Managing Wireless Landmines

Transcription

1 Managing Wireless Landmines Agenda: Overview of wireless technology in hospitals (Ken Fuchs) Real-world case studies (Ali Youssef & Shawn Jackman) Best practices for deploying apps on hospital WiFi networks & discussion (Phil Raymond et al)

2 Ken Fuchs Center for Medical Interoperability OVERVIEW WIRELESS IN HEALTHCARE

3 Overview Wireless in Healthcare is pervasive and ubiquitous. Convergence of Information and Computer Technologies (ICT) multiplies the rate of Convergence of Medical Devices with ICT. Adoption and deployment of wireless medical systems outpace standards, regulations, and accreditation programs

4 Wireless Ubiquitous and Pervasive! Hospitals Physician Practices Free-standing clinics, surgi-centers, ER s, etc Skilled nursing facilities Rehabilitation hospitals Long term care facilities Assisted living facilities Home Care services AND

5 Wireless Ubiquitous and Pervasive! Emergency and First Responder Services Inter- and Intra-enterprise clinical and security communications Patient/family entertainment and hospitality services Electronic Patient Records (aka, EMR, EHR, PHR) e.g., Meaningful Use requires physicians, other clinical providers, and physician practices and hospitals to use Computerized Provider Order Entry and eprescribing regardless of location for Medicare and Medicaid Self-managed personal wellness and medical care And more is coming!

6 More Arriving Daily Machine to Machine (M2M) communication Includes wireless Device-to-Device, Device-to- System, and System to System communications M2M began as proprietary, single-vendor solutions; now rapidly staged for open source, multi-vendor solutions Robotic food, pharmacy, and supply delivery RFID for patient, product, or device location, tracking, data capture, or data transformation New iphone, ipad, and Droid medical applications released daily

7 A Wireless Medical Systems Map 2010 Elliot Sloane, all rights reserved. Courtesy of J. Wittenber, 7 Philips Medical

8 2010 Elliot Sloane, all rights reserved. Courtesy: Continua Alliance Personal Health

9 WBAN + WWAN WMAN WBAN WWAN WPAN + WBAN WPAN Wireless medical system networks Body Area Network (ZigBee) Personal Area Network (Bluetooth) Wide Area Network (Wi-Fi) Metropolitan Area Network Cellular Wi-Max (4G) 3G WPAN M2M WWAN 9

10 Aaarrrggghhhhh!! These current and evolving trends create a very challenging and dynamic challenge for the Healthcare Delivery Organization. Our panelists will discuss some actual situations that they encountered as well as best practices to consider.

11 Ali Youssef Henry Ford Health System WIRELESS CASE STUDIES

12 Agenda Introduction and WLAN overview at Henry Ford Health System (HFHS) 2 wireless case studies Trends and observations

13 Introduction to HFHS HFHS is a not-for-profit organization primarily located in Southeast Michigan. More than 23,000 total employees. 3.2 million outpatient visits and more than 95,600 patients admitted (2012) 16 Wireless Controllers Over 4,400 wireless access points and sensors Overlay IPS/IDS Over 100 facilities and 8 million square feet of coverage. 5,000+ concurrent guests daily 10,000 concurrent Wi-Fi devices 30,000 unique wireless devices in airspace at the Detroit campus per month

14 Wireless Services Current Services Future Services Guest Access BYOD VoWLAN Medical Devices Video over WLAN Employee Devices RTLS

15 Mobile ECG Cart Procured by 1 department without IT, or Clinical Engineering oversight Standalone bolt-on wireless bridge b/g only (2.4GHz) Lack of support for WPA2 Static IP requirement Case Study 1: Wireless medical devices

16 Case Study 2: Medical applications Growth of medical application use on consumer grade smartphones and tablets. Traditional architecture segmenting traffic by device type is inadequate Prioritization by application/user is required. Vocera example purpose built device vs. application

17 Observations & Trends Dynamic traffic and policy enforcement on the Wi-Fi network is key Standard certification and onboarding process for wireless medical devices Phased approach to migrating all devices to authentication and encryption best practices Standard service catalogue for wireless medical devices IT Request Submitted Feasibility Study Operating Level Agreement Procurement End to End tracking Wireless Team Security Team Clinical Engineering Team Clinicians Service Level Management IT Governance Standard service catalogue item created Procurement purchase device

