Healthcare Wireless and Device Connectivity

Post HIMSS 2012

While there are many blogs that will describe this week, I only will give some highlights that I saw. Understand that this was a very what I consider a unique HIMSS. First it had the largest attendance ever on record, (34,000 attendees), and over 1,000 exhibitors. However, it was crammed into two floors of the Sands Convention Center. Needless to say, space was a a premium. The first floor contained the "big companies", plus a some smaller companies. The lower floor was really very interesting. This was where the Intelligent Hospital was located and well as the Interoperability Pavilion. My hats off to Paul Frisch and Harry Pappas for a well done show of the RFID/RFLS Pavilion. The traffic there was tremendous. Many, many first time exhibitors of technology and infrastructure. Definitely HIMSS is not only about clinical applications but everything. I will post more comprehensive over the weekend, but I feel that this has become the one stop CES (Consumer Electronics Show) of Healthcare. From a mobility, wireless, software, hardware, integration, testing, patient monitoring companies, infusion therapy companies. you name it...this show has morphed into this. Everybody was there. My only issue is that after eight miles of walking in three days, the exhibit hours simply were not long enough to cover everything because it has gotten so big. It was like I did a fly by to the companies and people that I know. My suggestion is that exhibit hours and days need to be extended to five days instead of four. But that is only my opinion.

Broadcom Moves into Healthcare Device Connectivity

From conversations yesterday at HIMSS (pre-show), it seems that www.broadcom.com is making it's move into the wireless medical device connectivity space. Rather than providing just the radio(s); they are truly supplying the SOC, "systems on a chip". Like Atheros in the wireless radio side of things; they however are taking an aggressive approach, thus lowering costs, footprint, and interoperability.

Download ConnectingEverything_HenrySamueli

QualComm 2Net

When I first saw this I thought interesting...somewhat mirrored what I did for a medical device company two years ago. Had no idea that QualComm, was going down this route...but it really makes sense. The business problem that was presented (to Integra Systems), required a similiar design. The issue though is the medical device company does not know how to deal with the back services model...so the actual prototype has languished. Well QualComm it seems has taken away the mystic as they provide the 2Net platform in a variety of service models. They are firmly committed to this and just like providing the right CDMA radio for the Verizon phones; they seem to have the right model to make "connectivity for home healthcare and/or wide area connectivity a reality. All the medical device company really has to do is provide the PAN wireless embedded radio. It makes it easy to provide the connectivity from the home. Finally it takes what all has been discussed as the Continua model for years and brings it to reality. Looking forward to visiting their pavilion at HIMSS today.

wwww.qualcommlife.com

Integra Systems provides SEO for wireless and medical device companies

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HIMSS 2012 - Looking beneath the surface at technology investments

One day before my arrival in Las Vegas, early tomorrow morning. An interesting fact is that this is my 15th HIMSS conference and certainly I have seen tremendous change from the first time attending in 1997. Based upon my 27 years in the medical device space, 18 years in the wireless, and 15 years attending HIMSS, I will give some of my brief initial perspectives. More will come during the week...time permitting, but hope to have a re-cap by next Friday.

The EMR space
All I can say that this is hotter than hot due to all the initiatives surrounding meaningful use and the incentives for reimbursement. Every physician it is seems is in a scramble mode to get their EMR up and going. My family practice physician and orthopedic surgeon...just within the last 60 days have implemented a EMR! Certainly I am betting my dollars on Siemens and Cerner from the IDN space, but NextGen is rapidly gaining major traction. Look to how easily the application model can be transformed to both mobility models from what we know as the laptop to the I-Pad, Android, and I-Phone and where this fits into the secure cloud computing model.

