M2M & Internet of Healthcare Things€¦ · + Wearables: Instead of subjecting a patient to a...

White Paper / Healthcare

M2M & Internet of Healthcare ThingsHealthcare IT Enabled by 4G LTE

WHAT YOU’LL GET:

+ An overview of the Internet of Healthcare Things (IoHT) with examples of practical, cost-effective IoHT applications

+ Considerations for choosing a solution for your organization

+ The advantages of 4G LTE connectivity over wired solutions

+ Considerations and best practices for network security with IoHT applications

+ A Customer Success Story featuring Healthsense

UTILIZATION OF INTERNET OF

THINGS & M2M TECHNOLOGIES

AMONG HEALTHCARE ORGANIZATIONS

GREW 40% IN 2014.¹


©2015 Cradlepoint. All Rights Reserved. | +1.855.813.3385 | cradlepoint.com 2

Major market forces are reshaping the healthcare landscape. Sweeping changes ushered in by the Affordable Care Act and a public mandate to stem continually rising healthcare costs mean that healthcare providers must find ways to become leaner and more efficient without sacrificing quality of care or patient service. These pressures have begun to turn the standard reimbursement model on its head, shifting from a pay-for service model to a pay-for-value model that focuses on wellness and prevention.

Patients, too, demand a greater focus on wellness and preventive services. With the Internet at their fingertips, patients now feel a greater sense of empowerment and choice, and are driving the “consumerization of healthcare.” Today’s savvy patients seek providers who can turn the litany of available patient data into actionable, personalized insights, and help enable wellness outside the doctor’s office.

New paradigms in healthcare IT provide care providers the best of both worlds: superior care with less overhead. Machine-to-Machine (M2M) communications automate previously manual processes, gather real-time data, and allow machines to communicate without human intervention. M2M technologies promise to create massive efficiencies and a transformed patient experience, both within and outside the provider’s walls. However, these technologies are largely untested and healthcare as an industry has traditionally lagged in its ability (and willingness) to adopt cutting-edge technology.

Healthcare organizations sit at a crossroads. Those that can find effective and safe ways to offer intelligent care services will find themselves at the forefront of an increasingly competitive field. Organizations that delay in implementing new technologies, or make poor IT investments, will fall behind—to the detriment of both their patients and their business operations.

This white paper explores considerations for choosing healthcare solutions that ensure secure, reliable, and cost-effective network connectivity; how network administrators are enabling mobile Internet access through 4G LTE; and the advantages of 4G LTE connectivity over traditional wired solutions.



THE INTERNET OF HEALTHCARE THINGS (IoHT)

The healthcare system of the future will function like a living organism, with the Internet of Things for Healthcare (or the Internet of Healthcare Things) serving as a central nervous system that controls every aspect of operations. However, for a number of reasons, healthcare institutions have been slow to implement IoHT applications. Use is now on the upswing, and the race is on to see which providers will be able to most effectively implement intelligent systems to become market leaders, and which will get left behind. IT professionals enthusiastic to bring the Internet of Healthcare Things to their organizations should begin with applications that are immediately practical and can bring a big boost to the bottom line.

EXAMPLES OF PRACTICAL & COST-EFFECTIVE IoHT APPLICATIONS INCLUDE:

+ Wireless Real-Time Location Systems (RTLS): RTLS allow IT administrators to “tag” medical equipment with radio frequency transmitters to quickly locate the devices using cloud-based applications. These systems can also trigger location-based device actions. For example, to help keep patient data more secure, the RTLS can prompt a device to automatically log off of the network if it leaves a secure location. These systems have the potential to save institutions hundreds of thousands, if not millions across their organizations.

+ Wearables: Instead of subjecting a patient to a litany of redundant questions from multiple practitioners, healthcare institutions can store the patient’s electronic health record (EHR) in wearable technology that practitioners can view and update in real time. Each practitioner that comes in contact with a given patient is able to spend less time on intake questions.

+ Medical Device Monitoring: Medical devices that need maintenance or supply refills can be monitored remotely; when a problem arises or supplies become depleted, the device can send an alert. This helps to ensure proactive maintenance and to avoid costly shutdowns or scheduling conflicts due to a lack of needed medical devices.

