ROI of WIFI: Nintendo DS light in Healthcare?

Follow-up on a previous article about DECT versus WIFI in healthcare.

What are the main criteria for going for WIFI?

1. Lower communication cost
   
2. Wireless care registration
   
3. Wireless flexibility needed
   
4. Hardware flexibility needed
   
5. Communication flexibility needed
   

Lower communication cost
If your telephony costs are skyhigh, WIFI can surely lower them. Especially in situations with subsidiaries and international communication. VOIP-solutions are evolving rapidly, your organization and your customers will benefit from that evolution.
Wireless care registration
I can't see any reason why you should not switch to VoWIFI if you have already chosen for wireless care registration. Alternatively one could also state that one should not choose for WIFI if you are not going to implement wireless care registration. I would go for wireless registration because of the improved customer service and because of the lower labor time and stress. Scrupulous vendors will subsequently not hesitate to argue that, if you do not choose for WIFI, your organization is not patient-centered or employee-friendly.
Wireless flexibility needed
Lot's of changes in your building, rooms with different functions, flexible workstations, ... lots of cabling continuously needs to get moved?
Hardware flexibility (connectivity) needed
Need to couple WIFI-enabled devices and streaming audio/video? Need the freedom of choice in choosing (different) WIFI-devices from different manufacturers (Nintendo anyone)? Need to trace devices/stock/people (cfr. RFid and such)? Need to couple devices with extensive features like camera, digital pens, bluetooth and iR? WIFI can offer these convenient possibilities and offer a tailor made solution.
Communication flexibility needed
More efficient handling of calls, more possibilities to route communication to email, SMS, web, ... Coupling webtechnology is native. More choice in software solutions. WIFI is not a propriety system like DECT.

Hey, you left out "internet for customers"!
Internet for customers also offers extra headaches for security, QOS, bandwidth, configuration, invoicing and paperwork. And what about concurrent users in central parts of the building, will they encounter the bottle neck on the transmitters? There are too many hidden costs in this service. I suppose that customers/patients who really want to be online continuously already have a wireless subscription of some kind. I don't think this to be an completely pro-argument as this service has many contra's as well.

What about improved team-communication?
Sure, (unified-)messaging, limitless routing possibilities of data, availability of data, design (userfriendly visualizations) will enhance communication and productivity.
But beware of userfriendlyness of the tools and technicality of the applications. In the "ideal" situation the cellphone/PDA should handle: voice, messages, alarms and care registration (I even leave out other functionality). I haven't seen one solution yet that doesn't require employee training. Technicality might be a big cost, technicality might be the cause of faulty registration or interpretation. I would suggest taking some of your staff to a demo and let them respond voice-calls and handle alarms without training or instructions, let them think, observe how they do.

Doubts taken away:

• Quality of voice-calls is impeccable.
  
• Handover (going from one transmitter to another) is seamless
  
• Transmission is secure. I checked 3 manuals and all could provide strong security (reminder: stay away from basic WEP or easy WPA-PSK passphrases)
  
• I can't say I experienced interference. But I haven't really tested that item thoroughly. Otherwise I can't imagine that interference could be an issue, because WIFI solutions have been widespread in different offices.
  
• I still haven't got a 100% guarantee that no alarms (like fire) will be lost. But such doubt could be cleared within a SLA.

Calculating WIFI ROI in a healthcare setting

1. Write down a description of current call- and care-handling in a IF -> THEN way, followed by the needed time to perform that handling.
   
2. Write down the ideal handling of call- and care-handling. See what you can improve. Brainstorm with your staff. Write down the findings. Compare times.
   
3. Now talk your findings over with two or three WIFI-companies. Check feasibility, ask for further improvement. Make final comparison of times for handling.
   
