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Institutional Refusal to Allow Wireless Transmission of EM Ultrasound Files
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


I am sending this to the list serve in hopes that some of you might be able to offer some advice or experience with how to deal with institutional refusal to allow wireless transmission of ultrasound files.  

At Carilion we are experiencing institutional refusal of our department’s request to implement wireless transmission of ultrasound images.  Their argument is that they are concerned that wireless transmission of large image files has the potential to disrupt other wireless communication, ie Vocera, and portable computers.  Our IT department argues that the ultrasound files are much larger data packets and that this will eat up too much bandwidth.

1) Has anyone encountered resistance to wireless transmission of US data for this reason, and if so, how did you overcome this?

2) Do you have concrete information regarding how much bandwidth is required/used by your department’s wireless transmission of ED ultrasound files to an ultrasound management system?

Any information regarding this topic would be much appreciated as we are attempting to compile a consensus from other institutions that wireless transmission of ED US files does not interfere with other wireless devices or require an extremely large amount of bandwidth.

This refusal of the institution to allow wireless transmission of US files is limiting our ability to accurately supervise and bill for resident scans and ultimately, advance our US program.

Please send responses directly to me, and if anyone else is interested I can send a synopsis to the group.
Thanks
Michelle Clinton

Associate Director of Emergency Ultrasound, Carilion Clinic


pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


This is crazy.

In an era where hospitals will have to show meaningful use of technology or else be hit with heavy fines it is in the institutions best interest to support this. 

If ultrasound is being performed, documented and billed under the hospital roof they must take this seriously.

During my term last year the community / workflow committees developed an ACEP informational paper that explained the need for archival / workflow systems intended to target hospital administrations so hospital IT could make implementation a priority as many people were getting blocked at this level. We are in the final stages of getting this approved for distribution.

It did not focus on wireless vs wired systems but we can certainly re-look at this and add wordage on this as it obviously more powerful to have real time information to show consultants and remain transparent with the institution.

I can tell you we send 6 second clips 24-7 from 6 machines and the system  has not had a hiccup in 4 years.  That being said a poll of the section may prove useful as people use different  systems. 

Will get back to everyone on this.

Rajesh Geria MD FACEP
Chief, Division Emergency & Critical Care Ultrasound
Assistant Professor
Immediate Past Chair ACEP Emergency Ultrasound  Section
Director, Ultrasound Fellowship
Department of Emergency Medicine
Robert Wood Johnson Medical School
New Brunswick
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


Michelle and Rajesh,

 

 If you (anyone else with experience/input on this topic) can keep me in the loop on your responses and when the position paper comes out I would appreciate it.  We are implementing Q path at our institution on a system level and I am getting resistance from our wireless IT guys.  I am likely going to have to present to the hospital "wireless committee"  (it amazes me that their is a committee for everything).   I know we have  two different bandwidths which can make a difference.  I will let you know how I fare and what arguments they present.
 
Thanks.
Rob
 
 
Robert Strony DO, RDMS, RVT
Program Director, Emergency Medicine Residency
System Point of Care Ultrasound Director
Geisinger Health System
100 N Academy Ave. Danville PA 17822


pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


I would also suggest investigating if other departments within your building are utilizing wireless transmission. Often portable studies performed by Radiology, Cardiology, etc. utilize wireless transmission.

Chris
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


We have used wireless transmission for ED US video clips for a couple of years now, also have mobile heartbeat phones, EKG machines on wireless, lots of workstations on wheels etc. without a problem. I can check with our IT people on bandwidth but it is certainly not an insurmountable problem.
 
One thing to keep in mind if you are billing for US is that the hospital should be getting the technical fee (which typically exceeds the professional fee) - and this is intended to help fund equipment, image archival including image transfer etc. (and techs, which we generally don't use...),
 
Chris
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


The wireless capacity is a common concern for IT. After careful consideration, our IT department decided that we could handle to traffic on our wireless network as long as we did not batch upload many files at once. We have been uploading from a single sonority machine without any known interference problems. Before activating wireless, we made certain that all images were already backed up to avoid an upload of multiple files at once. After we went up, IT watched the wireless network for any sign of degradation.

If your IT department determines that your wired network has enough capacity to allow transmission of files through a wired connection, then you could consider setting up a separate wireless network for your US machines. The wireless network could be limited to the ED. Perhaps an IT department would consider an ED US wireless network as a possible solution?

-Michael Baker, MD, FACEP
ED US Director
St. Joseph Mercy Hospital
Ann Arbor
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


Our entire division (14 EDs) are implementing sonosite systems and Qpath as part of an ED ultrasound initiative.  Don Nisler, CEO and founder of Qpath, has been very helpful with the implementation and development of the needed IT infrastructure. As a community ultrasound director for a number of years now, I can tell you that an efficient workflow and image management system is crucial to the success of the program.

There is no question that this can easily be done in your hospital. Just a matter of making the IT folks (and hospital administrators) realize that the ultrasound machine is as important to the ED as an EKG machine or CT scanner.


Don is a great resource if you are using Qpath.  Please feel free to email me directly and I am sure I can put you in touch with our IT folks who helped get our programs up and running.

Preston Wendell
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


Dear Michelle,

You might consider investing in some new IT support instead. Sending 1-10 megabyte files every few minutes is nothing. Most modern routers/access points should be able to handle 150-300megabits (about 18-36 megabytes) each second (or more). Most hospitals have multiple access points per room.

More importantly my $200 dollar home router can easily be setup to prioritize wireless data by application, IP address, port number.
Enterprise level hardware is capable of the same. Your data upload can be set to lower priority so that it never interferes with bandwidth/delay sensitive applications.

-Calvin Huang

Division of Emergency Ultrasound
Massachusetts General Hospital
pererap
Posted: Friday, June 27, 2014
Joined: 8/31/2011
Posts: 231


I have heard this argument is not infrequently brought up by hospital IT while in talks of setting up wireless transfer, although I have never heard from any sites where it actually led to problems once implemented.

We actually do have data to support it's widespread successful implementation. From the ACEP survey last year regarding EUS workflow, 77 out of 168 (or almost half) of the sites who responded were doing wireless transfer of ultrasound images. Not surprisingly, 107 sites noted hospital IT as an obstacle to implementation of a workflow system (see attached slides).

The ACEP EUS section has put together an EUS workflow white paper, which details important aspects of workflow in the ED including wireless image transfer. We are still in the process of finding a home to publish the guidelines, which will be important to legitimize them in order to help sites like yours so you can bring to hospital IT and admin.

Mark


Mark Byrne MD RDMS
Division of Emergency Ultrasound
Department of Emergency Medicine
Boston Medical Center
 
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