Wireless Strategies for Healthcare Provider Organizations

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Virtual Medical Worlds
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Wireless Strategies for
Healthcare Provider
Organizations

Washington D.C
. 28 January 2006

As the
American population increasingly carries
portable telephones and personal computer
devices, Federal agencies are continually
seeking new cost
-
effective ways to bring
Government to the people instead of making
people come to "fixed"

government offices
during normal "business hours". Whether it
involves using mobile van offices at shopping
centres or setting up additional government
portals for citizens to use on the Internet,
wireless communications will play a key role in
providing
improved services to citizens across
the country in the coming decade. The scope of
wireless and/or mobile computing is expanding
daily. It is no longer enough to just know about
available mobile devices and applications to
gear up an organization's wirele
ss strategy. One
must now be aware of the wireless architecture,
wireless standards, special security needs for
wireless devices, the growing range of
application choices, and the unique support and
maintenance requirements needed for wireless
systems and
users of mobile devices. The use of
wireless modalities in settings such as hospitals,
clinics, long
-
term care facilities, and home care
is becoming well established. The proliferation
of software applications and use of mobile
computing devices in health
care settings
indicates that the wireless landscape is finding a
secure place within our health care settings.
This specifically holds true for any major health
care organization. One of the greatest risks
related to the acquisition and implementation of
w
ireless technologies is to focus on technical
features before addressing the issues of privacy
and security. Privacy and security of
transmissions of sensitive patient information
within the health care setting must remain a
high priority to prevent any br
each of patient
confidentiality and leakage of data about any
individual's health condition. It is essential that
stakeholders across the health care arena
become fully aware of the wireless architecture,
mobile computing devices, mobile computing
applicat
ions, the scope of benefits and
limitations, alternative solutions available for
different health care settings, security risks,
guidelines for implementation success, and the
end
-
user experience. Becoming more
knowledgeable is essential before a health ca
re
organization takes any major steps forward
towards acquiring and implementing wireless
solutions.


The Department of Veterans Affairs (VA) in
support of their health care facilities nationwide
has already taken initial key steps in supporting
medical s
ervices at the point of care through the
use of wireless technology and the adoption of
appropriate mobile computing devices and
applications. For example, staff from the
Veterans Health Administration (VHA) Office of
Information (OI) national Bar Code Med
ication
Administration (BCMA) Joint Program Office
were selected by the Security of Mobile and
Wireless Business Applications in Government
II Conference Awards Committee to receive the
award for Outstanding Accomplishment in the
category of Enterprise
-
wid
e Applications of
Mobile and Wireless Security. The award was
given for their work on deploying VHA's Bar
Code Medication Administration (BCMA)
software over secure wireless data networks
throughout VHA medical facilities. The system
ensures VHA's network
and patient information
are secure from unauthorized access and meet
HIPAA privacy guidelines for the health care
industry.

What is Wireless Communications?

Wireless communication is currently one of the
fastest growing technologies in the information
tec
hnology (IT) industry. Wireless
communications can be further divided into two
major categories:
wireless voice

and
wireless
data
. Wireless voice includes cordless/cellular
telephones and mobile phones. Wireless data
includes cellular digital packet data (
CDPD) and
Wireless Local Area Networks (WLAN).

Background on the Wireless Sector

The whole wireless sector is under close
scrutiny from research agencies, analysts,
consultants, and enterprises keen to implement
some sort of wireless solutions. While the
d
iscussion related to Return
-
On
-
Investment
(ROI) continues, it now appears that wireless
technology will deliver on its promises over
time. The technology will solve a lot of
problems over the long term once sufficient
infrastructure is present and products

reach the
same level of maturity found in other commonly
used electrical appliances produced by industry.


Many companies have already chosen to move
forward and are using wireless networks to
connect portable computing devices to
enterprise applications.

These are the companies
that have examined the business processes of
their customer
-
facing employees and identified
areas where today's technology can improve
those business processes.


Possible business process improvements exist in
the following areas:



Cost reduction.

Activities and resources
can be removed from existing processes.



Cycle time reduction.

Sales, service,
expense, and billing cycles can be
reduced.



Increased revenue.

It can introduce
revenue
-
generating activities that
wouldn't otherwise be

possible.



Optimal use of time.

At points in a
business process where there is a wait
state, workers can perform other useful
tasks.



Increased customer satisfaction.

The
quality of the service to the customer is
maximized.



Increased employee satisfaction.

It can
reduce tedium, unnecessary trips to the
office, and paperwork.

Mobile Health Applications Software

Most technology tools available to physicians
today are complicated and cumbersome and do
not yet fit easily into the flow of patient care.
However, a

new generation of information
systems and technologies are changing the way
physicians practice. For example, physicians
today can acquire a mobile practice companion,
or PDA device, that offers immediate and secure
access to critical clinical information

no matter
where or when physicians need it to help them
provide patient care. Just as important, these
types of portable wireless tools should improve
practice efficiency and may potentially increase
patient satisfaction.


