A system for Kingston Hospital

Proposed System

A table PC that allows the users to: -

• Obtain information from different departments about patients e.g. patient record.  The system is accessible by using a username and password.  The device transfers information over a secure server and use Wi-Fi technology to transfer the information.  Bluetooth has not been used has it can only be used within 10 meters of the connecting system.
• The device can also be used as a source of reference for each user allowing them to obtain the latest information on medical news e.g. latest research news.  This is useful as Doctors will not longer need to reference from books or wait for the information to be sent to them.  The information will be stored on a database and updated when needed.  This ensures that all users have the latest information needed all over the country.
• At present, a patients’ record are on hardcopy and for a patient to move from one GP to another, their record will also need to be moved.  A copy of the patients’ records will be kept electronically making it easier for the Doctor to access.  The information can then be printed and used to update the hardcopy of the patients’ record.  This saves time when ever patients’ record need to be accessed in an emergency.  
• All data will be backed up on a server at regular intervals.
• The system could be used to remind patients of their appointments.  Currently the NHS loss a lot of money and time because patient do not turn up for their appointments.  When making a appointment for a patient, the date could be input into the device.  24 hours before the appointment, a text message could be sent to the patient giving them the details of the appointment as well as how to cancel it if needed.  Patient’s will need to sign up for this system and sign a form to state that they know that details of their appointment will be sent to their phone.  It covers the hospital as far as the DPA is concerned.  No details of their meeting will be sent by text due to Doctor, patient confidentiality.  The system will work using reverse charging where the patient pays for the text e.g. 50p per text.  17p of it would go to the service provider e.g. T-mobile and the other 33p could go to the NHS to help maintain the system.  
• The system could also be used for making notes or used as a pager for the users.
• Cell location information could be used to locate the doctors within the hospital in case of an emergency.  This aspect of the system may be expensive and may be considered for future development.
• Used for video conferencing from one Doctor to another.

Current state of technology and information systems

Current problem

Currently within KH: -

• Patient records are kept on hardcopy and passed from department to department as needed.  The information is then sent to the patients GP when the information is no longer needed.

The Cost to the NHS - Accoring to REMtext (REMtext (2002) Lazy patience’s cost NHS £300m a year [Online] Available on <http://www.remtext.com/dailymail.cfm> [Accessed 02/03/04]), the NHS loss £300m a year because patience forget to turn up for appointments and can not be bothered to turn up.  A third of people asked forgot about the appointment.  As part of the system, Doctors will be able to make appointments for patients during a consultation on the system.  The system is connected to the central database which stores the appointment of the patients.  48 hours or 24 hours before the appointment, an SMS message, email, or automated phone message is sent to the patient.  Before this is possible, the patients will need to sign a form concerting to this as well as confirm the type of service they would like to receive.  All messages sent electronically would be encrypted for security reasons.

Current state of technology and information systems

At present, patient records are kept and updated manually.  Patients are referred from their GP to the hospital or can walk into A&E to be seen.  Not all patient information are sent from A&E to the patients GP as this is time consuming and patients so not always remember the details of their GP.  Some people that visit A&E do not have a local GP and sometimes give incorrect personal details e.g. their name and age.  For information to be sent from the hospital to a patients GP, the information is sent manually.  

For all patients that visit KH, a Patient Admin System is used to keep track of patients that visit.  Patients that visit are given a unique ID that only referrers to their visit to the hospital.  Patient appointments are made at the hospital and given to the patients on a card.  The NHS currently have a system that allows patients to book appointments with some hospitals over the internet but at present KH are not part of the system.

The IT department at KH tried to introduce PDAs for the Doctors to record their working hours.  This system failed as the system as the system was fragile and was not used regularly.  Another explanation as to the failure of the system could be the purpose of the system.  As the system was not compulsory and was not a critical part of the Doctors’ daily duty, it was not essential and therefore not used regularly.  

NHSnet is the NHS main system that deals with the connection of all NHS services as well as th development of new projects to bring the NHS service into the 21st century.  Some of the currently available on form NHS.net include: -

• EDI (Electronic Data Interchange) - The exchange of information from departments like Pathology to the GP.  Some approved third party softwares areused in this exchange
• On-line booking of minor surgeries for pateitns over the internet directly to be required hospital by a GP
• Exclusive information for all NHS professionals.

