In light of all of the electronic tools we use in our daily lives, it might not seem so hyperbolic to say that semiconductor technology has had the same impact on modern society as the wheel has had on our primitive counterparts.
Semiconductor technology produced all of those devices we can no longer live without: mobile phones, Palm Pilots, laptop computers, and the like. In the business sector, more complex wireless systems have enabled organizations to operate more efficiently, productively, and profitably.
Typically, the health sector follows behind the consumer and business sectors when it comes to embracing some new technologies; however, more and more healthcare organizations are recognizing the benefits of wireless technology. It has even reached a point where wireless solutions-such as wireless networks-are becoming essential to healthcare providers in their efforts to achieve those critical goals that sometimes seem elusive: reduced medical errors, enhanced efficiency, improved patient care, diminished costs, and greater security.
Wireless solutions can be large-scale, such as enterprise solutions; or they could have a much more narrow purpose, such as a modality-focused solution. They could simply be handheld tools that increase individuals’ efficiency. They can be invisible, such as laser beams that connect data between facilities, or quite noticeable, like the numerous electronic tools that seemingly become fixed to the palms of our hands.
Bridges of Light
Austin Radiological Association (ARA of Austin, Tex) is one of the country’s leading radiology centers. In 2004, it took the wireless route. Comprised of 14 imaging centers in central Texas, it performs more than 650,000 imaging services each year. As ARA grew, it faced increasing networking complexities, including bandwidth issues. For solutions, ARA turned to LightPointe (San Diego), the manufacturer of high-speed optical wireless products.
“PACS implementation had us looking at high-speed technology, whether it was a fiber-based synchronous optical network [SONET] or a Metro Ethernet,” reports ARA CIO Todd Thomas.
As it turned out, through its free-space optics (FSO) technology, LightPointe enabled ARA to create bridges that provide high-speed physical transport for bandwidth-intensive applications without the time and cost constraints of fiber.
In 2001, ARA converted to PACS and soon realized the envisioned benefits of implementation. However, the conversion to all-digital imaging substantially raised networking requirements, particularly transmission capacity. Bandwidth was critical, as referring physicians wanted reliable and rapid access to imaging studies, some of which can be as large as 40 megabytes (MB).
For ARA, LightPointe seemed the best solution. The company’s products offer cost-effective “last mile” connectivity in enterprise and carrier networks. Its bridges provide bandwidth speeds of up to 2.5 gigabytes per second (GBps) and uses beams of light to transmit voice, data, and video through the air over any network protocol. Its access points (aka link-heads) connect campus networks to fiber backbones or bridge two or more buildings in classic LAN-to-LAN (local area network) topologies typically addressed by T1 links or 802.11 solutions, according to ARA.
ARA’s move reflected a growing trend: Many organizations now seek a straightforward, secure way to extend the reach of their high-powered networks to an otherwise inaccessible campus LAN location.
Deployment enabled ARA to achieve connectivity speeds of 100 megabytes per second (MBps) at all connected sites. At the same time, ARA reduced its infrastructure costs and eliminated recurring monthly access charges to its telecommunications service provider. Most importantly, it provided better patient care through quicker decision-making. Clinicians simply log on to the system to look at real-time images and access other patient information. In addition, ARA will see a return on investment ranging from 6 to 18 months on its wireless LightPointe links.
At first, ARA deployed a SONET, which provided high performance levels but entailed sizeable recurring costs. As technology evolved and prices for high-speed networking options inevitably dropped, ARA looked at other possible solutions that would provide the necessary bandwidth, reliability, and security while keeping down infrastructure costs.
After a comprehensive analysis, ARA replaced its SONET with a more cost-effective wired-based Metro Ethernet network. As ARA rolled out the Ethernet circuits to area clinics and hospitals, staffers realized they could save more money by aggregating network traffic from several locations instead of establishing new circuits-with recurring monthly costs of $1,500?$2,000-at each site.
ARA looked at fiber-optic cable and radio-frequency solutions but rejected these options, due to right-of-way issues, time delays, security concerns, and bandwidth limitations. ARA next investigated FSO, a line-of-sight technology that delivers high-bandwidth connectivity through the air on beams of light. FSO uses lasers to provide optical bandwidth connections that can carry combined data, voice, and video traffic.
For many applications, FSO technology solves access or last-mile bottlenecks at a fraction of the cost of fiber and in much less time. “As we started to get into locations where the buildings were relatively closer together, we looked at alternatives for that so-called ?last mile’ that was more cost-effective for us than the charges of a monthly carrier,” Thomas explains.
Since many of ARA’s clinics and hospitals were located near each other, with clear line-of-sight between the buildings, the FSO option looked good. Thomas notes that FSO is a laser technology that uses laser light between two link-heads to transmit data over the air. “In a typical setup, you have a transmitting link-head on one building and a receiving link-head on another,” he explains. “Both link-heads have transmitters and receivers. Essentially, the data is taken from the Ethernet segment to one link-head, where it is converted to laser, and then it is beamed across to the other link-head, which receives the data transmission and then converts it back into Ethernet.”
