10 min reading time

As originally asked by Kah Yee Eg(吴家义).

There seem to be many Health Cloud started where EMRs are built and all of these Healthcare Clouds are quite useless if the measurement from the medical devices are not connected to the IP network. Survey shows that the EMR entered manually are fairly error prone.

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Tova Adepoju
CEO/ EXECUTIVE ANALYTICAL OFFICER
In the history of Medicals worrld such technology have never be mentioned and if now their is development moving towards that imbibe that great idea it wl serve the world of medicine better.

Tova Adepoju
CEO/ EXECUTIVE ANALYTICAL OFFICER
In the history of Medicals worrld such technology have never be mentioned and if now their is development moving towards that imbibe that great idea it wl serve the world of medicine better.

Jithu Niruthambath
Co-founder and CEO at Atoll Solutions Pvt Ltd
We have worked with a Leading Healthcare company to enable BT, BLE and WLAN (b/gn) in to a 12 lead ECG. It was a wonderful experience… The most important point is bringing latest wireless technologies driven by smartphones (Wifi direct, SOFTAP, BLE etc) in healthcare fast and at affordable price.

Stephen Refeld
Systems/Data Manager at Lady Cilento Children’s Hospital
Stephanie,
Network connection types are more dependant connection requirements of the device.

Zigbee is great, low power!!, convenient and can be set as a short range mesh network. Requires a ‘base station’ to connect to. Common frequencies across all countries.

WiFi much longer range, higher power requirements, can be configured to connect to other access points. Higher bandwidth than Zigbee. Common frequencies across most countries.Biggest issue is the custom configuration for each home network, campus networks can be setup to allow the device to roam.

Cellular has the highest range (due to network coverage), lower power requirements than WiFi. Bandwidth (and power) vairies with network, CDMA/3G./4G. Highest ongoing cost. Easiest setup.

Gary Neel
GM at Omni Biomedical
Wifi would be the best standard as it is everywhere including Starbucks……need low cost low power Wifi solution for home glucose meters. Glucose meter is a $10 device without Wifi….likely $30+ with it……. Companies cant afford to gives these away in the millions to get the strip business….The model will need to change to make it happen….. Professional hospital meters different story…..Meters get paid for….but often stolen so cost still needs to be around $50…….

Stephanie Kong
Global Technology Marketing Professional
Brian –

Interested to hear what your thoughts are on embedding cellular into the Athena GTX vital sign monitors? Or is WiFi/Zigbee good enough for the products now?

Rennie Allen
Security Engineer at Arxan Technologies
Siwei Tang,

Attackers can place the device inside a Faraday cage ([http://www.youtube.com/watch?v=tw9vEiys2Zk|leo://plh/http%3A*3*3www%2Eyoutube%2Ecom*3watch%3Fv%3Dtw9vEiys2Zk/2sPW?_t=tracking_disc]) and it will be unable to communicate with the network. This way they can hack it while it is on, with no fear of remote wipe (unless the auto-wipe with periodic cancel is employed). Another, even lower tech (Faraday cages are not really high-tech) is to have a work shop at the bottom of a canyon in California where there is no cell service.

Siwei Tang
Program Project Manager, Engineering, PMP
Rennie,

You definitely bring up a good point. If the device is not registered on the network (ie turned off), it will not be wiped. However, I would think that they would have to turn the device on in order to access the information. If this is the case, there would be an alert notification being sent to the network or medical device manufacturer to know to wipe when they see it registered on the network.

Currently, with GSM cell phones (AT&T & T-Mobile) you can remove the SIM card and it won’t register on the network. CDMA cell phones (Verizon & Sprint) has a radio module & no SIM card. Thus, harder to remove. If you are thinking about security, it’s best to use an embedded SIM card so it can’t be easily removed by the user.

Rennie Allen
Security Engineer at Arxan Technologies
Siwei Tang,

Yes, very good point. Neither MDM nor sandboxing/virtualization will protect against a stolen device. The only defense in the case of a stolen device is full device encyrption, a strong user password (on login to the device), lack of rooting/jailbreaking and strong anti-tamper/anti-reverse-engineering protection on the medical application itself.

Another point to consider, is even if there is wipe-logic on the device (provided via some sort of MDM facility) so long as the attacker keeps the device off the network (so that it can’t receive the wipe command), they are free to hack all they want.

One possible option is to have an automatic wipe-device timeout with a periodic cancel command delivered from the back end server; that way if the attacker obtains the device and keeps it off the network via a faraday cage or the local canyon (aka dead spot) in California, they have only the automatic wipe-timeout period in which to successfully crack the device. Since having a short timeout could provide a very bad user experience (device randomly wiping itself, even when not stolen if there is a period of non-connectivity) it is likely that the timeout would need to be reasonably long, and that provides a window in which the attack might gain access.