Health Secretary Alan Milburn announced an additional £60m investment to accelerate the Government's plan to revolutionise patient care using new information technology in the NHS.  This financial boost has so far been used to develop the system the NHS is currently using e.g. making the NHS WAN more secure.  The money has also been used to start up new projects and expand current projects e.g. making all NHS hospitals have VoIP.

Mobile opportunities

• Universal service network defined profiles using usernames and passwords – This will ensure that only authorised personal have access to patient details or other confidential data.  This will be unique for each user.
• Seamless connectivity within the hospital grounds – This will ensure that data is accessible when ever needed with no reconnection needed.
• WLAN – Wireless LAN has some security aspects that will need to be addressed but can be more convenient in a medical setting. As it is wireless, there will be no need for cables or the extra cost to have them put in.  This will use Wi-Fi standard (Wireless Fidelity using the IEEE 802.11 standard).  The different standards have different cons and pros.  KH will need to look into this to see which standard best suits them (e.g. 802.11b was geared for the home user whilst 802.11a was geared at he business market and more costly).  802.11b and 802.11a use difference and can not be used side by side.  For this to be possible, KH will need to consider using a hybrid 802.11a/b that implements both standards side by side.  802.11a has the fastest maximum speeds, does not allow form interference from other devices and supports simultaneous users.  For this reason it is stronger than 802.11b.  On the other hand, 802.11b is less expensive and has a higher range signal which means it is not easily obstructed.  Apart from 802.11a and b, one of the other common standards is 802.11g.  This supports a bandwidth of up to 54 Mbps like the 802.11a and uses the 2.4Ghz frequency for a greater range.  This standard has some of the pros of 802.11a and some of the cons of 802.11b.  For a decision on what standard to use, the system designers at KH will need to look at the layout and budget of the project to decide which would be more suitable for this project.  One of the technologies for Wireless networks that has not be considered for this project is Bluetooth has it only allows for short range connectivity and is not very secure.  Only the 802.11 standards, Bluetooth does not have as much pros as 802.11a, b and g.  In short, Bluetooth does not offer much benefits for WLANs.
• QoS (Quality of service) – The aim of QoS is to guarantee
• AP (Access Point) – Access point needed for connection to the WLAN
• UTMS (Universal Mobile Telecommunication service) – Used for video conferencing and other real world streaming information.
• GPRS (Global packet radio service).  If this technology will be considered than other supporting attributes have to a lot be looked at e.g. GGSN (gateway GPRS support node)
• Mobile IP address (IPv4)
• SCTC which allows multi-homing to be made e.g. between 2 separate networks

Technology options

Alternative technologies

VoIP allows calls to be made via a computer network over a data network e.g. over the LAN at KH. This transfers voice into digital signals that travel through the network until it gets to the destination and converts back.  A trail using VoIP (http://www.nhsia.nhs.uk/nhsnet/pages/voice/iptel/pilot.pdf [Access 15/05/03]) has already been carried out by NHS.net and was success.  As this system is already in place, it may be considered as it would save money and also MMS is a service that allows media message to be sent across a network e.g. sending pictures of patient x-rays rather than viewing it using UTMS for video conferencing.  

Partnerships

The NHS currently have a partnership with BTand Cable & Wireless.  Both companies deal with the NHS

Other partnerships to consider

• When delivering the system solution, we will be working with VODAFONE uk when looking at the 3G data network card. With this you can log onto NHS network to get information about patients if necessary, or other further information on related subject.
• Working with Symbian as an operating system, good for mobile devices
• Supplying the network will be CISCO
• The tablet PCs will be supplied by SONY, DELL, SAMSONG
• Symbol- Mobile Application Gateway (MAG)

Likely issues with implementation

Likely issues with implementation

There are key issues associated with using video conferencing that has to be taken into consideration e.g. the quality of the images received vs. the speed of the information received.  One alternative that may be considered is using VOIP (Voice over IP) along with MMS (Multimedia Messaging Service).  VOIP (aka IP telephony) allows calls to be made via a computer network over a data network such as the Internet. This transfers voice into digital signals that travel through the network until it gets to the destination and converts back.  MMS is a service that allows media message to be sent across a network e.g. sending pictures of patient x-rays rather than viewing it using UTMS for video conferencing.  Companies like NowSMS allow for free trails of their MMS software to be used.  This can be used to the trail within the hospital and then purchased if the service it offers meets the requirement of the project.

