Mobile Services Opportunities in the Healthcare Market · Mobile Services Opportunities in the Healthcare Market Author: Jose R. Claudio, ... The cabling must also meet the ANSI/TIA-1179

© 2012 SpiderCloud Wireless, Inc.

Mobile Services Opportunities in the Healthcare Market Author: Jose R. Claudio, IT Consultant December 2012


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Healthcare is an increasingly mobile service, especially as Mobile Health (mHealth) initiatives continue to evolve and be deployed. Mobile Operators that can deliver signal enhancement technologies within a few weeks, versus months, along with enhanced services, such as Unified Communications and Managed Services, will be in a better position to partner with healthcare organizations.

Healthcare organizations are on the same trajectory as many Enterprises today, as they transition from a wired enterprise to a mobile enterprise.

Reliable in-building wireless coverage is essential for quality clinical communications and increased patient/visitor satisfaction. Providing pervasive wireless coverage will:

• Improve patient care and safety by ensuring that the staff and departments involved in the continuum of care have timely and accurate information.

• Reduce signal emissions, mitigating interference between cellular devices and clinical equipment by allowing the mobile devices to maintain low power communications.

• Help with patient satisfaction scores that the Centers for Medicare & Medicaid Services will be using as one of the metrics to pay hospitals. “Medicare will begin withholding 1 percent of its payments to hospitals starting October 2012”.

Mobile operators can take advantage of new in-building small cell technologies to enhance their market position within a healthcare organization by providing mobile services at little to no Capex cost to the healtcare organization, and using the added connectivity to sell other services to the organization.

• Managed mobile services: Installing a managed small cell with Wi-Fi network, for access by patients and visitors, will enhance the patient/visitor experience and remove the management burden from internal IT staff, therefore liberating them to perform functions that are germane to patient care and business functions.

• Unified communications: Organizations are continually looking for ways to cut expenses, and as the population becomes less attached to their wired devices, and more attached to their mobile devices, they are looking at eliminating on premise voice communications services by leveraging the existing mobile eco system for devices and services. Mobile Operators that can extend the functionality of the internal system, by enabling a “Clientless” Unified Communications that leverage internal dialing plans and features to the mobile device, will be in a better position to gain favorable partner status with organizations.

• Location based services: In a Healthcare setting, the speed of locating the right people and equipment can greatly affect patient outcomes. With modern in-building mobile technologies, the ability to locate both, with more precision, on a friendly interface, enables employees to find critical resources faster and more effectively.


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Facility Access Challenges

Installing any equipment or system in an existing hospital, especially in the in-patient areas, is costly and very disruptive to hospital operations. Solutions that can be installed with minimal interruption to patient care, have minimal implementation costs, and can be made operational in short order are of greatest interest to healthcare executives.

Healthcare facilities are facing a multitude of challenges with systems, wireless devices, and signals:

• Voice badge Wi-Fi • Clinical device Wi-Fi • Telemetry • Pager • Public Safety • Low frequency mesh networks supporting RFID for asset tracking, refrigerator monitors, etc.

The healthcare community favors in-building mobile and wireless enhancement solutions that support multiple technologies, and eliminate the need for additional wireless antennas.

Infrastructure

The need to integrate clinical devices and medical records systems, along with the addition of workstations, and mobile devices that facilitate point of care data entry, image viewing, patient education and clinical communications are straining the physical infrastructure and budgets of healthcare organizations. Solution providers that are better prepared to alleviate communication gaps with solutions that minimize the interruption to hospital operations, using little to none of the scarce infrastructure resources, and minimize implementation time and costs, will be in the best position to win in the lucrative healthcare market.

Access to the medical facilities existing infrastructure by an external mobile operator for purposes of adding in-building wireless service enhancements, may be constrained by one or more of the considerations outlined below.

Considerations to Leveraging an Existing Network

Power over Ethernet (PoE) and Port Capacity

Healthcare organizations have been installing extra equipment to address additional port and PoE requirements. The need to add more PoE dependent devices on the network, in addition to workstations and clinical equipment, may exhaust the ports available for the installation of wireless radios. If this is the case, a possible solution may be to deploy a dual power supply, 24 or 48 port PoE capable standalone network switch, to support the wireless radio.


