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Wireless ways on the wards
Handheld Devices
21 May 2003

Doctors at some European and US hospitals have been walking around the wards with unusually large bulges in their pockets. At the Royal Brompton and Harefield hospitals in the UK, medical staff have tablet PCs tucked in their white coats and are using the wireless-enabled handhelds to access and update patient records.

At Beth Israel Deaconess Medical Center in Boston, doctors have abandoned their pagers for mobile phones, dealing with emergency calls on the spot, rather than running to the nearest wall-mounted phone. Meanwhile, nurses at Bradford Hospitals NHS (National Health Service) Trust in northern England are using Pocket PCs to make and track orders while on the move.

A growing number of medical centres are building wireless local area networks (W-Lans) and using handheld devices, such as personal digital assistants (PDAs) and mobile phones, to access, record and share information instantly from anywhere within the network.

From ordering medicines using a technique known as computerised practitioner order entry (CPOE), to researching dosage information, handheld devices are enabling hospital workers to provide a high standard of care while saving valuable time.

"One of the principal drivers of the market for W-Lans in hospitals will be its potential for productivity and mobility," says John Gilsenan, research analyst at Frost & Sullivan, the IT consultancy company.

"Streamlining internal communications, eliminating the need to duplicate records, as well as ensuring reliability in documents, such as prescriptions, have all contributed to wireless technology's image as a productivity enhancer."

The implementation of wireless networks in hospitals is a new phenomenon - yet many early adopters are finding handheld devices indispensable. "The tablet PC brings everything together," says Mark Dayer of London's Royal Brompton & Harefield NHS Trust. "It allows me to view the entirety of a patient record wherever I am in the hospital. I can write on it in electronic ink. I can update my patient notes anywhere. I don't need to type them up."

"Traditionally, doctors would walk around the hospital with a bulging Filofax and pockets full of paper," says Matthew Berry, who is specialist registrar in respiratory medicine at London's Chelsea and Westminster hospital. "The PDA allows you to keep all your data in one place."

Several factors have contributed to the growth of handhelds in hospitals. W-Lans can be installed more cheaply and easily than fibre optic cables, there is widespread acceptance of the 802.11b (Wi-Fi) wireless standard and the usability, quality and availability of hardware and software have been improved.

From software players such as Microsoft and PalmSource, to network companies Cisco and Avaya and hardware manufacturers such as Hewlett-Packard and Fujitsu, companies are capitalising on recent government drives towards the digitisation of hospital processes and data.

In Britain, where the government has called for all patient records to be computerised by 2005, companies such as like IT supplier Centerprise International are hoping to cash in. "The NHS Plan has identified IT as a key area of importance with a great deal of funding being allocated to the purchase of new IT equipment," says Ricky Harvey, NHS account manager for Centerprise. "As a result, we expect demand for our products to be high."

Healthcare technology advocates have high hopes for mobile devices in hospitals. "Wi-Fi is an important technology for hospitals because it suits the itinerant nature of key hospital staff," says Paul Lee, director of mobile and wireless research at Deloitte Consulting, a New York-based management consultancy.

A survey by Cahners In-Stat, a US-based research company, predicts that 20 per cent of physicians will be using handhelds by 2004, generating $2bn in sales. According to research undertaken by Frost & Sullivan, the market for wireless infrastructure technologies in European hospitals is expected to reach $92.3m by 2007, an almost eight-fold increase on 2001 figures.

Despite the excitement, several challenges must be overcome before handhelds become as common as stethoscopes. With wireless networks more susceptible to hacking than their wired counterparts, one of the major concerns is security.

In the US, where the Health Insurance Portability and Accountability Act (Hipaa) places strict regulations on patient confidentiality, wireless operators are taking data protection seriously. "The Hipaa sets a benchmark that forces the suppliers of wireless technologies to prove that their technologies protect patient data," says Mr Gilsenan. Vendors are rising to the challenge. Information is being stored on secure servers rather than on hardware. Wireless devices are being rolled-out with 128-bit encryption and in-built defence mechanisms including voice and password authentication.

For example, Pirilis, a PDA-based patient records system from ComMedica, an Imperial College spin-off, and Intel, the chip and networking giant, stores data remotely and ensures that the wireless network does not interfere with hospital equipment.

Another issue concerns hardware. PDAs have been used on wards for a couple of years, but the more recent arrival of portable, digital-pen-operated options such as Microsoft's tablet PC device is engendering debate.

"Wireless has limped along in hospitals because of the limitations of the PDA with its high power consumption and tiny screen," says Jeff Bauer, senior vice-president of Superior Consultant Company, a Michigan-based healthcare consultancy. "With the tablet PC's better battery life, touch-screen programming and larger interface, finally we have a device that will catch doctors' attention."

But Keith Washington, general manager of the healthcare solutions group at EMS, an Atlanta-based hardware manufacturer, does not agree. "The carrying under the arm of a panel is where clinicians object," says Mr Washington. "Worse, once you're done using tablet PCs, you have no place to put them and they're not secure."

Instead, Mr Washington advocates the use of desktop-sized "Mobile Clinical Workstations" that physicians wheel around the ward as necessary to input or access patient information.

With ever-tightening budgets and increasingly pressured medical staff, the healthcare sector is characteristically conservative about IT spending.

Also, several recent high-profile technological meltdown horror stories in two US hospitals have not helped the case for wireless. Ultimately, the main factor inhibiting the uptake of handhelds in hospitals boils down to user adoption.

"From the user's point of view, there has to be an overwhelmingly strong case for replacing a traditional manual process with an IT one," says Steve Garrington, chief executive for health at Torex, the UK-based IT services provider.

Problems seem to occur when hospitals rush to implement new technologies without checking their usability. The technology should improve upon traditional processes and experts say hospitals need to consider human factors, such as the willingness of clinicians to adopt these systems. "Any new equipment must be introduced sensitively and selectively into the healthcare system," says Mr Lee at Deloittes. "Imposing PDAs with pop-down menus on consultants who have spent the last 30 years with a Dictaphone may be hard work."