Pushing cows (computers on wheels) and communicating via badges attached to their scrubs, the healthcare workers in the emergency ward of The Children's Hospital at Westmead are free to roam, immediately track each other's whereabouts, and improve patient care.
With the hospital admitting 46,000 patients per year, clinicians needed to cut the amount of time spent walking through the wards to consult each other. To help alleviate some of the logistical challenges, and get immediate access to information and communication, they opted for a sprinkling of IP wireless networking technology from Cisco and voice controlled badges from Vocera Communications.
Nurses had to literally look behind curtains and doors to find the co-ordinators, the hospital's director of information services, Dr. Ralph Hanson, said.
The implementation was the result of a two-year pilot project integrating wireless networking technologies in a bid to streamline manual processes and workflow and improve patient care. The initial trial involved about 80 clinicians including surgeons, visiting medical practitioners and nurses.
Hanson said it needed systems that facilitated mobility and delivered ubiquitous access to information.
"We weren't interested in putting in IT for IT's sake, but to make life easier for the busy doctors and nurses," he said. "We know IT brings benefits to healthcare. But we can't put systems in that lock doctors down to desks."
The goal was to implement a secure network that allowed connectivity between clinicians, thereby boosting productivity and quality of service. "It's not about the cows or the voice communication, but about the connectivity," Hanson said. "It's about freeing up the worker's time to focus more on patient care."
The hospital was originally opposed to implementing wireless, but security improvements and productivity benefits helped the health service to change its mind, he said.
And the latest technology rollout is just the beginning. Hanson said Westmead was looking to expand wireless functionality beyond emergency and surgery departments and out to the rest of the hospital. He also wants to bring on-board radio frequency identification (RFID) to track staff, patients and equipment.
"We are grappling with patient logistics, which is a major issue. RFID would help us track patients - for example when they're in X-ray and back," he said.
Hanson also expects to have the systems operate on mobile devices. "We are already reaping the benefits from the technology, but this is a journey, and it doesn't stop there: the systems have to work on mobile devices (like PDAs)," he said.
Research firm, NFT Group, did an observational assessment on the effectiveness of the implementation at Westmead. Director, Joan Nelson, followed eight clinicians on their rounds during a typical day.
"I conducted in-depth interviews, and identified process bottlenecks that might be alleviated with a wireless network," she said.
Nelson estimates the hospital will save about $450,000 a year based on staff time saving. "Nurses saved, on average, 25 minutes each day using the Vocera voice system," she said. "There was an improvement in patient care and the ability to give patients an instant answer.
"There's been a big process improvement using the wireless devices. Before the trial, nurses spent a bit of time and effort on determining bed availability, and locating people."
Healing pain points
Resellers selling wireless into healthcare need to have an understanding of the unique challenges within a medical environment, D-Link marketing manager, Maurice Famularo, said.
Angst over security, coverage (interference) and reliability are top concerns.
"Make sure the patient info is secured," he said. "Hospitals are notorious for having lots of interference: X-ray machines, MRI scanners, cat-scans. There's lots of machinery and multiple floors. So partners need to help identify the sources of interference and where coverage might be a problem. Do a thorough site survey and proposal, and use a spectrum analyser. Partners need to understand the environment."
To successfully implement a wireless network, resellers need to develop a comprehensive design, develop user acceptance, articulate the return on investment, ensure reliability, make it easy to use and come up with a training module.
While it's hard to sell wireless to public hospitals, private institutions are more open to the concept and it's easier to get a foot in the door, Famularo said. He suggested partners look to hook up the general hospital wards, the main administration desk or nurses' stations.
Wireless is also picking up steam in select vertical markets including hospitality, education and in the motor industry, as well as in general business environments. D-Link recently signed a deal with Ford which sees wireless implemented across its 400 dealerships nationally.
"The motor industry is using wireless networks for its service departments. Mechanics plug laptops into the car's computer system to do diagnostics and car servicing, downloading the info and sending info back to head office," Famularo said.
The health industry is also a main target market as demand for immediate access to patient records grew, Famularo said.
D-Link is seeing an increase of 70 per cent in its business-class wireless products with wireless switches leading the charge. Famularo said the latest wireless products are getting smarter.
"Both switch and access points can communicate with each other, making them easier to manage," he said.
Partners can help blend wireless into the wired environment. "Wireless can be adapted anywhere for customers who want mobility and flexibility within the network. Integrate wireless into the existing network and offer a wired/wireless combo," Famularo said.
But it was important to identify where wireless made sense. He pointed out the data throughput for wireless was not as high compared to a wired network.
"In health, if workers are transferring scanned images of X-rays or MRIs then data needs to be transferred fast," he said. They need the performance of a cable network.
