Project Description

The communications sector as a whole has reached an interesting juncture, not least within the healthcare sphere. The roll-out of 4G networks to replace the incumbent 3G network has been pre-empted with complaints that the previous 3G system, which showed a lot of promise, has never had the wide geographical coverage that many users would have desired.

This has left providers with two potential aims – not only to introduce the new higher speed connections but also to ensure that coverage is sufficient to meet user demands. This has been partially fuelled by the rampant consumption of mobile devices such as smartphones and tablets which rely heavily on good bandwidth to fulfil their potential.

The healthcare sector is equally watching developments with baited breath to see if providers can offer the levels of service that could be used to support their communications needs. With a wider move to using bespoke apps and the popular embrace of Bring Your Own Device,  BYOD, there is more pressure than ever for organisations to utilise new ways of working and new methods of communication. All this leads us to question, how will the future of communications play out for the Healthcare sector.

The Trends
It is already clear that smart devices have become an important tool for most professions and healthcare sector professionals have equally embraced this. Traditionally, the UK National Health Service (NHS) sees a new influx of doctors in February and August following graduation and the latest young generation will be highly fluent in smart devices and the numerous methods of communication these offer, super-users with high expectations from the technology they use. Often they will have a preference for their own devices over those offered by the employer and this BYOD expectation means healthcare communications providers need to be aware of the advantages and issues this brings, as well as the requirements to meet these expectations where possible.

Trends in smart devices and their software have also rapidly advanced. Most platforms are open to more data transfer than ever before, with bespoke apps, developed for a range of different devices, being developed for an organisation. The market for apps has never been stronger, with developers designing the software for any use (however niche) and the market indications are that within the next five years the majority of users will migrate to this way of using IT and communications, centralising everything through one device.

The need to share information with differing groups within a complex organisation helps to shape the solution used. The NHS, as a community, needs to share varying information between multiple people (including Consultants, GP’s, Nurses etc.), multiple organisations and agencies (Hospitals, Surgeries, social services etc).

There are a number of key policy drivers for change in the way communications are dealt with in the NHS which include:

  • Health and Social Care Act 2012 bringing strategic changes to how the NHS is structured and organised
  • Putting Patients First – NHS England Business Plan 2013/14 which promotes integrated care putting patient at the centre of the NHS
  • QIPP challenge – £15 to £20bn cost reductions through quality, innovation productivity and prevention

There is also a general move towards making information more readily available so the NHS can provide a better service, using one data source, with electronic records giving instant access to full patient history etc. Coordination of departments will make it easier to book appointments (with reminders), schedule activity for each patient, plan ahead for optimised business performance and to reduce waiting times (and wasted time).

There is also a potential paradox when it comes to communications and patient care. Transparency has become a buzzword for healthcare communications and readily sharing important patient information is crucial in providing care that is timely and accurately addresses overall needs.  At the same time, the NHS prides itself on ‘Putting the Patient First’ so the security of these communications, and restricting access, is equally important. Inevitably this could drive costs up, so the ideal solution is one system that can perform all the communications tasks (voice calls and data sharing) effectively whilst ensuring effective security is in place. Such a solution can help to save time and money overall. Centralisation means that rather than being assessed a number of times, a patient can have one assessment which is easily shared with all the required parties (be it the GP, hospital-based specialists, therapists or even wider to social workers for example). Sharing a single database makes the process simpler and more cost effective.

Critical Communications
Whilst undoubtedly all communications for healthcare are important, the actual Critical Communications (the real ‘life or death’ situations) need to override any other messages. If a healthcare organisation is to use the desired single messaging platform then some messages simply must take priority and reach the right people and teams.

In many ways, having all the communications routing through one system could actually present an advantage. The most critical messages can easily be prioritised, with less critical communications traffic being surpassed to ensure that priorities are clear to all those involved. Having just the one platform may be viewed as a weakness, therefore to overcome the rare cases of failure, support systems and architecture need to be considered.

With any critical messaging system there are a number of essential requirements that must be met, whatever the chosen solution. It must:

  • Have straightforward architecture with no single point of failure
  • Be as reliable as is possible
  • Be separated from normal communications to ensure messages always get through
  • Be resilient (with failover, backup and clear warnings of any problems)
  • Be supported 24/7/365
  • Be fully auditable and transparent

To date paging has been the stalwart communication choice in this environment as it automatically adheres to the above criteria. Whilst understanding the vital role that paging continues to play, we question if other options will overtake this communication method at some point in the future?

Supported Integrated Networks
From a user point of view, if there is a single communications system there needs to be flexibility on the way they access it. Whatever the device used or the way it accesses the communications stream (be it internal wired networks, Wifi or 3G/4G, LTE), the user will need to be able to access all the services and realise the full benefit. In recent years the level of available IP bandwidth has been an issue at some locations with both landline and 3G data levels being disappointing. With the increasing popularity of mobile smart devices and video streaming, there is greater than ever pressure to provide integrated communications networks that can provide the results of networks or smart devices..

The healthcare sector this has seen a marked rise in the use of devices relying on good Wifi connections within healthcare facilities and indeed medical equipment now provides wireless connectivity to share information. There are other benefits too, cleanliness benefits from the removal of wires and large computer equipment which can easily trap dust and dirt. Touchscreen devices can also be kept clean much more easily than traditional keyboards and small devices can be stowed away when not be used, to cut down on clutter throughout the facility.

