Healthcare services are evolving to embrace enabling capabilities provided by new technologies. Representative use cases includebut are not limited to real-time patient monitoring for peri-operative observation and post-operative monitoring, location-based services for tracking of assets, caregivers, patients, and visitors, building management services such as room environmental controls, security and surveillance, and advanced digital communications.
Paradoxically, healthcare facilities are not constructed in a way that is favorable to wireless services, and this is a largely an artifact of building construction materials. Inherently, such facilities need to withstand the rigors of untoward events, not to mention sufficient shielding in certain areas of the building to prevent interference from external sources as well as internally from equipment including MRIs and similarly, sources of ionizing radiation (i.e., CT systems). Additionally, healthcare systems will often employ a labyrinth type of design to create zones of isolation for patient and visitor safety (two examples being behavioral health and neo-natal care).
Ironically, the latter environment creates an unprecedented opportunity for entrepreneurial organizations to capitalize on the meteoric growth of Consumer Digital Health services for patients and visitors in combination with mobility-based platforms and services for use by physicians, caregivers, and staff. A case in point is the utility of smartphones, which has proven invaluable as a tool for nurses to manage patients much more effectively and efficiently relative to traditional “point-of-care” solutions. Similarly, patients (and to a lesser degree, visitors) are able to use their smartphones to perform self-check-in and self-rooming, access their education and entertainment systems, review their medical records, navigate the facility, and even better manage their recovery via application-based services.
To offer such capabilities, the healthcare facility must feature wireless services that are scalable, high-performing, robust, and highly reliable, while offering strong security and privacy protections. The latter is particularly acute as healthcare operations increasingly incorporate mobility-based solutions ranging from the afore-mentioned use of smartphones to digital kiosks and even digital signage. In this regard, a technology-oriented healthcare executive such as a CIO or CTO must consider one of three main areas of focus: 1). wireless services that enhance patient care, 2). wireless services that promote operational efficiencies, and 3). wireless services that support innovation. As we shall see, there are unique benefits and challenges associated with each, and sometimes certain healthcare services may span more than one of each of these categories.
Wireless services that enhance patient care is the most mature of the three areas given that in-patient wireless solutions have been available for well over a decade, allowing vendors to refine solution offerings. A prime example of the latter is wireless telemetry (used for patient vitals monitoring). Generally, such services employ either a proprietary wireless technology or use WiFi. In the past, these technologies have been able to scale both technically and economically. However, the challenge with both wireless approaches is that with the growth in application of Internet of Medical Things (IoMT), proprietary and WiFi technologies won’t be able to scale efficiently to meet demand. To illustrate, consider the ubiquitous use of per patient wireless monitoring. Emergent use cases may include biometric monitoring (i.e., body temperature, heart rate, oxygen saturation, breathing rate, and blood pressure). Additional monitoring may include the patient’s EKG, physical range of motion sensors for rehabilitation therapy, patient tracking monitors (i.e., step rates and gait performance), along with the possible use of specialized sensors such as “electronic tattoos” for blood glucometer measurements. Clearly, traditional, relatively power-intensive wireless communication pathways present multiple issues at scale: battery life including device maintenance and management, signal propagation, and signal interference.
Fortunately, biomedical engineering communities and the medical device industry recognize the inherent limitations of today’s approaches, and are promulgating personal area networks (sometimes referred to as body area networks) using more power-friendly and scalable Bluetooth technology standards. Some researchers are demonstrating self-powered biometric monitoring sensors using either a patient’s physical motion or heat differentials between their skin temperature and that of the ambient air. Hence, planning to support Bluetooth wireless will be an important consideration. It should be noted that the use of proprietary networks and WiFi will not subside. Instead, it will gradually be augmented with the former, particularly as Bluetooth network infrastructure costs continue to decrease and its availability becomes more prevalent.
In contrast to the above, wireless services that promote operational efficiencies will require a combination of existing WiFi services and a mix of cellular-based approaches, which may include 4G LTE, 5G, and nascent CBRS offerings. The reason for this is more pragmatic: such services generally address patient and care team mobility inside and outside of the healthcare facility. The need to solve the traditional boundary challenge of service across the proverbial “4 walls” of the healthcare facility is particularly acute. As such, reliance on a singular technology such as WiFi is not practical nor is reliance solely on in-building cellular service from cellular-type approaches. Healthcare facilities concerned with focusing on operational efficiencies and clinical excellence will prioritize spending that may not address solutions aimed at resolving poor cellular coverage. Accordingly, it is best to assess and plan to provide wireless services that are expected to meet forecast demand using a hybrid WiFi and cellular approach. Most probably, this will mean utilization of cellular services near the outer areas of the facility with gradual utilization of WiFi as the cellular service becomes insufficient to support high-performance demands. The deployment of Private LTE and similar such technologies (i.e., CBRS) is a very promising strategy to address the shortcoming of above, provided the economics can be justified, and there are many industry providers who are able to provide consultative services in this area.
Finally, wireless services that support innovation present the most challenges to the modern healthcare facility. Innovations in healthcare are far-ranging. Notable examples may include the use of virtual reality (VR) and augmented reality (AR) to support distraction therapy or pain management, artificial intelligence (AI) for streamlining revenue cycle management or for providing voice-enabled control and management of hospital services (i.e., food ordering), and location-based services for managing a patient’s length of stay, the patient experience, and caregiver workflow optimization. Wireless infrastructure to support such services will by necessity require a unified communications solution that is able to dynamically address user needs based on multiple factors including the user’s place and/or location, their role (i.e., patient or caregiver), their priority of service, the veracity of data communications, and service level requirements. Accordingly, a solution that is able to navigate and negotiate between different wireless services is needed. Traditional “pillar” or siloed based approaches of the past will not be scalable or relevant given alternatives that are becoming more commonplace via newly available mobile-based computing platforms, which are able to provide “rightsized,” efficient point of presence services. In this environment, true virtualization of the healthcare facility may be achieved by eliminating conventional barriers to healthcare. By combining near range (i.e., Bluetooth), medium range (i.e., WiFi), and long range (i.e., cellular services) using edge (close to the user) computing intelligence, sophisticated virtual health services may be provided that could include tactile capabilities in conjunction with video and remote sensing abilities. In the short term, this would mean greater fidelity of in-patient care using the advantages that each wireless service provides, thereby improving care coordination and patient safety through greater situational awareness of care. In the long term, this has the anticipatory benefit of evolving in-patient care to conceivably include care at home settings, potentially mitigating the costs of traditional in-patient care while simultaneously creating a better patient experience. While such solutions are still in early development, it is important to recognize the value of partnering with wireless industry leaders and with mobile health (mHealth) vendors to collaborate on delivering the promise of the latter.
In conclusion, the road ahead for wireless services to support in-patient care is changing. While traditional approaches have worked quite well, changing healthcare operations and shifting consumer demand and expectations are pressuring healthcare facilities to adapt to meet new paradigms of care, especially as it relates to unified, real-time care modalities. It is essential to understand the risks, benefits, and economics of different approaches to ensure that today’s healthcare facility is able to service the needs of tomorrow.