Case Study: Hospital Uses WLAN To Provide Better Patient Care

Reliability: Hospital networks simply can't go down; lives depend on them. If a physician relies on a wireless network for access to patient information and that network can't deliver, then the quality of health care suffers. At Overlake, this is a situation we absolutely wanted to avoid.

We achieved the highest level of network reliability by deploying redundant WLAN controllers that could service wireless users in the event that another controller became disabled. In addition, we leveraged real-time radio-frequency (RF) management to let access points (APs) increase power and, therefore, coverage area to negate the loss of a neighboring AP. And we put all WLAN equipment on uninterruptible-power-supply systems, ensuring that the wireless network continues working during power failures. In this respect, the WLAN is more reliable than our wireline network.

Security: The Health Insurance Portability and Accounting Act (HIPAA) outlines stringent requirements for protecting patient information. This affects a wireless network in two primary ways: First, a network infrastructure must guarantee that only authorized users have access to individual patient records, and second, patient information must be transferred in a secure fashion. HIPAA doesn't dictate how these goals are accomplished, but, in most cases, it requires tight access control, advanced authentication techniques, and a variety of encryption tools for enhanced privacy. Unfortunately, various client devices—PDAs, tablets, PCs, and voice handsets—have different capabilities when it comes to security. Therefore, our wireless network had to be flexible enough to accommodate these devices and meet the stringent security requirements.

Ease of use: Our hospital doesn't have a large IT staff; in fact, our entire networking infrastructure, including routers and switches, is managed by a single individual. In addition to his traditional wireline-networking responsibilities, this person would take on managing the wireless network; we simply couldn't afford to dedicate an additional resource to the exclusive management of a WLAN. We contracted a local VAR to help with the installation, but the day-to-day operations fall squarely on my team's shoulders. We needed a WLAN solution that was easy to manage, without requiring a great deal of attention. Otherwise, the operational expenditures of this project would make the endeavor much more difficult to handle.

Seamless roaming: Mobility is the key to our overall plan. If doctors, nurses, and support staff couldn't continuously use Overlake's applications as they moved through different rooms and departments, then the value of the wireless LAN—and our mobile health-care initiative—would be in jeopardy. Surprisingly, this was a major impediment in the first set of WLAN products we evaluated. Though these products established adequate stand-alone pockets of coverage, they didn't function as an end-to-end system. This might have sufficed for some applications, but it was unacceptable for others—for example, voice. Consequently, seamless roaming rapidly emerged as one of our biggest evaluation criteria.

After a product evaluation and one unsuccessful trial, Overlake standardized on Airespace Inc.'s Wireless Enterprise Platform. In 2002, this was a new WLAN architecture that leveraged a centralized controller with lightweight APs. A lightweight AP handles the real-time 802.11 functions of traditional APs, such as client probe requests and air monitoring. The centralized controller handles other 802.11 functions that affect an entire enterprise—for example, mobility across APs, quality-of-service (QoS) policies for users, intrusion detection and prevention, and other WLAN security mechanisms. Since our deployment, the industry has widely adopted the centralized architecture as an evolutionary platform from the traditional, distributed AP model.

The platform enabled seamless roaming across all APs and established a mechanism for centralized creation and enforcement of security policies across the entire hospital. We easily implemented wired-equivalent privacy (WEP) to provide a rudimentary level of traffic protection through encryption, and we're now migrating to the recently ratified 802.11i specification via an easy software upgrade. It also let us suppress the broadcast of WLAN service-set identifiers (SSIDs) to prevent unauthorized users from accessing our wireless resources. This feature helped us maintain privacy in accordance with basic HIPAA guidelines.

The system also provided built-in RF intelligence whereby AP channels, coverage area, and load dynamically change in real time based on altering RF conditions. This meant we didn't have to dedicate full-time resources to WLAN management. Currently, we allocate just a small portion of one employee's time to managing our wireless network; basically, our network infrastructure manager checks in every now and again to make sure things are running smoothly.

We began by delivering wireless services across nine departments, including emergency services. By the end of this year, I expect 95% of the hospital to be covered with wireless fidelity (Wi-Fi), providing mobile access everywhere a health-care provider requires it—waiting rooms, labs, cafeterias, pharmacies, radiology, and other specific departments. We use 802.11 b/g technology throughout the hospital, because it operates in the 2.4-GHz band, which avoids interference with other medical equipment.

The first phase of our WLAN deployment involved giving voice-over-WLAN handsets to the nurses. The goal was to facilitate communications with patients, their families, and other staff members. The nurses noticed immediate gains, such as dramatically improved productivity by eliminating the need to return to their desks to make calls. This increased productivity by 15 to 20 minutes per shift per nurse, according to our best estimates.

The second phase involved deploying tablet computers with integrated health-care software for mobile connectivity to patient records, hospital pharmacies, and ordering systems, creating a completely portable office. In addition, we deployed five wireless carts equipped with Meditech software for bedside registration. This streamlines the registration process and reduces inaccuracies by eliminating the need to transpose patient information from clipboards to computers.

