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What's New With Wireless?

September 1, 2003
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Based on an interview with Jon Bogen, President, HealthCIO Inc.
What's New With Wireless?

BASED ON AN INTERVIEW WITH JON BOGEN, PRESIDENT, HEALTHCIO INC. There are a number of promising applications for wireless technology in long-term care, but for many their realization has a way to go. Healthcare in general has been traditionally risk-averse and slow to adopt new technology, and making the business case for its use has been a significant problem. A good place to start would be in clarifying some concepts. There has been some confusion about the terms "wireless technology" and "mobile technology"; they are not necessarily the same thing. One frequently mentioned advantage of wireless technology is that it frees staff to move about a facility and instantly record resident data at the point of care using devices such as personal digital assistants, or PDAs. PDAs can transmit wireless data but are more often used simply to record data for downloading later at a computer port. In short, if the communication is not in real time, it isn't "wireless."

There are several advantages to mobile technology, whether it's wireless or not. Because resident information can be captured immediately, staff don't have to rely on memory or paper for later record keeping. Also, the enhanced detail possible through this modality can lead to better-quality care. It can also lead to more accurate and complete billing, which is no small matter in this era of Minimum Data Set complications and Medicare reimbursement difficulties.

For wireless technology, there are other impressive possibilities. Remote sensing devices-which in long-term care can be used for departure alert tracking, wrist-mounted medical monitors, incontinence recording and management, and "smart house" applications for assisted living, have to be described as the wave of the future. Today's problem, though, is that for many companies, these are expensive technologies to develop. The sensors themselves are not very costly, but creating the systems and architecture in which to use them can take a great deal of money-especially if they reach "medical device" classification and must be approved by the Food and Drug Administration. It's true that remote-sensing products have been introduced in the long-term care market-and the technology seems to be getting better and better-but widespread availability and use should not be expected, at least for a while.

Another promising area of wireless development in long-term care is in medication management-specifically, instant tracking of residents' drug utilization in real time. There is, in fact, legislation in Congress that would require the pharmaceutical industry to bar code all drug packaging for convenient monitoring by facilities with bar code readers. Bar coding is a hot topic right now and was widely discussed at this year's meeting of the Healthcare Information and Management Systems Society (HIMSS). The question remains, though, whether long-term care facilities will actually purchase and use bar code technology for medication management, although the potential savings from averting medication errors would seem to make the case quite easily.

Another important area of change is the growing use of wireless phones, PDAs, and tablets for messaging alerts. More and more we have seen pagers being used in conjunction with, and finally being supplanted by, wireless phones in healthcare settings. The problem here is a peculiarly American one, i.e., the lack of a wireless communications standard, such as the European countries have, to expedite compatibility. Because the United States has elected to go the competitive route in this area, the compatibility and practicality of this technology for the American market have been slow to develop. Admittedly, the problem is starting to solve itself-somewhat-as current digital networks are built out.

A few cautions about wireless technology: Security is still an issue. The current standard-labeled 802.11b, to be exact-is relatively slow-acting and easy to intercept by passersby, as compared with the newly emerging standards, such as 802.11a and, farther down the road, 802.11g. For the moment, it is worth checking to see whether the vendor has made special security arrangements for wireless transmission, such as use of a virtual private network, or VPN.

Claims have been made on occasion that the mobility and convenience afforded by wireless technology will result in reduced staffing needs. While studies have shown increased staff productivity, there are no studies as yet demonstrating reduced staffing needs. Today's health-care staffs in general are pretty much stretched to the limit, so any increase in productivity can only be welcome.

Finally, wireless devices vary in range of operation and ability to penetrate obstacles, such as walls. A facility needs expert planning to acquire the type and number of devices that are suitable to its specific needs and requirements. This is not a "do-it-yourself" project.