Very soon your web browser will become your next telephone!  Surprised.  You should be.  Soon you will be able to make voice and even video calls to anyone running the latest web browser.  No apps to download, no installs and no sign ups.  It’s just you and your web browser.

WebRTC is a free, open project that enables Real-Time Communication (RTC) capabilities to be built right into the web browser without any extra plug-ins or software.  In addition to voice and video calls, it will also be possible to screen share and transfer files. 

What does this mean for you?
Websites will become more interactive “environments” where other users will be able to interact and communicate in real-time, rather than static pages of text and images.  It will also allow for imagine browsing on an online store, being able to chat with other shoppers or even talk with a salesperson or customer support directly and immediately.

What does this mean for healthcare?
This will make telemedicine easier and cheaper to achieve because it won’t require any special hardware or software to setup a videoconference between a patient and a healthcare provider.  It could also change the landscape of medical devices, for example, a nurse could receive a critical alarm that links to the patient monitoring device showing the live waveform or real-time values like heart rate.

What browsers have it? 
WebRTC is not generally available in any web browser yet, but you can try it in early experimental versions of Google Chrome, Mozilla Firefox or Opera.

When will it be generally available? 
I guesstimate that 2013 will be the year of WebRTC and it should be available on all major web browsers.

I am very excited about this new technology because it will take web browsers and communication to the next level.  Telecommunications started with landline telephones that only made voice calls, then wireless smartphones enabled voice, video and data and now the web browser will have the ability to allow easy real-time collaboration between individuals and offer direct access to real-time data.

Recently I had the privilege of attending User Interface Conference 17 over in Boston where I met some really interesting and talented people. I attended some outstanding sessions and workshops to help us improve and innovate our design process over here at Voalte. One session that resonated with me was Luke Wroblewski's talk on 1st person user interfaces where he spoke about the current trend in touch-based interfaces and how augmented reality and the use of sensors in everyday items will become the interfaces of tomorrow, paving the way for natural interaction interfaces over learned voice or esoteric device specific commands (swipe to delete anyone?).

Being part of such a saturated market, where the new buzz word 'HIPAA-compliant text messaging' is being slapped on everything like a 'Gluten-free'' label, means we constantly have to keep one eye on the goal and one toward the future. This talk got me thinking about some of the cool new ideas we could use to improve healthcare communications in the future.

Imagine being able to use your phone's altimeter (or interpolated location based on WiFi access points) to trace a nurse's route throughout the hospital. You could automatically set them as 'busy' when they enter the cafeteria or the break room and forward alarms to their backup.

There is also the concept of wearables, where users affix an unobtrusive device to their clothing which records information from a built-in GPS, altimeter, pedometer, gyroscope, accelerometer, temperature sensors, and more! We would be able to tell if a physician is sleeping, driving their car, or out on a hike, and look through their backup list to try and not disturb them if another physician is readily available.

New tools and paradigms like this will allow us to gather information about a user's surroundings and let the software work for you, naturally, as you would expect it to. As a software developer and user interface designer, it is a very exciting time to be in the healthcare communication market. 

You may have heard about cloud computing, but what is it and where did it come from? If you’re a Voalte user, you are already using the cloud. Congratulations, you’re on the cutting edge of technology! 

Cloud computing got its name from engineers' practice of drawing networks as clouds on whiteboards. Drawing a cloud is easier than drawing a bunch boxes and lines for the connections between the client and server. Over time it also became an easier way to talk about server computers too.

The term is used to describe various ways of sending data across a network from one computer (like your iPhone) to another (like the Voalte server). The server then processes your data for you. In this case, it’s the Voalte cloud! Think of it as an assistant doing your bidding. Or think about it like an iceberg. The software running on the iPhone or on the desktop is the tip, but underneath there’s big chunk of software in the network doing its job. That software is running on the server computer.

When you send a message on your Voalte phone, despite what you might think, you’re not sending it directly to your co-worker. Your message goes through the hospital’s WiFi network to a computer called a server. This is a computer in an equipment rack somewhere in your hospital’s IT department. The software on that computer then looks at your text, figures out if your co-worker is logged in and can be reached on WiFi, then relays that text. Otherwise it waits until it can reach your co-worker and sends that message later.