18 Shawn Jackman Kaiser Permanente DEPLOYMENT USE CASE

19 Agenda About Kaiser Permanente Use case path to a smartphone

20 Shawn Jackman Kaiser Permanente About Kaiser Permanente Use case path to a smartphone

21 Introduction to Kaiser Permanente 9.1 million members 650 medical facilities 17,000 physicians 50,000 nurses 174,000 employees million mobile visits to kp.org 88+ million sign-ons to My Health Manager 116+ million visits to kp.org 32.3 million lab results viewed online $169.4M invested in health research 11.9 million online prescription refills 94,292 babies delivered $50.6B in operating revenue

22 Network Statistics 50+ million square feet requiring Wi-Fi coverage; more than halfway there 17,000 APs 80,000 daily Wi-Fi guest users 145,000 active RFID tags 100% WPA2 Enterprise/802.1X

23 Clinical Mobile Communications Project Overview: Equip all clinicians with reliable, mobile communication device capable of voice, secure messaging and video; device consolidation. Goal: Leverage smartphones as a platform. Divest from ASDs and invest in a mobile platform. Considerations: Wi-Fi is the chosen wireless medium to be used indoors.

24 Comparison VoWiFi phone versus a smartphone What s different? What are these designed for?

25 VoWiFi Phone Features Application specific voice Designed for Wi-Fi only Highly honed for Wi-Fi performance Fast Secure Roaming Rugged Control over OS and versions Primary market enterprise

26 Smartphone Features Open application platform Designed for cellular networks Wi-Fi is for cellular data offload Roams sometimes Not rugged No control over OS Primary market consumers Comments are not iphone specific; applies to all major smartphones.

27 Real-time Applications Real-time applications such as voice and video have stringent performance requirements. There are 50 fps required to transmit audio using G.711 or G.729 (common codecs). 100 fps for both directions. Audio is buffered to de-jitter the variability of time of arrival. If frames arrival variability exceeds de-jitter window, audio clipping will occur. Poor performance drastically affects end user experience.

28 Performance Considerations Infrastructure designed for performance. Clients seeking to roam before connection quality gets too poor. (non-sticky client) Wi-Fi radio doesn t go into excessive sleep mode. PHY rate transmission optimization. Leverage Fast Secure Roaming protocols. Support for QoS (airtime priority).

29 Results? Smartphones are sticky Wi-Fi clients; not designed assuming highly dense enterprise environment. Optimized for battery performance. Weak support for enterprise security. QoS support? VoIP application prioritized in OS?

30 What can you do? Different applications have different requirements for: Bandwidth Capacity Latency Is every application designed for an unreliable network connection? What is the device SLA for different applications? How do multiple resident apps affect each other?

31 Ensure Safety By testing devices, applications and infrastructure properly you identify problems early. Consider risk mitigation and backup plans. Controlled introductions.

32 Phil Raymond Philips Healthcare BEST PRACTICES

33 System of Systems Internet Its just a smart phone app, why do I care about wireless??? Without wireless, no m(obility) in mhealth Smart phones are not single purpose devices so sacrifices are made Robust and reliability require enterprise grade wireless Wireless devices So what is good enough? Smart phone apps

34 Device usage model Know your Connectivity Requirements And your internet service provider s requirements Clinical user and workflow, real time streaming, asynchronous Data security needs (HIPAA, ephi) WPA2-PSK minimally Client Server traffic Unicast best; m cast & b cast not L3 friendly offers no guarantee for connectivity TCP or consider application layer ACK What ports are used? VoIP type deployment rules RSSI > -67 dbm, SNR > 20dB Support QoS/WMM Prioritization 34

35 Trust but Verify System connectivity From device to server, not just on the network Test in mixed device environment Coexistence with all devices Test for impact of network outage Clinical impact on loss of connectivity Certify HW platforms Differences between vendors and even versions Mobility or roaming impact Handover performance 35

36 IEEE : More than alphabet soup? IEEE continuously enhances at the PHY and MAC layer PHY = Radio MAC = Data frames Speed n ac RF & Network Mgmt k/v Healthcare App QoS e TCP or UDP IP Security i Mobility r 36

37 Additional Resources AAMI site includes Wireless Workshop and and accompanying technical reports Wi-Fi Alliance Design, Deployment and Management of Wi-Fi in Hospitals, published Q1, Security guidance for Wi-Fi networks in Hospitals, published Q1, Fi_Security_for_Hospital_Networks-Final.pdf Wi-Fi and the Quality of User Experience Additional Wi-Fi white papers, free to non-members 37