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In safe
hands
In science
fiction movies we often come across doctors monitoring patients
using a video image on a cell phone or hand-held device. Such Wi-fi
phones in healthcare services were quite unthinkable even a few
years ago. Back then wireless networks were expensive, slow and
insecure.
On a wireless network, clinically sensitive
information is out in the air. For instance, a celebrity actress
gets pregnant and her test results are hacked and leaked to the
media even before she gets to know anything. In 2001, Adam
Stubblefield, a 20-year-old student from Rice University, cracked
the encryption protocol used in 802.11b wireless networks. The
weakness of the wireless encryption protocol discouraged many
hospitals from adopting wireless solutions. Palms and similar
wireless devices had small screens that made it hard to view data
and graphics. They typically had a black-and-white screen of display
specification160 pixels by 160 pixels. Most advanced digital phones
with Web browsing capability had nearly no memory and limited
processing power. The average bandwidth available was 9.6K bit/sec
to 14.4K bit/sec, with some carriers running 19.2K bit/sec. Sprint
Wireless came up with a special service for entrepreneures that
boosted the bandwidth up to 56K bit/sec. But it still didn’t serve
the purpose as a good-quality video requires about 300K bit/sec of
continuous bandwidth. Hand-held devices also used to run out of
power quickly, sometimes destroying all the information in the
process.
Today, things are different. Both devices and network
technologies have improved by leaps and bounds in the past year or
so. The Institute of Electrical and Electronics Engineers (IEEE),
New York, has approved a new 802.11i wireless standard on June 24,
2004. The most significant feature of the 802.11i standard is
Advanced Encryption Standard, a strong encryption standard
supporting 128-bit, 192-bit and 256-bit keys. Generally, a 128-bit
key is considered good enough and is used for online payment
transactions. To read a message secured by a 128-bit key, an
algorithm needs to compute 2 to the power 128 (2128) possibilities.
This may take over trillions of years, which is much greater time
than the age of the universe.
Mobile devices now have color
screens, more memory and faster processors. Such improvements
enabled a physician, at El Camino Hospital, Mountain View, Calif.,
to pull out the medical records of her next patient. Routinely, a
doctor gets out a Personal Digital Assistant (PDA) and downloads the
medical history of the patient. If there is some doubt or concern
about some entries, she talks to a badge on her coat, “Dial the
lab.” Soon she gets in touch with a medical technologist and
discusses her concerns.
In the neonatal intensive care unit at
Children’s Hospitals and Clinics, St. Paul, Minnesota, a nurse
quickly responds to an alarming situation while she is doing her low
priority job, such as doing order entry rounds on a wireless tablet
PC. As soon as her tracer badge flashes signaling some problem in
one of her patients’ monitors, she leaves her order entry job and
goes to check on the patient. Meanwhile, another alarm triggers:
Another baby needs attention, too.
In such a situation, the
hospital’s buddy system comes handy; that is, one more nurse gets
the same alert. If the buddy doesn’t respond within moments, the
tracer badges and handsets carried by every nurse on the ward
automatically go off. In the end, all the patients receive care
promptly. Baltimore’s St. Agnes Hospital began a pilot of the Vocera
Communications System, developed by a California-based company, in
mid-2003. The technology allows a staff member’s voice to be beamed
instantly anywhere in the hospital just by talking to a badge. Later
that year, First Consulting Group, Long Beach, California, did a
comparative study of nursing workflow in two units at St. Agnes
Hospital, one using the badge phone and one using traditional
telephony. The Group found that the technology saved users about 30
minutes per day—or about 3,400 hours annually per
department—previously wasted trying to locate people. Overhead nurse
paging also dropped by 94 per cent.
Emilia Bielli and colleagues
in Italy have developed a system called Wireless Health Outcomes
Monitoring Systems. It helps doctors to detect any significant
change in a patient’s wellbeing without actually having to see them
in person. The researchers have developed a 10-question text
questionnaire that was sent to the cell phones of 97 cancer patents
at the Istituto Nazionale Tumori, Italy. Forty-two percent patients
refused to participate in the study, mostly because they were not
comfortable with the use of cell phones. Patients, who willingly
participated in the study, sent in the completed questionnaire via
their mobile phones. Fifty-six patients completed the
questionnaires. Of the 560 expected answers, only 6 percent answers
were missing. The researchers believe that most patients can fill in
the questionnaire if they get help from their family members. The
study has been published in the June issue of the BMC Medical
Informatics and Decision Making Journal.
The Italian researchers
are now planning to provide a better user interface and wider
choice. They propose to offer WHOMS functions through palm
computers, speech recognition and interactive voice responder.
Nortel, Cisco and others have released desktop-IP phone combinations
allowing users to view data and videoconference simultaneously.
Advanced healthcare institutions are adopting these systems because
they enable doctors to have dialogue on an on-demand basis. A recent
report Going Mobile: Choosing the Right Inpatient Mobile Solution by
BCC consulting is a practical guide to selecting the right mobile
solution for healthcare institutions.
The report evaluates the
top 20 providers of inpatient mobile solutions and provides their
detailed profiles. Healthcare everywhere is a rapidly growing field
in the health sector, with more than 25 firms competing to provide
remote monitoring solutions.
Raj Kaushik
(A former project
coordinator with the National Council of Science Museums, India,Raj
Kaushik now works as senior server developer in
Toronto.)
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