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Equipment and Cable Installation Requirements for Meeting Code

Installing equipment or wires in patient care areas, especially in-patient care areas, require infection control training, OSHPD or similar approved wiring and parts, tenting, and in some cases, closing down the area being worked on. The cabling must also meet the ANSI/TIA-1179 Healthcare Infrastructure Standard, which was ratified in 2010.

Network Traffic Segmentation

Network segmentation or Path Isolation can be accomplished through VLANS or MPLS. The simplest solution may be to implement multi Virtual Routing and Forwarding VRF, where each network service is assigned a separate IP Address and separate routing instance. Traffic, traversing networks, would go through a firewall and/or IPS/malware appliance, and be inspected before access is allowed. This solution is limited to 4 or 5 segments, so it may not work for all customers.

Cable Plant Access Issues/Concerns

Healthcare organizations are very security and uptime conscious, so cable plant access will depend on:

• Where the equipment is located. If it is located within a closet that the vendor already manages, the access protocols should be fairly well defined. Typically access into these areas requires prior notification to the space management department, and may or may not require escort.

• The organizational relationships between the vendor and space management department, in addition to the colocation requirements. The better the relationship and the bigger the separation between in-house equipment and the vendor’s, the easier it is to get agreement on access protocols. If colocation of in-house and vendor equipment is necessary, then agreements usually require prior notification stating when the vendors staff will be on-site, the purpose of the visit, and will likely require escort.

Common Electronics Access Issues/Concerns

In addition to the aforementioned items, the following should also be taken into consideration:

• When connecting vendor equipment to organizations equipment, the organization will typically perform the connection and configuration of their equipment. Vendor configuration of organizations equipment is usually not allowed, and communications to the vendors equipment is typically segmented using a VLAN, VRF or other network protocol that ensures the separation of organizational and vendor data.

• Configuration and support access will generally require: – Contacting the organizations service desk to open a ticket, and request account activation. This

ensures that there is a record of the access, why it is needed, and ensures that access is only granted when necessary, and not on an unregulated basis.

– Secure remote access using VPN and possibly 2 factor authentication. – Secure wireless access using VPN and possibly 2 factor authentication. – Direct connect access to equipment may require escort oversight.


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If operating on the shared network, it is very unlikely that vendors will be permitted open access to their equipment. Due to the need for reliable communications, the organization may want to be informed of all physical/electronic access, equipment upgrades/changes, and may require the vendors to follow the organizations change control process.

The Opportunity for a Mobile Service Delivery Network

Benefits of Separating Delivery Architectures

Delivering Managed Mobility and Wireless Services on a separate network alleviates many of the operational and security concerns outlined above. Physical security, escorting technicians, and possibly change control, will continue to be required by the healthcare facility.

There is an additional benefit of a separate Managed Service that Healthcare IT professionals have expressed. They said that by “adding a new delivery network, the existing Wi-Fi networks that are already ‘jammed’ at a physical level with clinical equipment, can be ‘off-loaded’ to another physical Wi-Fi network”. There is an apparent need in larger facilities to offload internal VoIP traffic (e.g. Vocera badges) and guest Wi-Fi (for patient/visitor access), so that the Wi-Fi attached clinical devices have less competition for the scarce resources. Also, many clinical devices have a negative performance impact on the modern computer’s Wi-Fi performance due to their use of older 802.11 protocols that slow everything down. This can be a result of older equipment in extended use, or newer equipment that the supplier chooses not to update (avoidance of having to execute FDA certification processes).

Common Physical Constraints

With the accumulation of additional equipment, some healthcare organizations may not be able to provision adequate space to properly house it. As such, there may be areas where installing additional vendor equipment will not be an issue, and other areas where doing so will be almost impossible. Vendors and organizations will have to work together to design solutions that work for both. Possible solutions:

• In ceiling network enclosure, see example. • Locating vendor equipment in closets that don’t typically contain network equipment. Analysis is

necessary to ensure ventilation, electrical and physical access meets the vendor requirements. • Use other innovative solutions, such as the HVAC system to run wires and access points. According to

an article in Healthcare Design Magazine, Simi Valley Hospital used HVAC ducts to enhance their cellular signal. “A technology popular in after-construction situations uses existing heating, ventilating, and air conditioning (HVAC) ducts to efficiently and cost-effectively distribute RF signals throughout a building. Metal HVAC ducts, which are designed to reach the entire building, are typically excellent waveguides for radio signals.”

Any solutions design must ensure that all local, state and federal regulations are being met.