Siwei Tang
Program Project Manager, Engineering, PMP
Kah Yee – Hospitals have their own cloud and back-end system and it should be easier to include devices into this private network. However, privacy is their #1 concern. That’s why there’s push back from their IT department to the medical device manufacturer for integration into this private network. That’s usually the biggest delay for these manufacturers!

If you can provide a stand alone solution that sends the data to the hospital backend system and you take away this delay, imagine how much less money you have to spend on the overhead cost of just negotiating with the IT department.

Additionally, if you look at the different reports that came out on breaches of EMR records for hospitals, the number is pretty astounding. Just take a look at the reports HIMSS puts out. The biggest reason for this breach is because of hospital staff having access to devices they shouldn’t or misplacing it & the device gets stolen.

From a cellular perspective, what if you can wipe the data on that device once it gets stolen? Cellular networks are able to do that (at least ours) or if the medical device manufacturer had implemented the logic into their application. I’m not sure Wi-Fi can. I know bluetooth or USB cannot.

Siwei Tang
Program Project Manager, Engineering, PMP
3. Battery: If your medical device has a docking port, this isn’t normally a concern. If it has to be out with the patients for more than 1 week without being recharged, then you might run into some concerns. This is where it helps if you work with the carrier & radio manufacturer to really understand your application and how to optimize it to prolong the battery life. we’ve been able to help some of our customers prolong their battery life to 5 years, but this is dependent on the battery as well.

The rate of cellular adoption is slow because of these roadblocks. However, medical device manufacturers are looking at their 1st/2nd gen devices that contain bluetooth or wi-fi and realize it doesn’t work for their patients. It’s not simple to use or they can’t take it outside. Therefore, they are looking to cellular for their next generation devices.

I’ve also run into some cases where companies want to use cellular in their first generation devices, but the cost of the module was too expensive and they didn’t have the funds for it. Unfortunately, this happens more often that not.

Siwei Tang
Program Project Manager, Engineering, PMP
Stephanie, you’re correct in your last comment. The current solution for embedding cellular connectivity is usually for remote patient monitoring. When you look at the different applications that have cellular embedded into them (ie sleep apnea, home hub/gateway, EKG devices, medication reminders, etc…) they are all located at the patient’s home. The information is being sent either to the medical manufacturer’s backend system to be processed and sent to a cloud server where doctors can access the information, or to the hospital’s backend where doctors can access the information.

Embedding cellular into these remote patient monitoring applications instead of bluetooth/wifi/USB is important when you think about the patients. Most patients are not technologically savvy (thinking older generation) so they might not know how to input Wi-Fi passwords or sync medical devices. Even if they did, would they really want to deal with the connectivity issue of unpairing or reinputting passwords all the time? Or would they want to use USB to put the information into their computers all the time? Not really. it decreases their chances of using the device, which defeats the purpose of having the device in the first place.

Cellular takes care of those problems by making it easy for the patient to use the device and have it automatically upload to the backend system. It works out of the box.

This is the biggest driver of cellular connectivity: ease of use for the patient. However, there are a couple of other drivers:
1. coverage & not having to rely on the patient or the clinic’s Wi-Fi to send data. Or if the device is not going to be used at the patient home, but outside.

2. more control of the device: being able to update firmware on the device or touch the device

3. being able to monitor compliance: if a device is cellular connected, it’s suppose to send data once the patient uses it. Therefore, if it does not send data for the day, you can assume the patient has not used the device provided the connectivity for the device is working. The last portion is crucial to the M2M business. Knowing that the connectivity is working for the device through your carrier’s device management portal allows the medical manufacturer to take the appropriate steps in troubleshooting the device & quickly figure out of it’s a device problem or a network problem. For example, the Aeris dashboard conveys this visibility to their customers by showing if their VPN connection is working or if their data connection is working or not. If yes, & there’s no data being sent, then it’s a compliance issue or a device issue. If no, then it’s a network issue and there’s subsequent actions you can take to fix it.

In terms of the biggest roadblocks:
1. Cost: Cellular radio modules are more expensive than bluetooth or wi-fi or USB. However, 2G CDMA radios are coming down in price to be almost comparable to 2G GSM radio modules thanks to AT&T shutting down their 2G network. Depending on volume and radio module manufacturer, you’re looking at $20-$50/cellular radio module.

