Healthcare Wireless and Device Connectivity

Ultra Lower Power Wireless Quarterly Application Opportunities The PAN Crossing the WLAN and WAN

Integra Systems, Inc. www.integrasystems.org over the past twenty years has provided the connectivity knowledge and technical expertise to many companies in multiple vertical markets on a global basis based upon our decades combined of the end point device and the wireless domain knowledge experience.

Our work has extended to working with Nordic on several projects and we consider them the de-facto standard in BTLE SoC, ANT, and Thread.

While this issue of the ULP (Quarter/Spring 2018) is very interesting from the BTLE application perspective; the convergence of cellular into the IOT space with BTLE and WLAN will drive a major cross the chasm business opportunity.

Download ULP_WQ_Spring_2018

Wireless Convergence Healthcare Web Event

Thanks to Tim Gee and Medical Device Connectivity; Integra Systems was able to conduct an interactive web event today that touched on this convergence.

Here is the link to the audio and video of this web event.

https://medicalconnectivity.easywebinar.live/replay-6?__s=r24cmwdigo6wsux2bmss

In one hour we tried to cover the landscape of wireless in healthcare today and all the changes going on in 2018.

No easy task!

Like a multifaceted pocketknife; wireless in healthcare is a constantly changing landscape with all different levels of technology and application requirements.

A New Approach for WLAN Healthcare Deployments

WLAN (802.11a/b/g/n/ac) has been deployed within hospitals for the past sixteen years. Early day site deployments were simply WLAN (AP(s), that were installed down the hallway or in a Dixie Cup approach. This worked fine when applications were limited to computers workstations on wheels or the occasional voice over IP phone. (See attached article). However, as all the infusion pump companies and almost all the patient monitoring companies now have WLAN enabled their devices, challenges arise.

Previously site surveys tended to be designed with a signal level strength of -85dBm, (dBM = an abbreviation for the power ratio in decibels (dB) of the measured power referenced to one milliwatt (mW), in the case of WLAN voice over IP, this requires around an increased signal strength of -65dBm with a CCI (co-channel interference) of less than 2%.

With infusion pumps being used in the patient room, and now WLAN telemetry located near the patient, this poses some unique RF challenges. Many patient rooms have a lot of metal, water, and also tile bathrooms. This poses a lot of challenges for the 802.11 signal which is often attenuated by fluids in the room to actually get through the walls of the patient room to the WLAN access point in the hallway. Tile and metal tend to reflect the wireless signal as it moves from the WLAN client to WLAN AP. (Part of the reason you have two antennas on a WLAN AP is to provide antenna diversity to overcome nulls)

Here seems to be one very unique and interesting solution. A plug and play solution to provide the coverage that is needed for today’s modern healthcare WLAN at a surprising affordable cost.

Put the “wireless access point” and “controller” in each room!

The ExtremeWireless WiNG 7502E access point is purpose-built for public facing micro-cell environments such as patient rooms in a RJ-45 wall plate. Universal mounting bracket for worldwide structured cable boxes includes US 70 mm x 115 mm decor trimplate

Since the AP 7502E is readily accessible to guests and patients, it has been made virtually tamper-proof. Once the AP 7502E is snapped into its metal bracket that is mounted to the wall, it cannot be removed without a special tool. For additional security, you can also bolt the AP 7502E directly to the metal bracket with a special torque screw that also cannot be removed without a special tool.

The dual 802.11n and 802.11ac radios, five internal antennas, plus a host of Extreme Networks-only features provide a dependable high-performance wireless connection for every user and every WLAN enabled medical device in the room. Its revolutionary small size makes it easy to install anywhere, while the understated design allows it to easily hide in plain sight. Deployment couldn’t be easier or faster — the AP 7502E can be installed in just a few minutes, with zero-touch automatic configuration.

BTLE (Bluetooth Low Energy) is also provided. This allows for the next indoor location based systems as well as provided the BTLE to WLAN back haul to the enterprise.

The basic radio and interface specifications:

