KINGSTON, Ont. — Pioneering work at Kingston General Hospital is making up-to-the-minute medical data available to physicians at the bedside or in the operating room — and testing wireless network security.
The Queen’s University Anesthesiology Informatics Laboratory (QUAIL) has been working
to develop new technology for patient care since 1999. One goal was to provide anesthesiologists — and, in the long run, other health-care professionals — with instant access to medical data.
Dr. David Goldstein, medical director of acute pain management at Kingston General, says a shortage of anesthesiologists means those practising must be more productive.
Doctors needed current info
Anesthesiologists don’t work only in the operating room, Dr. Goldstein says. Their job starts with a pre-operative assessment before patients come in for surgery.
“”I need (the data) there at the bedside because I’m not necessarily the same anesthesiologist that did the pre-operative assessment,”” he explains.
About two years ago, QUAIL started exploring the use of handheld computers to give doctors immediate access to medical information.
The first experiments did not use wireless networking. Physicians downloaded patient information to handhelds in the morning and could refer to it during the day. Mike Rimmer, QUAIL’s director of technology and development, says doctors found this useful, but were concerned the system did not give them the latest information, such as new test results.
So last spring, the first wireless network access point was installed in a hospital corridor near QUAIL’s offices. The approach was to test the technology on a small scale and then expand, Rimmer says. Now there are 46 access points throughout the hospital. Eventually, about 96 will provide access almost everywhere.
Physicians can use handheld or notebook computers to enter data from pre-operative assessments and check medical information and test results. They can even add spoken notes to patient records, and other physicians can play these from their own machines. The same data is also available from wired systems within the hospital, using a Web interface developed by QUAIL.
At registration, patients can use handheld computers to answer questionnaires providing essential information for their files.
Making hospital patients’ medical data available through a wireless network presents an obvious concern: security.
The hospital’s location on the edge of a university campus does nothing to increase Rimmer’s peace of mind. “”We have a lot of Queen’s University students from the (computer science) program that are aware of the fact that we have wireless here,”” he notes. “”I don’t think their intent would be anything other than mischievous — just to say that they could (break the security).””
Security is also important because the data being entered through the network may affect the treatment a patient receives. “”We want to address the issue of non-repudiation,”” Rimmer says, in order to know for sure that the person who appears to have entered certain data really did enter it.
Like most wireless networking equipment, the Avaya 802.11 wireless LAN gear in use at Kingston General comes with support for 128-bit Wired Equivalent Privacy (WEP). That’s not good enough, Rimmer says — programs that can break it are readily available on the Internet.
The answer was virtual private network (VPN) technology, also from Avaya. A VPN gateway sits between the wireless devices and servers. Each portable device connecting to the network must have VPN client software that authenticates itself to the gateway and provides 168-bit Triple DES IPsec encryption.
“”We take the traditional approach of what you have and what you know,”” says Matthew Hartman, programmer/analyst and head of PocketPC development for QUAIL. To connect, you must have a machine with the VPN client installed and an authenticated address and you must know your password.
Stroke victims may benefit
Devices also log themselves off the network after five minutes without user activity, so a unit left unattended doesn’t become a security risk.
Over time, Kingston General plans to expand its use of wireless networks and handhelds. For instance, Rimmer says, stroke victims may be spared debilitating side effects if they receive a certain drug within three hours of a stroke. The drug cannot be administered safely until certain tests have been performed. Paging a physician through a handheld computer the instant test results are available could mean acting quickly enough to allow a full recovery.
With the wireless network installed at KGH, “”we’ve got a 10-floor laboratory in medical informatics,”” Dr. Goldstein says.