Unfortunately, the tablet computers' technical limitations made them too difficult to use. As a result, we're beginning a 12-month project to replace the tablets with handheld PDAs for the same purpose.

Finally, we added wireless coverage in communal areas, such as waiting rooms, for patients and visitors.

We deployed our WLAN as a seamless overlay to our existing IP/Ethernet backbone. We viewed it as complementary to the wireline network and didn't replace or modify the LAN in any way during this project. In fact, we were keen to leverage many of our wireline security and QoS policies in our wireless environment. This gave us two unified networks that will coexist for some time to come.

WLANs have proven indispensable to Overlake's primary objective of delivering outstanding patient care. While it's difficult to quantify the return on investment, numerous intangible benefits justify our decision. Most important, wireless connectivity lets our health-care professionals spend less time on administrative tasks, such as retrieving records, and more time with patients. This is particularly useful in emergency-care facilities, where rapid patient processing is essential.

We've also improved decision support. Real-time access to patient records, drug information, and medical reports help Overlake deliver appropriate care. In addition, nurses can more easily consult with a patient's family and with specialists through our voice WLAN system, which met with instant success. The nurses took to the devices rapidly and noticed immediate productivity improvements.

By automating key tasks, such as medication administration and patient registration, we can avoid errors during transcription. And by enhancing communication among staff members and streamlining processes, Overlake can respond more rapidly to patient needs. This can be the difference between excellent and mediocre health care.

Getting to the right WLAN platform requires diligence and persistence. From a platform-selection and deployment standpoint, the trust-but-verify method is a good way to avoid pitfalls. As with any IT decision, no CIO should take vendor claims at face value. We were surprised to see the vast difference in capabilities among WLAN solutions and disappointed when vendor and integrator promises went unfulfilled. Of course, understanding application requirements and usage patterns is critical for proper WLAN design and maintenance. In selecting the right product, you need to answer basic questions: How much bandwidth is required? Where will users likely require wireless access? What types of wireless clients will be used? Is the network safe?

By its nature, wireless is a shared medium, but you must decide who will share it. Finally, expect the unexpected, and implement a WLAN infrastructure that can adapt to changes. If you lose an AP, make certain others will compensate for the lost coverage. With the right networking infrastructure, mobility can be your best friend. In some instances, it can even save a life.

Kent Hargrave is CIO at Overlake Hospital Medical Center.

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Internet users anxious for extra-strength Wi-Fi will have to wait a few years. Even as wireless Internet access takes hold in business environments, WiMax, a fledgling wireless technology with a range of up to several miles, won't displace cable and DSL Internet access just yet.

Most businesses are familiar with wireless standard 802.11b, known as Wi-Fi. With its maximum range of 50 feet to 250 feet, Wi-Fi technology works well for wireless Internet access in the office, at a cafe, or in airports.

The new generation in wireless Internet connectivity, the 802.16 standard, better known as WiMax, spans distances up to 30 miles, filling in the last-mile gaps and bringing connectivity to underserved, remote areas. And whereas Wi-Fi manages only a limited number of connections, WiMax can handle thousands of connections at once.

Recently, Intel has touted implementation of this next step in wireless broadband connectivity as imminent, but it likely will take a year or two before the vendor's WiMax-enabled chips will reach end users.

Most vendors are awaiting the ratification of 802.16e, the mobile version of WiMax. So far, the IEEE, a New York-based standards body, has ratified only the initial, fixed WiMax standard, or 802.16a. The "e" standard is expected to be ratified by May 2005.

"The U.S. market is looking for this next generation of WiMax, which means companies here will have to wait to see products in the marketplace until at least 2006," says Mo Shakouri, VP of business development at Alvarion Ltd. and VP of the WiMax Forum, a nonprofit industry group comprising more than 150 companies, including AT&T and Intel. The group certifies and promotes the compatibility and interoperability of WiMax broadband products. "Internationally, there's more traction for products based on the fixed WiMax standard, which was ratified this year. Solutions based on this initial WiMax 802.16a standard are going to be implemented abroad first, especially in developing nations," Shakouri says.—Anne Donker

The Overlake Hospital Medical Center decided that wireless LANs were essential in supporting its strategic mobile health-care initiatives. The following guidelines, derived from Overlake's experience, can assist any company in implementing a successful wireless-technology project:

Analyze the business case: In some instances, a cost/benefit analysis is required. In others, as with Overlake, implementing a WLAN is intrinsically tied to other strategic objectives, such as deploying new business applications.

Understand your constituency: Wireless is a shared resource, so understanding bandwidth requirements, traffic load, and user-mobility patterns is essential to product selection and overall network design.

Kick the tires: Evaluate network products in a live deployment to prove vendor claims and establish viability in your specific environment.

Stay flexible: Radio frequency, by its nature, changes from minute to minute. Implement a solution that can change in real time without a lot of hand-holding. Otherwise, operational expenditures can eclipse any intangible benefits garnered from WLAN deployment.