Portal de Periódicos da CAPES

Remote access of electronic patient data with cellular wireless broadband technology

2007; Elsevier BV; Volume: 132; Issue: 2 Linguagem: Inglês

10.1016/j.ajodo.2006.07.023

1097-6752

Mel Mupparapu,

Wireless Body Area Networks

Wireless cellular broadband technology currently transmits data at speeds that only wired broadband connections were capable of until now. By using high-speed data access protocols such as evolution data optimized (EV-DO) or enhanced data rate for global system for mobile communications evolution (EDGE), gaining access to patient data in an orthodontic office remotely has become a relatively simple task. Affordable and convenient cellular broadband networks allow the orthodontist to remotely access schedules, and update, review, add, or modify data virtually from anywhere. Newer generation wireless broadband technologies have made the virtual office a reality. This article discusses the various broadband technologies that are available for the orthodontist as a techno-savvy consumer and the availability of wide area networks that include third-generation cellular technologies that can be used for remote access of patient data. The new enterprise-level gadgets that use third-generation technologies are also introduced. Wireless cellular broadband technology currently transmits data at speeds that only wired broadband connections were capable of until now. By using high-speed data access protocols such as evolution data optimized (EV-DO) or enhanced data rate for global system for mobile communications evolution (EDGE), gaining access to patient data in an orthodontic office remotely has become a relatively simple task. Affordable and convenient cellular broadband networks allow the orthodontist to remotely access schedules, and update, review, add, or modify data virtually from anywhere. Newer generation wireless broadband technologies have made the virtual office a reality. This article discusses the various broadband technologies that are available for the orthodontist as a techno-savvy consumer and the availability of wide area networks that include third-generation cellular technologies that can be used for remote access of patient data. The new enterprise-level gadgets that use third-generation technologies are also introduced. Electronic patient data stored in an orthodontic office can be accessed in many different ways. If the office uses practice-management software and the entire office is connected via a wired or wireless network, access can be either direct or indirect. Direct access is when the practitioner accesses patient data directly from the primary computer in the office that doubles as the server (computer that stores the patient management systems, applications, and patient data). All other access methods are considered indirect, especially if the clinician is not on the premises. Indirect access can be via a wired network in the office or a wireless network. Both wired and wireless networks can be programmed for remote access via a dedicated broadband Internet connection. Traditionally, for Internet connection, most offices used a dial-up service that might not be entirely suitable now for remote access of patient data because of the dial-ups' slower bandwidths. Today, both cable and digital subscriber lines (DSL) via telephone land lines provide the necessary speed and bandwidth to consumers for higher-end networking and remote access functionality. The office can be wirelessly networked via the Wi-Fi optimized standards such as the 802.11 a, b, g, super g, ag, pre-n, or the like, eliminating the wire and cable clutter in the office. Previously, remote access to office data was only possible with a broadband connection either via wireless hotspots or wired Internet connections, and, if the hotspots or similar services were unavailable, access was curtailed. There was a need for instant access without having to look for a hotspot while away from the office. The exciting aspect about current cellular technology is the functionality of the newer hardware (pocket personal computers [PCs]) that can be used with both telephonic services and computer functionality. Since the ubiquitous availability of newer generation (beyond second generation), cellular technologies and their applications are more handy, and remote access to data is more convenient. Evolution data only or evolution data optimized (EV-DO) is an upcoming and dominant wireless broadband data protocol, commonly referred to in the telecommunications industry as DO (dee-oh).1Evolution Data Optimized. Available from URL: http://en.wikipedia.org/wiki/Evolution-Data_Optimized. Accessed March 20, 2006.Google Scholar, 2Evolution Data Optimized (EV-DO). Available from URL: www.evdoinfo.com. Accessed March 20, 2006.Google Scholar Wireless local area networks (WLAN) are built on a set of standards—802.11—and are otherwise known as Wi-Fi.3Wireless Fidelity (Wi-Fi). Available from URL: www.wi-fi.org. Accessed March 20, 2006.Google Scholar They have emerged as an alternative to traditional wired local area networks (LANs), eliminating the need for ethernet cables. Wireless LANs have been used in many orthodontic offices and health care settings, giving access to multiple computer workstations as long as they remain within few hundred feet of the wireless router. Mobile computing devices such as laptops or tablet PCs with their integrated Wi-Fi capabilities made access to networks easier and gave way to a new world of information technology. Accessing patient data had never been easier.4Mupparapu M. Arora S. Wireless networking for the dental office: current wireless standards and security protocols.J Contemp Dent Pract. 2004; 5: 155-162PubMed Google Scholar, 5Mupparapu M. Binder R.E. Cummins J.M. Use of a wireless local area network in an orthodontic clinic.Am J Orthod Dentofacial Orthop. 2005; 127: 756-759Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Wi-Fi-based Wi-Max, a wireless technology that at 1 point seemed to be the answer for all high-speed networking applications, fell behind in the implementation phases. It was supposed to deliver a hefty 70 megabits per second (Mbps) download speeds anywhere within up to 25 miles well before the introduction of any advanced broadband wireless protocols such as EV-DO or enhanced data rate for global system for mobile communications (GSM) evolution (EDGE). It is important to distinguish wireless broadband from wireless access to broadband speed. Technology consumers today are not fully aware of the differences. Wireless LANs have 2 requisite components—wireless and wired. The wireless component links the user to the wired Internet connection. The wireless component by itself does not access the Internet connection. The EV-DO connection, instead of hooking up to a particular router in the office building, connects directly to the broadband provider's cellular tower just as a cell phone would. Practically, access is unlimited and from anywhere a normal cell phone would work (Fig 1, Fig 2). Investment in elaborate wireless LAN setups might be practical and convenient for a networked office when Wi-Fi is used with EV-DO. EV-DO is used for access to the office network and Wi-Fi for connectivity in the office. Access to the office network or patient records has become easier and is always at the fingertips for the office manager or the clinician on the go. In addition, other commonalities with any broadband connection, such as security (firewall) and file download capabilities, will be automatic and at speeds much higher than their predecessor technologies.Fig 2WAN access to patient data via EV-DO can be accomplished with laptops and other enterprise-level mobile devices similar to Palm Treo 700w.View Large Image Figure ViewerDownload (PPT) The first cellular technology (that was never adapted to the health care industry) was called the first generation (1G) (Table I). It used an analog signal protocol called advanced mobile phone standards (AMPS). Second generation (2G) cellular technologies switched to digital protocols that improved the overall performance of the devices for consumers. Focusing on voice rather than on data, 3 major technologies emerged in the 2G (Fig 3): GSM, code division multiple access (CDMA), and time division multiple access (TDMA).Table ICompilation of cellular wireless networks, data speeds, commercial vendors, and operational statusGenerationWANData speedCommercial vendors/operational status0GAMTS<30 KbpsNone currently available; technology of 1970s1GAMPS<30 KbpsAnalog cell phone standards introduced in 1980s2GGSM<60 KbpsCingular, T-Mobile2GCDMA<60 KbpsVerizon, Sprint2GTDMA 700 KbpsT-mobile deploying in Australia and Italy in 2007 Open table in a new tab Because these technologies are mostly voice based, it became necessary to migrate to a data-rich environment because picture messaging and mobile browsing became imperative and hence the emergence of 2.5-generation cellular technologies. The enhanced CDMA was called CDMA 2000. Enhanced GSM was called general packet radio service (GPRS). TDMA did not