In October 2004, ARA deployed four LightPointe optical wireless bridges to connect clinics, hospitals, and physicians sharing digital medical images and information. One of the installations involved a linkage between the ARA data center and Seton Northwest Hospital, a PACS environment located about 800 meters from the center. (Previously, ARA and the hospital were linked by two T1 lines, which were far too slow. A 50-MB image took 3?4 minutes to download, which did not acceptably meet ARA’s needs.)
Specifically, ARA installed LightPointe’s FlightLite 100 and FlightStrata to transfer patient data though a high-speed wireless connection. These provided optimal balance of performance and affordable optical wireless networking. Initially, ARA installed the FlightStrata, a high-performance system with up to 155 MBps bandwidth speed and innovative multi-beam array tracking as well as optical beam shaping. These provide connectivity speeds ranging from 1.5 MBps to 1.25 GBps.
ARA is now linking new imaging centers to its information technology facility, which will bring the total to six wireless systems. Thomas says that whenever ARA considers bringing up a new site, staffers first look for an opportunity to put in another LightPointe system, rather than buying another circuit. In addition to the speed and economic benefits, the products are easy to install and manage. Moreover, the LAN extensions are in complete compliance with HIPAA regulations.
Finally, ARA is transitioning to a Voice-over-IP network to carry voice traffic. “It will reduce our telephone costs by about 50 percent,” Thomas says.
He also comments that LightPointe wireless technology will play an increasingly critical part in fostering regional cooperation, reducing costs, increasing efficiencies, and improving quality of care throughout the ARA organization.
Sonography in the Palm of Your Hand
Unlike the LightPointe enterprise solutions, some wireless-based innovations adopted by healthcare organizations are modality-specific, a good example being the handheld iAssist device developed by Toshiba America Medical Systems (TAMS of Tustin, Calif). The device is designed to make scanning a great deal easier for sonographers. By increasing the efficiency of ultrasound exams, iAssist can help speed exam times and, more significantly, reduce ergonomic problems.
The iAssist capabilities are enabled by Bluetooth technology originally developed for consumer wireless technology products. Bluetooth, a wireless personal area network technology from the Bluetooth Special Interest Group (founded in 1998 by Ericsson, IBM, Intel, Nokia, and Toshiba), is an open standard for short-range transmission of digital voice and data that supports point-to-point and multi-point applications. Early applications included mobile phones, laptops, and wireless connections for headsets.
Bluetooth provides up to 720 kilobits per second (Kbps) data transfer within a range of 10 meters and up to 100 meters with a power boost. It uses omnidirectional radio waves that can transmit through walls and other nonmetal barriers. The technology has found its way into the medical imaging arena, and, as far as ultrasound, it will be a boon to sonographers who have long suffered workplace injury due to poor ergonomic conditions.
The iAssist is available in TAMS’ Aplio CV ultrasound scanner, a new device designed with ergonomics in mind. Specifically, iAssist is a handheld remote-control device that provides postural and musculoskeletal advantages for users.
And that is no small consideration. According to a study1 conducted by the Society of Radiographers (London), 70%?80% of sonographers suffer work-related pain, a direct result of the upper-body contortions they’re forced to assume while simultaneously manipulating a transducer and operating the ultrasound machine.
“Technologists often have neck, back, and shoulder injuries,” reports Kim Wolfe, lead vascular technologist in the heart-vascular center of the University of Cincinnati, where she has been using iAssist for several months now. “When [a traditional ultrasound] machine is on one side of the bed and you’re on the other, you either need someone else to run the machine, or you need to reach and overextend your body.”
According to the Society of Diagnostic Medical Sonography (Plano, Tex), resulting injury and pain can be great enough to force individuals to end their careers. So far, suggested solution approaches-including modification of working practices and environment, training, and equipment design-have fallen short. The iAssist is a technological solution that integrates all of these elements into one handheld, wireless device.
Essentially, iAssist improves examination efficiency through ease of operation. Fingertip control enables operation of any system function remotely at the touch of a button. Examination procedures, or workflows, are registered in advance, and sequences of key operations are automatically executed. Thus, the operator can perform examinations by pressing a button and observing the flow of operations on the screen.
Conversely, in conventional ultrasound examinations, the operator needs to switch to the required function by pressing a panel key with one hand while holding the probe in the other. As image data is being received, measured, and recorded, operators must perform various function-switching procedures to change modes, adjust imaging parameters, freeze images, perform measurement, and record images on the videocassette recorder (VCR).
With the iAssist fingertip control, a sonographer no longer has to switch the required functions manually. “It has all of the capabilities of a keyboard in your hand,” Wolfe says. “It’s much faster and much more comfortable.”
Users can adopt the most comfortable and least strenuous positions, reducing the risk of upper-body disorders and injuries. Not only is it easier on the sonographer, but it enhances patient care: Efficient workflows help prevent incorrect operation and reduce the risk that required parameter settings might be overlooked. Also, sonographer comfort translates into a better exam. “If you’re not stressing your body, you can get a better image in faster time,” Wolfe reports. “The fewer hours you work, the less tired you are; and if you’re not stressing your body, you’ll be less fatigued and do a better study. So, this benefits the patient, too.”
