Harnessing the Power of Mobility for Healthcare: Why We Need a “Medical Grade Wireless Utility”

A huge opportunity exists to lower health care costs by accelerating the availability of wireless medical solutions. In order to achieve this, a ubiquitous and reliable wireless infrastructure is needed—a utility that will build a framework for offering the right care, at the right time, wherever a patient may be.

Health care has yet to harness the full power of the wireless revolution that has transformed other aspects of our lives, including the way we work and play. Yet wireless medical technology offers one of the greatest opportunities to materially lower health care costs and extend care to a patient regardless of physical or geographic location—“the right care, at the right time, wherever a person may be.” What will it take to get this obvious benefit from this ubiquitous technology?

With the proliferation of wireless devices—both medical and consumer—in health care settings, it is critical for hospital administrators and all of those engaged in the health care enterprise to feel confident that using wireless technologies within patient environments is safe and reliable. However, unlike the wired network, wireless connectivity comes with added levels of complexity—coverage, signal strength and capacity concerns, among others—and impressions about performance and robustness have doubtlessly been seeded with individual experiences surrounding quality of service issues in consumer wireless devices.

To address this complexity and the associated concerns, there is a pressing need to create a reference architecture where the numerous wireless standards and protocols can be deployed with a known level of assurance. Ultimately, what is required is a ubiquitous medical grade wireless utility for wireless health care delivery, specifically within hospitals and other medical facilities.

What Do We Mean by “Medical Grade Wireless Utility”?

First, let’s define the term medical grade wireless utility, keeping in mind four principles inherent in the term: coverage, signal strength, capacity and certainty.

Within this context medical grade means a known level of assurance to support mission- and life-critical wireless medical devices and applications. A wireless sensor or downloadable “app” to help a marathon runner track his or her daily calorie expenditure does not require a medical grade utility to ensure proper function. Conversely, a known level of assurance may be required for a wireless medical device that is being relied upon to send an alert about a life-threatening condition.

Wireless refers to telecommunications connectivity, typically via radio waves, and encompasses both licensed and unlicensed spectra for health care. The wireless network is considered an extension of the wired network, and when deployed fully and correctly, creates an end-to-end level of assurance via ubiquitous coverage, signal strength and capacity. Such capability allows for true mobility, which in our opinion has the potential to transform health care.

Finally, in our definition, utility is any basic, expected resource. Just as electricity, plumbing, and heated and cooled air are necessities within a hospital, wireless connectivity is increasingly “expected” and must be deployed as a base-building utility with the same level of engineering and control. The number of wireless devices inside a hospital is growing exponentially, and a medical grade wireless utility (MGWU) is required to ensure these devices work with a known level of assurance. So, how do we get there?

In response, the West Wireless Health Institute (WWHI) is working closely with ecosystem stakeholders to help create an MGWU that will be used as a platform for wireless health care delivery. Together, the vision is to establish the reference architecture for a reliable, utility-like resource that will address the four principles of assurance mentioned above: coverage, signal strength, capacity and certainty.

In its role as an independent, nonprofit medical research organization, WWHI is currently convening stakeholders including hospital CIOs, CTOs and CMOs, as well as wireless service, infrastructure, equipment, sensor and application providers. The initial focus will be to develop the reference architecture (the basic building blocks) for open and carrier-neutral infrastructure, as well as to create processes that will facilitate end-to-end interoperability and quality of service.

In conjunction with these activities, WWHI will also proactively engage with regulatory organizations to define and stratify levels of assurance needed for wireless health applications that are considered to be medical grade. These activities will fully contemplate and embrace existing standards created by bodies such as Continua Health Alliance, IEEE, WiFi Alliance and others working diligently in this space.

Developing a Reference Architecture for the MGWU

There are a number of “success factors” or best practices inherent in developing a reference architecture for the MGWU. First, it must closely align with other base-building utilities. It should not only incorporate current requirements, but also anticipate future requirements. It must be designed with the discipline needed to ensure such requirements are met. It must also include processes for proper installation, verification and validation. Lastly, policies should be established to ensure devices and applications work together without interference.

Now consider the distinct “pillars” of the reference architecture (Figure 1). The first pillar is the Wireless Wide Area Network (WWAN). The WWAN will address most wireless services that are intended to work outside the premise—if it works outside, it should work inside. This includes, but is not limited to, PCS & Cellular, First Responder, Paging and Two-Way Radio services. The MGWU reference architecture will ensure that each wireless service works inside the hospital to the performance standards agreed to between the service provider and the hospital user.

