$$ - Mobile broadband for clinicians

Introduction

While 10 years ago, using a laptop outside of your home or typical workplace could be classified as “mobile computing”, truly mobile computing these days infers mobile Internet connectivity.

Unlike the wireless (Wi-Fi) networks found in many homes and small businesses, which sport coverage areas of up to only a couple of dozen metres, mobile Internet solutions utilise mobile phone networks to provide vastly greater coverage zones. Basically, anywhere you are able to use your mobile phone, you should also be able to access the Internet.

Benefits

While the relatively poor performance of older wireless mobile broadband technologies limited their usefulness, modern iterations perform extremely well with all but the most network intensive applications.

Clinicians can access their email, browse the Web, update their blogs, relax in front of YouTube, download music, and email holiday photos within minutes of them being taken.

Thanks to recent performance improvements, the use of Skype and other computer-based Voice over IP (VoIP) and video conferencing solutions is now also feasible, albeit with slightly lower voice and video quality when compared to wired Internet connections.

Remote access

Over and above these generic computing tasks, the most obvious benefit mobile broadband affords clinicians is the ability to access their practice database remotely, regardless of their physical location. Typically this access can be facilitated via remote access solutions such as Terminal Services, VNC, pcAnywhere, Citrix, or one of the myriad of other proprietary solutions available.

With some practice software products, directly accessing the database is also feasible, although it is advisable to check with your practice software vendor and IT support professional to ensure adequate security measures are in place.

Mobile remote access can be particularly beneficial to clinicians in settings such as hospitals and aged care facilities where suitable Internet access is typically either heavily restricted, or nonexistent.

While many clinical software packages have long had “briefcasing” or off-site synchronisation functionality, remote access negates the need for databases to be copied from the practice’s server to the laptop, and later synchronised. By alleviating the need for clinicians to transport their clinical data on their laptops, the chance of such data being stolen along with the laptop is effectively eliminated.

Redundant Internet connectivity

With the exception of medical practices that host their practice software in a remote data centre, the temporary loss of Internet connectivity in most medical practices is typically classed as an annoyance rather than a catastrophe. Despite this, there are an increasing number of clinical and administrative functions that cannot be completed in a timely fashion during periods of Internet downtime.

Online verification of patient details and other Medicare Online functions, the downloading of pathology and radiology results, secure messaging, automated bank reconciliations, and online backups cannot be performed in the absence of an active Internet connection. Coupled with the fact that both Shared and clinician accessible Personal Electronic Health Records are starting to emerge, medical practices will be in less of a position to tolerate Internet outages.

With these considerations in mind, many practices may find the instigation of a redundant Internet connection that is not dependent on the copper wire telephone system to be a worthwhile exercise. An automatic “fall over” system that will utilise a wireless connection in the event that the practice’s primary Internet connection fails can be established with minimal investment in hardware and IT expertise.

Technology

While all mobile broadband technology is often referred to as “3G”, this umbrella term encompasses a range of telecommunication technologies that have widely varying capabilities and performance profiles. The confusion generated by this term is compounded by the fact that many mobile wireless broadband solutions are able to connect to multiple network types, and seamlessly switch between these based on the signal strength of the available networks. In short, the term 3G does not convey any useful information and should be dismissed as a marketing buzz word.

The two terms that would-be purchasers of mobile broadband solutions do need to be aware of are HSDPA (High Speed Downlink Packet Access) and WiMax.

WiMax was the wireless network technology that the now defunct OPEL consortium had planned to roll out to complement an investment in ADSL technology. With the OPEL contract having recently been cancelled by the Federal Government, the chance of WiMax becoming a widely deployed network infrastructure in Australia in the near future is slim at best.

A significant investment in HSDPA technology has occurred in recent times, with most of the deployed infrastructure forming part of Telstra’s Next G national mobile network. Optus, Vodafone and Three are also deploying HSDPA technology, however presently, the network coverage provided by these Internet Service Providers (ISPs) is restricted to capital cities and a few major metropolitan areas.

Mobile Broadband Hardware

Mobile broadband hardware comes in many shapes and sizes:

USB

As essentially all computers (mobile or otherwise) have USB ports, this interface is the default option for mobile broadband solutions. The modems vary in shapes and sizes, but are all typically around an inch wide and two to three inches long.

ExpressCard

This portable expansion technology emerged a few years ago, but is not yet a feature in all laptops. ExpressCards are inserted into a slot, which means the awkwardness of having an external device can be minimised (however note that most have antennas that protrude outside the laptop case).

Because the technology is geared towards mobile devices, an ExpressCard can’t easily be used with a desktop computer, limiting its flexibility somewhat.

PC Card (PCMCIA)

The long-lived precursor to ExpressCard technology, the PC Card interface is still supported by several ISPs. It should be noted however, that ExpressCards can be inserted into PC Card slots using an adapter. For this reason, if the user wishes to purchase a card-based modem, the author recommends purchasing an ExpressCard and an adapter instead of a PC Card to minimise the chance that the modem will be made obsolete by the purchase of a new laptop without a PC Card interface.

