Network connectivity is a critical piece of health IT infrastructure. As organizations continue to add connected medical devices and other IT tools to their digital environments, reliable networks are required to allow providers to interact with information more quickly, so they can spend more time interacting with patients.
Connected medical devices include more than just the smartphones and tablets clinicians use to access EHRs and administrative tools. Over the past several years, connected medical devices have grown to include Internet of Things (IoT) devices and an increasing array of health monitors.
All of these devices are constantly communicating with the network and cannot function properly without consistent and dynamic network connectivity.
Network connectivity is the process of connecting the different parts of the network through access points (APs), routers, and gateways.
Since this process supports devices that often offer critical services to patients and providers, slow or unreliable connectivity is unacceptable. Yet the number of failed or slow connections in healthcare environments is much higher than it should be.
Around 45 percent of connections initially fail, which causes an average of two additional seconds of wait time to load an application.
While two seconds may not seem like a significant delay, any amount of time wasted can result in a user abandoning the application.
While perfect connectivity may be an unrealistic goal, understanding what will disrupt a network signal and how to identify these challenges can help provider organizations develop networks that function at the highest possible standard.
Why is network connectivity so important?
Clinicians and patients rely on connected devices to give and receive care. This dependency on information makes the network one of the most important pieces of health IT infrastructure.
“Information is liquid gold,” said Shafiq Rab, Rush University Medical Center Senior Vice President and CIO, to HITInfrastructure.com. “Getting the right information at the right time for the right person in the right format, securely, everytime is very important.”
“In the world of healthcare, the choices we need to make can be critical life and death decisions.”
Patients rely on the network while they are in the hospital for more than just their monitoring devices. They also use connected tools to learn how to navigate their stay, such as learning when the cafeteria is open, or even to check their email to keep in touch with home.
“A reliable network needs to work 100 percent of the time. Not 99.99 percent of the time - all the time,” Rab continued. “In the world of healthcare, information has become part of the standard of care.”
Whether through WiFi or hardwired connections, all of this critical information is delivered in packets that travel over the network. Wireless is becoming ubiquitous and cellular devices are improving rapidly. If organizations want information immediately without any latency, a reliable network is required.
Connection failures can threaten patient safety
Medical error is the third-leading cause of death in the United States, behind heart disease and cancer, according to research conducted by Johns Hopkins Medicine. While this statistic is not limited to errors in technology, errors with digital tools and connectivity are factored in.
Healthcare providers are constantly adding more connected devices their network. Every new device increases the probability that there will be a communication error.
Organizations are responsible for working with their IT department to make sure digital tools are always available and that the entire team is working towards eliminating errors to protect patients from malfunctioning equipment.
Performance and response time are key components of a safe and effective network. In fact, clinicians even rate application performance and response time as more important than the actual features and functionality of their tools.
In addition, patients relying on their doctors and their digital tools can lose faith in their doctor’s ability to treat them if the doctors don’t have reliable access to the information they need.
Many patients don’t necessarily understand the impact of network connectivity on their providers’ job performance, and may blame the individual instead of their equipment for any shortcomings or delays.
Getting to the root of the problem
Networks can fall victim to a number of challenges, including physical barriers that disrupt wireless signals.
“The physical limitations of a hospital include so many different things,” explained Dean Shold, Medigram Vice President of Technology.
“Hospitals have to be built to support enormous amounts of weight. Everything within a hospital is load bearing. If you want to drill a hole through a wall, it requires approval. It can take years to retrofit a wireless network in a hospital.”
Physical signal obstacles are often not considered when provider locations and building materials are selected. Urban healthcare organizations that are looking to expand their medical campus will often purchase older buildings or buildings that were originally intended for a different purpose.
These buildings are not conducive to the signaling needs of medical devices and machinery such as MRI or radiation machines that also use radio frequency (RF).
“When you think about the decision tree of who designs the building, how it gets funded, and what its purpose is, who is going to have the vision and the technical literacy to foresee that they want to enable free connections as fast as possible?” asked Medigram CEO Sherri Douville. “Probably no one.”