As a Voalte engineer, my co-workers and I create features by writing code on the server, on the iPhone, and on the desktop clients. That software has to communicate across the network. We also define the network protocol that our software uses to talk across that network.

When we find problems, we have to figure out if the problem is on the iPhone, desktop, or the server. Or, maybe there’s a network communication problem in the middle? We don’t like WiFi problems any more than you do!

Writing networked software can be challenging, but it’s also rewarding. I enjoy writing our Voalte software and seeing it used for an important purpose: taking care of patients.

I’ve written my last couple of blogs on ISDN vs. SIP and Open Source vs. Proprietary PBX’s. Now I would like to conclude this subject with why Hospitals really should implement the SIP protocol on their PBX rather than remain with their legacy PBX, which could be TDM, or even the earlier signaling protocol H.323.

I would like to go over a couple of problems I have seen in the industry with utilizing these legacy PBX’s. The largest complaint on legacy PBX’s, especially the ones with TDM interfaces, is the lack of bearer channels. Every time you want to increase your capacity, you will need to add another T1 card, which of course only adds 23 more bearer channels, or 24 if you have the capability of running a shared d-channel as in a NFAS configuration. A second common problem is the display name being sent over the TDM trunk via the ISDN protocol. Some ISDN protocols use Information Elements (I.E) in the ISDN Setup Message while others may use Facility Messages to send the Calling Name. Sometimes, if supported at all, this configuration can be cumbersome. A third problem also seen, especially in a Tandem PBX, is the lack of the ability to sometimes send the actual calling number or perform any digit manipulation.

With a SIP PBX, especially Open Source, all of these problems can be easily resolved. There is no 23 bearer channel limitation. If you want the ability to place more calls, you just have to make sure you have the appropriate hardware such as memory and CPU power. As for the Calling Name, it can be taken from the Display Info in the SIP Header. This is pretty much automatic, really little to no configuration. Digit manipulation and the calling number are simple with SIP. The calling number is generally sent in the host part of the SIP from header. The calling number can also be obtained easily from what is referred to as a P-Assert or Remote Party-ID.

As for H.323, it really is an end of life protocol, still used somewhat in the public sector, but not much use in the private sector. Although closer than SIP in relation to ISDN signaling, there is little development being done with it today.

So in conclusion, choose SIP for your hospital.

There is no question that the iPhone is the king of smartphones when it comes to clinical communication. No other device has been so widely adopted by nurses, doctors, and other caregivers.

In celebration of the iPhone 5 release, the five improvements listed below ensure that Apple’s latest iPhone continues to be the king of communication devices in the enterprise healthcare space:

1. Larger display with 44% more color saturation. As more applications provide medical document and imaging features, the richer and better display continues the iPhone’s dominance as the essential medical device for accessing patient information.

2. 802.11N support. The iPhone 5 supports 802.11 a/b/g/n on 2.4Ghz and 5Ghz. This is a HUGE, HUGE win for future VoIP support on the iPhone. It also supports secure information downloading on an enterprise’s wireless network.

3. 4G LTE connectivity. The future of mHealth depends on ultra fast connectivity in locations outside the walls of the hospital. Furthermore, 4G LTE support from iPhone promotes video and other telehealth focused applications.

4. A6 CPU – faster performance, better battery life. Having the iPhone survive through a 12-15 hour shift is critical for point-of-care communication. The iPhone 4S was easily able to make this mark – with a new and improved battery, we can expect the iPhone 5 to last even longer at the point-of-care.

5. 20% lighter, 18% thinner. Caregivers have to carry around many tools to do their job. A lighter, thinner iPhone is just icing on the cake.

Apple continues to amaze and dominate the smartphone market with the design and functionality of their products. It’s incredible to see the improvement from the first iPhone 3 to the new iPhone 5. One can only imagine what the iPhone 10 will look like in 5 years…

Long live the king of mHealth!

As my colleague, Frank Watts, mentioned in his post “Noise and Patient Anxiety,” a cacophony of alarm signals, nurse call equipment sounds, and the like, can wear down a patient’s recuperative efforts and assurance that they are receiving the best possible care. So, too, can a frequency of alarm noises cause anxiety in hospital caregivers, which in turn, can deplete their ability to provide excelled healthcare. This syndrome, known as alarm fatigue, occurs in a clinical scenario when alarms sound so often that responders become desensitized causing them to respond slowly, inaccurately, or not at all. Another issue of “alarm discriminability” arises which affects the clinician’s ability to discern between one or more alarms. Hence the need for a better alarm delivery solution – Voalte One!

