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Wireless Technology and Healthcare

By Obi Igbokwe
Can wireless techonology offer healthcare organizations another option of using technology to improve the delivery of healthcare?

Wireless technologies have been used to transmit medical information for almost 80 years. In the early 1920s the US Army Corps developed a “wired wireless” electronic stethoscope for potential use in ship-to-shore transmission of cardiac sounds. Today, many healthcare providers and administrators are considered mobile employees and often require mobile information access and messaging tools to improve communications, control accessibility and enhance decision making capabilities.

The driving force for IT during the 1970s, 1980s and 1990s was the advance in semiconductor design and manufacture with emphasis being placed on smaller sized and lower powered components as a means of increasing physical mobility and performance of systems and other electronic devices. This has led to a proliferation of such devices as laptops, personal digital assistants and wearable computers with an increase in the demand for wireless networks.

With affordable wireless communications technology and availability of inexpensive wireless-based laptops, portables and CD-ROM based problem resolution and diagnostic technology, the value of wireless technology is clearly seen in improving service productivity, efficiency and profitability.

Though healthcare organizations have been slow to embrace wireless technology, more and more organisations are finding that they can save money and improve care with this technology, and as it eliminates the need for wired connections, it increases mobility of the patients and healthcare professionals, invariably improving treatment outcomes.

At the Baylor College of Medicine, Houston, Texas, wireless technology has allowed the transmission of 12-lead electrocardiogram (ECG) waveforms from remote locations to handheld computers of cardiologists. There is no significant difference between in interpretation in the results using the handheld liquid crystals display (LCDs) screens and the traditional paper but the immediate accessibility of the results leads to a reduction in treatment time.

At Nottingham University, wireless cardiotocography via RF telemetry has been used to monitor the condition of the fetus during labor and has potentials for being adapted for other multi-patient monitoring applications. Wireless terminals have also been used to access medical data during ward rounds at the renal unit of the Glasgow Royal Infirmary.

Wireless technology has been motivated by the increasing importance of portable computing applications. At its very basic, wireless technology refers to the use of radio or infrared signals instead of physical connections to link two or more components - a wireless network. However mobile computing devices have been sometimes been lumbered as “wireless” as well.

Although they probably will not replace wired networks completely, wireless networks will be used to fill several niches in network applications. Wireless networks are principally classified into three broad categories:
• Wireless wide area networks (WWANs): These cover wide areas such as cities and allow mobile devices to connect on to the Internet. It also makes provides of wireless telephony services for voice communication and data transmission.
• Wireless local area networks (WLANs): These cover a smaller area, from a couple of meters to a city block or university campus. Functions like a wired LAN.
• Personal area networks areas (PANs): These allow for peripheral devices such as mobile devices, keyboards, mice and printers to be connected to printers without any wired connections.

Wireless LANs are often used in medical environments but with multimedia capabilities such as CD-ROM drives and MPEG decoders making their migration towards portable devices, wireless extensions to broad band networks would be needed to support user requirements. The basic idea is to provide a network that is both wired and wireless with an environment that has uniform protocols applications across both mobile and fixed devices.

In 1997, IEEE (Institute of Electrical and Electronics Engineers) adopted IEEE 802.11, a family of specification, as the standard for wireless LAN with the most popular version being IEEE 802.11b (commonly referred to as Wi-Fi). Using this standard, wireless LANs can be safely installed in hospitals as they hardly cause any malfunction of medical equipments.

Although WLANs do not transfer as much data, nor as quickly as wired LANs do, one of the advantages they offer is devices that communicate over the network can be used virtually used anywhere within the reach of the network without having to have hardwired terminal, and they are often easier to install as they no not require wires.

At the Jikei University Hospital in Minato-ku, Japan, a wireless reporting system was developed using a wireless LAN. The system consisting of a DICOM (Digital Imaging and Communications in Medicine)-based picture archiving and communication system (PACS), a diagnostic server, and portable laptops, is used by radiologists, physicians and technologists to review current radiology reports and images and instantly compare them with reports and images from previous examinations.

The systems provides the same functionality as a wired systems, but with less cabling infrastructure and has currently been incorporated into the emergency and radiology departments of the hospital with future plans for the operating rooms, outpatient departments, hospital wards, and intensive care units.

Meanwhile other wireless networks such as the wireless personal area networks (PAN) connect users with mobile and stationery devices usually within a range of ten meters are becoming increasingly more prevalent in the teleradiology and telemedicine industry.

Wireless PAN communications can occur over optical, magnetic, electric and electromagnetic channels. However the most promising one is the Bluetooth technology.