Data Protection Act (DPA)

All personal data most compile with the DPA.  As personal data will be passed from one place to another, and viewed by numerous people, measures will have to be taken to ensure that the DPA is complied with to ensure that the Doctor, Patient confidentiality is kept.  Related points of the Act (or the eight ergonomic principles)

• Point 6 of the principles: “personal data processed with the rights of data subjects under this Act.
• Point 7: “Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.

Security measures

• The system will not work outside the hospital as it is unnecessary for such confidential data to leave the KH permissions.  The system also works as a security measure for those that may consider steeling the system.  
• The system will only work within the KH grounds.  For this to be possible, KH may consider using DFID.
• Other security measures can be taken e.g. looking into using AES (Advanced Encryption Standard) which is an American Standard which is a next generation cryptography algorithm.  
• Other security measures for the WLAN that may be taken into consideration include PEAP (Protected Extensible Authentication Protocol) and Password.  This solution was specifically designed for the IEEE 802.11 technologies by Microsoft and RSA Security.  Some may see this as a good thing as the OS used within the hospital is by Microsoft.  Others may consider it a solution developed by a problematic organisation, as Microsoft is known for its continuous attacks by viruses and hackers (e.g. worm viruses that only attack Microsoft PCs).  The solution has only been tested on some Servers.  The success of this solution depends on what type of Server is being used at KH.

Links with other companies

Companies currently working with Kingston University on Mo-Med and E-health include Orange UK and Vodafone UK.  Such companies could be connected to work along KH to provide a better service for its employees and patients.  With the introduction of the Vodafone 3G card, a deal could be struck to include the card in the system whilst getting a deal from Vodafone.

Other companies that can be taken into consideration include Ericsson Motorola, AT & T and T1 JV.

Those affected by the proposed system

• NHS: Extra funding will be needed by KH to help facilitate the project.
• Patients: Some patients may find the changes hard to comprehend and may have a problem with the changes in the hospital whilst the project is going on
• Doctors: Not all Doctors may want to use the system and may find it more of a hindrance than a help

How the system may affect other similar organisations

Other NHS hospitals may choose to undertake this project if a trail at KH works.  The system could link hospitals in the local area together enabling them to share information and offer a better and more efficient service to their patients.  The system would also make the work of its employees easier as time would be saved looking for patient information and waiting for patients that do not turn up for their appointments.  As the cost of this to the NHS is more than £300 million a year

Advantages and disadvantages of some of the technologies

UMTS is a future mobile communications system, which, among other features, will offer direct connection between terminals and satellites.

ATTRIBUTES: UMTS will allow for wireless Internet access, video-conferencing and other bandwidth intensive applications. Benefits from this new system of wireless communications are expected to be

• Allows fixed telecommunications services of up to 2Mb/s.

• Support to unique mobile services such as navigation, vehicle location, and road traffic information services, which will become increasingly important in world market.

• The ability to enable the use of the system terminal from multiple environments - in the home, the office, and in the public environments and in both rural areas and city centres

Based on some of the attributes above, there are several benefits that make UMTS an ideal mobile application to our organisation.

• Such as fixed telecommunications services of up to 2Mb/s, which allows large amount of data to be transmitted from one device to the other, or from the database to the device.
• Being that one of the capabilities of our device involves being about to have voice communication, UMTS would be ideal for such tasks as it makes use of VOIP (Voice over IP) which allows voice over the network.
• The use of UMTS also promotes versatility, as it promotes the use of the device in multiple environments

RISK: Some of the risks involved with UMTS is based on the health and security

• Health: Due to the fact the radio waves is being released, there is a possibility of the people working around the hospital getting ill from the effect of the radiation released from the use of UMTS.
• Security: Due to the nature of data transmission, which is wireless, there is a risk of the signals being tapped or intercepted by intruders that can log on to the system

GPRS is a non-voice value added service that allows information to be sent and received across a mobile telephone network.

