizon rolled out the first large-scale 4G LTE (Long Term Evolution) network on December 5.  Voice and data sessions on a device will be able to operate simultaneously with voice on 3G and data on 4G LTE. Longer term, Verizon will migrate traditional voice to VoIP on LTE (VoLTE) probably in late 2012 or early 2013, when the LTE network footprint is comparable to 3G. Deployed over the 700 MHz spectrum, the data network will allow downlink rates of 5 to 12 megabits per second and uplink rates of 2 to 5 Mbps. It is not about just getting faster email and making faster voice calls. It is finally allowing public safety personnal and first responders access to advanced communications and massive data files (video, mapping, and GPS applications). 700Mhz also allows better penetration of buildings. 850MHz is cellular and 1900MHz is PCS, thus the tighter requirement for -85DBm.  The lower the frequency, the better the penetration.  Imagine now physicians having the ability to being able to share PACs images from the clinic to the hospital on the fly or from the ambulance to the emergency room!  This not to discount WiFi or 802.11n, but both serve very unique markets are are complementary to each other. Any in-building DAS being contemplated has to be planned for this...ironically a lot of current installed DAS is questionable here, in other words what will be the cost to upgrade to provide these capabilities?  All the need present in 2011 to have healthcare institutions draft a Strategic Technology Wireless Business Plan. Often technology decisions have been made in a silo without considering the overaall business strategic requirements.  That is something we can help with. (Sorry plug here for what we do).  So in final how do you create the best TCO for an overall wireless strategic plan for not just what we know as WIFI, but everything else?

The pre-4G technology 3GPP Long Term Evolution (LTE) is often branded "4G". LTE has a theroretical net bit rate capacity of up to 100Mbit/s in the downlink and 40Mbit/s in the uplink if a 20MHz channel is used and more if MIMO is used. The physical radio interface earlier was named HSOPA (High Speed OFDM Packet Access), but is now named Evolved UMTS Terrestrial Radio Access (E-UTRA).  LTE Advanced is expected to be released in 2012. It is essentially an enhancement to LTE. LTE-Advanced is similiar to the upgrade from WCDMA to HSPA. Additional spectrum and multiplexing will allow for higher data speeds. Coordinated multi-point transmisison will allow for more system capacity to help handle enhanced data speeds.

iPhone Verizon for Healthcare

Verizon Wireless is expected to obtain the iPhone early next year, no one will say when. The current version of the iPhone will not be compatible with the Verizon's wireless network.  AT&T and all the other wireless carriers offering the iPhone are GSM carriers.  Verizon uses CDMA of which in my opinion is a lot of reasons why Verizon's network is bullet proof. No doubt Apple will unveil a CDMA version of the iPhone.  Current iPhone 3GS can only be used on AT&T's network.  It could be unlocked and used for example on T-Mobile, but AT&T and T-Mobile use different frequencies for 3G services, so even swapping SIM cards, you will not get 3G on T-Mobile, but the slower 2G/2.5G network.

WIFI WLAN and Distributed Antenna Systems - The Reality

I have written much about this, however most recently want to dispell marketing fluff, but also want to lend some valid technical considerations if any of this is being thought about.  As I continually tell people, it is physics (yes you cannot change E=Mc2, and the pesking link budget. The link budget is the accounting of all the gains and losses from transmitter, through the medium (free space, cable, waveguide, fiber), to the receiver in a telecommunications  system. It accounts for the attenuation of the transmitted signal due to propagation, as well as the antenna gains, feedline and miscellaneous losses.

Received Power (dBm) = Transmitted Power (dBm) + Gains(db)-Losses (db)  or logarithmically            Prx = Ptx+Gtx-Ltx-Lfs-LM+Grx-Lrx

There are three salient issues about WLAN AP's and the WLAN Controller as a part of or integrated with a  DAS. 

1. Interference between adjacent AP's

2. LBS (location based solutions) beacon location

3. Wireless voice over IP compatibility. 

4. Cost

5. Support

1. AP Interference  - The interference can be somewhat solved by putting the AP's in metal bags or partioned in racks with metal dividers.  It is never a perfect solution. If there is interference then the software power controls from the WLAN controller through the AP do not work correctly and the bandwidth of the system drops by 30-40% or often it can just shut down.  This a is major issue for some manufactures of APs and WLAN controllers.  AP(s), need to beacon each other by design when out in the enterprise, but this is a really bad idea if stuck together with coaxial infrastructure in the IDF.