Bluetooth was developed using short-range radio network for personal networking. The original concept was to enable the universal wireless connections for laptops to cellular phones but it has become apparent that there are many other applications for Bluetooth.

Bluetooth supports voice and data transmission and is currently a global standard meaning that any two devices that are Bluetooth certified would be able to communicate with each other.

Bluetooth devices transmit and receive in 2.4GHz radio range and the technology allows up to eight devices to be connected in what is called a Piconet. This Piconets can also connect to form larger networks called Scatternets. More work is being done using Bluetooth applications for Ethernet access.

However Bluetooth has capabilities to provide a universal bridge to existing data networks, a peripheral interface, and a mechanism to form small private grouping of connected devices from fixed network infrastructure. Even though there is support for data and voice transmission, there are developers who would like to connect other services using this technology.

These limitations of Bluetooth have led to emphasis in low-level hardware connectivity. Thus using technologies such as Sun’s Jini or Microsoft’s Universal Plug and Play (UPnP) which allows hardware or software services to find and use each other in an already established network (regardless of operating system or processing platform) will definitely add more weight to the Bluetooth Technology.

Thus one can walk into an office with a mobile Bluetooth certified, Jini enabled device which checks the network and communicates with other Bluetooth certified devices within range and would be able to uses the services of other Jini enabled hardware or software.

At the Glenrose Rehabilitation Hospital, Edmonton, Canada, a Bluetooth wireless databases consisting of a Bluetooth-enabled laptop or PC and a Bluetooth-enabled PDA (personal digital assistant) was developed in aid the data mining of research studies and increase the efficiency of their scoliosis clinics.

Each patient has their details in the database which can be viewed and updated by physicians over a Bluetooth wireless connection. This has improved both the efficiency and accuracy of the records, as well as save time as there is no duplication of work and no dictation is required.

In Germany, vitals signs have been transmitted to a PDA for interpretation using Bluetooth wireless connectivity.

The benefits of wireless technology in healthcare could be far reaching if used in an appropriate manner. Doctors could store information in real-time, access patient records and medical reference materials from the Internet, send e-mails through handheld devices that are connected to a server. This would ease the burden of doctors and medical students alike as it impossible to store all the information one needs for patient care in one’s memory.

The practicality of having a hand held device, which can access and transfer information could prove to be life saving. In a study done by the Department of Informatics, Columbia University, New York, it was found that wireless computing led to better access to information and the key success element of the study was the recognition of critical priorities. Doctors would able to, through hand held devices, transmit prescriptions to pharmacies, check efficacy and side effects of the possible drugs regimes before making a choice, all at the patient’s bedside.

Wireless networks would allow doctors in a hospital, with their hand held devices, to stay in touch with each other at all times, arrange their schedules instantaneously and receive results of procedures and investigations not just at any time but also almost anywhere within the hospital’s vicinity.

This would lead to better and more efficient care. Doctors in remote areas can be equipped with a hand held device and be able to send details of their patients from their homes to a hospital’s database, receive the results of any investigations or procedures done and access the Internet for any medical reference no matter where he is and what time it is. This could be especially useful when applied in medical disaster response where communications is frequently inadequate and medical responders need access to adequate, effective and reliable communication.

The Bluetooth technology would get rid of computer cables, which are not only a health risk, as it is possible to trip over them but would allow for better spatial arrangement of connected hardware, freeing up more needed space in hospitals. Moreover it makes for a neater and tidier environment.

Bluetooth together with a Jini-aware device would allow a physician into a ward find the network enable printer and a PC running a contact database. The physician can, through this device, access consent forms and have them printed out in the nearby printer and without leaving the patient’s bedside or hook up his device through the use of cables to either the printer or the PC. He does not need to go his office to have this done or delegate someone else to do it.

Wireless technology does offer healthcare organization options on how to improve the delivery of health care. The European Union have financed a telemedicine project, MERMAID, with global reach and 24 hours, multilingual capability and takes all categories of telemedical applications with the full range of networks choices including wireless networks, that would make specialist care available to the remote patient.

A healthcare professional does not have to be in an office to have access to the services of a PC, the possibility of being available anytime, anywhere and from any device, greatly increases the mobility of a doctor.

Broadband networks such as WLANs would allow for faster, more stable and much easier connectivity to the Internet and other available networks. Being able to send and receive information when and where it is needed will not only improve the delivery, speed and efficiency of healthcare but it would also reduce costs, which is an important factor, especially in this era of finite resources.

Hopefully having global standards such as Bluetooth and IEEE 802.11 would encourage more healthcare organizations to embrace wireless technology.

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