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Other Concerns to Consider

Managed Service Agreement

There are pros and cons in any agreement. A properly written outsourcing agreement with detailed responsibilities, escalation and problem resolution guidelines, can be used to show the organization the benefits of not having to hire subject matter experts, or add more responsibilities to an already overburdened staff. An outsourced solution will provide:

• Best practice service management and configuration services • Improved network operations monitoring • Configuration backup and recovery services • Subject matter experts • 24x365 management Since some within the organization may not agree that outsourcing is a viable solution, questions such as the following, and any others uncovered during meetings with the organizations leadership and staff, must be reviewed and answered before a meeting to discuss the subject is scheduled.

• Scope of Service • Retention of WLAN operations for mission critical devices • Loss of control • Less customization flexibility • Fragmented services and vendor coordination issues • Lack of vendor commitment to quality service, especially versus in-house staff.

Single Operator Per Access

Justifying a radio node per mobile provider used to be hard for any organization, mainly because, in most cases, they do not have the environment to support the additional radios along with all the other devices they must add to the environment. However, with Small Cells technology entering the market at a fraction of both the cost and the installation time, the decision criterion has shifted.

Questions that will be asked within the healthcare leadership could be:

• Do we budget and fund a shared DAS? • Is it really a priority? • Do we allow a mobile operator to fund the improvements to signal themselves? • Will we avail ourselves of the Wi-Fi Managed Services? • What is in our, and our guests, best interests?


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Mobile Operators and Small Cells

Mobile operators want to win or retain healthcare customers, and sell them new mobile devices and services. To accomplish these goals, a cost effective small cell system that provides high capacity 3G, LTE, and Wi-Fi data and seamless voice coverage, with practically no dropped calls is required. Data throughput should be comparable to the LAN. A small cell system must be able to measure system performance, and offer service level guarantees. The systems should be secure, easy to deploy and inexpensive to operate. Plus, it should easily integrate with the enterprise’s local network.

This section discusses each of these design considerations in some detail:

• Seamless Mobility: Users in enterprise environments are not stationary. People are moving throughout the day in an enterprise. Statistics from an operational 3G small cell network experience shows that in a building with 800+ subscribers, these subscribers move across small cell boundaries over 20,000 times an hour. Soft handoff is critical in a hospital environment.

• Consistently High Throughput: Customers are now accustomed to a multi-megabit data experience on their smartphones, and they will not be satisfied with an in-building mobile or wireless system unless it provides them such rates. Further, customers are unlikely to tolerate wide variations in data rates as they move throughout their offices.

• Enterprise-Centered Management: A mobile operator should be able to manage each enterprise small cell system as one unit, rather than managing individual small cells. Not only does this reduce operational costs, it also allows the operator to differentiate by offering SLAs to its enterprise customers.

• Self-Organizing and Rapidly Deployable: Speed of deployment is important, both for reducing deployment expenses and increasing revenue. Healthcare organization systems are often deployed after work hours when the operator (or enterprise) is paying overtime wages. Further, the sooner an operator can deploy, the sooner it can acquire new customers and start receiving revenue.

• Efficient Use of Backhaul: Backhaul (the connection between the small cell system and the operator’s core network) is a very large recurring expense, and must be minimized. To do so, all small cells in an enterprise should share a single backhaul link. Traffic on this link should be prioritized, and overhead minimized.

• Local Switching of Voice and Data Traffic: Healthcare organization employees need to securely access their Intranet and PBX, without installing special client software. A small cell system should make this possible, without breaking basic features like mobility.

• Scalability: Since it is expensive for operators to commercialize new technologies, an ideal small cell system should be able to cost-effectively cover multi-story buildings and campuses that are as large as 50,000 square meters (500,000 square feet), or offices as small as 1,000 square meters (10,000 square feet).


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Scalable Small Cell Coverage, Capacity and Mobility Services for Healthcare

SpiderCloud Wireless enables mobile operators to build very dense small cell networks to address their own network coverage and capacity needs, and offer enterprise customers reliable mobile, application and cloud services, as they transition from a wireless to a mobile connected enterprise.

The system, sold direct to mobile operators, is called an E-RAN (Enterprise Radio Access Network) system, and consists of a Services Node (SCSN) that can control over 100 self-organizing and multi-access 3G, Wi-Fi and LTE/4G small cells that can be installed in just days using an enterprise Ethernet Local Area Network (LAN).