MANY LARGE HEALTHCARE

INSTITUTIONS CURRENTLY

PURCHASE THREE TIMES MORE

EQUIPMENT THAN THEY ACTUALLY

REQUIRE, COMPENSATING

FOR DIFFICULTIES IN LOCATING NEEDED

EQUIPMENT.²


CHECK-IN KIOSKS

Under traditional systems, each patient visiting a provider would need administrative attention in order to check in, update personal and insurance information, complete copayments, and schedule appointments. Patients might wait in line to check in for an appointment and then see long wait times after checking in with administrative personnel. Many of these processes also required significant “back-end” administrative resources dedicated to data entry from paper forms filled out by the patient, and often left patients’ personal information at risk of being compromised.

Today, forward-thinking providers use patient kiosks to streamline simple data entry, as well as help create a more personalized experience for the patient.

With kiosks, patients can:

+ Check in for appointments

+ Complete healthcare & personal questionnaires

+ Scan drivers licenses and insurance cards

+ Set appointments

+ View account balances and pay for services

+ Review medical information on file

+ Use interactive maps for navigating the building or campus

Patients also benefit from the use of check-in kiosks; they will likely see reduced waiting times, and some people feel more comfortable divulging facts about their medical history in more private interactions.

Veterans Affairs hospitals began introducing check-in kiosks as early as 2011. Administrative personnel are on staff to help users learn to navigate the kiosks, and those patients who refuse to use the kiosks may utilize traditional processes. While the kiosks don’t (and shouldn’t) completely eliminate the need for administrators to help with the check-in process, they allow multiple patients to check in at once, greatly enhancing the speed and efficiency of the process for both parties.

WAITING ROOM KIOSKS

Implementing waiting room kiosks and interactive experiences can enable healthcare organizations to capture a larger consumer market moving forward. These types of kiosks can be used for education and infotainment as friends and family members wait for patients, patients wait to be treated, or as a part of a pre-op experience.

Practical applications of waiting room kiosks include:

+ Education for oncology

+ Teaching proper dental care for toddlers at dentist offices

+ Prenatal best practices

+ Games and apps provided for infotainment

+ Health and wellness or customer satisfaction surveys




TELEHEALTH KIOSKS & “CLINIC-IN-A-STORE”

Providers, public health organizations, and researchers searching for ways to make wellness a regular part of every patient’s life are pioneering new uses for kiosks with integrated M2M technology to meet (and sometimes treat) people where they already are—whether that happens to be at work, at the mall, or on the street.

While the concept of diagnostic kiosks isn’t a novel idea—blood pressure stations in pharmacies and grocery stores have been around for decades and are used by some 70 million people annually—M2M promises to dramatically increase the capabilities and efficacy of such measures. Today’s “clinic-in-a-store” kiosks gather data such as height, weight, and age, test vision (and yes, blood pressure) and update patient health records on the spot or indicate whether the patient should seek further medical advice. The kiosks often save the test results, and the patient can review them and track progress at the kiosks or even online from home.

Some kiosk deployments aim for even more ambitious (and complex) care objectives that require connecting patients to physicians in real time. For example, a patient may use a kiosk to conduct and transmit a retinal scan to an ophthalmologist who can diagnose common ocular disorders based on the scans. Other kiosks allow patients to meet physicians via video. Working in concert with an onsite healthcare professional, a remote physician meeting a patient via a Telehealth kiosk can conduct other diagnostic exams and make initial recommendations for further exams or treatment.

The Mayo Clinic recently piloted a set of Telehealth kiosks for “walk-in” patient visits. The kiosks, which were deployed in workplaces in partnership with various employers, included a video screen and several medical device attachments. Patients used the kiosks to speak face-to-face with the doctor and transmit physiological data to their own electronic health records using the medical device attachments, all without leaving their offices.

Other novel patient kiosk projects aim to increase medical donor awareness and identification. Often staged in retail outlets, office complexes, and other high-traffic areas, the kiosks allow potential organ, blood, and bone marrow donors to answer screening questions, view a video about the donation process, see profiles and photos of patients in need of donations, and sign up to receive a testing kit in the mail. The potential donor completes the DNA or blood testing at home and then returns the kit in the mail for testing and eventual inclusion in the donor registry.