2. LBS Compatibility - Customers using Location Based Services (LBS) running on the DAS WLAN have a whole other set of problems most them relating to design changes.  The system can work on a DAS, but the problem is that when designing a WLAN that is LBS capable you have two rules that need to be followed.  1) APs positioned on the perimeter and 2) the ability to move AP(s) AFTER installation to optimize location performance.  Both 1. and 2. are very expensive and difficult to execute on when you have to run 1/2" coaxial cable to each and every antenna and they are at fixed locations for the antenna element.  Hospitals do not want to rip out their ceiling tiles a second time!  Understand that the AP has diversity of which is combined, so you also have to contend with this loss as well.

3. Wireless VoIP compatibility - RSSI or "received signal strength (indicator)" is the issue here.  In the early days of wireless VoIP, -72dbm was acceptable.  As hospitals started to deploy wireless VoIP, they quickly learned that -67dbm and some cases -65dbm was what was needed.  This increased the density of AP(s) in a dramatic fashion.  Any area where you had RSS to drop, you would experience handoff issues as well as dropped calls. Some DAS vendorshave have such a layered approach, but this changes the coverage issue to a capacity issue as APs are limited to 3 per layer. 

4. Cost - What is the cost delta between a separate WLAN and separate broadband services, (two separate quotes, versus trying to combine all of this.  Heck of a lot cheaper being separate. The potential client simply needs to compare these costs in detail.

5. Support - Will the manufacture of the WLAN infrastructure provide in writing that they will support all warranty and after warranty support (on site and calls), if they WLAN AP(s) and controller is combined with a DAS?

POSITIVES - Relocation of AP assests, some aesthetic improvement by putting AP not in the ceiling or in the IDF.  However, with LBS, and Voice over IP, going into the ceiling after the fact is a major issue.

NEGATIVES- 802.11n, no MIMO, or not true MIMO because antennas not within 2-3', high cost of cabling and additional combiners splitters, not LBS capable, lack of future compatibility with future WLAN or cellular vendor.  For instance support of LTE at 700MHz for Verizon 4G rollout?  Ask existing installations.  Will true 802.11n MIMO performance be guaranteed?  Will the WLAN provider of infrastructure put in writing that they will provide technical after installation support?  if any issue comes up, then the hospital will point the finger at the AP vendor and DAS vendor, and then they both say it is not our problem and it ends's up the customer and and end user problem. 

 Better to keep the WLAN separate, a lot less cost, can work right, and big time less issues. Who will assume the potential liability and eat the technology change costs if the applications do not perform the way they should?

 

 

ECRI Report and the Top 10 Health Technology Hazards for 2011

Please find the 2011 ECRI report. Download ECRI Top 10 Health Tech Hazards 2011

 

What is very interesting is the discussion of item 5.  This pertains to the most recent patent award LinkSense (including) I, and the cross licensing of this to www.capsuletech.com.  I have most recently last week, run into another medical device company that simply feels that enabling bar code scanning (actually embedding a scan engine), into their device makes sense.  After coming from the Auto-ID industry, I do know the market.  However, this is not the point.  The point is looking at this from the "clinician" perspective. How are they going to handle perhaps this application (for association of patient ID, medical device, and clinician ID), as well as the same type of bar code application for the EMR, and yes, another bar code application for the smart infusion pump. This is where the Capsule Neuron fits it in.  It is patient centric. Using RFID (and no this is not expensive), the medical devices will be able to "auto" associate and "dis-associate" as well as the patient ID and clinician ID.  The clinician simply has to confirm on the screen and the correlation is made with an HL-7 messaging stream sent out.   When you provide automation at the point of care, all kinds of new rules and algorithms can be built.  For example, when the ventilator is moved away from the patient into the hallway (i.e. disconnected), no longer do you have to call or forget to call the RT to pick it up.  The auto-disassociation triggers a text or email to the RT, that this specific ventilator in this specific room needs to be picked up.  Same with the infusion pump, a text or email is sent to SPD to pick up the pump for cleaning.  This can only happen when automation occurs in the background, not adding more and more manual intervention.  I would compare the clinician to an aircraft captain.  While we have two different industries both share the same common attributes.  The aircraft captain of today simply cannot handle all the complexities of flying a Airbus or 747 on an overseas flight for eight hours plus. 

 

That is why automated sub-systems and auto-pilot exist.  As a result flying has the highest safety record in the industry.  Same with the clinician.  As you provide more automation in the background, the job becomes easier, they can concentrate on taking care of the patient (like the captain actually flying the plane), the potential for risk goes down as well as costs.  I would not want to get on 747 to fly from Los Angeles to Japan with a 20 year veteran captain using only a compass, altimeter, and turn and bank indicator.

Capsule Neuron Solution Addressing ECRI Issue

Under full disclosure, I am part of the content and thus approval of the patent on 23 November 2010.  However, with the ECRI discussion this just validates our  vision of what is occurring now and will transcend the healthcare delivery network in the years ahead.  It is not device specific, but patient specific.

Currently the LinkSense is licensed exclusively to www.capsuletech.com