Maybe we all need something to take our minds off the debacle at HMRC, so here’s a bit more about wireless networking devices in hospitals.

Last week we published a post about medical clinical assistants, mobile devices for use by hospital professionals. We profiled one that is coming to market soon. We received two comments which I’m dragging out of the comments box and putting in a post of their own, as I think they deserve a bit more exposure:

Responses to “Information Security and Healthcare”
David French Says:
November 7th, 2007 at 8:22 pm e
… I suspect that the subject of healthcare privacy needs a shake up from top to bottom. A few questions …

* Is it clear what the customer (that’s us, not the health managers) wants?
* What ‘need’ do these ‘wants’ reflect?
* Do the legislation and ethical requirements reflect this underlying need?
* Is there suitable compliance and enforcement of the legislation and ethical requirements?
* Should we get anaesthetists and paediatric cancer specialists before worrying about privacy and security?

When we have a good answer to those, we may be able to evaluate the technical questions about encrypting data at point of entry; securing information over wifi; ensuring that laptops and tablet devices are not attractive to thieves of information, identity or property (because they certainly will be available to all of those). …

Louise Ferguson Says:
November 19th, 2007 at 7:45 pm e
A tablet device is too large and heavy for any kind of pocket (and hospital staff don’t have anything other than pockets), so tends to get treated much as a paper file would: left around on top of drug or record trolleys, unattended in corridors, on patient beds, or just plugged into a base unit for recharging in an often unattended clerk’s area of the ward. At one hospital I was told they had for years had a serious problem with theft of equipment, drugs and so on, reportedly by local junkies, and I understand the same problem exists elsewhere. Ward drug trolleys had to be chained to immovable objects, so tablet devices might suffer similar problems.

If devices are shared, there is no device owner so nobody really takes responsibility for the device (security, recharging and so on). And until costs really come down, I don’t see such devices becoming personal (each ward would require dozens). (Of course many doctors already use their own PDAs, which do fit comfortably in the pocket and are very much personal devices. They don’t get talked about as they are often not hospital equipment or part of a procurement strategy.)

I think hacking and malware come a little way down the list of problems, which tend to be pretty mundane. For example, it’s actually difficult getting a reliable wi-fi connection throughout a hospital ward (partly owing to the built environment in healthcare I guess). If a single set of paper notes is missing, things can be rejigged while they are located, but if you can’t access any patient records at all for several hours across an entire ward (and I’ve seen that happen), the problem is a little more serious.

Picking up a tablet PC from the clerk’s desk and popping into the toilets with it would, in my view, not be a problem in the average hospital ward. Data is stored remotely, but password-sharing is widespread and indeed passwords may be available in the clerk’s area. Many people do not always logout anyway, so as long as the machine has not already auto logged out already, you’re in.

It has to be said that data privacy never seems to have been much of a concern in the paper era: files lie around everywhere for anyone to pick up and read, white boards display sometimes quite personal info to any ward visitor, and telephone conversations about patients take place in the hearing of any passer by. But the difference is in the volume of data to be had for so little effort.

I don’t see any online systems doing away with the traditional informal records that every patient has - handwritten notes tucked into the nurse’s pocket, prepared at shift handover. Or on the SHO’s PDA. Wireless tablet devices promise data input and data availability at the bedside, but I don’t see tablets being used for any serious volume of input. Which may mean people are going to continue writing things down in paper files…