Healthcare: The Most Challenging Wi-Fi Environment?

Healthcare: The Most Challenging Wi-Fi Environment?

By CWNP On 08/10/2011 - 16 Comments

Is healthcare the most challenging vertical market for Wi-Fi design? Many engineers could make a strong case that it is, and I would probably agree. A few weeks ago, I spent the day with Jon Linton and Doug McDonald (both CWSPs) at Henry Ford Health System (Detroit, MI) for a first-hand tour of their environment, challenges, and deployment strategies. Like most healthcare environments, they have their hands full.

Every vertical has its own challenges: K-12 education has paltry budgets, old brick buildings, and potentially high user density; Universities have extremely diverse client populations, broad security requirements, high density, and demanding user expectations; retail and warehouses have difficult building designs and construction materials, as well as highly dynamic RF conditions; hospitality has aesthetic restrictions and access restrictions; everyone is understaffed; and the list could go on.But, healthcare has almost all of these challenges and more, all at the same time.

The Applications
VoWiFi, video over Wi-Fi, teleconferencing, hi-res image transfer, location services, guest access (email, browsing, chat, etc.), hospital apps on consumer tablets, custom mobile apps, patient records (COWS and tablets), patient monitoring, x-ray, and a long list of other applications are standard fare in hospitals. Mission-critical applications all have their own service requirement from the network, and they’re often demanding.

The Client Devices
That list above is only the beginning of the applications, but what’s more dramatic is the number and types of client devices that must access the network. For example, any given hospital will likely have a diverse set of laptop computers (with variant OSs, drivers, NICs, etc.), consumer tablets, business-ready tablets, mobile phones, VoWiFi phones, and guest laptops and mobile devices. On top of that, add at least 10 (or significantly more) different types of purpose-built medical hardware with widely varying capabilities and design.

Many of the custom healthcare applications (x-ray machines, infusion pumps, telemetry and other monitoring systems) are deployed on purpose-built medical hardware. This can be a bit of a problem. The medical device manufacturer decides to make a wireless EKG or X-ray machine, and they decide to use Wi-Fi for connectivity (Wi-Fi is easy, right?). Their specialty is EKG or X-ray, not Wi-Fi. So, they build a killer mobile X-ray machine that sells for tens or hundreds of thousands of dollars, and this machine has a $13 802.11b Wi-Fi card with no diversity in it. And when I say “in” it, I mean somewhere deep down in the bowels of the machine, mounted behind lead, RF-blocking panels.

However, the high-dollar doctor (whose Wi-Fi experience is based on a MacBook and a home wireless router) chooses the medical devices that will be used and the wireless engineer is stuck untangling the connectivity mess. In most industries, the network guys have a voice in client device selection, but in many healthcare situations, the engineer’s voice has only a whisper of influence. At a minimum, it would be great if we could provide decision makers with a list of recommended medical device options meeting a minimum set of network criteria (possibly Wi-Fi Alliance certification).

As it is, engineers are stuck with

  • Legacy devices (how often do you want to replace a two-hundred thousand dollar machine?) that don’t support modern WLAN features.
  • Poorly designed devices with sub-optimal RF performance: antennas, radios, diversity settings, polarization, or mounting configurations
  • Buggy devices with unfortunate dependencies, such as 1 Mbps data rates or long preambles.

The Buildings
While at HFHS, Doug often referred to the old hospital in downtown Detroit as a “bunker.” It really is. It’s a certified bomb shelter, which makes the RF challenges…challenging.

While walking through the polished two-year old facility where I visited, at one point I felt like we were walking in circles. We turned a corner and Doug and Jon both sort of looked at each other quizzically: “There was a wall there before, right?” “Yep!” Hospitals (even new ones) are undergoing constant construction, reminding us that the RF domain is in a continual state of flux.

Intuitively, we’d think this tees us up for automated channel and power features, and in some instance that may work well. However, many hospitals also have significant access restrictions, forcing engineers to mount APs mostly in the hallways, which can have an unsavory affect on radio resource management features because power levels are tuned down too low.

As it relates to RF challenges, I also found this door to be interesting:



That’s the 80 dB (give or take) entrance to the cancer treatment room. They use a focused beam of radiation to destroy cancer cells. Yikes.

Aesthetics and Access Restrictions
The business of hospitals naturally requires cleanliness and aesthetic appeal. These requirements limit the locations and methods for AP mounting. Patient comfort and medical procedures also require privacy, further restricting AP mounting locations and access. Other competing priorities in healthcare environments naturally take precedence, which funnel us network folks down into a claustrophobic box of deployment options; but, contrary to the often ego-centric whims of doctors, the laws of physics refuse to change to accommodate our needs. Darn you, inflexible physics.

Regulatory
For fun, let’s add some regulatory requirements, like HIPAA and PCI, to the monitoring and security mix as well. Why not? Then we’ll add some more challenges with OSHA and other oversight groups that require us to get approval before we can mount an antenna anywhere at all.

