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Patient monitoring in the fast lane: New York emergency department uses a virtual local area network within their existing AP network to continuously monitor patient vital signs, while running other applications on the same network

Health Management Technology, Dec, 2005 by Timothy Rhue, Michael Maloney

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High Speed Lane

Since SMC's key patient monitoring requirement was that critical alarm messages get through each and every time, we incorporated a device to manage the traffic on the hospital's wireless network. Packeteer, a provider of application traffic management solutions, had developed technology for corporate wide area networks (WANs) in which "packets" or units of digital information could be prioritized and managed appropriately on a network, depending on the application that created the packet. This saved companies from having to buy more bandwidth. We determined that the same concept could be combined with a wireless VLAN network to ensure quality of service on the OneNet system.

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The PacketShaper, an intelligent network appliance, would read the priority level of the application involved and control the section of bandwidth allocated to that priority, much like a traffic cop. To route the large amounts of critical data (e.g., waveforms) coming in from patient monitors and keep this separate from other applications' data on SMC's network, it would allow only those packets with a patient monitoring tag to go in the larger, high-priority bandwidth (the equivalent of a "high-occupancy" or "high-speed" lane).

In this way, we were able to prevent the network from bogging down, and allow a continuous flow of critical information. If the administrative applications ever reached a point that maxed out their assigned bandwidth (controlled by the PacketShaper), the transfer rate of that data would automatically slow down.

We first used the PacketShaper to view the data that was already running on SMC's network, packet by packet, from multiple applications. Then we set up the prioritization by application, utilizing the appropriate bandwidths for each.

To test the new wireless system, over the course of a week in early March 2004, 10 monitors and up to seven laptops were set up to transmit a large patient monitoring file including simulated data (ECG, NIBP and pulse oximetry), while running HIS data simultaneously. There was no degradation in information throughput. Then we reversed the process, flooding the normal application bandwidth to see if it affected the monitoring side. Again, there was no overflow, and no loss of quality in the monitoring information.

Benefits of Continuous Access

The transition to the new wireless system was completely seamless for out day-to-day ED staff. To switch from a wired network to wireless, the Ethernet cable was simply removed from each monitor, which automatically changed over to wireless operation. Outwardly, everything else stayed the same.

Today, all 10 of our patient monitors can be moved to any of the 22 beds in Samaritan's ED, and they share the same wireless network used by the 80 HIS laptops located throughout the hospital. Whereas SMC's old telemetry system only captured the patient's heart waveform, now our ED staff has access to all vital signs monitored and recorded continuously via the Wi-Fi access points, with no loss of signal. The nurses do not need to stay with the patient every minute to observe the vitals; instead, they can see the data on a central monitoring screen at the nursing station, or on monitors at the patient's bedside. The PacketShaper continuously monitors the integrity of the network, providing 100 percent connectivity at all times so that alarms reach their intended destination within one second.

Health Care Industry

Patient monitoring in the fast lane: New York emergency department uses a virtual local area network within their existing AP network to continuously monitor patient vital signs, while running other applications on the same network

Health Management Technology, Dec, 2005 by Timothy Rhue, Michael Maloney

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