The Path to Paperless

The Expenses of Going Wireless

This appealing option incurs numerous costs.

By Peter J. Polack, M.D., F.A.C.S.

Our practice EMR system will be relying in large part on wireless devices: slate computers operating as thin clients, connected wirelessly to our network. But it is important to know the limitations of a "cordless" practice. First, wireless is not truly completely wireless. Somewhere along the line, something is plugged into something else. Second, wireless systems incur an expense at every level.

You must have a consultant. You need to hire a consultant who has experience with wireless networks so that it is set up properly. A poorly laid-out wireless network will result in mediocre performance. We used a consultant who is a Cisco-certified wireless network engineer. If you can't get someone like this, at least get somebody who specializes in wireless installations.

You need a survey. The consultant performs Radio Frequency (RF) mapping throughout the building to determine where antennae are needed. At the end, we were given a floor map of our building with an RF map overlay and a recommendation on how many antennae we needed and where they should be placed.

You need an adequate power supply. If you want to use cordless computers, you'll not only need long-lasting batteries but plenty of extra batteries as well. Also bear in mind that regular laptop batteries cannot be charged if they are not in the laptop, unless you have a special charging dock. Count on a typical laptop battery giving you 3 hours of use and plan for your clinics accordingly.

You need to know what is in your walls. Perhaps there was lead in the walls from the last tenant who was a radiologist. Metal girders in the ceiling can either be good (boosting the signal by reflecting it) or bad (by degrading the signal).

You need to know what else is in your building. Wireless networks operate across a spectrum that overlaps with commonly used devices. Microwave ovens and cordless phones can cause interference and wreak havoc on your device's connection to the EMR system.

You need to have a budget. One practice opted to use laptops in each exam room with an external 24-inch monitor. This setup allows both the doctor and the patient to each view a monitor. But this option is pricey — regular laptops are generally the most expensive way to go.

Going it Alone

Want to try to set up your own wireless network and save money? The consumer wireless network devices that you can buy at a retail store may work fine for surfing the Internet or checking your e-mail. But they may not be sufficient to run an EMR system for a couple of reasons.

First, if you need to use more than one wireless access point, they may conflict with each other — walking down the hall is likely to drop your session, requiring you to log in again and possibly losing your information.

Second, consumer wireless access points generally operate at a signal strength much higher than the typical wireless card in a laptop. That means that the laptop can detect a stronger signal than it is able to send back, resulting once again in a broken connection.

However you decide to incorporate wireless devices into your EMR scheme, make sure everyone involved is on board. The end goals are cost-effectiveness and creating new efficiencies in seeing patients. OM

Next: EMR Go-Live Structure and Rollout