Currently these mobile applicati
ons focus
primarily on tasks at the point of care and do not
require a sophisticated data transfer
infrastructure back to the organization's main
computer system. Using these mobile
applications in conjunction with wireless
technologies, the following bene
fits have been
realized within the health care setting:



Convenient access to patient data



Accurate and timely entry of data



Cheaper installations than wired
networks



More efficient utilization of provider
time



Reduced medical errors



Eliminating duplicate d
ata entry



Improved patient care



Decreased operating cost



Improved work flow



Decreased patient and clinician wait
times

Business Drivers

Some of the most widely noted drivers in the
growth of enterprise mobile computing are:



The need for faster, decentraliz
ed
decision making



The need to be closer to beneficiary
population



The availability of better mobile
computing technology



Increased responsiveness to beneficiary
service needs



The need for real time medical decision
making



The need to decrease medical erro
rs



The need for bedside standardized
protocol



Increased industry pressure for better
data quality and efficiency

One of the biggest challenges for mobile
computing vendors is to provide deeper and
broader functionality. Expect mobile computing
vendors to c
ontinue to expand their functional
capability from solely prescription writing into
clinical documentation or charge capture in the
coming years especially as they merge with or
acquire other mobile computing application
vendors.


Despite the economic situ
ation and recent world
events, the basic drivers of growth in mobile
computing are as strong as ever. In fact, health
care is re
-
engineering its workplace and
provision of care utilizing wireless information
technology to achieve many of its business
objec
tives. Optimal to its success is the priority
of securing the infrastructure and data stream.
Any wireless strategy must understand how
every decision impacts the security of the
enterprise and yet implement devices and
applications that provide great valu
e. The
landscape changes everyday and remaining
mindful of the advancements is the first step
toward an efficient, secure, and tangible wireless
enterprise.

Technology Drivers

High
-
speed Internet and portal technologies will
dramatically transform the deli
very of health
care. Portals will be accessed ubiquitously via
computers, wireless devices, and telephone
(using voice recognition and speech synthesis
applications). Patients and providers will have
the capability to collaborate in real time, search,
publ
ish/subscribe, or even obtain personal
information. Portal infrastructures will also
enable an environment that promotes customer
service. They will provide common access to
accurate, consistent, and reliable information
across business lines.

Life Span of

Wireless Solutions

Mobile computing using wireless technology
involves a range of solutions that enable users to
obtain access to data from almost any location,
at any time. Currently, there is a wide array of
mobile computing device options ranging from
cellular phones to full function wireless laptops.
Before proceeding with the selection of mobile
solutions, it is important to consider the 1)
Infrastructure requirements, 2) Mobile
computing device capabilities, and 3) Integration
with existing systems.


The expected life span of wireless technology is
currently about two to four years. While the
equipment itself may last much longer, the
increasing network requirements of new health
care software (e.g. Wireless EHR and Pocket
Rx) may force an accelerated

replacement
schedule. Network is an issue as well. As a rule,
plan to begin replacement of existing wireless
technologies within two years of installation and
anticipate completing the replacement within
four years.

Core Recommendations

Business needs are

evolving daily as are the
solutions within the wireless landscape.
Knowing the business needs of one's
organization will help tailor the
recommendations that are essential to the
success of any wireless technology
implementation effort. During implementat
ion
and deployment, security issues and concerns
must remain visible. Every decision must
address how it will affect the security integrity
of the enterprise. The following is a list of basic
recommendations:



Standardize on a single mobile
infrastructure p
latform



Standardize wireless devices and
application solutions whenever possible



Maintain a comprehensive security
protocol



Enable connectivity to the intranet and
legacy systems



Look for new applications that can
improve existing processes



Purchase produc
ts centrally to secure
volume pricing



Deploy wireless systems management
tools from the outset



Begin to build key skills now with pilot
deployments in the field



Document procedures for testing and
design of wireless infrastructure and
applications



Ensure y
our enterprise Help Desk can
respond to wireless technology questions

Training

Training is a valuable tool to use for the
organization's non
-
engineering professionals
who provide invaluable expertise to the
operational network. An organization without a
fo
cus on training personnel in such a
technologically changing environment runs the
risk of rendering their networks liable for
breaches in security, inappropriate network
design, and future technological problems.

Resource Analysis

There is a need for all h
ealth care organizations
to do a resource analysis prior to undertaking
any major project to implement wireless
solutions in order to determine:



what resources you will need to
aggressively pursue wireless
communication opportunities;



which Internet and in
tranet
communication, document management
and work flow procedures need to be put
in place;



what type of staff or vendors you may
need to bring on board to help implement
your wireless applications; and



how to use your existing resources to get
up and runn
ing quickly with wireless
tactics.

Trends and Future Direction

For the foreseeable future, wireless technology
will complement wired computing in enterprise
environments. Even new buildings will continue
to incorporate wired LANs. The primary reason
is tha
t wired networking remains less expensive
than wireless, although wireless has decreased
support costs. In addition, wired networks offer
greater bandwidth, allowing for future
applications that may be beyond the capability
of today's wireless systems.