have a successor. EV-DO emerged as the ultimate successor to the CDMA technology.1Evolution Data Optimized. Available from URL: http://en.wikipedia.org/wiki/Evolution-Data_Optimized. Accessed March 20, 2006.Google Scholar GSM technology has an enhanced third-generation (3G) version known as EDGE. Currently, even though both EDGE and EV-DO are competing broadband wireless technologies, EV-DO outperforms EDGE. The download speeds of EV-DO start at 300 kilobits per second (Kbps), whereas EDGE has speeds that of 100 to 300 Kbps. Connection to the office network while on the road was tedious with wireless cellular technologies before the introduction of 3G because the average transmission speeds were about 50 to 70 Kbps. The transmission speeds of the newer cellular technologies average 300 to 500 Kbps (Table I) with peak rates of about 2.4 Mbps.6Kim J. Juniper strategy LLC: the evolution of mobile data. Sprint Nextel White Paper, 2006: 1-4Google Scholar Security of data transmission is an important aspect of any new broadband technology, and 3G technologies are no exception. Apart from being protected by the inherent security of the underlying networks and newer 3G security measures such as 128-bit privacy and authentication keys, additional secure algorithms such as secure hashing algorithm-1 (SHA-1) and advanced encryption standard (AES) are part of the EV-DO technology. Although the advantages of EV-DO over the traditional Wi-Fi are clear (Table II), EV-DO is but 1 broadband solution.7Null C. Broadband to go. PC World 2006; January:97-104.Google Scholar, 8Lowenstein M. Making way for 3G. Guide to wireless mobility. Network World 2006; January:42-5.Google Scholar Globally, GSM is by far the most popular technology that is available in almost all countries. There are more than 600 live GSM networks in over 200 countries and territories, serving approximately 1.2 billion subscribers.9EDGE revolution. The revolution in end user experience. Available at: http://www.nokia.com/networks/references. Accessed July 5, 2006.Google ScholarTable IIComparison of Wi-Fi and wireless broadband network featuresFeature802.11 wireless standards (a, b, g, super g, ag and pre-n)802.16a Wi-MaxWANs (EV-DO, EDGE, HSDPA)PopularityStill being used; popularity fadingRapid growth expected in next few yearsAdvanced technology that has surpassed Wi-Fi technologySpeed11-54 MbpsUp to 75 MbpsDirect access to wireless networks; up to 3 Mbps directFrequency2.4-5 GHz2.11 GHz1850-1900 MHz (2G). 3G technologies have dynamic time division duplex (TDD)RangeUp to 300 feet indoorsUp to 30 miles with cell radius of 4-6 milesAccesses wireless towers automatically; virtually present as long as towers exist similar to cell phonesPublic accessAccess via public hotspotsAccess via public hotspotsNo need for public hotspots; consumers can use virtually everywhereCompatibilityWidely adopted except 802.11a, which is incompatible with other standardsInteroperates with 802.11 wireless LANsCompatible for coexistenceSecurityLess secure than EV-DO for hackingLess secure than EV-DO for hackingMore hacker proof than Wi-Fi Open table in a new tab Currently, there has been an explosion of enterprise-class devices and a wide array of PC cards, all leveraging the new 3G networks (Fig 2). Although EV-DO hardware for laptops is a Personal Computer Memory Card International Association (PCMCIA) card, integrated EV-DO in notebooks and other mobile hardware is not far off. The Palm Treo 700w (Palm, Inc, Sunnyvale, Calif) uses Microsoft Windows Mobile 5.0 operating system (Microsoft, Redmond, Wash). Available via Verizon wireless, this gadget uses EV-DO technology. This smart phone comes fully equipped with Microsoft Office Word, Excel, PowerPoint, and Outlook Mobile. Data can be synchronized wirelessly. A standard 60 megabytes (MB) of dedicated storage lets the user download large files and documents seamlessly. Similarly, other companies such as Nokia (Irving, Tex) (E-series, E61 using symbian operating system and EDGE 3G broadband service) and Motorola (Schaumburg, Ill) (Q phone with Windows Mobile 5.0 is lightweight and features electro-luminescent keys, QWERTY keyboard, thumb wheel for single-handed control, and internal antenna) have devices that take advantage of WANs. Wi-Fi capability is becoming a standard on most personal digital assistant (PDA) devices.8Lowenstein M. Making way for 3G. Guide to wireless mobility. Network World 2006; January:42-5.Google Scholar These enterprise-class devices are used not only for accessing patient data, but also in general allows