Desktop solutions

Desktop solutions are also available, but their size and requirement for an external power source limit their suitability for mobile use.

Wireless broadband routers

Hardware solutions exist that can route the connection from a wireless mobile broadband modem to an entire Wi-Fi or cabled Ethernet network. Similar to an ADSL router in appearance, these devices typically contain either a USB port, or a PC Card or ExpressCard slot to allow one of the aforementioned types of wireless broadband modems to be connected.

While not suitable for mobile use, this type of device is ideal for establishing a redundant Internet connection of the type described earlier in this article.

Internal capabilities

As occurred with short range wireless (Wi-Fi) networking solutions some time ago, laptop manufactures are starting to include wireless mobile broadband capabilities in their core feature sets. Smartphones, Ultra-Mobile PCs and laptops are emerging that support HSDPA networks, requiring only that the user inserts an ISP SIM card into the designated slot. As the antenna and modem technology is fully integrated into the device, the user will not require any additional hardware to access wireless broadband networks.

Mobile phones

For many years, it has been possible to share a mobile phone’s network connection with a laptop or desktop computer using a USB or Bluetooth connection. As you would expect, many present day phones also offer this functionality, albeit at much greater speeds and lower costs than their ancestors facilitated.

Before purchasing a wireless mobile broadband modem for use with your laptop, it is recommended that you check to see if you could instead utilise the network capabilities in your phone to access the Internet.

Performance

The theoretical capacity of Telstra’s Next G network is currently 14.4MB/s, however this is slated to be increased to an impressive 40MB/s in 2009.

Despite the capacity of the network, currently shipping mobile broadband modems top out with theoretical download speeds of 3.6MB/s and 7.2MB/s, however Telstra quote lower “typical speeds” for their service.

As with all wireless technology, real world performance will vary greatly, and is dependent on many factors such as the distance of the modem from a mobile tower, whether you are indoors or outside, what the surrounding buildings are constructed from, whether you are using an external antenna, and how many people are accessing the network simultaneously.

Using Bigpond’s “7.2 USB Mobile Card” in Canberra, the author was able to download a 100MB file in 250 seconds. Uploading the same file took 670 seconds, for real-world download and upload speeds of 400KB/s and 152KB/s respectively.

For the purpose of comparison, the same file was transferred using an ADSL2+ connection registering a link speed of 12MB/s and 1MB/s in the download and upload direction respectively. Downloading the file took 90 seconds and uploading it took 980 seconds. While the ADSL2+ connection out performed the wireless technology in the downstream direction, the performance of the wireless connection was still impressive, soundly trouncing the ADSL2+ connection in the file upload test.

It should be noted that pure upload and download performance is not the only indicator of the performance of a network connection — a characteristic of mobile broadband solutions that needs to be pointed out is that they have a higher latency profile than cabled connections.

Ad hoc testing of the performance of the author’s Bigpond Next G connection produced ping response times of around 90ms, however on the odd occasion, the response time slowed to as much as 400ms. By way of comparison, the author’s ADSL2+ connection registered a ping response time of 20ms, 33% better than an ADSL connection that clocked in at 30ms.

Technical jargon aside, the higher latency basically results in an Internet experience that is slightly more “jerky” than that associated with a modern hard-wired connection. For many typical tasks such as email and web browsing however, the difference between an ADSL or cable connection and a wireless broadband connection will barely be noticeable.

While Telstra’s Next G network touts a coverage footprint of around 99% of Australia’s population, other ISPs offering mobile broadband services rely on slower GSM networks to provide Internet access to their customers outside of their broadband coverage areas. The net result is that when a user of one of these services travels outside of the coverage area, the performance of their Internet connection will dramatically decrease, and they may be liable for exorbitant “roaming” data charges.

Costs

Compared to wired Internet services, the costs associated with wireless mobile broadband are not trivial. Prices have been steadily falling since Optus, Vodafone and Three deployed HSDPA technology, however it is made apparent by Telstra’s pricing structure that the organisation does not consider the smaller mobile broadband ISPs as serious competition at this point in time.

Due to the variable nature of prices and data plans, a comprehensive cost comparison of the various mobile broadband services available is outside the scope of this article. As with mobile telecommunications, there are a wide array of plans available and it pays to shop around and take advantage of the try-before-you-buy options on offer.

Conclusion

Mobile broadband technology has, and continues to, evolve rapidly, improving in both performance and coverage. As with the introduction of mobile phones, mobile broadband will give rise to new products, services and workflows that were not previously feasible.

The technology promises positive implications for the delivery of healthcare, providing clinicians with timely access to information at the point of care, where ever that may be.

With computer and phone manufacturers starting to build the technology into new hardware offerings, mobile broadband will rapidly become more pervasive, and ultimately, common place.

Presently, viable competition for the wireless broadband capabilities of Telstra’s Next G network only exists in capital cities, and the recent unwinding of the Opel contract by the Federal Government means that this situation is unlikely to change in the near future. Baring regulatory intervention or a significant investment in HSDPA infrastructure by a consortium of smaller ISPs, the mid-term prospects of national mobile broadband competition emerging are not much better.

Posted in Australian eHealth

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