Other benefits include:
- the operator can focus his or her attention on the images displayed on the screen;
- communication with patient is enhanced;
- the system can be placed anywhere in the room, creating the most effective setting for the user; and
- the device is not difficult to master-some users have learned it within 5 minutes.
In the long run, iAssist’s greatest impact could be on the sonographers. “If technologists aren’t getting stress injuries, they tend to want to work longer,” Wolfe says. “So, something like this can prolong the quality of your work life.”
Going Mobile
The mobile Motion Tablet PC from Motion Computing (Austin, Tex) is another example of a hands-on wireless tool. Though it’s not modality-specific, the Motion Tablet PC features a “view anywhere” concept that makes it especially useful to healthcare providers working with images.
The Motion Tablet provides an alternative to cumbersome tools and materials, such as hard-copy patient files and laptop computers. Functioning in conjunction with wireless networks, the tablet-a lightweight, clipboard-sized unit-enables healthcare providers to maintain a normal workflow. It features Intel Centrino mobile technology and is enabled by high-speed wireless and Bluetooth connectivity. Essentially, healthcare professionals have PC capabilities in an unpretentious-appearing device, and the tablet’s mobility brings critical, real-time patient information to the point of care-and anywhere else, for that matter. It provides access to medical records, images, and other important data. The Motion Tablet’s 12.1-inch-wide display enables physicians-particularly subspecialists, like orthopedists, cardiologists, or neurologists-to show X-rays to patients from any angle.
“In an outpatient environment, subspecialists frequently need to access images, but they might not have the expensive high-resolution monitors in their office setting,” says Joel French, VP of health industry development in Motion Computing’s Seattle branch. “If you have a patient in an exam room, and you want to see their images in the broader context of their health history or medical records, you could literally pull up the image on the tablet. Also, on a preoperative or postoperative basis, the physician might want to illustrate for the patient what they’re going to do or what they did.”
But more than just a display device, the tablet can automate paperwork and enable access to patient files wirelessly. It can convert paper forms to “ink-writable” electronic forms. A digital pen allows users to input information directly onto patient files, images, and medical applications. In this way, the tablet streamlines office workflows, increases productivity, and reduces errors.
In addition, the digital ink capability, coupled with Speak Anywhere audio technology, allows physicians to automate dictation, reducing the need for manual transcription. Furthermore, it is equipped with security solutions, such as an integrated fingerprint reader and a software-based security layer. As a result, multiple personnel within a facility easily can share a pool of machines, while sensitive patient data remains secure.
In several ways, the Motion Tablet is similar to a personal digital assistant (PDA) or laptop computer; however, it is much more versatile. PDAs don’t provide enough performance to tackle high-end medical applications or the functionality to serve as stand-alone computers. “And with some laptops, you can’t see the image unless you are right in front of it,” French notes. “But you can rotate the tablet to a 180-degree angle. You can see it indoors or outdoors, or in a high fluorescent environment. So the clarity is very rich.”
Also, a laptop can be difficult to use in exam rooms or in consultative settings, such as physician to physician, physician to nurse, and physician to patient. “The tablet provides a very naturalistic experience, because everyone can see it and see it clearly,” French says.
With the Motion Tablet, electronic health records (EHRs) are easier to access and share with patients, and X-rays can be annotated with digital ink. Physicians can collaborate on patient cases and access real-time EHRs while making rounds. Patient charts or lab results can be accessed from home. “For physicians, it’s an ubiquitous device: They carry it from room to room, to the hospital, and to their office,” French explains. “And if physicians want to show something to a patient, it’s right there in their hands.”
Firmly Entrenched
When considering all the capabilities that wireless technology brings to the healthcare table, the conclusion that wireless systems and medicine go hand in hand now seems obvious. However, many in healthcare initially had serious reservations about security. How can we just send all of that sensitive data out in the air? How difficult would it be for a technically savvy interloper to just reach out and grab it?
With advances in systems and technology, security has almost become a nonissue, so one of the more significant barriers to acceptance has been removed. Indeed, with wireless systems and devices, healthcare providers-physicians, nurses, technologists, anyone-have reached a place where they can’t even remember what things were like before the technology enhanced their daily workflow, and they certainly can’t go back now. The corner has been turned.
“It is really fascinating to observe the increasing sophistication level of it all,” French says. “Originally, people introduced wireless technology for a point use. What we’ve seen over the past year is that organizations have come to the point where they realize they can have performance and mobility by deploying line-of-business applications in a wireless network that’s adequately secured. So, we are seeing rollouts that are more pervasive in application providers. They have really [backed] the idea that [wireless applications] can provide a great user experience.”
Dan Harvey is a contributing writer for Medical Imaging.
References
- Musculoskeletal injury amongst sonographers in the UK. June 2002. Available at: www.soundergonomics.com/PDF%20Files/SCOR-MSI%20Book.pdf . Accessed January 12, 2005.