the user to be constantly in touch with the office via e-mail and phone. Devices similar to BlackBerry (Waterloo, Ontario, Canada) that dominated the consumer electronics with their exclusive access to text-based e-mail must migrate to 3G as well, and the Windows-based devices have merged the BlackBerry connect software in their gadgets.8Lowenstein M. Making way for 3G. Guide to wireless mobility. Network World 2006; January:42-5.Google Scholar It is predicted that wireless broadband research will continue to advance by leaps and bounds, mainly driven by stiff competition and consumer demand. Currently, EV-DO has a significant advantage over EDGE. EV-DO networks automatically switch to the 1 × radio transmission technology (1xRTT) when an EV-DO network is unavailable for use. Any advancement in the technology from this point forward will only be good news for technology consumers such as orthodontists because access to the data will be unlimited whether a few feet from the orthodontic office or on the other side of the country. Both the CDMA and the GSM based providers will continue to work on the next generation technologies as they compete with each other. EV-DO is a significant technological breakthrough for consumers and organizations that desire the required throughput and mobility now. Accessing patient data remotely has become that much easier with the speed and mobility of EV-DO broadband wireless networks (up to 700 Kbps) for the techno-savvy consumer. Mobile routers that use EV-DO broadband wireless can also be used for Internet access from remote locations. They look just like any other commercial wireless router except that they do not have a WAN ethernet port on the back. Instead, there is a port for sliding the wireless WAN card. If office networks are being accessed via a cell phone or a PDA, the router can be connected via a USB cable for the WAN connection (KYOCERA KR1 mobile router [Kyocera Corp, Kyoto, Japan]). This in turn can provide LAN connection to additional users. This is a great way to access data simultaneously when several users need it.10Kyocera Mobile Router. Available from URL: http://www.Kyocera.com. Accessed March 20, 2006.Google Scholar Wi-Max promised a hefty 70 Mbps download speed anywhere up to 25 miles well before the introduction of EV-DO.11Mupparapu M. Wireless local area network for the dental office.N Y State Dent J. 2004; 70: 28-31PubMed Google Scholar, 12Mupparapu M. Contemporary, emerging, and ratified wireless security standards: an update for the networked dental office.J Contemp Dent Pract. 2006; 7: 174-185PubMed Google Scholar The Wi-Max forum, with its 350 member companies, is currently working on interoperability issues and getting ready for the launch across the United States in 2007 or 2008. With the Wi-Fi security standards becoming obsolete so quickly due to the rapid introduction of newer standards as well as associated accessories to boost signal strength,12Mupparapu M. Contemporary, emerging, and ratified wireless security standards: an update for the networked dental office.J Contemp Dent Pract. 2006; 7: 174-185PubMed Google Scholar the contemporary orthodontist must watch for emerging technologies that will keep the office up to date. Even though W-Max is still promising for the mobile professional, looking into EV-DO or the GSM equivalent high-speed downlink packet access (HSDPA), high-speed uplink packet access (HSUPA), or universal mobile telecommunication system (UMTS) for the mobile broadband solution is not out of place. Better technologies will boost the overall functionality of the orthodontic office especially, one that makes the office connected 24/7. Just as the Wi-Fi revolution and the production of subsequent generations of Wi-Fi enabled notebooks and PDAs, laptops are currently being manufactured with built-in WAN hardware with EV-DO or HSDPA integrated into the hardware. Alternatively, some PC cards combine Wi-Fi and WLAN functions and will at least be able to detect WAN signal strength and WLAN access points. The introduction of high-speed wireless broadband networks has revolutionized the remote access to data at orthodontic offices. The broadband speeds of EV-DO such as wireless network technologies have made it possible to virtually manage databases without physical barriers. Contemporary orthodontists must use available technologies and lose the barriers of communication that have slowed down the functionality of a demanding orthodontist and will eventually lead to better patient management and increased productivity.