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Making wireless work for you.

Few new technologies offer such glowing promise--and head-scratching problems--as wireless communications. When installed and operated properly, wireless devices can transform a long-term care environment. Resident safety and, therefore, independence are enhanced. Staff can more flexibly provide attention when and where it is needed, and in real time. Patient-monitoring data and other clinical/MDS information can be transmitted to providers quickly, efficiently, and virtually error-free. Internet access can be opened up to the growing ranks of interested elderly. Building system controls can be operated more cost-efficiently. However, the inevitable headaches in achieving all this must be surmounted first. Principal among these are concerns about operating interference, facility "dead zones," and loss of healthcare data security via leakage through walls; the last point, in particular, is no small matter, with HIPAA security arrangements taking hold this April. Are these obstacles sufficient to discourage facilities from moving toward expanded wireless operations any time soon? Not according to Paul Norine, principal at the IP Design Group, a consulting firm that specializes in helping healthcare and other organizations adapt wireless systems and realize their promise. Recently, Norine shared his optimistic outlook in an interview with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

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Peck: To what extent is adaptation of wireless technology a consideration in long-term care facilities?

Norine: Although nursing homes don't have the extent of monitoring systems and equipment that hospitals do, they do have a growing number of wireless-based systems. The biggest challenge, and opportunity, posed by this is the growing emphasis on resident mobility and independence. The same goes for assisted living, where wireless access for resident monitoring, nurse call, and the Internet can work well in achieving the appropriate environment. One problem, however, is that, as the technology grows, there may be multiple frequencies to deal with and, with that, a growing potential for interference. Yet, when it comes to design of new or renovated facilities, communications systems are often treated as a follow-on, left to the owners to deal with on their own.

That's why we strongly recommend the development at the outset of a formal frequency plan, or RF master plan--a detailed layout of existing and anticipated wireless systems and how they will be used. All users--facility management, staff, clinicians, and others--should be brought into these discussions so that the results are practical for everyone. Communications should, in fact, be considered as the facility's "fourth utility," along with mechanical, electrical, and plumbing systems.

Peck: Where can administrators get guidance for developing such a plan? Would vendors be of help?

Norine: Possibly. However, there's always the chance that one system will be put forth as "the solution" and to avoid that, it would be helpful to turn to a consultant who is familiar with the technology and how it might relate to the long-term care environment.

Peck: What should management expect of this consultant and the frequency-planning process?

Norine: The result should be a master plan involving all communications systems, including wireless, hardwired and, if wireless, the specific frequencies anticipated and the security requirements. At some point there should be a walk-through of the facility to check for potential dead spots or "dark" spots, especially those that might interfere with telemetry or tracking systems. These dead spots can be caused by several factors, including finishes on walls and the steel used in construction, and it is critical that antennas, or access points, be placed appropriately to negate them.

Peck: What is an example of optimal location of access points?

Norine: An example would be a PDA-based or PC-based system for clinical record keeping and transmission. To keep the transmission speeds up, you would plan wireless access points located on-center at 65-foot intervals. Actually, though, there is a relatively new, and better, approach to designing access to all wireless systems. It is called a "leaky coaxial broadband cable system," or wireless utility.

This is essentially a "backbone" system providing connection of all wireless systems at a centralized location and also providing flexibility for continued growth of these systems with minimal difficulty. The system has a bandwidth ranging from 300 to 2,500 megahertz, accommodating virtually all frequencies, including those for enhanced cell phone coverage, two-way radios, and the like. It is more expensive than installing multiple stand-alone systems as wireless technologies are purchased, but some cost is offset in reduced labor costs from eliminating those installations. As I mentioned, this is relatively new technology, and the overall costs are anticipated to come down.

Peck: What about the security concerns of wireless?

Norine: That, too, should be taken into account in the frequency plan. The access points have to be strategically placed so that the signal levels drop off sharply at the facility walls. This is easier to accomplish, actually, with the leaky coax wireless utility I just described. Obviously, with information technology (IT) systems involved, you also need all the security measures relevant to IT, such as restricted access, firewalls, and so forth. Again, some consultant help would be useful here.

Also, both from the standpoint of security and avoiding interference, it is important for facility and IT managers to develop some rules and regulations regarding the use of wireless devices within the facility. It is essential to identify the frequencies to be used by the different systems, such as medical telemetry, wireless nurse call, cell phones, and so forth; incorporate them into the master plan; and enforce them. Enforcement is the most difficult aspect of this, but it is critical. As wireless systems continue to evolve and become operational, enforcement of the RF master plan will be the key to making life easier.

Peck: Is this wireless utility approach you've described feasible for all-size organizations, or is there a size cutoff point for cost-efficiency?

Norine: So much depends on the extent of wireless systems planned or whether, for example, a paperless environment is a particular goal. In general, facilities smaller than 30,000 square feet might not find a wireless utility to be cost-justifiable. On the other hand, it would be highly suitable for large facilities and for multifacility regional organizations with outlying rural operations for which telemedicine, for example, might be useful.

Internet access is another factor. As this increasingly becomes a selling point in assisted living and even some nursing facilities, a carefully planned wireless system will expedite providing Internet access to all interested residents.

Peck: Any final thoughts?

Norine: What's so interesting about wireless in long-term care is how well it plays to today's growing emphasis on resident-focused care and encouraging the maximum possible independence. Wireless systems can provide a practical and safe way to support that. Meanwhile, facilities are gaining more and more freedom and flexibility in how they conduct their operations. That's why it is so exciting to see what is happening in this field and what's coming next.

For more information, see the white paper "Harnessing the Power of Wireless Technology in Healthcare," by Paul Norine and James W. Hermann, Program Manager of Wireless Solutions at Johnson Controls, Inc., available at www.johnsoncontrols.com. For further information on IP Design Group, phone (402) 346-7007 or visit www.IPdesigngroup.com. To send your comments to the author and editors, e-mail 2peck0205@nursinghomesmagazine.com. To order reprints in quantities of 100 or more, call (866) 377-6454.

INTERVIEW WITH PAUL NORINE, PRINCIPAL, IP DESIGN GROUP
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Title Annotation:featurearticle
Author:Norine, Paul
Publication:Nursing Homes
Date:Feb 1, 2005
Words:1223
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