So how do Wifi, GSM and other onsite communications compare? Currently, for onsite communications Wifi offers a more reliable local connection platform, for which the site has control. Mobile public networks can provide onsite / offsite compatibility but is prone to congestion and irregular service. Wifi can be fully integrated with the voice communications network using VoIP. It is generally more acceptable as it is less affected by the environment around it. However, there is high investment by providers of 4G and this likely to continue with the roll-out of future LTE systems.

For onsite and staff who are onsite and offsite and in good coverage areas have access to a high capacity connection and information systems, the use of onsite GSM removes the issues associated with public networks. A wholly owned GSM network can be designed to cover the entire site or just a portion; it also remains working when the public network is congested or not operating.  The use of Distributed Antenna Systems, (DAS), allows in building or site wide public network to be achieved reliably and when coupled with an onsite GSM system, site wide reliable GSM is a reality. The service being as reliable as Wifi may offer a highly cost-effective alternative which is removed from  the internal data communications network within an organisation.

What technology to invest in is a perpetual question for the healthcare sector, as much as any other. It’s essential that organisations invest wisely in their communications technology and it needs to see a steady return on this to make it worthwhile. Critical communications are especially important to consider. Their necessity to work means they will also often have the longest lifespan because of the upheaval and fears of reliability and downtime.  99.9% service level still means nearly ½ a day a year with a non-operating critical system.

One of the benefits of investing in a communications app approach is that the software can easily be updated or replaced.  Onsite GSM with a voice enabled WiFi can provide a robust highly featured communication system for a multitude of applications offering not only niche content and reliability, but when linked to a critical systems architecture can provide varying levels of normal, important and critical content.

As is often the case, evolution is better than revolution and long term investment can really benefit from flexibility in the technology used. Any system which can readily share information back and forth between users and the communications hub, and can grow with the market offering flexibility and choice, will have a longer lifespan than a static single technology solution such as DECT. Inevitably this will normally mean the use of IP enabled systems because to the Internet means a huge number of systems can be connected with minimal effort. IP connectively is largely future-proofed in that it can evolve with other online services. The initial short-term outlay may be substantial in providing facilities that haven’t previously had wireless connectivity, however installation costs and inconvenience can be managed in stages creating minimal disruption to the business, through integration of existing systems to the new, creating a community of technologies which can be updated and adapted over time

While technology advances and BYOD, VoIP, WiFi, Apps and mobility all become considerations for enterprises; the healthcare system needs to consider each carefully as each has implications for security, level of service, incompatibility, theft, loss, reliability and support, all coupled with auditability.

Traditionally communications investment meant choosing a specific platform on which to operate that undoubtedly made it inflexible and difficult to replace. Using a modern IP- enabled centralised communications system can allow efficient use of many existing resources as well as new devices when run on a dedicated onsite platform. It also means that critical communications can be routed by the best method available.

Realistic expectations
Whilst it is clear that implementing IP, VoIP, Smartphone Apps, IP, is theoretically  an ideal solution for many healthcare communications needs, a reality check is sometimes needed as to when and how this can be implemented in the real world. Budgets cannot always stretch for the initial costs of installing a completely new system so many organisations will find that they want to be able install a new IP-enabled central communications system which routes to older devices (such as DECT phones) on the wards, opening up the possibility of implementing   solutions for these new users at a later date.

There is a ‘chicken and egg’ situation with apps as well. Good bespoke healthcare communications apps will undoubtedly drive further adoption of smart devices but providers need to invest in these first. Whilst there are estimated to be over 10,000 apps for healthcare applications across various different platforms,  many of these are for fitness or managing illnesses such as diabetes – consumer orientated uses. Much of the development of specific hospital facility apps is currently highly bespoke to specific uses or departments. However there are distinct signs that there will be professional apps with wider uses in the near future. Much like the way the PC software market developed, these smart device apps look set to evolve from being aimed at early adopters to industry-solid apps that offer strong performance across a wide range of needs. These apps are also becoming more complex and detailed, so they will eventually offer the levels of service improvement currently aspired to by large enterprises.

Undoubtedly healthcare communications will always be a critical function of the sector. The communications industry is evolving rapidly, but all indications are that users of all kinds will continue to adopt new smart devices and many will want to use them as their primary methods of communication.  The healthcare sector and the people who work in it are just as influenced by this as anyone else. However, healthcare communications and the sharing of data in general have wider ramifications with regards to policy and law so careful consideration is essential in the roll-out of any on-going solutions.

Perhaps the biggest change is the ability to offer more choice to users in the way they want to interact. The emphasis on using IP connectivity is offering a wider scope of applications than ever before and app development is adding even further flexibility to this. This flexibility also means that organisations can feel more confident that their investments will bear long-term fruit as well as short-term benefits. Inevitably the strain on budgets means that some healthcare organisations may not always be able to prioritise upgrades immediately and may have to introduce them by degrees.

However, the marked rise in the ability to offer better patient care from modern communications is a reality, but not one without issues.  Budget, operational improvement, usability, security and adoption by staff all contributed to the need to consider comments, by department, carefully.  Having the ability to offer IP-enabled connectivity offers a flexibility that can suit most budgets and needs and could take the emphasis off the organisation in having to supply an entire communications system from beginning to end. This will have profound effects on the way the healthcare sector views its future communications needs and how it manages the opportunities of a shared information system.

Article by Multitone