The potential benefits of wireless technology applied to healthcare are fairly well understood, from wireless access to medical data and patient IDs with smartcard chips to equipment tracking and remote diagnosis. In many hospitals, these emerge as add-ons to existing infrastructure, but in cases where a new facility is being developed from scratch, it's an opportunity for healthcare managers to really harness the latest technology available and put it to work in fresh scenario.
Take Kiang Wu Hospital in Macau, the former Portuguese enclave and current special administrative region that is currently laboring to reinvent itself from a small gambling haven to an international city in its own right. In doing so, the city is bringing its institutions along for the ride, to include its healthcare sector. And the Macau government has decided that an international-class city needs international-class healthcare, says Dr Manson Fok, deputy director and chief of surgery at Kiang Wu Hospital.
"We have two major hospitals, and we look after at least half the population. But we definitely have to upgrade to provide a specialist hospital that will provide a high-end specialist service," he says.
To that end, Kiang Wu is constructing a new extension - the Dr. Henry Y. T. Fok Specialist Medical Center - that will comprise about 20 different specialist services. Wireless/IT technology features heavily in the blueprint, but, says Dr Fok, "because the center will handle a variety of specialty services, we need an integrated network to support all of them in a way that not only improves the efficiency of the hospital, but also improves the working conditions for staff, and especially patient safety and comfort."
In late April Kiang Wu unveiled the wireless/IT side of the project, along with technology partners Cisco Systems, systems integrator (and certified Cisco partner) Macroview Telecom and local incumbent telco CTM. The center itself won't be ready for business until October this year, and many of the applications listed in the press kit are wish-list apps that may not be live when the center's doors open. But the point - at least for the tech partners - is that the center will be equipped with an IP-based wireless framework that will allow the center to install whatever medical apps it likes.
By perhaps no coincidence, Cisco has just such a framework on offer, based on its product line of routers, wireless LAN gear and IP-based unified communications solutions.
"Kiang Wu hospital's vision maps very well with Cisco's medical-centric framework, and together with very good applications, design, integration and the infrastructure network everything goes together very well," says Barbara Chiu, general manager of Cisco Hong Kong and Macau. "And it is flexible, interactive and most importantly scalable, so after this specialist center is built, the network can be expanded to other premises."
Chiu adds that Cisco's medical framework isn't just a packaged collection of equipment and apps - it's also endorsed by the American Hospital Association (AHA) for use in hospital environments (particularly in regards to using wireless technology without interfering with medical equipment).
The backbone of the specialist center network includes Catalyst 6500 and 3750 series switches with power over Ethernet (PoE), Cisco 4400 WLAN controllers, Aironet 1130 access points, and Cisco's Unified Communications Manager Version 5.0 with 7900 series IP phones.
Macroview provides its applications platform to support new apps, and CTM provides the project management and service support via a dedicated team.
The network also features a centralized database to store all of the medical data that hospital staff need to access - such as patient data, PET scans and medication instructions. The database servers are clustered as a redundancy measure, says PH Tang, CTO at Macroview Telecom.
"One of the advantages of this sort of clustering technology is you can build two data centers that are geographically separated, but you still have a single cluster image," says Tang. "And with that in place, you can do things like data replication from one side to the other side, data synchronization."
Wireless flexibility
The wireless layer of the network comprises a centralized wireless LAN controller and 180 so-called thin-access 802.11a/b/g access points covering the 14 floors of the center. The APs are backhauled (and powered) by PoE, and are deployed under an RF plan that provides for signal overlapping. That not only allows for handoff of Wi-Fi devices as staff roam the hospital floors, but also provides redundancy in case an AP fails, Tang says.
The chief function of the wireless access is, of course, to untether staff from desks and nurse stations. Armed with Wi-Fi phones and other devices, staff will be able to make voice calls (including functions like push-to-talk) and access data and video over the wireless links.
The wireless system also supports tracking applications via Active RFID, says Tang.
"You have some very specialized equipment inside the hospital that gets moved around where it is needed, but after they are used, they get left behind in some location," he explains. "If you want to find that particular piece of equipment it is hard to track. But you can use this wireless LAN to track the equipment's location with Active RFID, which uses the 2.4-GHz frequency instead of the normal RFID frequency. So we can use the APs to triangulate and calculate the location of the RFID tag."
The same location-based capability can also be used for other apps, such as an electronic article surveillance (EAS) system that can track, for example, safety tags on newborn babies. "The basic idea of EAS would be if someone removed a baby out of the newborn room, for whatever reason, the tag would trigger an alarm and send a voice call or message to various locations," says Tang. "But with current systems, you would be alerted when a baby was removed, but you wouldn't be able to track its actual location. You're only alerted to the event. With Active RFID, you can also know where the baby is."
The EAS system can also be combined with other apps on the IP network, Tang adds.
"For example, in our proof-of-concept, we showed that we can control the CCTV system over the IP network, and we can automatically zoom in on the location where the alarm goes off, so you can keep video surveillance on that particular incident," he says. "When people follow up they can easily retrieve all the video clip information, as well as a list showing who triggered the alarm and when, and so on."
Initial applications
While such apps are possible, whether they're actually deployed in the specialist center upon opening day remains to be seen. Dr Fok says that while Kiang Wu intends to install the latest high-tech medical applications to achieve its goals of efficiency and better operations, the hospital is naturally limited by its budget. Dr Fok declined to name a figure as to the hospital's IT budget, or how much the initial Cisco platform will cost.
However, applications that are officially in the works include bar code point of care (BPOC), nurse call system, patient panel and telemedicine.
The BPOC makes use of bar codes on the patient's wristband, which can be scanned by a barcode scanner on a PDA linked to the wireless network. The PDA then retrieves patient data over the air so the nurse can determine, for example, what medication the patient has been prescribed and the proper dosage to administer.
The nurse call system performs the same function as standard standalone nurse call systems in place today - which is to say, the patient presses a button to page a nurse - but is integrated into the IP network. This enables nurses to be reached wherever they happen to be via wireless IP phones, rather than simply buzzing the nurses' station.
Patient panels at each bedside are also integrated into the system to perform similar functions as nurse call and BPOC as a redundant form of input and communication. They also serve to keep the patients themselves informed of the latest developments, says Dr Fok. "We can use the panels to transmit imaging and patients records, so that when the patient has a scan done, for example, they will get the results once they return to the ward. And for things like blood tests, they can get the results immediately once it's done."
That same sort of fast feedback, he adds, "will also allow nurses to spend more time with patients rather than chasing up records or lab results, and checking and double checking on these."
Dr Fok emphasizes the ability of a centralized, easily accessible data system to guard against staff errors, citing numerous instances in Hong Kong of patients accidentally being given the wrong dosage or the wrong medicine. He acknowledges that the apps are only as reliable as the people using them, so it's important to make sure staff are properly trained on the new apps. How easy a transition it will be for hospital staff to break old habits and use the new technology "depends how user friendly [Cisco and Macroview] make the system," he adds.