Healthcare Wireless and Device Connectivity

The Smart Phone versus the Enterprise Purpose Built Phone for Healthcare

We all over the past several years have become enamored with our smart phone; it is like our third hand and second brain. Because of the user interface and that BYOD (bring your own device), it has made logical sense to use this in the healthcare domain. While practical to use from the carrier perspective; there are some significant limitations for actual clinical use. These limitations can be summed up in several areas.

The Radio
All smart phones were designed primarily from a user interface perspective with the primary connectivity model to the carrier of choice. While these phones also have BTLE (Bluetooth Low Energy) and WLAN (Wireless LAN), the WLAN radio it is not enterprise grade. The primary use model is cellular versus WLAN, as the WLAN radio was designed to connect to ad hoc networks, i.e. home or coffee shop. The challenge becomes when the phone becomes connected to the enterprise WLAN and authenticated that roaming occurs. In the case of using the device for voice over IP, you need a RSSI of at least -65dBm and a CCI of less than 2%. More than often the WLAN network connection drops because of the roaming algorithms in the smart phone just do not work effectively, if at all. Trying remedy the situation by adding more WLAN AP(s) only raises the noise floor. Not wise. The reality is the poor WLAN radio put into smart phones as an afterthought.

The Battery
Most smart phones today are moving toward an integrated battery. The challenge of using WLAN with a portable device like a smart phone is the radio is power hungry. Ideally the clinician, desires to use the mobile phone throughout an entire shift. If for example the battery is getting low, you should have the ability to “hot swap” batteries and maintain the same application session. However, now that we have non-replaceable batteries, the only way to provide extra power is to use a “sled with another battery”. Now the challenge becomes charging and maintaining two batteries and two pieces of equipment. Does not make a lot of sense.

The “non-rugged” nature of the consumer phone
Consumer smart phones have all kinds of sleds and overlays that you can to make them more rugged; but in general nature they are delicate and if dropped the screen will crack or the case will break. If then tend to be dropped in water or sprayed down with disinfectants, water will ingress and the plastics will crack.

The Lack of a Bar Code Scanner
Having a mobile computer with an integrated bar code scanner, eases the clinician’s job versus have to use a tethered bar code scanner to the laptop. However, the smart phones of today require a separate sled (with a battery and the CCD camera for bar code recognition)

Bottom line, a smart consumer phone simply does not work in the enterprise! It is like using a high-end sports car to pull a horse trailer.

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ASCOM Alarm Fatigue and the Right Device

While there are a myriad of systems out there in the marketplace today that are addressing this...the reality is you need a communications methodology and device that actually works!

Consumer devices (smart phones), were not designed for the enterprise environment. Folks out there fail to forget that the radio and the algorithms were designed for hotspot environments; not the high mobility requirements demanded in healthcare. Put in a low cost WLAN radio...and well. That is why they have "dropped connections" via WLAN voice over IP calls. Finally, WLAN radios are power hogs, so does that consumer device use PSP modes to conserve power?...think not. So, asking a clinician to charge the "smart phone" once a day or maybe even during a shift...just another thing that get's in the way of patient care.

Next, you have to consider the context of how you are going to actually use the device. For a nurse to pull this out of his/her pocket, then scroll down to something...probably is not the best use model. Cannot see the rationale of trying to access the EMR on a tiny, tiny screen. Finally, devices like this will be dropped, run over, etc. It has to be bullet proof and yes waterproof. (think of the term IP56...) Been in the clinical environment for many years...stuff get's destroyed.

So hat's off to ASCOM to actually making an device that solves and addresses the use model. To a care giver, it looks like a combination of legacy paging/notification being brought into 2014...while at the same time being able look and feel of an intelligent communication device.

This is truly demonstrating...versus talking...."workflow improvements"!

http://www.ascommyco.com/en/

From Paging to the Smart Phone era in Healthcare

I am old enough to remember carrying the old voice pagers when I was working in hospitals. Thought that this was pretty cool. Cannot remember now when I ever see a pager, except maybe on a police officer or a physician.  However this is definitely not the trend. According to market-research firm Manhattan Research LLC of New York, about 64% of US physicians are using smart phones, up from just 50% two years ago. The firm expects that figure to increase to 81% by 2011, with the majority of physicians owning iPhones or Blackberrys. Among U.S. doctors with smart phones, however, Blackberry devices still prevail with a 37% usage rate, compared with 27% for the iPhone, according to Manhattan Research.

Here is a very good article from AmCom, about "Six Things Hospitals Need to Know about Replacing Pagers with Smartphones."

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UltraSound Imaging Now Possible on a Smart Phone

Computer engineers at Washington University in St. Louis are bringing the minimalist approach to medical care and computing by coupling USB-based ultrasound probe technology with a smartphone, enabling a compact, mobile computational platform and a medical imaging device that fits in the palm of a hand.

William D. Richard, Ph.D., WUSTL associate professor of computer science and engineering, and David Zar, research associate in computer science and engineering, have made commercial USB ultrasound probes compatible with Microsoft Windows mobile-based smartphones, thanks to a $100,000 grant Microsoft awarded the two in 2008. In order to make commercial USB ultrasound probes work with smartphones, the researchers had to optimize every aspect of probe design and operation, from power consumption and data transfer rate to image formation algorithms. As a result, it is now possible to build smartphone-compatible USB ultrasound probes for imaging the kidney, liver, bladder and eyes, endocavity probes for prostate and uterine screenings and biopsies, and vascular probes for imaging veins and arteries for starting IVs and central lines. Both medicine and global computer use will never be the same.

"You can carry around a probe and cell phone and image on the fly now," said Richard. "Imagine having these smartphones in ambulances and emergency rooms. On a larger scale, this kind of cell phone is a complete computer that runs Windows. It could become the essential computer of the Developing World, where trained medical personnel are scarce, but most of the population, as much as 90 percent, have access to a cell phone tower."

"Twenty-first century medicine is defined by medical imaging," said Zar. "Yet 70 percent of the world's population has no access to medical imaging. It's hard to take an MRI or CT scanner to a rural community without power."

Shrinking the electronics over 25 years

Zar said the vision of the new system is to train people in remote areas of the developing world on the basics of gathering data with the phones and sending it to a centralized unit many miles, or half a world away where specialists can analyze the image and make a diagnosis. Zar wrote the phone software and firmware for the probes; Richard came up with the low-power probe electronics design. He began working on ultrasound system designs 25 years ago, and in that span he has shrunk the electronics from cabinet-sized to a tiny circuit board one inch by three inches. A typical, portable ultrasound device may cost as much as $30,000. Some of these USB-based probes sell for less than $2,000 with the goal of a price tag as low as $500.