Deploying Wireless LANs

From the August 2001 Issue

Deploying Wireless LANs

Today’s smart planning helps wireless users to add and expand well beyond tomorrow.

Lynn Chroust By Lynn Chroust, the director, commercial networks business unit, for Proxim, Sunnyvale, CA. Contact her at lchroust@proxim.com.

Recently I had occasion to visit my local ER for minor stitches. It went like this: Go to the window, check in, sit; turn in forms, sit; get triaged, sit; go to exam room, sit; get diagnosed, sit; get treated, sit; get discharged, wait for bill, sit; go home.

Lots of different steps with lots of different people and lots of sitting and waiting left me feeling like just another number to be processed. Fortunately, this did not negatively impact my recovery. But for those with more serious injuries or illnesses, increased wait times could result in longer and/or partial recovery.

The use of wireless LAN technology in healthcare can improve this and other standard processes dramatically, offering improved customer satisfaction along with increased medication delivery accuracy, improved clinical documentation, reduced inventory shortages and tighter efficiency.

Who’s Using Wireless

Wireless LANs, in use since the mid-1990s, offer the ability to stay connected to a network while remaining mobile. Healthcare institutions can deliver better patient care with an improved bottom line when nurses, doctors and other caregivers use mobile devices such as laptops, pen tablets or handheld PCs equipped with wireless cards and appropriate application software.

Patient charting. Traditionally, doctors, nurses and medical technicians used handwritten notes on individual sheets of paper for transcription into a medical record. Using wireless clinical documentation software on the bedside device saves time, improves accuracy and provides team-based caregivers in multiple settings with up-to-date information (since it does not have to be transcribed) to make better decisions. The result is lower cost, greater accuracy and better clinical outcomes.

Medication delivery. The Institute of Medicine has identified adverse drug effects as the single largest cause of extending patient length of stay. Wireless mobility allows caregivers to access a clinical information system to ensure that proper medication is ordered and there are no adverse interactions. When medication is administered, it can also ensure the famous “rights:” The right patient receives the right medication at the right time in the correct dosage.

Inventory management. One of the most tangible forms of healthcare expense reduction comes from accurate tracking of medical supplies. Handheld devices can reduce waste and lost charges and can improve inventory management by ensuring that materials are always accounted for when dispensing or distributing to floors or facilities.

Improved efficiency. Wireless can deliver improved efficiency beyond the original application for which it was intended. For example, Proxim deployed wireless systems to respiratory therapists for patient charting during rounds. The initial intent was to improve clinical documentation accuracy and to provide the most up-to-date information to the entire healthcare staff.

Respiratory therapy is a dynamic environment; new patients arrive and are moved from emergency to intensive care to cath lab. With real time wireless communications, the respiratory team did not have to constantly return to their offices to learn about new or revised orders. Their productivity increased because they treated more patients each day.

Eye on the Future

Higher speed wireless standards are just around the corner. While you may just be learning about standards such as IEEE 802.11b or 10 Mbps frequency hopping, the wireless industry is pushing the technology to even faster speeds at 5 GHz. The latest standard is IEEE 802.11a, operating at speeds five times faster than what is available today, up to 54 Mbps. If you are just planning a wireless deployment, which technology should you use? Should you hold off a year and wait until higher speed technologies are more stable?

The answer is no. Real improvements in patient care and your bottom line can be made today. It is very likely you have a mix of 10 Mbps Ethernet, 100 Mbps Ethernet and perhaps fiber or ATM within your facility. For the same reason—using the right technology for the right application—you will deploy multiple wireless networking technologies as well.

IEEE 802.11b provides an 11 Mbps data rate that is sufficient for many healthcare applications including patient charting, inventory management and medication delivery. IEEE 802.11a with its much higher speeds will enable new healthcare applications: mobile viewing of MRIs and X-rays in radiology and beyond, streaming video for telemedicine applications in surgery or other specialized procedures, and greater densities of users and applications on a single access point.

