Medical Center Knows the Right Prescription

WLans work in medical field-if done right.

As both a CIO and a medical doctor,John Halamka understands as well as anyone a hospitals need to be technologically advanced and secure. And knowing the value and risk of wireless networking, he is an early, careful adopter.

Halamka serves as CIO of CareGroup Health Systems, which comprises several Massachusetts hospitals, including the Beth Israel Deaconess Medical Center in Boston; Mount Auburn

Hospital in Cambridge; New England Baptist Hospital in Boston; Beth Israel Deaconess Hospital-Needham Campus; and Deaconess-Nashoba Hospital in Ayer. He also serves as CIO of the Harvard Medical School.

As is the case with most CIOs and doctors, damage control is a big part of Halamkas job. "One of the big things we want to deal with is medication error," said Halamka. Workflow management is a key part of reducing such errors, but its no mean feat in a work space the size of the BIDMC—2 million square feet —where employees are rushing around saving lives.

"How do you manage a doctors workflow?" Halamka asked. "How are you going to deal with a workflow that requires the use of computers tethered to a wall? Thats where wireless comes in."

The BIDMC runs an 802.11b WLAN (wireless LAN), which includes 50 Aironet access points from Cisco Systems Inc., connecting 3,000 mobile users, doctors and technicians who share some 500 Dell Inc. wireless Latitude notebooks.

The hospital is evaluating faster WLAN technologies such as 802.11g, but because most WLAN use at the hospital is episodic—a compressed digital X-ray download here, a medication entry there—a shared 802.11b connection suffices. Data is sent to an electronic whiteboard.

"The key is real-time updates," said Larry Nathanson, a doctor in the emergency department at the BIDMC, which began the wireless transition a year and a half ago. "Whiteboards help organize the complex choreography of the ER. The difference with the computerized dashboard is that it continues to display accurate and updated data when things get hectic, while a manual whiteboard will often get out of date when the staff gets busy."

There are problems with a wireless network that are unique to a hospital, namely making sure that data transmissions dont interfere with any medical equipment attached to a patient. 802.11b runs on the 2.4GHz radio frequency and so does a cardiac telemetry monitor.

WANs are a concern as well; most tech-savvy patients have heard rumors that cell phones can stop pacemakers. Halamka hired a specialist to deal with such concerns in 2001. "We created a position in clinical engineering called the spectrum manager," Halamka said. "The role of that person is to understand what spectrum is going to be used, what medical monitors may use the same frequency, where there are going to be issues of interference—and we dont allow devices into clinical areas until the clinical manager says its going to be OK."

Data security is also an issue, of course. The Massachusetts Institute of Technology, a bastion of computer science students, is right down the road from the BIDMC. The hospital uses myriad intrusion detection software products such as the open-source IDS Snort, but it outsources some traffic to Counterpane Internet Security Inc., of Cupertino, Calif.

"The likelihood of a graduate student doing war sniffing and packet hacking is pretty high," Halamka said.

He said he chose Cisco gear for the hospitals WLAN because Cisco is known for LEAP, its Lightweight Extensible Authentication Protocol, which includes authentication and encryption features not found in WEP (Wired Equivalent Privacy). WEP is still the default security standard for most WLAN equipment.

Meanwhile, Halamka is in charge of technology at the Harvard Medical School, where there are 750 unique wireless users getting access to 16 access points. The back end is still Cisco gear, but at the school, he does not have the luxury of assigning standard clients across the board.

"When youre dealing with as big an enterprise as we have, you learn quickly," he said. "You have to do wireless intelligently."