The connected hospital: Wireless technology shapes the future of healthcare

With an aging population across much of the globe that is increasing the volume of patients in hospitals and pushing current systems beyond their limits, hospital administrators are being asked to do much more with the existing personnel and facility infrastructure they have in place.

Compounding that challenge is the increasing focus on outcome-focused models for healthcare delivery, which demand insight into and accountability for health metrics even as workloads rise relentlessly. Simply put – hospital administrators and their staffs are being asked to do the impossible: deliver quality healthcare to more and more patients in a way that is reliable, economic, scalable, secure, measurable and efficient; and do so with facility limitations and budget restrictions that eliminate the simplest solution—throwing more staff, more beds and more everything at the situation to scale up in response to those rising demands.

The harsh reality of those increasing demands and limited resources creates a difficult bind for hospital administrators, but new technology is starting to alter that dynamic in dramatic ways. Specifically, wireless technology that creates highly connected healthcare environments is helping hospitals to address each of those challenges discussed above, and in the process it is reshaping the future of healthcare for both patients and healthcare professionals.

Wireless medical devices are not new, but they are about to have a much larger impact because of the way that forward-looking hospitals are linking them together to create truly connected environments. In the past, these wireless devices have primarily been used to help healthcare providers improve real-time patient status and act more quickly on critical patient data. In and of itself, that is an enormous benefit, but the next generation of wirelessly-connected device networks will achieve remarkable efficiencies in terms of patient safety, data accuracy, and mobility, which are crucial to providing quality patient care, reducing costs and handling higher patient volumes. This increasing number of wireless medical devices in hospitals has led to the vision of the connected hospital, a fully integrated hospital where wireless technologies allow caregivers and patients to roam throughout the hospital while providing accurate and timely monitoring. In connected hospitals caregivers can focus on providing the best quality of care to their patients, rather than administrative tasks.

In connected hospitals, connecting medical devices to Electronic Health Records (EHR) systems has reduced the time it takes to enter vitals from 7-10 minutes to less than 1 minute per patient, Real-Time Locations Systems (RTLS) are now used to quickly find usable equipment for treatments, and advanced bed and fall monitors can monitor patient movements and alert staff as soon as there is an issue. All of these technologies are enabled by the underlying robustness of the wireless connection.

Inevitably, implementing these new technologies brings upon challenges which include deploying a strong, secure infrastructure with robust reporting and monitoring features, along with utilizing Enterprise Internet of Things (EIoT) technology to speed up administrative tasks. This article discusses the factors driving the connected hospital and the associated challenges.

IoT Drives a More Connected Medical Landscape
The Internet of things (IoT) has grown significantly in just a few short years, specifically in the consumer wearables space. For the consumer, activity trackers and other wearable IoT devices promote behavioral changes in order to facilitate a better outlook of health and wellbeing. This type of self-monitoring has evolved to include more critical data such as insulin and cortisol levels and has even forced changes in the medical landscape – recognizing the IoT's influence, larger organizations and manufacturers look to its capabilities to support critical challenges in complex connected medical environments. However, there are a number of reasons why current wearable devices are not suitable for medical-grade applications.

Most importantly, activity trackers and other wearables do not actively promote health and wellness. For example, a blood glucose monitor is a medical device designed to diagnose or treat a medical condition – this functionality is far beyond the means of a consumer grade device. The wearable IoT space may not be medical-grade and fails to provide detailed or streamlined data points to be used by clinicians, but it does have benefits and can change the human outlook on health and wellness for the better.

In contrast, medical devices like infusion pumps and patient monitors require a more stringent set of security protocols and require constant connectivity. All Wi-Fi connections must be secure so that sensitive information transmitted over the air is protected and access to hospital Wi-Fi networks and the resources behind them is controlled. Multi-parameter patient monitors represent a large portion of key patient monitoring equipment, approximately 19% in 2013. These devices continuously measure key parameters of patient including blood pressure, heart rate, and respiratory rate. These devices need to be continuously connected to ensure accurate data and instant alerts to nurses for better patient safety.

