by Alan Dash, Senior Consultant, The Sextant Group
This article also appeared in Healthcare Facilities Symposium & Expo’s The Leaflet, October 2015

Hospitals used to love it when you came and stayed for days on end. But now with recent insurance and accountability changes, they are facing significant fines for re-admission (and the resulting public perception of poor care). They want you in and out.

In the past it made financial sense to admit and re-admit patients — that’s how they got paid. However, there is substantial financial incentive to get patients out the door, and just like the old Ray Charles hit, “Don’t you come back no more.” From the healthcare provider’s perspective, this now means remote monitoring of patients. From a technology perspective, this means just keep doing what we have been doing, only on a different network type, and using different technologies.

Currently inpatient data travels on a hospital Local Area Network (LAN). If that hospital had multiple buildings on one campus, we would use a Campus Area Network (or “CAN”), to transport patient data between facilities. Stretching that into a city we would use a Metropolitan Area Network (or “MAN”), and for larger hospitals with locations across greater distances, we employ a Wide Area Network, or WAN.

To remotely monitor a patient, pre or post-care, we would use the MAN and/or WAN and we would connect that network topology to something relatively new, a Mobile Body Area Network (MBAN). An MBAN is made up of wearable and portable technologies consisting of similar sensors currently attached to patients who are in a hospital bed. Technology folks will tell you an MBAN is really nothing more than a personal LAN (also called a PAN, Personal Area Network — as though we’ve not had enough acronyms to already make a Government envious).

Like a Doctor in Your Pocket

BAN technology is not new — it’s been around since the mid 90’s. What is new are the drivers associated with remote patient monitoring and the technical ability to miniaturize and allow mobility of these existing sensor devices. MBAN sensors can include implanted devices, elements embedded onto the body, devices we swallow for temporary monitoring, and/or devices we wear or carry (by hand, in pockets, purses, or even jewelry – effectively a medical version of a Google or Apple watch). Blood pressure, EEG, ECG, SpO2, glucose, even fall detection are but a few of today’s capabilities, along with vital sign monitoring, motion detection, acceleration, speed, distance, impact, and temperature sensing.

Because the use of mobile sensors is increasing, we are seeing a re-use of existing radio frequencies that in the past were used by amateur radio, portable wireless microphones and other devices. Many of these signals have the capability of penetrating buildings, making them attractive for manufacturers (and tax-payers, should the Federal Government decide to sell additional frequencies). It is a lot more complex than this of course, and if you’re interested in a deeper-dive into frequency and power operations, I can share a few good articles.

Obviously remote monitoring can literally be performed anywhere and at any time. But while the technologies are emerging, its use is limited today due to a couple of factors. One element stifling widespread use of ubiquitous clinical monitoring is the inability of hospitals, ACO’s, and physician practices to bill for the time taken to remotely monitor patients. New codes will need to be drafted and accepted by insurers and providers to allow better billing transaction.

Another component of remote monitoring not yet stirred is the construction of clinical remote monitoring call centers. This is where the ‘old news’ meets the new. Someone will need to watch the sensors and watch the networks these sensors are running upon. Program space will need to be created for training patients and staff on the use of these technologies, space will be required for repairing and testing devices, and simulation areas will be created to teach patients how to employ these technologies in concert with their smart phones and home networks.

WAN, MBAN, Thank You, Man!

What could this mean to the built environment? Many of us can visualize a new type of hospital facility where a cube-farm of clinicians and technology staff work together to monitor sensors attached to patients and monitor networks attached to sensors. Get ready for it – WAN’s attached to CAN’s, MAN’s, LAN’s, and PAN’s connected to sensors making up MBAN’s. Future hospital renovation projects may include a decrease in program space formally dedicated to in-patient beds and in-patient services. These existing in-patient areas would be re-purposed into these soon-to-be-needed clinical monitoring centers. New hospital construction should have a larger focus on staff and training and a smaller focus on in-patient practices. It’s a lot of work.

And the effort does not stop there. Clinical will need to be flexible enough to enable faster through-put of out-patient visits since care givers will already know more about the patient walking in the door than they do today. In-house hospital wireless networks will need to be re-engineered to accept external connections seamlessly, security practices will need to be re-addressed, and emergency policies and procedures will need to be drafted for both the patient sensor activity and the networks they will be running on.

For clinicians this could create a new career field. For architects and engineers it will mean a change in program space calculation and power requirements. For most of the technology staff this will be no different than monitoring an ATM machine or point of sale terminal. Just a lot more critical.

And then in the words of Ray Charles, it’s time for patients to “Hit the Road, Jack,” and get on with their life with a song in their heart and a doctor in their pocket.

ABOUT THE AUTHOR
Alan Dash, Senior Consultant for The Sextant Group, is an international specialist in Medical Communications Systems and an expert in hospital technology design.

This article also appeared in Healthcare Facilities Symposium & Expo’s The Leaflet, October 2015