4. Compare hardware costs.
   
5. Compare calling costs.
   

Frustrating in this exercise is that there is no way you can quantify the convenience of flexibility. It is certain that your initial hardware investments will be higher. It is also certain that your future investments and communication costs will be lower (compared to DECT). WIFI-receiving devices are more mainstream, cost is definitely lower.
Uncertain is how much you will actually save because of the future freedom in choosing the best possible solution for your organization.
Clarification: I do NOT want to cut labor time because I want to lay off staff. Cutting time is essential in allowing care-staff to spend more time on the patient/customer ... instead of loosing time with old-fashioned communication. Lowering labor time and stress in healthcare is a major issue. Also frustrating is the fact that it is nearly impossible to compare current and future employee absence caused by stress. You have to rely on your gut feeling here.

Hidden costs

• Employee training needed for working with devices.
  
• Employee time lost by devices that are not userfriendly.
  
• Power consumption of the devices (more transmitters + more devices + more battery charging)
  
• WIFI technology is newer, you need more specialized and trained experts. This will result in greater costs
  

WIFI touchscreen questions
I'm on a quest for a basic wall-mounted touchscreen with identification, browser, onscreen keyboard and WIFI. I already had contacts with Panasonic and Mobilevision but the cost of those devices might be too steep for use in elderly care (about 2.000,00 EUR/piece).
Onboard sound (speakers or headphone in) is a plus, power consumption and absence of moving parts (like ventilation) are very important features.
Such touchscreens could be easy-to-use care-registration and care-consulting devices in homes for the elderly and service-flats. They should be installed in every room, price is essential (read: low). In my humble opinion the screens of domotics, Blackberrys or even PDA's are way too small and do not offer a decent solution for interaction (FTR: SMS on a 12 button phone is not a decent way to interact!).
Maybe the cost could be lowered by a using a fingerprint protected USB-stick with a small operating system on it.

Might also write Nintendo for a more ruggedized version of the Nintendo DS Light for care registration in healthcare.

WIFI brands
http://www.ruckuswireless.com/
http://www.trapezenetworks.com/
http://www.merunetworks.com/
http://www.extricom.com/

thanks to Steven De Keyser and Lien Vleminckx from Ascom, staff at Witte Meren, Luc Thierens from Multicap, Christof Delsupehe from Avaya, Peter De Baets from Newtel, Evert Bopp - Wimaxxed, Naima Messoudi from CLB-Belgium, Stefaan Delagrange from Telecom-IT, Dirk François from Essec and Ivan Gerard from Eyepea

WIFI in healthcare = too many arrows

updated: 2008-10-13

Never in my life i have underestimated a buyers decision more than the one I am facing right now. This decision is about replacing the current PABX business phone system in a home for the elderly.
As we are building new rooms for new customers, we will have to change the current system as it's maximum capacity will be exceeded.
Replacing the current PABX/DECT solution by a new one seems most obvious. But I am frustrated by the high costs, the limitations and inflexibility towards rapid evolving technology. It is very difficult to add value (through improved team-communication, better response to customers, better logging, better compatibility with third party software, etc.). Buying a telephone solution with PABX/DECT looks like trowing away your money.
Wading through enormous piles of information and brochures, I quickly understood that WIFI gives me the best (future-proof) possibilities and added value. Team communication can be optimized (imagen an interface like MSN/Gtalk/AIM), data and voice is integrated (and coupled) in one system, integration of WLAN and web-based applications, ... flexibility galore, without expensive cabling! Moreover I can improve communication for elderly customers: big button WIFI-cellphones, big screen devices, softphones, message boards (kiosk), free possibilities like Skype, Netmeetings, etc.

The theory is obvious, the practicalities not. I spoke with 9 firms, some once, some 3 times. Each firm contradicting the opinions of their opponents, some firms making mistakes in areas/technologies they are not familiar with, each firm giving more questions and doubts than answers. As a customer I'm forced to study the possibilities and impact of the technology for an objective view.
In this study it's very easy to get completely lost in information overload. As a technical minded user it is very easy to get blinded by the thrill of the chase of new technology.

Bottom line is that WIFI is entangled in so many disciplines within my care organisation that I end up with too much different technologies, too many questions, too many sales reps, too many technicians, ... each defending their technology. I have too many arrows on my diagram ...

