Speeding Up Tennessee Medicine

By Gerry Blackwell

September 02, 2003

A major urban hospital is making the move to dual-band Wi-Fi in an effort to upgrade standard applications as well as take advantage of new imaging applications.

When a patient comes into any one of the four Baptist Health System of East Tennessee hospitals in Knoxville, Tenn., doctors, nurses, pharmacists and clerks can instantly get access to everything about that patient -- records of past visits, allergies, x-rays, MRI scans, medication, clinical notes.

Even better, they can get the information wherever they are in the hospital -- wirelessly.

Baptist is one of the first hospitals in the country to provide comprehensive wireless coverage with both 802.11b for text and business-related applications and 802.11a for mainly clinical applications, especially medical imaging which requires the higher speeds of 11a (54Mbps vs. 11Mbps).

The hospital has deployed over 350 access points of various flavors to support a similar but growing number of terminal devices.

Wireless networking in hospitals is no longer news, of course. In the last couple of years health care facilities across the continent have begun to get the message about the benefits in time savings and efficiency from giving clinical staff wireless access to patient records wherever they wander.

Those time savings sometimes translate into life savings, and almost always into better patient care -- quicker response to patient calls, faster response on calls to physicians, and quicker turn-around on medical imaging and imaging-based diagnoses.

It also means clinicians work from more accurate, up to date and comprehensive information, and the system provides a complete clinical audit trail on each patient.

Baptist Hospital was a wireless pioneer. It started back in 1996, the WLAN dark ages, installing pre-standard 2.4GHz gear from Proxim. This was Proxim's frequency-hopping 1.6 Kbps OpenAir network system. It's still doing yeoman service in some areas of the main downtown facility, though all will be systematically upgraded over the next several months.

Before that, data networking at Baptist was virtually non-existent.

"The first application was clinical documentation," explains senior systems specialist Rick Simpson. It's still one of the most important.

"Now it's a complete electronic record -- it includes everything the patient has seen, signed, touched or been touched by," Simpson says. "All of that is now readily available to physicians and nurses everywhere in the clinical areas of the hospitals."

Baptist Hospital came to wireless originally almost by a process of elimination. Going wireless meant the hospital could avoid breaking into the cinder block walls to install Category-5 Ethernet cabling -- a traditional cost justification for wireless. That was certainly one factor.

Baptist could not cost justify putting a computer in every patient room. That meant the PCs used by nursing staff would have to be mobile. Mobile computers that had to be connected to an Ethernet wall jack each time they were moved was not practical. The only solution: wireless.

There were clearly additional benefits to going mobile -- nurses can be located and signaled more easily over the wireless network. Ditto for physicians.

Terminal devices used on the network have evolved over the years. Initially they were notebooks on trolleys that had to be plugged in to electrical sockets. Nurses used early tablet PCs for a time before moving back to notebooks. The notebooks are now fitted with additional batteries that last a whole shift before being replaced with freshly charged batteries.

In recent months, more and more physicians have started using PDAs, allowing doctors to take notes electronically while on rounds and save them to network storage.

The decision to upgrade from the early Proxim gear and go with dual-mode 802.11a/b infrastructure started with the decision to build two new facilities in the west end of the city. Baptist Hospital West and Baptist Hospital for Women opened July 2003, joining the main downtown campus and a fourth facility in suburban Cocke County.

That the new facilities would be equipped with wireless networks was never in question. The benefits of mobility had long since been proven at Baptist. The only questions were which technology and which vendor?

One concern was that with the widespread adoption of Picture Archiving and Communications System (PACS) technology for electronically storing and transmitting medical imaging data, 802.11b would be a bottle neck when physicians needed to download images quickly. Medical imaging files can be up to 20 MB, not huge by the standards of some applications, but certainly big enough to benefit from a higher-speed network. Faster 54-Mbps 802.11a technology was one answer, but it would be overkill for most other applications.

Dual-mode 802.11a/b technology -- available from most corporate WLAN equipment vendors -- offered an ideal compromise. The architecture of the Proxim gear Baptist ended up buying also left open the option of upgrading to all 11a or 11a/g in the future.

The 11a infrastructure could be used for clinical applications where speed was of the essence. The 11b infrastructure would be perfectly adequate for clerical and e-commerce applications -- such as food trolleys from the cafeteria selling snacks in patient rooms and needing to swipe a credit card for payment.

Although Baptist had a long history with Proxim, it did look at other vendors, including Cisco, 3Com and others. "We stuck with Proxim because of the reliability we'd always enjoyed [with their equipment]," Simpson says. "But you have to test other vendors to see which [equipment] works best in your facility."

Security, never a concern with the proprietary OpenAir protocol of the pre-standard Proxim gear, became a significant issue with the move to Wi-Fi. "Security was one of our biggest concerns to be quite honest," Simpson says.

The hospital implemented WEP (Wired Equivalent Protocol) Plus security features on the Proxim ORiNOCO equipment. WEP Plus, which works only on ORiNOCO-to-ORiNOCO transactions -- the majority in this network -- rotates encryption keys to make them less vulnerable to brute force hacking attacks.

Baptist also uses MAC (Media Access Control) authentication, but opted not to tighten security any further.

"We thought about doing a whole bunch of stuff with RADIUS (Remote Authentication Dial-In User Service)," Simpson says. "The problem is if we had to ask clinical staff to log on five times a day, it would seriously reduce the productivity gains wireless gives us."

Once the decision was taken to go with 11a/b in the new facilities, it made sense to upgrade the infrastructure at the existing hospitals to match. Baptist physicians move from hospital to hospital through the day, Simpson points out. Expecting them to switch network devices in their PDAs or laptops as they moved about did not make sense.

Will other health care facilities follow in Baptist's footsteps and install dual-mode or single-mode high-speed Wi-Fi networks? We're betting they will.

Given the long-term cost savings of PACS and the efficiency and speed promised by filmless, hard copy-free medical imaging, even broader acceptance of the technology is inevitable. Baptist Health System of East Tennessee



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