The second pillar is the Wireless Local Area Network (WLAN), which includes the traditional 802.11 Wi-Fi network, Personal Area Networks and Body Area Networks. This pillar will proactively address the increasing use of the unlicensed spectrum for wireless health applications. Since this spectrum is available to all, there are quality problems that can occur related to capacity or interference. The MGWU reference architecture will specifically address how each of the WLAN-based networks should be used to ensure interoperability standards are being met, with a known level of assurance.

The third pillar could be referred to as the Wireless Clinical Data Network. This is a new term meant to represent those wireless networks that are specifically designed to be a protected clinical data network. Today, this includes the protected spectra allocated to Wireless Medical Telemetry System (WMTS). In the future, the MGWU may include additional spectrum that will be used inside the premise for mission- and life-critical clinical applications. Creating “protected” clinical networks will be an ongoing priority for the reference architecture.

The fourth and final pillar is the Location Local Area Network (LLAN). This is also a new term that refers to the desire to use wireless to locate assets and people inside the hospital. Location is a critical part of the MGWU reference architecture. The LLAN will be a portfolio of technology and solutions to address the numerous location requirements. When deployed, the LLAN will be capable of producing location information, which will be made available without prejudice to those applications that need the data (Figure 2).

When the four pillars of the reference architecture are in place, true convergence can be achieved. This includes the convergence of the WWAN and the WLAN to ensure that voice, data and video applications work together on the most efficient wireless networks. When combined with the WCDN, devices and sensors can be developed to allow the patient to be continuously monitored inside and outside the hospital with a known level of assurance. Lastly, at such time as location data can be delivered when and where needed, the effectiveness of the wireless applications will dramatically increase.

So, How Will This Task Be Achieved?

As mentioned above, West Wireless Health Institute is convening a variety of ecosystem stakeholders to undertake this task. To start, WWHI is bringing together health care leaders such as CIOs who represent the “customer” and have extensive experience in establishing wireless connectivity within their facilities. This group will work with WWHI to create a reference architecture suitable for both new and existing venues. This reference architecture will be owned and self-governed by these healthcare champions over time.

The next step is to proactively engage regulatory agencies and relevant standards bodies for mutual guidance, as we work to define the various levels of assurance needed for wireless health applications that are considered to be medical grade. Think of this stage as “rational risk stratification.”

Once there is consensus from these groups, Wireless Service Providers (WSPs) will be engaged to ensure that the MGWU reference architecture meets the technical and economic requirements for both licensed and unlicensed providers. WSPs are critical to the future of wireless health because of their ability to create a ubiquitous platform both inside and outside the premise of health care facilities.

The overall quality of the MGWU will be heavily influenced by Wireless Equipment Providers (WEPs), and stakeholders will work closely with WEPs to ensure the desired outcomes can be achieved and maintained over time. As noted above, it will be vital to develop a reference architecture that meets requirements today and into the future.

Concurrently, wireless medical device manufacturers will be engaged, to ensure their devices operate according to the requirements and standards set forth by the reference architecture. Methods to both validate and verify performance under that architecture must be established.

The Mandate before Us

Although it is hard for most of us to imagine, consider what the United States was like before there was a national highway system or an electrical grid. Once these systems took root, inventors and entrepreneurs unleashed a wave of innovation—from automobile manufacturing to refrigeration and a host of conveniences we take for granted today. Innovation soared, as did our nation’s productivity.

Similarly, in the last decade, our wireless communications networks have made it possible for us to live and conduct business in whole new ways. Mass adoption of cell phones and smart phones is leading to another wave of extraordinary innovation—which is just beginning to take shape for health care.

The ability to provide “the right care, at the right time, wherever a patient lives” is within reach. Wireless sensors are being integrated into medical devices, with the capability to remotely measure and monitor a host of physiological parameters—including heart rate, blood pressure, respiratory rate, weight, temperature, oxygen saturation, activity, sleep quality, blood electrolytes, fetal heart rate, uterine contractions, and a wide and growing array of biomarkers.

But how is all of this data going to travel and flow with a known level of assurance, particularly within hospital and health care settings where some use-cases may not tolerate interruption?

Making wireless connectivity a medical grade utility in those venues is a critical step in removing barriers that are inhibiting the development and adoption of wireless medical devices—and to making their deployment inexpensive and ubiquitous. Once in place like the electrical utility, wireless health will be a profound and low-cost solution for delivering care within hospitals and health care settings.

West Wireless Health Institute
San Diego, CA.
[www.westwirelesshealth.org].