Wireless medium Direct Sequence Spread Spectrum (DSSS), Orthogonal Frequency Division Multiplexing (OFDM), Modulation and Coding
Scheme (MCS), High Throughput (HT)
Network standards IEEE 802.11a/b/g/n/ac, 802.11d and 802.11i WPA2 and WMM
Data rates supported 802.11b: 1, 2, 5.5 and 11
802.11g/a: 6, 9, 12, 18, 24, 36, 48 and 54 Mbps
802.11n: MCS 0-15 up to 300 Mbps
802.11ac: MCS 0-8 up to 867 Mbps
Operating frequencies 2.4 GHz band: 2400 - 2483.5 MHz, 5.2 GHz band: 5150 - 5250 MHz, 5725 - 5850 MHz
Antenna configuration 2.4Ghz: Two internal omni-directional, 1x2, 2x2, MIMO, 3dBi peak gain 5Ghz; Two internal omni-directional, 1x2, 2x2, MIMO,
5dBi peak gain Bluetooth; one internal omni-directional
Transmit power 6dBm to 15dBm per transmit chain 1dB increments (Actual transmit power dependent on national limits)
Receiver sensitivity 2.4GHz band: -96dBm @ 1Mbps; – 74dBm @ MCS7 40mHz
5.2GHz band: -95dBm @ 6Mbps; – 73dBm @ MCS7 40MHz
Bluetooth LE 2400 - 2483.5KHz in 2MHz channels, user configurable UUID, beacon period, format
802.11 Wireless Interface Dual Radio; 802.11a/b/g/n/ac, 2.4GHz and 5.2GHz
Bluetooth LE Interface Single BLE transceiver
LAN Ethernet ports 3 x IEEE 802.3 10/100Mb auto-sensing
Uplink LAN Ethernet 1 x IEEE 802.3 Gigabit Ethernet auto-sensing

Up to 25 7502E access points get the power of centralized management — without the need to purchase and manage a controller. (saves controller and switch port costs)

Deployment of WiNG Express Manager can help deploy a network with different WiNG Express Access Points and scale with more than 25 access points.

WiNG Express products can be configured and deployed in about 5 minutes. After powering on the access point, users can connect to “WiNGExpress” SSID and go to www.ExtremeNetworks.com/wingexpress to configure the access point. Once an access point is configured, the user can enable the virtual controller feature and let the access point configure and manage additional access points by simply adding them to the network.

Download Wifi-monitoring-wp-9068680-en

Download Ap-7502e-data-sheet

FCC and Channel 37

Have not responded to this as of yet; as wanted to listen to all the back and forth between all the parties providing input. One word…”interesting”!

As one, I have been in the medical telemetry space for over thirty years and I have designed many large antenna systems for both UHF and VHF for large healthcare systems. Thus you could say… have the field experience of not only design; but lugging around a spectrum analyzer and making this all work.

Working for a company that developed VHF receivers and transmitters; I vividly remember how WMTS came onto the horizon in the late 90’s. Also was I was in the throws of when Wi-Fi came out in 1999 and I transitioned to a company that helped develop the Wi-Fi Alliance. Wi-Fi can onto the scene in 1999, simply because 802.11b was approved. As a side, 802.11 was there years before. In addition I worked with many medical device companies to incorporate WLAN into their applications from 1999 till a few years later.
So in some essence know both sides.

When the issue of HDTV interference came into being, healthcare systems spent millions and millions of dollars to shift to WMTS out of UHF and VHF. The whole notion sold to the “end user” and the industry was that this was a “quote protected spectrum”. That was in the late 90’s. However; nothing really changed in terms of the actual design of the diversity antenna system or transmitter/receiver… still decades old..in my opinion. Companies simply shifted frequencies.

Moving forward to 2015, WLAN has been proven to work for patient monitoring, infusion pumps, and pretty much any type of healthcare application today. In fact there are very sophisticated real time spectrum analyzers built into today’s modern WLAN controllers and access points to monitor any potential interference and identify it.

This not present with WMTS. Fifteen years of progress and billions of $$ have been spent in the WLAN space. The little known technology of 802.11 in 1998 and 1999 has become a "household" word of WiFi today.

Question…. how much continued R&D has been spent in the WMTS space in the past fifteen years?

Spectrum is spectrum, it is precious and the FCC does control this. No doubt sooner or later Channel 37 would come under pressure.

See attached articles and white paper.

802.11af, also called Super Wi-Fi or White-Fi, employs unused TV spectrum at frequencies between 54MHz and 790MHz, over very long ranges (possibly several miles).

According to a study, there will be nearly 26 - 30 billion devices on the Internet of Things by 2020. ABI Research estimates that more than 30 billion devices will be wirelessly connected to the Internet of Things (Internet of Everything) by 2020.

Download Wp_medical-grade_life-critical_wireless_networks_stevebaker-3

Download 150728-statement-oversight-fedcom

Download DOC-334757A1

Download ExApril_24_2014

Download FCC to allow unlicensed devices on same band as patient monitors - Modern Healthcare

Download OTI-PK-comments-TVWS-Part15_02252015

Download Product_data_sheet0900aecd807033c3

IXIA Comprehensive Solutions

Integra Systems, Inc., has worked with former Veriwave and now IXIA for a number of years. We have supported their efforts through the authored white paper and various presentations at conferences. Their comprehensive network testing and monitoring solutions are the gold standard in the industry. We have used their solutions to validate scaled SLA (service level agreements) for an extremely complex pilot wireless voice over IP deployment that performed flawlessly based upon our RF predictive modeling.