KIOSK DEPLOYMENT PLANNING

A key consideration when deploying any type of kiosk is security and data management. Non-critical networks, like waiting room kiosks, should never be segmented on a critical network holding patient information. For example, a patient check-in kiosk should be on a completely separate network from devices like printers, surveillance cameras, imaging machines, and other “unintelligent” devices that are often easy security targets, and which hackers tend to use to pivot to lucrative information in harder-to-crack areas on the network.


Compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations should be top of mind during planning stages for kiosk deployments. Fortunately, kiosks help promote more accurate and secure data management as patients enter their information directly into the health system rather than writing the information down, creating the potential for unauthorized access under HIPAA.

One of the simplest and most reliable security measures, Parallel Networking creates complete “air-gapped” separation between devices that

are most likely to be hacked and those that store patient health and personal data by placing those devices on their own completely separate respective networks. This reduces PCI scope and is in compliance with HIPAA regulations.

Equally important, network administrators managing kiosk deployments in retail stores, offices, or other off-site locations should never rely on the host location’s connectivity solutions, but should instead plan to “Bring Your Own Network” (BYON), which can quickly and easily be executed with 4G LTE connectivity.




CHALLENGES

M2M technology has the potential to completely transform medicine, but Internet of Healthcare Things applications and patient kiosks are still relatively new healthcare tools. Healthcare IT professionals can expect that the popularity of diagnostic kiosks will continue to grow as providers iron out best practices for use. Regardless, those providers who work to be among the first to successfully implement these technologies will find themselves on the cutting edge of patient care.

The following are some challenges and best practices network administrators should consider when implementing M2M in healthcare contexts. Some of these measures, such as Parallel Networking, are implemented much easier with wireless 4G LTE solutions than wired solutions, and at a lower price point.

FLEXIBILITY

Pilot projects that need to be set up quickly don’t have time or budget to run wired lines, and kiosks placed in locations that don’t belong to the healthcare institution (such as those in retail or workplace settings) will need to provision their own connectivity. Furthermore, the healthcare institution may want to move the kiosks from time to time, so mobile connectivity is a must.

Solution: Using 4G LTE, healthcare providers can (and should) “Bring Your Own Network.” Because 4G LTE requires no wired lines, it offers the flexibility, cost-effectiveness, and speed-to-deployment required to make patient kiosks a viable (and portable) strategy.

CENTRALIZED MANAGEMENT

Successful M2M and Internet of Healthcare Things deployments provide the best results in economies of scale, but managing hundreds or thousands of routers in a multitude of remote locations can quickly become an unwieldy and expensive task.

Solution: Identify a connectivity solution that will provide remote deployment, management, and troubleshooting to avoid costly truck rolls and time-consuming service calls.

SUCCESS STORY:HEALTHSENSE

Healthsense solutions extend the ability of older adults to live independently by monitoring their health and safety wherever they call home. Services include remote and vitals monitoring, emergency response and nurse call systems for senior living communities and caregivers.

They needed a flexible and reliable connectivity solution that could be installed quickly in a variety of living settings. The company also sought a router that could be managed remotely, provide a failover solution and offer two networks, one for its system and another for residential use.

Cradlepoint technology was selected for its cloud-based management platform and its 4G networking solutions as a primary router. This unique combination of support and deployment tools enables Healthsense to install its IoHT systems quickly and effectively.

“Remotely performing updates, troubleshooting, & monitoring the performance of every Cradlepoint we have deployed saves us considerable time and ensures our technology keeps caregivers connected with older adults.”

– BRIAN FUHR, CO-FOUNDER, V.P. OF MARKETING & BUSINESS DEVELOPMENT



RELIABILITY

Even short network outages can cause major problems for healthcare organizations. Stalled data transmissions can cause patients to get frustrated in a hurry, and should a Telehealth patient visit be cut off in the middle of an appointment, the provider runs the risk of angering the patient. Internally, a network outage might mean that intelligent systems relying on Internet connectivity cease to function, stalling operations across the institution. Any sort of prolonged outage would likely be catastrophic.

Solution: In general, 4G LTE connectivity is less subject to network outages than wired connections. For mission-critical connectivity, look for a routing solution that offers dual modems for multi-carrier interoperability and primary and failover connections all in the same device.

