Case Study: Healthcare Facility WLAN Deployment

By Gerry Blackwell

December 12, 2001

Case Study:This analysis looks at the initial deployment and subsequent updates to a number WLANs in several healthcare facilities

Pioneers, they say, get arrows.

And in the case of WLAN early adopter CancerCare Manitoba (CCM), a government-run network of cancer clinics in the central Canadian province of Manitoba, there was some pain to be sure. But it was short-term pain for long-term gain, says director of information services Mark Kuchnicki.

And the experience evidently didn't dampen anyone's enthusiasm because Kuchniki and CCM continue to push out the WLAN frontier.

CCM's adventures with wireless LAN technology began over four years ago at a time when the organization was switching to computer-based charting - capturing and storing patient information in a computer database instead of the traditional clipboard-and-paper system.

It also moved to equipping staff with laptops, partly because real estate for setting up desktop stations was at a premium in its then cramped facilities. But using laptops also let nurses go where patients were in the clinic to gather information from them, saving time and making life easier for sometimes very ill patients.

Setting up a wireless network was simply a next logical step. It meant that nurses could now update central patient records in real time over the WLAN as they gathered the data.

CCM runs four cancer clinics in Winnipeg, Manitoba's capital, as well as 17 remote outpatient clinics across the province. It installed a first-generation 1-Mbps wireless LAN from Netwave Technologies Inc. in the main Winnipeg facility and eventually the remote clinics as well.

"We like using wireless in the [remote] clinics too," explains Kuchnicki. "The nurses can go from exam room to exam room and they don't have to worry about unplugging, plugging in again, rebooting. It was better for the patients and faster and more accurate for us."

The 1-Mbps network worked "reasonably well" for awhile, but as more staff began using the system, it started to slow down. "Nurses would be sitting beside a patient for five minutes waiting for screens to display," Kuchnicki says.

Part of the problem was the charting application CCM was running. Because of the way it configured server and client parts of the program, network traffic was unnecessarily heavy.

Besides the speed problems, it became difficult to get additional hardware for new network nodes. Netwave had been acquired by Bay Networks almost immediately after CCM installed the first networks.

So 24 months ago, CCM decided to upgrade to a standards-based 11-Mbps network. Kuchnicki was able to cost justify the 11-Mbps network on time savings alone.

"We figured the nurses would be saving 5 to 10 minutes per patient [over the old 1-Mbps system]," he explains. "Each one sees a dozen to 30 patients a day. So they saved an hour to an hour and a half every day. Plus, from our perspective [the new network] was easier to maintain."

CCM considered four vendors, including 3Com, the eventual winner, Lucent (now Avaya) and Cisco.

The selection methods were interesting. Kuchnicki's group tested all contenders on ease of set up since it planned to manage the implementation itself. They ordered starter kits for each and tried to set them up out of the box on newly re-imaged laptops.

The Lucent system, a front-runner, wouldn't work out of the box. It took two days for CCM to get the information from Lucent's technical support people that it needed to resolve the problem. The 3Com system was easiest to set up.

CCM also did methodical range and throughput testing. 3Com came out on top again, maintaining an 8-Mbps link up to 127 feet from an access point. The other systems barely made it over 100 feet.

3Com technology met the crucial prerequisite of allowing CCM to link access points together to provide roaming capability. Not that it was the only one offering this capability, but it was an important requirement because it means nurses and doctors don't have to reconnect as they move from one network cell to another.

CCM learned from the earlier implementation. It did a more careful and methodical analysis before deciding on placement of network access points. As a result it avoided coverage problems encountered the first time.

There were still glitches. They forgot power outlets for the access point servers and had to run power to each node after the fact. They could only work at night because of the risk of dust contaminating medical equipment, so outsourced installation costs - including for electrics - were doubled.

The roaming capability didn't work at first, though 3Com was able to solve that problem quickly. It required only a small software adjustment.

CCM initially installed 12 nodes in its central facility in Winnipeg, which is in the midst of a major, long-term re-build. With only 30 laptop users, contention and speed are not a problem at all for now. It has also installed 11-Mbps wireless networks in five of its other facilities, and hopes to have all of the rest upgraded within a year to two years.

Costs have come down since CCM started its implementation. At the time, with installation, it came to about $1,250 for one node and five wireless network cards.

As the renovation of CCM's main facility is completed and old and new sections set up for wireless, the network will expand. The user load will probably also increase.

Kuchnicki hopes to develop a new system that will allow doctors, who currently don't carry laptops, to get key bits of patient information on wirelessly connected devices - probably touch-screen tablet computers from NEC - while they're doing their rounds.

If Kuchnicki gets his way, they'll also be able to write up prescriptions online too. "I want to be able to do it [write prescriptions] so much faster with the [tablets] that when a patient walks out of the exam room, the script is already on the printer [in the office]," he says.

Kuchniki and CCM continue to push the envelope on WLAN technology. His own department is currently running voice over IP on the wired portion of the network for Help desk applications. It's now looking at extending IP voice to the wireless net. One possibility is setting up doctors and nurses to receive emergency calls on headset-equipped laptops and tablet PCs.

What's next? Video over wireless, of course.

The provincial government recently launched an ambitious telehealth program featuring satellite links for video conferencing. CCM doctors in Winnipeg are now piloting video conferencing for doing follow-up visits with patients in outlying centers. But they currently have to take time out of their busy rounds and go next door to a special video conferencing room.

Kuchniki has a plan to can solve that little inconvenience. If video conferencing pans out as a useful tool, CCM will create a wirelessly connected video conferencing terminal on a wheeled cart. If a doctor needs to do a conference with a remote patient, she can wheel it into an unused exam room, connect wirelessly using standards-based H.323 IP video and do the examination right in the main clinic.

"We'll be piloting [conventional] video conferencing for the next six to eight months, but we're hoping within a year to have that [wireless] capability in place," Kuchniki says. "We only need 300 to 500 Kbps to accommodate video. Then it's just a question of getting quality of service on the network to ensure the video gets there in good shape."

Will that cause some pain? In all probability. But Kuchniki is convinced it will be worth it.



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