TORONTO — Cost effectiveness and internal politics are two of the greatest barriers to the use and development of wireless technologies in the health-care sector today, according to a panel of industry executives and experts.
Eight representatives from various health-care organizations across
Ontario met Tuesday to discuss challenges and opportunities Wi-Fi presents in a health-care setting. One of a series of forums hosted by the Information Technology Association of Canada (ITAC) Ontario, the roundtable session also brought together the vendor community including Nortel Networks, Research In Motion (RIM) and Cisco Systems, among others.
“My bottom line is (Wi-Fi) going to be cost effective,” said Peter Catford, vice-president, information management and CIO, Centre for Addiction and Mental Health (CAMH) in Toronto. “We’re going to run out of copper, we’ll never run out of electrons and air. All we have to do is worry about the number of access points.”
CAMH is in the initial stages of a strategy to become wireless over the next 10 years. The initiative is part of a $300-million redevelopment project involving the destruction and relocation of 12 of CAMH’s buildings across Toronto, a 60 per cent decrease in the number of beds and a reduction of 2,800 staff.
Similarly, George Tolomiczenko, research director and interim public affairs, St. Joseph’s Health Centre, said keeping up with Wi-Fi puts a strain on limited health-care budgets.
“It’s a challenge to keep up without busting the budget,” said Tolomiczenko, giving the example of a patient in an emergency room and who asks himself why the staff doesn’t know what he needs like his fridge that does. Tolomiczenko made the comment in reference to a fridge that is linked to the Internet and can be programmed to order milk when a person runs out.
Thomas Goldthorpe, director, research information systems, University Health Network, also noted that integrating software with mobile devices like PDAs is costly for health-care institutions.
“Integrating smaller technologies or devices into back-end data sets is an expensive task,” said Goldthorpe.
High elevations can also pose financial challenges, as in the case of Lakeridge Health Corp., which serves the Durham region in Ontario. The region ranges from 600 metres in elevation at its lowest point to 1,000 metres at its highest.
“The solution is cost-prohibitive,” said Rejean Loisel, manager, technical services, Lakeridge Health Corp., who led one of the earliest Wi-Fi implementations at the Oshawa General Hospital six years ago. “I’m not in the business of building antennas. We need to outsource that stuff.”
Lakeridge recently upgraded to the 802.11g WiFi standard to accommodate RIM devices. Loisel, however, added that he doesn’t think RIM-type devices will work in a health-care environment, as the screen is too small for nurses to input and view information.
For that reason, Gerry Dimnik, director of information systems, North York General Hospital, said the hospital hasn’t settled on any particular device yet. Like many health-care facilities, North York General uses a computer on wheels (COWs) product that allows nurses to wheel a workstation from patient to patient. But when it comes to portability, nurses still prefer paper.
“There needs to be one device that provides both real estate and portability,” said Dimnik.
Diane Doran, interim dean of nursing, University of Toronto came to a similar conclusion in some of her research with the Ontario Ministry of Health.
“The two issues are the need for reliability and portability,” said Doran. “Nurses chose paper versus laptops.”
Doran, however, added that as new graduates from nursing programs get out into the workforce that will change as they are more in tune with technology than previous generations.
Another challenge to using and developing Wi-Fi is the autonomous nature of the health care industry.
In Ontario alone, there are an estimated 20,000 independent health care entities that receive some funding from the provincial government, said Linda Weaver, chief technology officer, Smart Systems for Health Agency. These include anything from doctor’s offices to short and long-term care facilities to hospitals.
“There are huge differences in funding, capability and knowledge,” said Weaver. “Until we level the playing field, it’s difficult to do anything.
“It’s hard to match a 30-bed hospital with a 100-bed hospital.”
Weaver added Canada Health Infoway (CHI), which is responsible for e-health records in Canada, is helping Smart Systems learn from other institutions’ experiences and benefit from that.
Catford also pointed out that the mechanical issues are much easier to deal with than the political ones that arise with Wi-Fi. He said there’s no business case behind him knowing what a client’s information is across the health-care sector.
“You can’t take an empire like University Health Network or London Health Sciences and ask them to play in a different playground,” said Catford. “It’s not a middleware problem but a political silo and cost issue.”
End user interaction with the devices themselves presents another hurdle for IT managers as well. In one case, Markham Stouffville Hospital last year chose not to implement Blackberrys, RIM’s popular mobile device.
“People want to use (devices) for everything, which leads to other exposures. “You have to have limits. They don’t know what’s involved in using (devices) in two different arenas,” Goldthorpe said, refering to work and home.
In addition to wireless devices like PDAs use of personal laptops on the network is also a concern for IT.
“I have had physicians ask to use their laptop on the hospital’s wireless network,” said Scott Briggs, director, information technology, Markham Stouffville Hospital. “We’re struggling with that.”
Wi-Fi also presents bandwidth issues, but it is not the only culprit, said Weaver, giving video over IP and telephony products as examples.
“We keep adding more to the network and expect it’s not going to fail,” she said.
Loisel added: “With IP integration you’re dealing with a whole other animal. You need to be more proactive and monitor what you have.”
In terms of solutions to these problems, one panelist suggested health-care organizations focus on business problems as a starting point for their conversation with vendors.
Said Weaver: “Ask people what they are trying to accomplish. Wi-Fi is the least of their problems.”