WIFI Plus

• No slowly dying technology like DECT. "It is clear that VoIP technology will replace traditional circuit-switched telephony in the enterprise. It is no longer a question of if, but when enterprises will migrate to IP-based telephony solutions. This is where WiFi holds a clear advantage over DECT, or any other proprietary TDM-based wireless solution. WiFi allows for end-to-end IP telephony making it the most elegant — and cost-effective — technology for enterprise wireless in the long run."
• Connectivity: all WIFI devices can be connected (no propriety installation like DECT)
• Compatibility: all (current + future) applications can be coupled to this one voice + data-highway
• Limitless configuration- and management- possibilities
• Flexibility: end solution being *exactly* what a customer wants, dataflow (like for example UMS) can be tailor made
  
• Possibility to add "tracing" to your network
• Cost of communication will go down as more people will use VOIP (instead of landlines)
• No expensive wiring.

WIFI Minus

• Battery-life of mobile WIFI-devices is 8 hours maximum. In a care-environment this could be insufficient.
• Range of WIFI-transmitters is smaller than it's DECT counterpart. You need more transmitters (about 30% more).
• Maximum length of an UTP (cat 5) cable is 100 meter.
• What if the switch has a defect? Default backup-solution is essential.
• Power-out = no communication possible.
• Cost of installation (a lot higher than traditional solutions, although no cabling is required)
• No completely integrated and proven solution in a healthcare-setting. Where can I personally witness a working WIFI-installation and ask for user-feedback?
  

Questions

• Is quality of voice communication with WIFI inferior to other solutions? As i've used different Java-communication-apps frequently, I can't say I've ever experienced any quality loss though. But this situation is a single user situation.
  
• Is it possible to have different ringtones on a DECT-phone. This is, can the receiver perceive a distinction in ringtones on a mobile dect-device, if it's origin differs. Origin could be: inbound call, room service, fire-alarm, etc.
• How much will internal WIFI communication cost? I fail to see any costs, 3 sales reps claim the opposite.
• Is seamless handover (from one transmitter to another) guaranteed with WIFI-handsets?
• Alarms-handling: How are alarms handled? Is it possible that a certain alarm(-signal) gets lost?
• Is WIFI secure? This is the communication itself, access to the network and usage (bandwidth).
• How much capacity should the switch have? How many lines are needed for, as example, 10 staff people and 70 customers?
• Will WIFI-devices interfere with one another?
• How much different actions do i have to perform to make an internal call, to accept an alarm, to put calls through, ... how easy can regular users perform these everyday actions?
  

Good Reads
http://www.howstuffworks.com/search.php?terms=voip&x=0&y=0
http://en.wikipedia.org/wiki/Voip
http://www.pcmech.com/article/taking-your-phone-line-online/
http://www.tmcnet.com/voip/0205/WiFi-Telephony-All-Grown-Up.htm
http://www.intel.com/healthcare/ps/mca/index.htm?iid=healthcare_mcadevelopers+tabs_overview
http://blog.abptech.com/blog/the-dect-versus-wlan-wifi-debate/
http://blog.voipsupply.com/mobile-voip/dect-vs-wi-fi-death-match%E2%80%A6who-will-be-victorious
http://www.chcf.org/documents/chronicdisease/HealthCareUnpluggedTheRoleOfWireless.pdf
http://www.texting4health.org/slides/Landscape%20of%20Texting4Health-R%20Adler.pdf
http://www.ehealth-connection.org/files/conf-materials/mHealth_%20A%20Developing%20Country%20Perspective_0.pdf
Considerations for deploying Voice over Wireless LANs (25' webcast registration required)

Thanks to
Nextel http://www.nextel.be/
Essec http://www.essec.be/
Telecom-IT http://www.telecom-it.be/
Newtel http://www.newtel.be/
Avaya http://www.avaya.be/
Televic http://www.televic.com/
CLB http://www.clb-belgium.be/
AMR-ICT http://www.amr-ict.nl/
Tadicom http://www.tadicom.com/

Follow-up article: http://zorgbeheer.blogspot.com/2008/11/roi-of-wifi-nintendo-ds-light-in.html