The Connected Hospital – A Vision without Wires
The connected hospital is a place where wireless technology allows caregivers and patients to roam throughout the hospital while providing accurate and timely monitoring. This vision stems from the increasing number of wireless medical devices in the hospital environment. The global wireless health market is projected to grow from 39 Billion in 2015 to 110 Billion by 2020 [1]. In a connected hospital, caregivers use wireless medical equipment to provide the best quality of care to patients, rather than being preoccupied by time-consuming administrative tasks. It is no longer efficient or feasible for medical staff to manually transport files, to spend precious time inputting patient data into legacy systems, or make time consuming trips from department to department to find medical devices or information. The availability of devices and patient medical information is vital to ensure a hospital runs efficiently.

Powerful New Infrastructure
The connected hospital needs a robust infrastructure to function effectively as well as secure, wireless medical devices that are guaranteed to work every time. A disruption of even a tenth of a second can cause a failure in the transmission of a continuous stream of data.

This means developing:
 Infrastructure that can produce sound reporting to ensure servicing requirements are met and don't become unavailable or fail at a critical time
 A robust monitoring environment to ensure that critical antenna infrastructure is sending the correct information at the correct time to the correct place

New infrastructure developments, from robust wireless bridge communication systems to secure low-power Bluetooth modules, are allowing hospitals to deploy advanced networking technology to integrate medical information in a reliable, secure, and rapid fashion.

Drivers for the Connected Hospital
The gained efficiencies resulting from a connected hospital are simply too beneficial to shy away from. Patient safety, data accuracy, and mobility will all be fueled by wireless technology. In the connected hospital, every device is connected and communicating with the EHRs for accurate patient records and real-time data analysis.
With increasing staff shortages hampering hospital efficiency, the integration of wireless medical devices can level the playing field for hospital staff. By reducing administrative time significantly and facilitating accurate record-keeping, wireless medical technology allows caregivers to spend more time with their patients. Doctors and nurses can easily access up-to-date patient information, enabling treatment decisions supported by real-time medical information and resulting in improved outcomes for the patient. No longer will simple tasks like getting the correct dosage of a drug be an issue. Both patients and family member can feel safe knowing that because of the abundance of accurate, real-time data, the very best care will always be received.

According to the United Nations, the human world population is expected to increase to 8 billion people by 2024. There is also an increasing aging population as mortality rates and fertility rates decrease. The global share of older people (aged 60 years or over) increased from 9.2 percent in 1990 to 11.7 percent in 2013 and will continue to grow as a proportion of the world population, reaching 21.1 percent by 2050 [2].

With this aging population comes an increased demand for quality access to healthcare and remote patient monitoring. The current nurse-to-patient ratios are already very demanding and the population growth will only make that gap more exaggerated. Through wireless technology processes can be streamlined, allowing each nurse to efficiently monitor and take care of a greater number of patients with better access to quality data.
http://www.worldometers.info/world-population/

Each patient within a hospital has on average 3-6 monitoring devices attached to them while at a hospital. Assuming it takes a nurse approximately 5-15 minutes to visit each patient and check all vital signs, he or she can only visit approximately 4-12 patients per hour. Medical device connectivity solves this problem by automatically sending data from devices to the EHR, saving nursing time, increasing productivity and ultimately allowing for better patient care. Hospitals that have deployed the Computerized Physician Order Entry (CPOE) system have facilitated analytical capabilities for strategic decisions within a hospital and have demonstrated a 20% decrease in hospital-wide mortality rates by simply reducing prescribing errors and streamlining a basic, time consuming and error-prone tasks [3].

Workflow automation ensures:
 Minimal transcription errors at point of care
 Remote configuration of patient dosage
 Reliable real-time data analysis
 Improved patient outcomes
 Automatic billing

Getting Connected. Staying Connected
For a hospital to function smoothly while delivering the highest quality patient care, its medical devices must operate reliably at all times. The same is applicable for the wireless network and means connecting anywhere, anytime. Medical devices must also ensure the highest level of security for their patients' safety and privacy. There is no cookie cutter approach to getting this right and with a clear lack of standardization of interoperability in the medical environment, each hospital will have its own unique considerations and challenges.

The Challenge
Hospitals are notoriously complex and difficult RF environments. Large, multi-floor campuses and obstructions such as human bodies, medical equipment, lead lined walls, and liquids make for a potential connectivity nightmare. Throw in roaming concerns for both patients and medical devices and it is clear that a robust solution is required.

Hospitals deal with huge amounts of critical information and the thousands of medical devices that help to operate in the hospital generate much of that data. However, as it stands, only a small amount of these medical devices have wireless capability making the free operation of these devices challenging.