As with most IT technologies, change does not happen overnight. From both the acquisition and resource perspectives, it’s cost prohibitive to make a wholesale switchover from one technology to another. Wireless is no different than other infrastructure investments; you want it to last. To make sure your investment won’t be obsolete in the short term, look for the following when purchasing a wireless LAN infrastructure.

Multi-standard support. Choose a wireless infrastructure with built-in support for multiple wireless technologies. While IEEE 802.11b provides the fastest speeds available today, IEEE 802.11a products will be available in six months. And new developments in wireless LAN technologies are expected for years to come. You’ll want to be able to take advantage of higher wireless speeds and new capabilities without having to deploy a completely new wireless infrastructure. Avoid wireless infrastructure solutions that offer no way to migrate or support the next wireless standard.

Phased approach to migration. There are two methods to provide support for new, higher speed wireless technologies. One approach uses a slotted architecture. This is the use of a single or two PCMCIA slots within the access point. The idea is that when you need to add the new wireless technology, you simply add a new PC card to your existing access point.

Nice theory, but the reality is that all wireless technologies have different ranges. IEEE 802.11a will probably cover distances half as great as IEEE 802.11b. If you use your existing IEEE 802.11b access point placement, you will end up with holes in your coverage and you may have to take down your existing network to perform the upgrade, causing disruption to the existing user community as you deploy the new technology.

A more logical approach that we at Proxim use is the multi-standard wireless LAN solution. We separate the management of access points from the radios themselves and centralize installation, configuration and management of access points through our product’s controller. Centralization results in a guaranteed migration path to other wireless standards and lower cost infrastructure.

Single configuration and management interface. You wouldn’t manage your 10BaseT network separately from your 100BaseT network, so why should this be any different for wireless technologies? A single configuration and management interface for all wireless LAN technologies within your facility eliminates the hidden costs associated with your IT staff learning how to install, configure and manage wireless infrastructure. You can support multiple standards from the beginning, so you won’t go through a new learning curve each time a new wireless technology is introduced, with a Web-based interface that allows you to install, configure and manage multiple wireless technologies simultaneously.

Ready, Set, Deploy

A phased approach to deploying wireless applications has multiple benefits, not the least of which is a lower price tag.

Staff culture. Often the best place to begin is the place where new ways of working will be most accepted, not where the biggest savings can be achieved. Wireless applications are designed not to create new processes, but to work with existing healthcare processes and procedures. Nevertheless, keying data into a computer instead of writing it longhand is a change. Successful deployment often comes down to a champion that develops interest and understanding with fellow colleagues.

Application design. Applications designed for wireless will run seamlessly, eliminate steps and save time, ultimately increasing their acceptance and adoption. Take, for example, a nurse dispensing medication. Using a wireless clinical information system running on a laptop in conjunction with a bar code reader, she zaps the bar code for each medicine on the chart to verify dosage, correct patient, etc. If after each medicine, she must put down the barcode reader and hit “enter” on the laptop to complete the entry, she will become frustrated with wireless. Be aware of small but annoying usage problems that can hang up successful deployment.

Device type. Ensure that the application you choose is suited for the mobile device you use. Application vendors should have taken into consideration the difference in information display for a nurse reviewing a case history versus a doctor looking at a two-page flowsheet. Other critical items include screen resolution (for viewing images), bandwidth capabilities, security and storage issues.

Wireless Partner. Covering a single doctor’s practice is a much simpler installation than multiple floors in a hospital. If your installation will tend toward the latter, choose a wireless partner with experience in large deployments. Time to operation will be reduced, allowing you to begin reaping the rewards of investment sooner.

Available expertise. Last but not least, invest in available expertise, either in-house or through a partner. The wireless infrastructure—access points—is initially placed for proper coverage and application performance. Over time, unknowing individuals may unplug a cable or move an antenna during the course of property upgrades or maintenance. These incidents may just degrade system performance rather than break it. Users experience less satisfactory sessions and the system slowly becomes underutilized. Ongoing monitoring and management of the wireless infrastructure can protect your investment. Most wireless vendors now include simple Web-based tools that allow in-house IT staff to determine wireless network performance.