Th
e complexity of mobile and wireless
applications, combined with a lack of standards,
will continue to make mobile and wireless an
area of overdue innovation. Risk remains, e.g.
more than 50 percent of mobile applications
deployed at the start of 2005 will
be obsolete by
the end of 2005. The lack of sufficiently useful
and usable applications will be the biggest
barrier to "always
-
on" consumer acceptance in
the near term. The real question about the future
of the wireless enterprise network is not whether
it

is here to stay but rather the extent to which
we have the foresight to fully exploit it while
preserving the privacy and security of the
individual's health information.

Next Steps

Although the implementation of wireless
computing can potentially provide

enticing
dividends, its full value cannot be recognized
without proper planning and extensive
forethought on the wireless enterprise design.
The goal is to be better able to define,
implement, deploy, and evolve state
-
of
-
the
-
art
wireless solutions that me
et the needs of the
evolving business environment. The clinical care
initiatives that many major health care provider
organizations are currently working on lend
themselves concretely to a proactive wireless
strategy. However, critical questions do need to

be asked prior to making any implementation
decisions.

1. Understand clearly the organization's
business objectives and business processes.

Health care organizations should consider
wireless applications in the context of a
larger business process reengin
eering and
enterprise
-
wide IT effort.

2. Establish an enterprise wireless working
group to develop a long range strategy and
plan.


3. Conduct an enterprise technology
assessment.

Complete a thorough technical
analysis on which to base the decision to
inst
all wireless solutions. Avoid choosing a
technology that fails to meet your
organization's business and clinical needs.

4. Identify the type of data to be transmitted.

Determine whether it is text intensive,
graphics
-
intensive; determine physical
parameter
s of the proposed installations as
wireless networks are limited in range; note
the span and throughput of wireless
networks offered by competing
manufacturers.

5. Conduct detailed on
-
site analyses of
critical physical and clinical problems at
health care
facilities to determine if wireless
computing offers the right answers.


6. Ensure the design of wireless
infrastructure products and components
chosen to be implemented comply with your
Enterprise IT Architecture and Standards.


7. Choose the right vendor
.

In addition to
their product line the chosen wireless
product vendors need to be able to provide
training and support to the organization over
time.

8. Lay the groundwork for a shift in mindset
and the work environment when wireless
solutions take hold.

Provide orientation and
training needed to help management and
employees embrace the new world of
mobility and increase autonomy of the
organization's workforce.

9. Secure data everywhere.

Wrap security
around the information, internally and
externally,
regardless of when, where or how
it is created, stored, processed or transmitted.
Be mindful of ever
-
occurring security threats
and create centralized policies.

10. Check on how the stations communicate
with different internal and external Access
Points (A
P) in order to assess to which AP
they should currently belong.


11. Develop a device management strategy
and approach to control hardware and
software purchases, inventory management,
back up, training, and help desk support.


12. Consider acquiring and d
eploying an
enterprise
-
wide "mobile infrastructure"
solution.

Deploying one integrated mobile
computing suite across the enterprise will
provide a range of benefits, e.g. one vendor,
one contract, less training, simplified
architecture, and lower support c
osts.

13. Determine how to quickly and cost
-
effectively integrate wireless technology into
your current environment
-

and achieve the
most positive impact on your business.


o

Determine which wireless
solutions will deliver the greatest
business value

o

Conduc
t pilot tests of various
solutions

o

Prioritize planned acquisition and
implementation of wireless
solutions.

List of Potential Wireless Solutions



Wireless Phone Switch (PBX)

o

Pagers

o

Phones



Wireless Data Networks

o

Wireless LANs (WLAN)



Wireless Internet/Intrane
t

o

Wireless Web
-
based Reference
Sites



Wireless/Mobile Enterprise Computing
Devices

o

Cellular Phones

o

Handheld Personal Digital
Assistants (PDA)

o

Laptop Portable PC

o

"Wearable" Computing Systems



Wireless/Mobile Enterprise Health care
Applications

o

Clinical Docume
ntation

o

Alert Messaging

o

Electronic Health Records (EHR)

o

Bar Code Medication
Administration (BCMA)

Key References



VHA IT Architecture
-

Paper by First
Consulting on Wireless Technology
1/2003
http://vaww.webdev.va.gov/vhaea/infrast
ructure/WirelessStrategyWhitePaper.doc




VHA Health IT Architecture
-

http://vaww.va.gov/vhaea/scripts/Current
Ea.asp




VA Wirel
ess Security Guidelines
-

http://vaww.infosec.va.gov/UploadedFile
s/Notices/VAGuidelineWirelessandHand
heldDecicesFinal.doc




Wireless Security for

Health care
-

http://vaww.webdev.va.gov/vhaea/securi
ty/WirelessinsecurityV11.pdf




HIMSS Wireless Technology Resources
-

http://www.himss.org/asp/issuesbytopic.
asp?TopicID=20




National Telecommunications and
Information Administration (NTIA)
-

http://www.ntia.doc.gov/opadhome/opad
_wire.html




Fe
deral Wireless Policy Committee
-

http://is2.antd.nist.gov/fwuf/fwpc.html




Wireless Telecommunications Bureau
(WTB)
-

http://wireless.fcc.gov/



Peter Groen a
nd Marc Wine