Monday, August 1, 2011

Tips from a Road Warrior (14): Wireless Works

Most airlines are starting to offer wireless on their flights, which is convenient for checking emails, especially during long flights. The fees differ and can be steep, often more than $10. Before you think you can also make calls using Skype, they have found a way to block that. I am sure that the airlines want to offer cell service under a separate fee in the future (not looking forward to that!). 

On one of my recent flights, there was a promotion for free access so I tried it out. You can imagine what happened, as everyone in the plane wanted to take advantage of the offer, they quickly exceeded the capacity of the available bandwidth. Needless to say it was frustrating to find that getting a connection was only randomly successful, and there were very frequent drops of the connection. It worked, but intermittently, which was frustrating. 

When using wireless in a life-critical situation such as transmitting an image from a portable x-ray unit or ultrasound device in the ER, one better make sure the devices can connect flawlessly and remain connected reliably. The feedback I have gotten from several users, however, is that reliability of wireless applications is still spotty at best in many cases. There are several reasons for this. One is the physical design of the environment, which may not be very "wireless-friendly." There are often steel doors, physical firewalls, many cables, high voltage generators, and other electrical devices that all interact and interfere with the radiofrequency signals. Another problem is “dead spots” where the reception is very poor. It sometimes requires trial and error to place all of the wireless transmitters and receivers to make sure there is consistent reception throughout the facility. 

The third reason has to do with communication equipment interoperability issues. The wireless routers in place might not work well with the hardware wireless board used in specific devices. Again, it seems to be hard to predict this and often requires trial and error, which can be costly. I walked into a department not too long ago and the administrator told me how they went to wireless DR portables for all his ER and ICU portables, which was very successful in providing better turn-around times and service to the physicians. I pointed to a device in the hallway and asked whether it too was one of his units and he told me that particular brand worked very unreliably and was basically unusable in the new wireless environment, versus the four other ones from brand “B” which were very reliable with the new system. 

Another concern is obviously security and privacy. There is a well-known story of a vendor who intercepted all of the hospital orders while sitting in the cafeteria. You can imagine the uproar if images from a celebrity who was just admitted to the ER with a fractured bone were intercepted. Unfortunately, the use of encryption and VPN's over wireless networks adds another layer of technical complication and raises the potential for interoperability issues. Another wireless issue is emerging with the growing use of tablet computers such as the iPad and others. Similarly there are wireless connectivity issues with COWs (Computer on Wheels). Most nurses are wheeling these computer carts from room to room within their departments. The problem is all the sensors needed to measure vitals, that can also interfere with the computer connection to the wireless network. That problem, however, may be short-lived. I can already measure my heartbeat with my smart phone and there was recently a publication about a nanotechnology sensor that can be applied to the skin that allows a smart phone to directly measure glucose levels and other vital measures without having to draw blood. 

In conclusion, wireless is here to stay despite intermittent reliability, so there is much to worry about. I, for one, would never purchase any wireless device without thoroughly testing it and getting a money back guarantee if it does not meet certain reliability and throughput requirements. The technology can only be expected to become better, but one might also expect that its usage will increase exponentially, which will keep us busy for a while figuring out how to make it all work.