One E-RAN delivers unprecedented capacity and coverage to over 10,000 connected smartphones and tablets, with just one connection to the mobile operator’s core network. The scalable system architecture simplifies deployment, and overall network configuration for mobile operators, as they address pent-up demand for reliable mobile services from enterprise and large venue customers.

The SCSN significantly increases average mobile data throughput for small cells, capacity and the overall performance of a small cell network, improving the small cell economics for a mobile operator.

A SpiderCloud system is proven to handle over 100,000 data sessions and handoffs on a daily basis, while providing reliable voice and data coverage for hundreds to thousands of employees with just one connection to the mobile core network.

Mobility, Applications, and Cloud Services

Managed Wi-Fi and Policy Enforcement

The Wi-Fi Network has capacity for 16 Wi-Fi SSID’s in both 802.11 frequency bands. Wi-Fi can be easily offered to satisfy the following scenarios:

Clinical VoIP

Adding a new delivery network can fix congestion in WLAN’s that are jammed at a physical level with clinical equipment. This also allows the clinical network configuration to be greatly simplified by removal of ACLs and QoS settings required for voice transport. By making this segmentation, the healthcare facility is also prepared for gradually increasing the use of real-time and stored video without the constraints of the legacy clinical devices holding back progress to this future use. The offload is also valuable for the clinical devices so they have less competition for the scarce resources, and critical patient events, they are reporting are not stuck in a traffic jam.

Patient/Visitor

Wi-Fi is expected and extremely important for patients and their guests in our connected society. The customer’s expectations are driven by the speed, quality, and simplicity of consuming Wi-Fi at their homes. Poorly performing Wi-Fi that is dragged down by clinical devices, or poorly serviced Wi-Fi delivered by an overburdened internal network staff, can reduce patient satisfaction scores and thus, endanger Medicare reimbursements or the facility’s reputation. What if Wi-Fi was well delivered by a service provider like in many hotel chains?


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Offload

Offload can be a direct benefit to both the healthcare facility and mobile operator. Offload Wi-Fi frees up capacity from the outdoor mobile network, and improves performance for all. Additionally, the Wi-Fi can be configured with other mobile operator’s offload SSIDs in a cooperative agreement to improve data services for all device owners that access the facility.

Web Security and Content Filtering

Wi-Fi data traffic must be secured to protect the Healthcare organization from liabilities associated with the activities of device owners or delivery of harmful malware. In many countries, if the Healthcare organization does not manage guest usage, they are still held accountable by regulatory or industry bodies for their guest’s actions.

Enterprise Mobility Management

Enterprise Mobility Management “EMM” application suites such as Airwatch or Mobile Iron can be hosted by the mobile operator on the Services Node to enable fast local delivery of these services to the enterprise.

Cloud PBX Voice + IM/Presence

The Services Node can integrate with the Healthcare organization’s UC environment. This solves a usability problem that is hindering Enterprise UC adoption on mobile devices. With this solution, voice, IM, and presence integration does not require software to be deployed to devices, nor does it force the healthcare organization into restrictions on supported devices. Up to now, UC strategies have been a way to move telephony from desk phones into computers, and have not fully factored in the culture shift to mobile devices and Corporate Owned Personally Enabled (COPE)/Bring Your Own Device (BYOD) change that has occurred over the last few years. With Cloud PBX Voice, the mobile operator provides a uniquely valuable service in the network plumbing, and allows medical personnel to use the device of their choice on-premise without limitations.

Location IQ

The Services Node is not a Location Based Services (LBS) platform, but it can greatly raise the Location IQ of other LBS platforms by providing a variety of data points that can be used in healthcare facilities for useful services. Locating both people, and important equipment with a high degree of precision.

SpiderCloud Wireless is based in San Jose, California and is backed by investors Charles River Ventures, Matrix Partners, Opus Capital and Shasta Ventures. For more information, follow the company on twitter at www.twitter.com/spidercloud_inc or visit www.spidercloud.com SpiderCloud Wireless is a registered trademark and SmartCloud a trademark of SpiderCloud Wireless, Inc. ©2012 SpiderCloud Wireless, Inc. v121212

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Mobile Services Opportunities in the Healthcare Market · Mobile Services Opportunities in the Healthcare Market Author: Jose R. Claudio, ... The cabling must also meet the ANSI/TIA-1179