Infrastructure
The wired and wireless infrastructure model has become commoditized. Yes, really...a switch is a switch and an AP is an AP...IEEE. IDN(s) have become better educated and have huge financial pressures to do more with less. While some CIO(s) will still in a blind fashion go down the path and purchase status quo...these days it is coming to a head. They need to evaluate the technology from a business perspective. Companies like Juniper Networks and Aruba Networks provide major compelling technology and financial arguments and should be carefully looked at. The whole issue of DAS (Distributed Antenna Systems) to provide the in-building cellular connectivity experience is becoming better understood. If the providers of DAS (whether integrators or manufacturers) promote the value of WLAN, WLAN enabled devices over a DAS, or even WMTS, then the potential buyer needs to ask some really tough questions about costs and risk management. Look to SOLiD as a major disruptive player in this space. They have the right message and technology and are taking names in this space...big time in healthcare.

Medical Device Companies to Include Patient Monitoring and Infusion Therapy
Again, like infrastructure, this has become pretty much a commodity. No new physiological parameter has been developed or "great new smart pump", that has revolutionized care in this space...but it stands that most companies are in an evolutionary process causing the big players to finally change. It stands to reason that the major patient monitoring companies will follow the lead of OneNet developed by Draeger...why...it saves a lot of $$. Sotera Wireless has some very interesting innovations (at the QualComm) booth. Plus Sotera has recruited some of the best technical talent in the industry. Jim Moon (invented the ProPaQ), came out with Alpha PC at Spacelabs, and Jim Welch, (innovator of Acuity at Welch Allyn).

Integrators
Lot's of network integrators are out there in this space...as everybody wants to target healthcare..oh yes wireless. However a lot of folks can do an admirable job at site surveys, network design, and implementations. What is done here is not unique but boilerplate. Look to those companies that can actually tie the technology investment and implementations to providing real clinical value, show how costs can be saved, and how the technology investment over the life of the investment...improves the bottom line. Also evaluate them towards their specific loyality to certain vendors...versus true technology consultants.

Smart Phone and Wide Area Connectivity
QualComm will have a big splash with their 2Net platform of which follows what I designed over two years ago for a major medical device company. Finally, the whole issue of "connectivity beyond the walls of the hospital"...has gained traction. While this concept and design does have extremely high merit (the fact that QualComm is behind this...says something)...interesting fact is while QualComm makes all the CDMA radios...2Net uses GSM). Zigbee does have it's merit, but also look to low power Bluetooth. The Android and i-Phone platform could become the gateway from the medical device to the cloud and to the EMR.

RFID/RFLS
Finally the technology is bringing real applications that demonstrate improvements in cost savings and risk management. Capsule and Centrak...innovators here. Remember RFID is different from RFLS and any RFLS solution needs to be house-wide.

While there will be a great deal of "technology" at this show, these are some suggestions to evaluate the technology, solutions, and integration thereof?

- How will the technology investment be measured against a hard ROI to include CAPEX and OPEX savings?
- Is there a way to demonstrate that the technology will actually help me reduce risk, versus marketing hype?
- What will ensure the the $$ invested in the technology will protect me from obselence?

In closing this blog is intended to give some food for thought prior to the next few days...See everybody this week in Lost Wages (oh Las Vegas) at HIMSS!

HIMSS 2012 Las Vegas - Leading Up

It is another HIMSS meeting/convention since we have been attending from 1997...however a lot has changed.

It is in Las Vegas of course!

Thus we are in preparation of a great unending number of meetings and figure this will be a super mobility and wireless experience in all regards.

Stay tuned on Twitter and this blog for posts...while this may be really late and not live, we will try to give the latest views on a daily basis.

Our focus will be giving unbiased views on the "who is who" of wireless in this space; at this meeting (while we can probably not cover all) (this includes LPBT, ANT, Zigbee,BT, 802.11x., i.e. a/b/g/n/ac, CDMA, GSM, LTE marketspace, oh yes the (RFID and RTLS must debated space)...sorry this is highly contested area of which there is a lot of confusion)

There is a huge marketplace convergence going in the medical device connectivity space. While WLAN (802.11a/g, and when n become a lower power requirement; there is the busines model of Zigbee.) However Zigbee is being encroached upon the recent adoption of the LPBT (Low Power BlueTooth) by Apple in I-Phone 4. (We think Zigbee is being moved to the BAS side of things...where it totally makes sense) Thus (the Android and I-Phone platform) in all likely, could be become the gateway. ANT is also making it's way. At the end of the day (based upon the convention), we could and probably should see a medical device equipped with a variety of wireless radios; that is dependent upon their specific use model. No longer is the medical device going to need just a WLAN equipped radio, but is must have a multi-mode WAN strategy to provide the total IDN (home healthcare experience).

