Computer Consult

Beam it up, Doctor

Inexpensive wireless networking technology, now available on PDAs and tablet computers, can connect you with clinical and scheduling data throughout your office.

By Ken Terry 

Personal digital assistants like the Palm or the Compaq iPAQ allow you to check drug references, keep track of your schedule, and code your visits properly, among other things. If you've wired your office computers together in a local area network (LAN), you can synch your PDA with a desktop computer to enter and retrieve information in the system periodically.

Now imagine the freedom of being continuously connected with the network from any location in your office. That's what mobile wireless computing allows you to do. By using a PDA, laptop, or tablet computer with a wireless LAN, you can:

• Interact with your practice management system to update your schedule or enter charges online.
• Pull up online lab results or clinical reports.
• Place test orders at the point of care.
• Print electronic prescriptions or fax them to pharmacies.
• Access electronic medical records, while making your notes instantly available to other clinicians on the LAN.

Internist Kenneth R. Kubitschek of Asheville, NC, uses a wireless pen tablet—a flat mobile computer with a pressure-sensitive screen—to view EMR data and document visits in his exam rooms. Having a PC in each room would be more expensive and harder to use in front of patients, he says.

Pediatrician David K. Trager's San Jose (CA)/Good Samaritan Medical Group doesn't have an EMR, but he can automatically fill the patient demographic fields on his iPAQ by using its wireless connection to the group's scheduling system. This comes in handy for e-prescribing and will eliminate double data entry when he starts using a charge capture program in the office.

The Physicians Medical Group of Santa Cruz County, CA, currently has wired laptops outside each exam room, but is adding wireless capability so that doctors can pull up clinical data on their PDAs, notes group president and internist Robert B. Keet. While the 28-doctor group doesn't have a full EMR, physicians have online access to lab results, transcribed notes, hospital reports, and scripts they've generated electronically.

"Wireless will do for PDAs what the Internet did for desktop computers," says FP David R. Blair of Lawton, OK, who's a health care informatics consultant to the US Army.

Wireless LANs are much more common today in hospitals than in doctors' offices. Only about 8 percent of physician practices have gone wireless, estimates Fran Turisco, director of emerging practices for First Consulting Group in Lexington, MA. By comparison, she says, 61 percent of integrated delivery networks and 36 percent of stand-alone hospitals have some wireless capability.

Wireless LANs are simple and cheap

All you need to set up a wireless LAN—besides computers to plug into it—are wireless cards for your handhelds or laptops, and one or more "access points," which receive radio signals and convert them into computer talk.

The most common type of wireless signal, sent in what's known as the Wi Fi 802.11b mode, can be received within a radius of about 150 feet indoors. One or two access points are usually enough to cover a small medical office. Besides the physical space, the number of users and the number of walls in the office are factors in deciding how many access points you'll need.

One problem: Data transfer over 802.11b wireless networks is only one-tenth as fast as transmission over the fastest wired networks. You might not notice the difference unless you're downloading complex graphics or radiological images. But if speed is a consideration, you can now buy wireless LANs in a new mode called 802.11a. This mode, which operates at a higher radio frequency than 802.11b, is capable of transferring data up to five times faster. The tradeoff is that its effective range is less than 100 feet. At this point, 802.11a wireless cards are available only for PCs and laptops, although vendors will soon supply them for PDAs.

Laptops, pen tablets, and PDAs can both transmit and receive in the 802.11b mode. Wireless cards for these devices cost $80 to $100 each. Access points usually cost $150 to $1,000. Those suitable for small-business use typically cost $300 to $600.

Depending on the size of your office, you can probably put together a wireless system for about $250 per user, says Blair. So a two-doctor office with a few nurses or medical assistants can do it for under $2,000. That doesn't include the costs of handhelds or other computers.

To install a wireless LAN in your own office, you'll need a server—which could be a Windows 2000, NT, or XP computer—and some related equipment. Alternatively, you could hire an application service provider (ASP) to run the software applications for your practice.* All you'd need to access the data wirelessly is a high-speed Web connection and a specially designed access point that's wired to your T-1 line or digital subscriber line (DSL) and the other access points in your office.

Robert Keet sees some small practices going wireless this way, and predicts more will follow suit: "Wireless will generally replace the wired LANs, because the technology has become so cheap. You call up your DSL company and your wireless guy, and a few thousand dollars later, you've got your office set to go."

A wireless LAN must be secure and reliable

The "wireless guy" is usually a local computer service firm or a "value-added reseller" that sells and installs networking equipment. The reseller will do a site survey and implement your wireless LAN for a set fee—probably a few hundred dollars, if yours is a small office.

The access points must be placed properly. If they're in the wrong places or you don't have enough of them, you could lose contact with the LAN during patient visits or rounds. At a Washington, DC, hospital where this happened, doctors and nurses became very frustrated, recalls Lee Johnson, product marketing manager for NetMotion Wireless, a wireless LAN vendor.

"They'd lose connection to their wireless network, and the patient information displayed on their devices would disappear," says Johnson. "After this happened a few times, the doctors went to their IT manager and said, 'We need to get rid of our wireless network or go back to paper, because we can't walk into a room and not have any access to information.' "

The security of wireless remains a concern, but it's getting better. Although encryption of signals between mobile computers and access points isn't perfect, Blair expects problems with wireless encryption to be solved by the end of the year.

A further safeguard, notes consultant Fran Turisco, is to use the virtual private network (VPN) feature that's built into Pocket PCs and other Windows CE devices (but not Palms). NetMotion provides software for operating what it calls a "roamable" VPN, which creates a roaming data "tunnel" that's accessible only to the sender and the receiver. With the VPN and 128-bit encryption, "It's unlikely that anyone could break in," says Johnson.

The author is Medical Economics' Managed Care Editor.

*See "Can an ASP save you money?" in The Connected Physician supplement to Medical Economics magazine, Fall 2001.

 

Ken Terry. Computer Consult: Beam it up, Doctor. Medical Economics 2002;13:34.