In addition to the importance of adapting wireless within a wired network, resellers should also ensure future customer requirements are taken into consideration, Famularo said.
Looking ahead, he expects hospitals to adopt IP cameras. Used as a high-tech Web cam, it could travel around on the crash trolleys with the laptops, giving doctors and nurses access to instant data and the ability to get a specialist in another part of town involved in the process.
"It could view the patient, zoom in and out, and do remote diagnostics," he said.
Cerulean, a division of IBM Global Services, was responsible for the installation, upgrade and integration of the Cisco wireless network and Vocera communications system for Westmead. Although IBM is the exclusive reseller of Vocera locally, communications practice manager, Craig Campbell, said there was a real opportunity for partners to jump into the game and help health services adopt wireless.
In many hospital environments there was lots of work to be done in terms of upgrading the existing networking infrastructure. "At Westmead, the existing switch infrastructure needed to be upgraded to make sure it would all work okay," Campbell said.
Cisco Asia-Pacific public sector director, Martin Stuart-Weekes, said there was a growing amount of research and development in the area of "connected health". This was gaining popularity with partners as they looked to help healthcare institutions connect, communicate and collaborate, he said.
"Connected health is only valuable if it affects deep process and organisational change," Weekes said. "Patient needs are at the centre in order to offer integrated rather than fragmented care. They need more time caring and less time chasing paper-based systems."
Resellers can help healthcare get connected clinicians and system efficiency. It involves a mix of services, applications and software. "At Westmead, we found an opportunity to put many of the ideas of connected health to the test in an Australian empirical study," he said.
Health is one of many hot spots for wireless this year, IDC telecommunications market analyst, Shing Quah, said. Local market uptake of overall WLAN equipment is booming. Numbers show the market reached $147 million in 2006, a 29 per cent increase year-on-year.
"The market is very healthy," she said. "Health is a big one, but so is government: both state and federal." IDC also found enterprise and SMB customers are changing their mindsets and demanding the delivery of one integrated wired/wireless network.
"In many office implementations customers are also considering voice over WLAN," Quah said.
And will commoditisation of WLAN gear, along with the advent of the 802.11n standard, make wireless connectivity a routine part of enterprise net infrastructure?
Quah doesn't think so, suggesting there's still plenty of reseller opportunity peddling WLAN gear into specific verticals that need a strong mobility and wireless play.
Meanwhile, the rollout of the new 802.11n wireless standard (currently in draft mode), which increases throughput, is being driven by the consumer products push.
At home care
Netgear corporate and education sales manager, Greg Basford, said it was just a matter of time before 802.11n became enterprise-friendly. At present, its target markets were consumers and SOHO users.
"802.11n will do to the g standard, what g did to b," Basford claimed. "The 802.11b standard has issues with roaming, coverage and security, which the 802.11g standard addressed. The 802.11n standard gives us greater bandwidth and coverage.
"It is ideal in a home environment as it lets users do multiple things simultaneously including VoIP, Internet browsing, and watching high-definition over a wireless connection.
"But there's much slower adoption of it in the SME space. Most business networks have built-in wireless support with laptops using b or g. There are some laptops with integrated n, but we're only just starting to see them now."
These include consumer models from Dell, Acer, Toshiba and Apple. Corporate notebooks were not up to speed with 802.11n just yet, Basford said.
"Generally, business doesn't like to put in third-party cards - it adds to support costs and is easily lost," he said.
"Business is sensitive to the risk of pre-standards products and business network managers are more risk adverse to draft standards. Caution will prevail and they will wait until the standards are bedded down."
He expects the IEEE ratification of 802.11n to come about in early 2008. The downside is the standard doesn't work as well in a multi-access point network, which is important for healthcare.
"Healthcare coverage encompasses whole floors and they need multi-point access points," Basford said. "But 802.11g offers roaming from place to place, which works well. Government is another good example where IT managers are not looking at 802.11n and sticking with 802.11g."
He said resellers should plug the overall wireless message to the business crowd given it remains a sizzling market for the technology.
"The need for business wireless, VoIP and security is driving the adoption of Power over Ethernet (PoE) technology at the edge of the network, so that's a major trend we're seeing in the networking arena," he said.
Another market driver for wireless is the fact it's no longer seen as insecure technology.
"Businesses now understand wireless has mature security. The 802.11x (identity management framework) in all wireless products gives customer peace of mind," Basford said.
Despite this, there are specialist security concerns, such as the integration with 802.11x, which often require a skilled reseller's helping hand.
"There's also monitoring, troubleshooting and reporting services," Basford said.
Education is another big wireless push for Netgear. The one-to-one notebook environment, where every kid in school has a laptop, was fuelling activity.
"The idea is to have a kid learn anywhere/anytime, in the playground and in the library. It's a major trend," Basford said.