NETWORK SECURITY

Security considerations are often the top hindrance for network administrators. Indeed, security considerations are complex and multi-faceted, and should a data breach result in patients’ personal, medical, or financial data being stolen, the resulting fallout could damage the provider’s brand, potentially scuttling any pilot projects—not to mention that the provider could be subject to fines for failure to comply with HIPAA guidelines. Fortunately, advances in wireless connectivity now offer healthcare providers the ability to create highly secure environments.

It is important to note that before any other security measures are considered, network administrators should ensure encryption of all health, personal, and credit card data.

The following additional considerations represent a slate of important—but by no means comprehensive—safeguards to consider.

NETWORK INFRASTRUCTURE & PARALLEL NETWORKING

One of the first steps to ensure robust security is to choose the correct network infrastructure for the application. Network administrators should consider whether their applications and security policy require using a private network. If using a public network, network administrators should choose an encrypted Virtual Private Network (VPN).

Any IT administrator planning to deploy M2M or IoHT solutions should also consider employing Parallel Networks through 4G LTE connectivity. Introducing Internet of Healthcare Things and M2M applications on the network creates hundreds or even thousands of extra network “on-ramps” that could lead to a massive security breach. By keeping “unintelligent” devices off the network used to transmit and store patient data, network administrators can significantly reduce the scope of HIPAA compliance and massively reduce the potential for easy-to-hack devices to allow a data breach.

MANAGEMENT

The chosen network management solution should offer controls that separate management data from user data. In this case, configuration, statistics, and monitoring data will be transmitted from the router over a secure Internet connection to the cloud management platform, while user data is transmitted directly to its destination on the Local Area Network (LAN) or across the Wide Area Network (WAN).



PAYMENT CARD INDUSTRY & HIPAA COMPLIANCE

Keep in mind that HIPAA and PCI standards provide guidelines on configuration, encryption, and more that should be referenced throughout the planning and deployment process. Additionally, depending on the application, network administrators may seek a connectivity solution that offers Unified Threat Management and centralized, cloud-based monitoring. Network administrators should note that whenever patient credit card data may be involved—thus placing the application within the scope of PCI regulation—Intrusion Protection Services and Intrusion Detection Services (IPS/IDS) are required. Further, HIPAA guidelines strongly imply that IPS/IDS should be implemented for applications that store patient health data.

PHYSICAL SECURITY

Deploying a mobile network that extends outside the confines of the provider’s premises creates specific challenges to maintaining HIPAA compliance, especially with regard to physical safeguards. HIPAA guidelines for physical safety specifically address access control, audit control, and user authentication. To comply with physical safeguards while enabling mobility, some providers are leveraging cloud-based data storage.

It’s also a good idea to use a geofencing-enabled solution that will allow network administrators to track the location of all devices from one central location. A geofencing solution offers the ability to automatically or manually lock-down the network should a device ever leave its assigned location.

UNIFIED THREAT MANAGEMENT & BEST-IN-BREED SECURITY APPLICATIONS

Cradlepoint’s 3G/4G/LTE solutions enable Parallel Networking, which keeps credit card and other sensitive data completely separate from other applications and third-party networks. Cradlepoint’s Enterprise Cloud Manager combined with Advanced Edge Routing solutions enable best-in-breed network security applications. Powered by Trend Micro’s industry leading Deep Packet Inspection (DPI) engine, CP Secure Threat Management is a comprehensive intrusion prevention (IPS) and intrusion detection system (IDS) that can be deployed instantly through the cloud.

Combined with Cradlepoint cloud-managed networking solutions, Zscaler Internet Security enables enterprises to embrace cloud applications and mobility, all while delivering a superior user experience.

ABOUT CRADLEPOINT

Cradlepoint is the global leader in cloud-managed 4G LTE networking solutions, providing secure, business-grade connectivity for the Internet of Healthcare Things. Cradlepoint was the first to pioneer and fully enable high-speed LTE in its solutions to maximize the potential of the cloud for enterprises worldwide.

Sources1Healthitoutcomes.com2Healthcareitnews.com

GO TO CRADLEPOINT.COM/HEALTHCARE TO LEARN MORE.

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