In our organisation GPRS will be used for:

• CHAT: Because of its use with the Internet, GPRS allows  users to participate fully in existing Internet chat groups
• TEXTUAL AND VISUAL INFORMATION: can be used to send textual or visual information such as graphs and location sensitive services

• WEB BROWSING: Because GPRS allows high data transmission rates, web browsing is possible with displays of pictures and texts.

• GPRS also facilitates multimedia applications such as document sharing with voice and pictures.

GPRS as several benefits that makes it an ideal mobile application in our organisation,

• Such as speed of data transmission.

• Speed of connection (Immediacy).
• Mobility

SPEED: Theoretical maximum speeds of up to 171.2 kilobits per second (kbps) are achievable with GPRS using all eight timeslots available. This is about three times as fast as the data transmission speeds possible over today's fixed telecommunications networks and ten times as fast as current Circuit Switched Data services on GSM (Global System for Mobile Communication) networks. By allowing information to be transmitted more quickly, immediately and efficiently across the mobile network, GPRS may well be a relatively less costly mobile data service compared to SMS and Circuit Switched Data.

IMMEDIACY: GPRS facilitates instant connections whereby information can be sent or received immediately as the need arises, subject to radio coverage. No dial-up modem connection is necessary. This is why GPRS users are sometimes referred to be as being "always connected". Immediacy is one of the advantages of GPRS (and SMS) when compared to Circuit Switched Data. High immediacy is a very important feature for time critical applications such as remote credit card authorisation where it would be unacceptable to keep the customer waiting for even thirty extra seconds.

MOBILITY: REMOTE LAN ACCESS

Being that our devices is based around mobility, doctors need to be able to access the data on the hospitals Local Area Network (LAN) or database applications i.e. Oracle, instantly when required.  In such case the amount of data being transmitted, latency and speed is important.  GPRS’s speed and latency makes it an ideal mobile application to use.

RISK: Lost of data (security breaches): One of the risk associated with GPRS is the fact that GPRS uses packet switching, this involves breaking down data into packets, sending it across the network, and rearranging the packets in there original order at the destination.

Packets are known to be lost during this process, some times through interception from an unwelcome intruder, and in the case of packets being lost, this can compromise the data integrity.

In our organisation, data integrity is important, and this risk may prevent GPRS being an ideal mobile application.

3G datacards will be used on the tablets for to connect to the WLAN.  One of the leading companies in producing 3G cards is vodafone.

---

Network diagram followed by wireless technology diagram

---

---

The diagrams above show different technologies that have been considered for the development of the proposed system.  The diagram below shows the main aspects of the net work that will need to be built or modified if already in place.  The main components of the system are: -

Servers - The servers are KH will b connected to the server at NHSnet to obtain some information e.g. patient records.  The KH at connect is acting as a go between, between the Tablet Pc and the NHSnet database as the information being exchanged will need to be managed and monitored.  A file server allows users to share the information over the network without the information literally being taken to the other user via an external storage device e.g. floppy disk.

Switches - Needed to direct data towards its destination e.g. directing information requested by a Doctor through the Tablet PC back to the Tablet.

Routers - This device/software (occasionally) determines the next network point the packet (information) should go, (its destination). It is connected to at least two networks deciding on which way to send the information, based on the understanding of the networks it is connected to. For the proposed system, routers will be used on the network to access the KH server.  As no data e.g. patient records will be saves locally on the Tablet, all will need to be a constant connection to the server.

Accessed Points (AP) - APs transmits and receives data, also known as a transceiver. Connecting from one user to other within a network. It is also used to serve as a point of interconnection between a WLAN and a fixed wire network.  The number of access points required depends on the size of the network.  With the proposed system, APs will be required to act as an access point for the tablet to the network.

The second diagram is a more detailed diagram of the wireless technology that can be considered for the system.  More details of how the technologies can be used can be reviewed on page 4 –5.

---