Even the most advanced medical facilities can be plagued by their own buildings that block critical signals and include areas with weak or no cellular or Wi-Fi connectivity.
Wi-Fi uses a high frequency, and the higher the frequency, the smaller the electrical sine wave. Smaller electrical sine waves are less able to penetrate the different construction materials found in most facilities.
Older facilities made of concrete, or buildings that were not originally built with wireless access in mind, present especially difficult challenges for introducing wireless devices into the health IT infrastructure.
“In health systems, there’s frequently little interaction between the people that manage the network and infrastructure and the people that are planning for clinical applications,” said Douville.
Executives and IT staff that are brought in from other industries and working in a healthcare environment for the first time may not understand the industry’s unique and particular demands.
“There’s a gap there that needs to be closed and there’s only a few top health systems that have figured out how to marry those two disciplines in a way that’s productive,” she continued. “They don’t understand that their network and infrastructure is the magic key to mobile.”
Clinicians are often carrying the same smartphones and laptops that are used by other industries or available to consumers. The healthcare environment is much more dynamic and these devices need to be re-configured for the healthcare space.
“Just because a regular device helps consumers find the fastest connection doesn't mean it will work the same way with hospitals and the way the hospitals manage their network structure,” Douville said. “Executives need to understand the distinction between the consumer environment and the hospital environment.”
Businesses in traditional office parks can be up and running with a complete wireless network within days. Hospitals have a unique set of challenges making network installation and upgrading time consuming and difficult.
Vendors and developers need to treat hospital environments differently than other verticals. But this isn’t always the case, especially when organizations are still using legacy devices.
Organizations need to avoid general enterprise solutions and seek out vendors and products that are healthcare specific and have been proven successful in a healthcare environment.
Avoiding common network connectivity mistakes
Many organizations are aware of their network connectivity issues and are taking steps to correct them. However, some common network fixes that might be applicable in other industries won’t have the same results in healthcare settings.
“There are many things that interfere in the environment, but the environment is dynamic and most software was never designed with the environment in mind,” Douville explained. “The environment is always changing because new machines are always being added. The problem is interdisciplinary, and very few companies are even able recognize the problem.”
“Health systems that spend millions of dollars upgrading and modernizing their network will still dynamically change because they’re adding new things to the building and they’re bringing in new equipment,” she continued. “There’s no one-time view of the network.”
Without planning for the entirety of the problem, organizations may find themselves coming up short, agreed Rab.
“The network is the beginning that will allow you to build servers which will allow you to build applications which will allow you to do build usable solutions. You have to do a whole cycle.”
“You can build a beautiful six-lane, 500 mile highway, but you could end up only walking on it because you don’t have enough money to buy a car,” he said. “That’s a failure. The entire project and the outcome needs to be understood for the network to be successful.”
When organizations lack visibility and control over their network as they begin upgrading, it’s hard to tell where the problem really lies. This results in quick patches that may improve connectivity, but don’t fix it permanently.
“I've heard many times organizations trying to solve their problems by putting more access points everywhere,” said Shold.
“Unfortunately, your phone is always searching for the strongest signal. If you throw in too many access points, you actually have a greater chance of a problem with devices disassociating and re-associating with another access point.”
For organizations using voice over IP (VoIP) services, this may result in dropped calls, he added.
“More is not always better,” he stated. “Better is better.”
Configuring mobile and wired devices can also pose a challenge, especially if each type of device serves a different function within the clinical environment. A provider may rely on her smartphone to access information quickly or on the go, but could turn to a desktop PC if she needs to conduct research, review notes after hours, or complete her clinical documentation.
“The mobile phone is more like a stroke patient,” Douville explained. “Everything happens fast and it happens quickly. A computer is more like a cancer patient, where you have a little bit more time. They are different forms with different anatomy.”
This variance between devices can cause serious connectivity issues when the network and device software are not configured in a way that caters to a healthcare environment.
