The use of wireless devices in healthcare operations is growing exponentially as mobile connectivity between caregivers and patients becomes increasingly pervasive. Examples include the use of smartphone applications by physicians for primary care and greater availability of purpose-built wireless sensors for remote patient monitoring. For leading healthcare organizations, having a comprehensive wireless strategy is critical to reduce stakeholder risk and to ensure operational excellence.
Two of the most popular modalities of wireless in healthcare are Wi-Fi and cellular (i.e. 4G LTE). Both of these technologies are supported by a rich ecosystem of wireless devices including smartphones, tablets, laptops and, more recently, small form-factor biometric sensors (i.e. wireless bandages). Wireless technology is now an integral facet of the treatment, provision and operations of healthcare for both clinicians and patients alike (as exemplified via the medical home). Accordingly, having a wireless strategy is essential for a healthcare organization. Just as toll highways are sized for capacity and future growth and governed by rules regarding their use, the acquisition and use of wireless in healthcare requires thoughtful consideration. Holistically, a systems approach is necessary including dependencies and constraints, the stakeholders and the benefits and risks. Without a wireless strategy, a healthcare organization is inviting unnecessary and avoidable risks that could potentially compromise quality of care, patient safety, or both.
Strategy may be broadly defined as an organization’s action plan or choices around its direction or mission. Namely, what products and services will be offered and not offered, what markets are served and not served, and what is in scope and out of scope. A successful wireless strategy begins with analyzing the healthcare organization’s environment from the perspective of its mission. Hence, the wireless strategy is not formulated as a reflex to address possible technical shortcomings (i.e. a gap in mobile communication modalities), but rather as a framework of specific activities to help achieve the organization’s mission. For example, if the mission is to provide healthcare of the highest quality, the wireless strategy will start with an assessment of how to deliver contextual real-time health services across the entire healthcare continuum serviced by the organization.
Step 1: Concept Exploration and Assessment
The first step is to use internal and external data gathering as part of concept exploration to understand what wireless technologies are available, including acquisition considerations (timing, price, functional requirements and so forth). For the healthcare organization, this starts with requirements definition, assessing the demand, gathering business intelligence about competitors and their offerings, understanding industry trends (i.e. mobile health solutions) and identifying the stakeholders (i.e. caregivers, payers and patients).
Step 2: Decision Making
The second step is to develop a framework of strategic decision choices around wireless services. These include the product or portfolio of wireless service offerings, their economic value add to the healthcare organization, their place and location (for instance, provision of cellular and Wi-Fi services inside the healthcare facility and cellular-only services for the medical home environment) and their promotion to stakeholders (i.e. clinicians, physicians, staff and patients). It also includes supply chain considerations such as identification of vendors, make-vs.-buy decisions and in-house-vs.-external partnering. For example, the organization may decide to support Wi-Fi services internally and outsource cellular services to wireless carrier(s) and/or a neutral host provider of cellular services. Additional decisions should consider organizational affiliates, contractors and the legal and regulatory landscape. The latter is especially important around mobile access and use of PHI, particularly when privacy cannot be assured. This even extends across state lines, given current licensure, credentialing and privileging standards of clinicians and physicians, and the inherent mobility of patients.
Step 3: Option Assessment
The third step is to assess the options associated with each of the strategic decisions above. This is the often the hardest part in defining a wireless strategy, as it involves a certain degree of subjective reasoning in addition to objective planning. Therefore, it is advantageous to use internal (i.e. domain knowledge) and external (i.e. industry experts) resources. An effective methodology is to analyze the decisions reached in Step 2 for alignment around people, process and technology. These may include the following:
- staffing;
- budgeting;
- operations (i.e. workflow integration, social motivation, structural implementation, training, documentation and acceptance testing);
- quality (i.e. plan, do, study, act) and;
- financials (i.e. dashboard and scorecard metrics, revenue cycle management improvements and benefit to cost ratios).
Fundamentally, organizational risk is best addressed in this stage. Scenario planning is useful to identify different wireless solution alternatives based on the healthcare organization’s tolerance and culture of risk. For example, if a bring-your-own-device (BYOD) strategy is permitted, scenario planning should address as many identifiable issues as possible. These include but are not limited to personal vs. private use of wireless assets, the choice of wireless technologies available to the user, policies governing the latter (i.e. use of Wi-Fi inside the facility and use of cellular elsewhere) and HIPAA security and privacy compliance (i.e. not permitting storage/caching of PHI on personal wireless devices/assets).
Step 4: Strategy Execution
A project management approach is required for effective execution. Otherwise, business and technical issues may arise leading to waste, poor quality and security and privacy vulnerabilities. A phased approach is best based on three facets: planning (i.e. goal setting, team formation), scheduling (i.e. resources, funds) and controlling (i.e. costs, budget, and quality).
By following the above steps, a healthcare organization can significantly reduce its exposure to both foreseen and unforeseen risk. However, the process doesn’t end in Step 4.
A risk–conscience culture must be institutionalized using a continuous improvement process that is timely, relevant and consistent. A probabilistic decision tree analysis is one way to analytically assess a variety of different decision concerning what wireless technologies to consider and their quantifiable impact to stakeholders for a myriad of evaluation criteria (i.e. cost, benefit, responsiveness). Similarly, leveraging the healthcare organization’s CTO office is a prime way to monitor and survey technology trends. The use of marketing tools such as surveys and other surveillance approaches will provide meaningful information about product and placement of relevant wireless services.
In a similar vein, the CFO office can provide invaluable guidance regarding the economic value add (i.e. net revenues and uplift to revenues) pertaining to implementation of wireless services). Finally, the IT office can perform a vulnerability assessment to determine what, if any, risks and exposures are present to the organization arising from the use of wireless technologies. In this way, the healthcare organization can avail itself of the advantages that wireless provides to positively affect its mission.
Eric B. Abbott, MMI, MBA, MS, is director of product management for ExteNet Systems, Inc. ExteNet Systems designs, builds, owns and operates distributed networks in key strategic markets for use by wireless carriers and venue owners.