They also (in most times) have a monthly cost. The medical device manufacturer has to figure out if they want to absorb this cost or pass this cost to their customers/patients and the logistics of it. Of course, this monthly cost is roughly in the low dollars for low usage profiles (roughly KB-4MB)

2. Form factor: some medical devices need to be a certain size and have height or width restrictions. There might not be a cellular radio module that can fit into this device & therefore the medical device manufacturer would have to redesign their device.

Stephanie Kong
Global Technology Marketing Professional
Kah Yee, yes I agree and see in the market that cloud platforms are indeed the case for medical device wireless connectivity. In the end, better patient outcomes relies on the ability to aggregate and effectively respond to the collected patient data. Also the incentives to reduce hospital admissions are high (due to unsustainable cost) which is leading to more remote home monitoring solutions. So in this case there is growth in home monitoring equipment integrated with wireless connectivity, though cellular is still at a slower pace compared with WiFi/Bluetooth solutions. For hospitals there is less incentive to integrate cellular as many hospitals now have their own proprietary internal wireless networks. I think the current trend towards at home monitoring will eventually change the traditional doctor/hospital dynamic with the patient. In what says though is still to be determined. Current healthcare systems cannot sustain the growing cost of treating patients.

Kah Yee Eg(吴家义)
Chairman and Founder of Key ASIC, UCrest
Stephanie, I think the reason to have connectivity on medical devices is to upload the data to the Cloud or EMR database. In the hospital, it is hard for me to imagine that the medical devices are going through an external cellular network to get the data on to the servers sitting in the hospital. Simply does not make practical sense to the network engineers taking care of the network in the hospital. It is either wired or WiFi, that’s my guess. I don’t see any problem using WiFi since WiFi is already deployed throughout the hospital. For home users to adopt wireless medical devices, there is a need to have a Cloud that will allow home users to upload their data to, and that there are doctors at the back end to help to analyze the data. Without the back end Cloud and medical services, there is no reason to upload those data. Doctors and hospitals should offer tele-health services aggressively in order to reduce overall medical cost. But then again, hospitals and doctors are there to make money, where is the incentive to reduce cost?

Stephanie Kong
Global Technology Marketing Professional
Siwei, I am aware that companies are starting to embed cellular but the growth rate/volume is not impressive. I am curious to understand the roadblocks for these device manufacturers and also understand exactly what drives cellular connectivity for certain medical devices and what does not.

Stephen Refeld
Systems/Data Manager at Lady Cilento Children’s Hospital
Steve Weisner, an example of WiFi in a medical environment is the transmission of data in HL7 or DICOM format. Both contain patient identifiers. WiFi ECG carts transmitting to centralised storage need patient identifiers to ensure correct matching of the data to the patient record.
None of this security is new though, but normal standards allow wifi snooping by any authorised device.
For home devices, there is the additional difficulties of configuration for the home network, the different configurations of the home network, and access to the device from outside the network. None are ‘show stoppers’ though.

If the data is uploaded via https or secure FTP then the security issues can be resolved.

Siwei Tang
Program Project Manager, Engineering, PMP
Modesto– actually, cellular isn’t that expensive depending on your application and usage profile. $30/month for cellular is typical when you are talking about cell phones or high data usage profiles (ie 2+ GB/month) which take up a lot of bandwidth.

However, most M2M applications and mhealth applications transmit very little data, where a typical device can cost $2.00/month for cellular connectivity depending on usage profile (i.e. less than 2 MB/month)

From the research that I’ve done, and please correct me if I’m wrong, Wi-Fi and RF cause more interference than cellular does because it’s using the same bandwidth the hospital is using. Cellular has its own dedicated channels, which can allow data to be transmitted faster. Additionally, it’s a stand alone product, which means you don’t have the stop gap by the hospital IT department about hospital security & allowing 3rd party devices onto their network.

Modesto (Mo) Casas
Increasing Worldwide revenues
What a great discussion. Tangents and all 🙂 Isn’t cellular too expensive to deploy in personal devices? I don’t know of a cellular plan for less than $30 a month vs. WiFi, which I already have and use for other purposes.
Secondly, aren’t there potential interference and network overload issues if too many devices use cellular inside a large hospital?

Rudolf Rohr
CEO bei barox Kommunikation AG
Hi Ka
Yes we have developed an HD-SDI and DVI Encoder – Decoder that can take any HD Signal in and transport over a standart WIFI network or over a leased IP connection from City to City with very low latency. This as a matter of fact has become very popular for OR transmission to a concress location.

Siwei Tang
Program Project Manager, Engineering, PMP
Stephanie, many companies are already embedding cellular into medical devices. The ones that come to mind are the PERs, Home Hubs, EKG devices since it is easy to see the need for cellular integration.