Medical device companies should look at this as the evolving wireless strategy.

Integra Systems, Inc. has built gateway models of all the above and now is in the process of developing both Android and I-Phone applications to take advantage of the recent announcement of LPBT and also ANT where applicable. We will be working with vendors of site survey tools to implement these design requirements into their software.

In closing on this blog post...HIMSS 2012 will become both tactical and strategic from the the wireless, connnectivity, and mobility side. That is our focus.

The macro market is going to the femto cell

Very good presentation by QualComm. Just like the explosion of LTE on the market and the huge demand for bandwidth, the macro market (cell tower), will migrate where to the the site is placed closer and closer to the user. However, the challenge is the back haul...or the pipe as they say. This is simply the same as WiFi, GigaEthernet probably is not going to be solution. Optical is the future and end game in town.

http://www.fiercebroadbandwireless.com/story/paolini-big-challenge-small-cells-backhaul/2011-11-09

Download Neiborhood_Femto_Network_Deployment_Model

www.airspan.com

What about a DAS (Distributed Antenna System)? Why should you really "Carefully" analyze away the marketing hype?

I have said this for years...but the physics dictate the design.. beyond the hype. The goal here is the overall to save the healthcare system major costs...versus going done a path of a proprietary design that will increase the initial as well as long term investment costs...let alone locked in.

There are manufactures that actually making the equipment...while integrators either purchase and install; or install versus purchased by others.

The manufactures always make the head end equipment and remote units and typically the integrator of choice or provided sub-contractor installs the coaxial cable and fiber infrastructure to their design model.

Integrators may have one or maybe two agreements with the the specific manufactures of the DAS technology or equipment. Certain contract obligations may push them toward a loyality to one manufacture or the other. The enterprise "manufactures" of what we consider DAS equipment commonly seen in the healthcare vertical market includes CommoScope, MobileAccess, and SOLiD.

The rationale here is that that these manufactures somewhat serve the the multi-carrier market that is needed in a market vertical like healthcare; versus some single carrier market in a other obtuse carrier market that have been traditionally served by LGC, ADC and/ now Tyco.

Anybody purchasing DAS (Distributed Antenna Systems) for healthcare really needs to look hard at what is the technology age of the technology offerings?

In this space a lot of technology providers have been able to get by by not investing in this space; (Yes really would you believe this...milking the market!!) thus providing technology in 2012 for implementation on projects that is truly legacy. This is a shame...why would I want to purchase ten year old technology for an industry that is moving daily light years speed. They have been able to get by...wow.

So in any technology discovery and evaluation...several areas need to be looked at.

Is the filtering advanced enough to provide the control for upcoming 4G and LTE?

Will the implementation provide a major cost savings to reduce the amount of fiber optic runs that are needed...meaning if you could get by with 1 instead of 7...how much cost would this save?

If you are using high powered remote units, can this reduce the amount of fiber runs and the actual amount of remote units? This needs to be checked out...big time.

What about the whole area of public safety and cellular and PC convergence? What manufacture of the technology has this figured out. Make sure your local codes support this.

http;//www.solidtech.usa.com

OK, a little to loyal here...but they got it figured out. Best gig in town.

What is the overall total cost of ownership that can be calculated. For instance if less fiber runs are needed then this starts out with the get go...major cost savings. Then the less number of remote units are needed...saving energy costs, let alone cabling costs.

Most importantly is the that the remote units as well as the BIU provide major league custom filtering to ensure the highest fidelity signal to suppor the current smart phone now running hundreds and then against thousands 4G devices now.. but in the future.

In closing you can see tht there is a huge amount of factors to consider; but oftem at times glossed over by a great sales and marketing event or job.

Let us know how we can help...we are totally unbiased and have a vested interest to provide the right roadmap to communications technology based upon thirty years of experience in this healthcare and communication space.

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 throw 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.