Download Solutions_brochure_2

Download Ixia-david-hoglund-medical-device-testing

Technical 802.11ac White Paper from Cisco

While this is a pretty technically detailed white paper on 802.11ac from Cisco; it does a very good job of explaining the technology "under the cover". Terms like channel bonding and others are explained.

Newer and faster necessarily is not always better as you have to consider your application requirements. Folks are not only now designing networks with different ESSIDS (there are reasons for limiting these), different security schemas and network topologies, but separation by frequencies. 802.11ac is all 5.0Gz. 802.11ac will like wireless has done is upstaging again the wired side of things. The challenge to deployment will become the backhaul of Gig Ethernet and/or fiber, and/or the combination to provide the capacity at the edge.

A long way from 1999 when I cut my teeth with Symbol when 802.11b got approved by IEEE.

Download White_paper_c11-713103

Integra Systems, Inc. has in the past several years worked with many major medical device manufactures to help validate and verify the wireless characteristics of their specific medical device for both regulatory approval and deployments. This has included roaming, security, quality of service and co-existence testing for regulatory and field implementations, and well as validation and verification of different WLAN infrastructures.

The Wireless (WLAN) enabled medical device

The assumption by some medical device manufactures is the WLAN adapter that may be used by the medical device just works like any enterprise WLAN adapter in a laptop.

Yes and No.

The real challenge often lies in the fact that the WLAN adapter is used in a different environment than the WLAN enabled laptop outside of the patient room...that often just sits there and is rolled into the room..maybe.

More than often the WLAN enabled medical device will be used inside a patient room, maybe on a patient (patient worn monitor), and will be used while the patient is up and walking down the hallway, down the elevator, and even down to areas like radiology. What this means is the wireless signal is often attenuated by the patient’s body (water), has to get through the glass, tile, metal, often inside a room and down the hallway to make the connection to the access point; let alone when the patient is mobile and roaming.

Several factors come into play.
1. How well the radio, antenna, and design factored into the real life challenging healthcare RF environment.
2. Are the roaming algorithms sufficient to take into account a highly mobile environment while maintaining a secure connection to the network?
3. Did the actual WLAN site design take into account the actual nature of the materials of the building, area of coverage requirements, the nature of the need to accommodate a -65dBm signal strength, and if using 802.11a/g/n, accommodate for the density of design requirements for 802.11a?
4. How is the network designed to accommodate all application requirements for the correct quality of service.
5. Who is managing the changes on the actual network after deployment that will ensure that the WLAN enabled medical device still operates for the intended use?

Integra Systems, Inc., feels the WLAN enabled medical device industry is somewhat in a perfect storm as there a lot of factors to consider here. All this boils down to the correct design of the WLAN medical device, the right overall network design for the application intended and overall management and documentation of the process and deployment. All areas where we have been down the road….before.

Wireless Medical Device Bandwidth Requirements

Wireless ethernet cannot be measured in terms of the wired ethernet side. Many have tried to correlate that the "network" bandwidth requirement (wired) and assume that this applies directly to the wireless side. Wired ethernet does not have to deal with roaming and the host of other parameters aplicable to wireless. The only to accurately measure this is to use www.ixiacom.com. I will speak directly regarding this in San Jose this coming week.

Motorola WiNG 4 WLAN Solution

First we had the era of the thick AP (802.11b...1999), then the "thin" AP and controller (early 90's), now we actually are reverting back to the distributed systems model...intelligence at the edge. If we can use the silicon and bring in intelligence in the AP...the controller does not become what I perceive as the "bottleneck"..and then do you really need redundant controllers? Motorola as the superior RF company provides more power per AP and better receive sensitivity versus the competition. (again...what I see from the specifications and analysis).
I was actually around then Symbol/now Motorola to witness this transition.

This Adaptive Architecture provides
No controller bottleneck
Improved application performance
Massive scalability
Collaborative intelligence in APand controller
(Think of the controller as being in the cloud...sort of!)

This all results in a more reliable WLAN design, less cost of ownership, and less TCO. Add in all the forensics of AirDefense..and you bulletproofed your WLAN. Know that Cisco and Aruba battle head to head all the time...but Motorola and others (well at least another that I have blogged about) are have innovation that is changing the landscape of the WLAN.

For at the end of the day...it how to take the commoditized WLAN technology...make it better and better to deliver real business value. Not just about moving widgets.

Wired & Wireless Firewall
QOS – WMM-PS/SIP CAC
Mobility – L2 and L3 stateful roaming
Native IDS/IPS
AAA Server for site survivable networks*
DHCP Server, with caching*
Dynamic RF Management with SMART RF
Traffic Load-balancing with Rate Limiting and Bandwidth Management
Locally managed firmware updates and configurations
Local troubleshooting capabilities with Statistics aggregation

* Typically separate servers and/applications.

Download Distributed Intelligence_WP_0411