Death
One of my favorite quotes from Indiana Jones and the Temple of Doom is when Indiana and Short Round are trapped in a collapsing room of skull-piercing spikes. Willie (the snobby princess archetype) has to endure swarms of creepy crawlies to save them. Indiana motivates her by saying: "We are going to die!!!!!" I sort of imagine him as the hospital patient talking to network engineers. :)
We might get off on some egoistic self-importance by making our jobs seem uber-important, but it’s undeniable that hospital network systems present some additional urgency and stress when it comes to mission-criticalness. Most businesses have high demands for network uptime, but the pressure for absolute up time in a hospital is pretty high. Maintenance windows are practically non-existent.

Final Comments and Suggestions (FCS)
First, I want to thank Doug and Jon again for showing me the ropes. These guys have their hands full, but the HFHS wireless networks are in very capable hands. Second, I want to qualify that this article is not based solely on my experiences at HFHS. I’m drawing upon other experiences and conversations about the healthcare field. HFHS is a characteristic, challenging healthcare environment, but they’re also addressing some of these issues head on.

Finally, I’ll just reiterate that healthcare wireless is a bugger. The business requirements of a hospital are a bit like a perfect storm for wireless networks. The applications are demanding; the client devices are diverse; the buildings are dynamic, with RF obstacles around every corner (or not); regulatory compliance, access restrictions, and aesthetic priorities create significant limitations; engineers have restricted influence in decision making; then there’s plenty of stress from uptime requirements, urgency, and office politics. Mix all of these ingredients together and the result is like a Ford Focus trying to fit through the eye of a needle. Good luck with that.

Tagged with: Wi-Fi, Design, WLAN, healthcare, Siemens, Henry Ford Health System, medical

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Susan James Says:
01/15/2018 at 09:11am
If you are using a wireless router with no security, check your router's client list. There may be other people using your access point for free wireless Internet access, especially if you live in a high-density residential situation, like an apartment. If others are sharing your bandwidth, your bandwidth (your slice of the bandwidth pie) will be smaller. MyAssignmentService

Says:
10/29/2011 at 12:10pm
Marcus I read this article a while back. I recently accepted a position as a WLAN Architect at hospital. I'm glad I had a chance to read your post BEFORE I took the job. You truelly nailed it. The technical challenges I have encountered in only 3 weeks on the job have run the FULL range of your description plus some. I think we may wind up needing a blog/forum for those of us who work in healthcare environments. Looking forward to corresponding with others who work the healthcare wlan arena.
I can be reached via email at "dwwebb@texaschildrens.org "

Peter Miller Says:
08/27/2011 at 08:35am
Just checked the WiTuners site.. seems like site survey tool? You mentioned "Automatic".. so you have a platform that can hook into and tune any vendors radios via their management platform? How do you deal with a dynamic RF environment and make changes on the fly ie warehouse where inventory is constantly changing? In reference to the Article in hand, Healthcare RF Environments can be very harsh, specifically ER area's where WiFi is typically deployed first do you have any examples of performance/reliability?

Says:
08/19/2011 at 16:07pm
I'm associated with WiTuners.com, so consider this comment self serving. For a highly dynamic (temporal and traffic type) mix of clients, a true on the fly WLAN optimizer is needed. We've found that problems like mobility offloading can hose an environment unless they're dealt with quickly (usually in airports and on campuses). If you want an optimizer that is fully automatic and does something besides frequency/power/CCA twiddling, check us out.

Says:
08/17/2011 at 09:10am
The FDA is only required to regulate up to the point of sale. After that it is the wild west. ISO and IEC have created a standard labeled IEC/ISO 80001 that could provide regulation possibly to the point that your WLAN is considered a medical device. Time to brush up on that 510K process. But until and auditing body such as JCAHO adopts this then it will remain mostly just guidelines. Also, just wanted to be clear that we are not using Ruckus gear, we actually use Siemens/Enterasys WLAN AP's. While beamforming may help the AP propagation, the majority of the issues that I see reside in the client drivers. Once all client are required to meet some sort of common criteria then I would be happy to start worrying about things like beamforming. As one philosopher once said "you can't fix stupid." Which rings true with me, we simply need smarter clients as GT mentioned it depends on the client how they connect to WLAN. Some of that is Layer 1 but a lot more of it is secret sauce in the WLAN chip software/driver and possibly supplicant software.

GT Hill Says:
08/15/2011 at 00:00am
brujo,
Not sure what you mean by "dogs fighting over the same clients". APs don't choose the clients, the clients choose the AP. Of course client load balancing and band (read band, not beam) steering can have a bit to do with that.
If you don't mind explaining a bit further I'll do my best to answer. Thanks!
GT

Says:
08/13/2011 at 19:10pm
Marcus,
Well described - I see the same scenarios on a daily basis. The X-Ray device with an internal AP setup is both horrific and true. Scarier still is that these devices get FDA approval, so who's killing who?
GT, I appreciate your response, but given how some of these shockingly unsophisticated and low power clinical devices behave, what keeps the dogs from fighting over the same same clients in a dense deployment?

Says:
08/11/2011 at 15:11pm
Thanks a lot for this article. Of course everyone reads it from their own perspective and mine is that I'm happy I'm with Ruckus. The only Wi-Fi vendor (IMHO) that is really trying to solve the problem where the problem lies.
GT

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