Private schools are the big spenders at the moment, although public schools are slowly, but surely jumping on-board.
Cloaked in mesh
IDC's Quah said resellers should also consider looking for opportunities in the wireless mesh arena. She claimed state governments were taking a particular interest in the technology.
"It is a good option as it extends coverage. It's useful in city-wide coverage deployments or in rural areas, whereby users can link up wireless mesh nodes," Quah said.
Wireless mesh vendor, Tropos, is currently trawling for partners in NSW and Victoria. It already has good relationships with partners in Queensland and WA servicing the mining and resort arenas. Tropos A/NZ managing director, Anthony Wong, said wireless mesh made perfect sense in government, education, mining and a host of other environments.
He cited public safety as a hot vertical, with customers using city-wide wireless video surveillance systems anchored on a metro-scale, Wi-Fi mesh network.
A typical mesh network deployment would include Tropos 5110 MetroMesh routers - an outdoor-optimised and ruggedised node based on the 802.11 standard. The Tropos 5110 features intelligent Tropos Predictive Wireless Routing Protocol (PWRP), which provides pervasive coverage.
Tropos MetroMesh routers form a wireless mesh, dynamically routing traffic along the highest throughput path to a wired gateway. This negates the effects of radio frequency interference, wired backhaul failure and node failure. As the network expands, the PWRP can scale to thousands of nodes.
Public venues are another hot spot for wireless mesh, and one that partners should consider adding to their repertoire, Wong said. Tropos recently hooked up a wireless mesh network for the Western Australian Cricket Association (WACA). The cricket ground needed a wireless network in place for visiting media.
"The goal was to install a working network that provided wireless Internet access across the entire playing area, and the network could not interfere with radio or television broadcasts," he said.
In its reviews of a host of technologies, WACA found a lot involved substantial installation work as each node had to connect directly to the wired LAN. Up to 150 wireless access points were also needed to be deployed to ensure full coverage.
The Tropos wireless mesh solution, however, was able to overcome some of these challenges. Wong said only four MetroMesh routers were needed to cover the entire grounds, with just one connected to the wired LAN.
Regardless of whether they deployed wireless mesh or other wireless networking technologies, resellers should get into the game and go after select verticals, representatives agreed.
For the folks at Westmead, the greater mobility is already improving patient care and saving staff time. Thanks to wireless, Dr Hanson said staff can instantly connect with one another to access the resources they need.
Cisco extends LAN security to wireless
Cisco Systems recently brought a raft of security mechanisms for wired LANs out to the wireless part of enterprise networks.
The dominant LAN vendor has upgraded its software and launched a set of guidelines for integrating wired and wireless security, called the Cisco Secure Wireless Solution.
The new capabilities were available to any customer with current Cisco software, manager of mobility solutions, Chris Kozup, said. Customers could use the guidelines themselves to build a security architecture or enlist the help of Cisco's services organisation or partners.
Enterprises are already able to bring wireless devices into Cisco's security system, which is built around ensuring any client is authorised and free of threats before it can hook up to the network. But bringing the same set of tools into the wireless domain could make that process easier, Kozup said. For example, if an enterprise wanted to secure wireless clients using Cisco's Network Access Control (NAC) appliance, the end user connecting via wireless would have to manually log into the NAC. Now that process could be transparent to the user, he said.
In addition to the NAC, the architecture includes Cisco's ASA firewall, Cisco Security Agent (CSA), Cisco IPS (Intrusion Prevention System) software, Cisco Secure ACS (Access Control Server) and Cisco Secure Services Client. These long-time features of its wired security were being extended to wireless LANs as the vendor's latest step toward unifying wired and wireless into one network, Kozup said.
The system makes the wired and wireless networks work together to bolster security. For example, if a notebook PC is connected to the LAN via a wired port, its wireless radio will be turned off automatically to prevent an attacker from using the wireless connection as a path on to the wired LAN. A Cisco wireless LAN controller can also disconnect a wireless LAN client that poses a threat.
The security built into all Wi-Fi products has improved in recent years and many vendors sell tools to secure wireless LANs, such as Aruba Wireless Networks' technology that uses encrypted tunnels.
Cisco's new approach might not be significantly more secure than those options, but it could simplify life for IT administrators, Farpoint Group analyst, Craig Mathias, said.
However, other approaches that are less expensive and more scalable can work just as well, according to Burton Group analyst, Dave Passmore.
"This is Cisco assuming the network perimeter needs to be protected right at the every edge, rather than a more centralised approach," he said.
Fact Box 40 Cisco 1200 Series wireless networking access points 40 Vocera Hands-free communication badges 10 Dell notebook computers, which operate on trolleys known as COWS 6 Dell PDAs