Along with medical devices, a hospital also has to deal with interference from the increasing number of wireless devices being used by both hospital staff and guests. There has been an exponential rise in the Bring Your Own Device (BYOD) trend within the healthcare profession, bringing with it a greater demand for data and forcing hospital administrators to bolster their wireless networks.

Lack of Standards for Interoperability
In order to ensure interoperability, it requires a collaborative effort between medical device manufacturers, wireless module manufacturers, infrastructure providers, and IT personnel. These organizations and personnel can lead the industry in generating guidelines and interoperability standards for wireless technology in hospitals. The benefit to the patient is clear; having data processed in this way means it can get into the right hands in a fraction of the time, doctors that are empowered with real-time, accurate, and up-to-date patient information can make better decisions which lead to better treatment outcomes.

Security
A hospital requires the highest level of security for their patient's safety and privacy and this especially applies to wireless medical devices. Security is a chief concern in order to ensure patient safety and privacy as well as that of the staff and visitors. However, there is a more critical reason that this.

Medical devices place stringent requirements on Wi-Fi connections because many medical devices require a persistent network connection. A disruption of even a tenth of a second can cause a failure in the transmission of data, which could create a life-critical situation. OEMs need to develop each medical device to require protection by WPA2-Enterprise security to ensure safe transfer of patient data with an AES encryption. It is the OEM's responsibility to ensure that the critical technology they are providing is up to the job and works the first time, every time.

Medical devices must be protected by WPA2-Enterprise Security and FIPS 140-2. To satisfy the requirements of HIPAA, a hospital Wi-Fi system needs:
 Strong, mutual authentication between every authorized client device and a trusted hospital network to ensure that:
– Only trusted Wi-Fi clients can gain network access
– Trusted Wi-Fi clients are not tricked into connecting to an untrusted network
 Strong encryption of all data, especially protected health information, that transmits between a Wi-Fi client and the hospital network

Fortunately, the Enterprise version of Wi-Fi Protected Access 2®, or WPA2®, provides authentication and encryption that are sufficient for HIPAA compliance. WPA2-Enterprise addresses the main security threats against Wi-Fi networks, namely network exposure, data exposure, and man-in-the-middle attacks.

Conclusion
Despite the clear benefits hospital administrators remain reluctant to adopt wireless medical devices due to security and patient safety concerns. However, the opportunities for growth increasingly outweigh the challenges when it comes to deploying the connected hospital. To fully realize the benefits of a connected hospital, the overriding issues of technological deployment, standardization, and trust must be overcome. Hospital administrators recognize the vision of the connected hospital, believe in its capability, but don't yet fully trust the technology and devices. Undeniably, the technology to realize a connected hospital exists today, but hospitals and medical device manufacturers themselves are challenged by its smart enablement.

The connected hospital goes beyond that of the hospital administrators and has been recognized by government as a vital upgrade to critical infrastructure. Today there are a multitude of incentives, documentation, and assistance for hospital IT to make informed decisions by joining an entire ecosystem of medical device manufacturers, wireless module manufacturers, and infrastructure providers. By working with a partner that can not only provide solutions but also advise on the realization of the connected hospital vision, the industry's various stakeholders can grasp the opportunity.

Resources
[1] Markets and Markets. Wireless Health Market by Technology, Component, Application, & by End Users – Analysis. Available at: http://www.marketsandmarkets.com/Market-Reports/wireless-healthcare-market-551.html. Accessed Jun. 16, 2016.
[2] United Nations. World Population Aging: 2013. Available at: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. Accessed Jun. 19, 2016.
[3] US National Library of Medicine National Institutes of Health. Decrease in Hospital-wide Mortality Rate After Implementation of a Commercially Sold Computerized Physician Order Entry System. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20439590. Accessed Jun. 21, 2016.

About the Author
Jay White is the Product Manager for Connectivity Solutions for Laird's Embedded Wireless Business Unit. Laird is a global leader in wireless technologies, embedded, pre-certified wireless modules and design services that are making the next generation of connected smart products possible, and its Embedded Wireless Business Unit provides a full range of modules and other solutions that simplify the process of using wireless technology. In his role as Product Manager, Jay oversees development of Laird's Wi-Fi and d BLE product line. Jay has more than 13 years of experience in the IT industry, the last 5 of which he has spent focusing on Wi-Fi. He is also an active member of the AAMI Wireless Strategic Task Force, the Wi-Fi Alliance Healthcare Marketing Task Group, and HIMSS.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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