“Software behaves on a cell phone differently than it does on a desktop,” she continued. “The problem is that most engineers that are leading companies have maybe never designed software for a mobile phone. They’ve never even thought of the phone’s hardware. They’ve only written software and compiled it into something that’s accessible online.”
“Not understanding the device as well as its operating environment will cause solutions to continue to fail unless they’re willing to dig into those details.”
These problems are typically only addressed at a surface level. In order to truly correct connectivity issues organizations need to dig deeper and get to the root of the problem.
How to improve network connectivity
There is no magic fix for connectivity issues. Organizations have spent millions of dollars on the problem, yet still face unsolved issues because of the complexities of healthcare wireless deployment, according to Douville.
Gaining control of the entire network requires forethought and robust planning, asserted Rab.
“Some organizations do not plan ahead, and many are reactionary,” said Rab. “They wait for the network to go down or until the protocols are outdated to assess the problem. There needs to be a cycle of preventative and predictive movement.”
“Organizations are moving from an infrastructure networking to software networking, so they have to be able to plan for that - but the network has to be protected during the process.”
Douville suggests that organizations conduct a network assessment to begin improving connectivity and plan a timeline for making necessary changes. Organizations need to identify the types of devices being used, their operating systems, their wireless vendors, and the success of their current mobile usage strategies.
Provider groups may also want to consider broadcasting different frequencies to prevent conflicts.
For example, MRI machines can conflict with network signals, even microwave ovens in break rooms can conflict with other networked tools. Organizations should make sure their access points are not only broadcasting 2.4 GHz and 5GHz, but also rebroadcasting AM frequency for pagers and LTE for mobile devices.
At Marin General Hospital in California, executives found that a network assessment and site survey illuminated challenges that weren’t immediately obvious.
“All of the wireless site surveys I have been a part of include radio frequency (RF),” said Jason Johnson, Marin’s Information Security & Customer Experience Manager. “When we did our last survey, we moved some microwave ovens around as a result.”
“You'll never get 100 percent coverage, but a solid site survey, strategic placement of APs, serious thought given to density, proper channel configuration, and solid handoff configuration should help,” he continued. “It's much easier said than done—its more art than science in some cases, especially with so many types of interference.”
Once a clear framework of network goals is developed, organizations can begin to assess how they are going to improve connectivity for their wired and mobile assets.
“Organizations need to develop software that adapts dynamically to changes by automatically detecting different kinds of connections,” Douville advised. “It also has to work offline securely.”
Shold also suggests that healthcare organizations look into strategic partnerships with their wireless vendors. Involving the engineering team from the vendor can make a significant difference in the network’s success. While working with a vendor in this way can be expensive, it will save money in the long run.
“It's an investment,” acknowledged Shold. “You look at the numbers and you may think that it’s a lot of money to spend to have the vendor help design the network. But you get a partnership and level of commitment where the vendor will make it work.”
“Upgrading a wireless environment is always difficult and it’s always risky, especially in an environment like a hospital where you can't support downtime,” he added. “The more you can work with a vendor earlier on, the better. It's really building that level of strategic relationship with whoever vendor you're choosing.”
Rab also urged organizations to seek out a seasoned vendor partner who understands the healthcare business and will be invested in the organization’s success.
The number of connected medical devices continues to grow, and the network will always be the common denominator that supports all digital communication activity. Without digging deep and building a network that can keep up with the constant and urgent connections, organizations risk unreliable systems that have significant negative downstream impacts.
Healthcare wireless networks are complex and will always challenge organizations, no matter how advanced they are. Investing in the network may appear to be a daunting expense, but less downtime and better connectivity is invaluable to modern healthcare organizations.
“It’s not just an IT project,” Rab concluded. “We want to make the lives of the loved ones who come here better. We want the lives of the clinicians to be better by making sure that our networking, WiFi, and infrastructure is 100 percent reliable.”
This article was originally published on June 1, 2018.