In a survey summary published in the MedSun Newsletter #65, October 2011 by The Medical Product Safety Network*, nine of the 350 health care facilities included in the network reported on the most common alarm fatigue challenges in their demanding and time-critical environments. The respondents represented a cross-section of the hospital staff: risk managers, staff nurses, nurse managers and biomedical engineers. Nearly two-thirds of the respondents experienced alarm fatigue daily, while the other one-third were clearly aware the term and the issues involved. Generally, many of the respondents felt that the varying alarm sounds required extra diligence that involved relying on other sources of observation. In order to determine the correct priority of an alarm, many clinicians would check central monitors in the nursing room, search from room-to-room, use split screens in patient rooms, etc.–all requiring invaluable time when seconds really count the most. Even with varying pitch and tone, many alarms in a localized area were still hard to distinguish properly.

Building considerations as to the overall size of the unit, high levels of noise, and closed patient room doors also factored into the ability for proper alarm signal discernment. That particular consideration and other conditions contributed to the survey-wide result that visual alarms faired better than auditory alarms when providing reliable, and rapid, information regarding alarm location and level of urgency.

When the respondents were questioned regarding their recommendations for better technological solutions to alarm fatigue and alarm discriminability, receiving alarm notification text messages on a smartphone was a survey-wide answer. Additionally, the ability to monitor alarm notifications and information portably through an iPad or similar tablet product was also mentioned as another important technology advancement.

*The Medical Product Safety Network (MedSun) improves FDA’s understanding of problems with the use of medical devices so that the FDA, healthcare facilities, clinicians, and manufacturers can better address safety concerns.

I've been thinking a lot about the impact of mobile technology on Healthcare. For the last few months I have been working with a task group with mHIMSS that is attempting to prepare hospital IT staff for the flood of mobile connected devices heading their way and recently released the “What’s Next Work Group Report: Emerging Tech Trends 2012”. Some of the BIG trends that are moving more rapidly than we expect will change everything. In this blog I will take a crack at some of those issues.

Everything is going wireless… EVERYTHING! This is tough because hospitals are traditionally hostile environments for radio waves. They have lots of concrete and steel walls, long hallways, elevators and lots of electrical equipment that radiates interference.

It is time to get serious about your wireless infrastructure. Many hospitals have relied on 3rd party service providers to maintain their wireless networks. These networks may have been designed a decade ago with only data-quality capacity and little concern for fast roaming, packet loss, jitter and a myriad of other considerations needed for today's demands. Access points maybe hidden under ceiling tiles, have poor power settings, or have an obsolete topography and channel settings. When was the last time you had a top-to-bottom, campus wide assessment / audit of your network?

Have you been thinking much about the "Internet of Things"? Maybe you should. The amount of R&D that is pouring into development and use of wireless sensors is mind-boggling. Sensors will soon be arrayed throughout the physical space to detect a variety of adverse conditions…think smart beds, smart rooms, smart gurneys, medical devices. Sensors will be worn in clothing, stuck to the skin (smart band aids and patches), taken internally or embedded under the skin.

All of these sensors will need to be connected into a data network where they can accumulate massive amounts of information. All of these wireless devices and sensors are producing massive amounts of data and that leads me to the topic of Big Data. We will need a way to store, access and analyze petabytes of information. That's right, petabytes… 2,000,000,000,000,000,000,000,000,000,000 (plus 20 more 0's) of data… but who's counting. Hidden in this data will entirely new medical protocols, diagnosis and disease markers just waiting to be discovered. Healthcare institutions will be drowning in data if action is not taken immediately.

The future is roaring down on vendors and providers and we all need to be ready to embrace the change. So…buckle your seat belts and hang on! 

I’ve often been asked if a proprietary SIP PBX or an open source PBX should be utilized in my environment. Well, the answer to this question can be rather complex, depending upon your needs. There are reasons one may be beneficial over the other, as I have explained below.

An open source SIP PBX will normally interoperate with any PBX, proprietary or open, as long as it supports the SIP RFC 3261, the IETF SIP standard. The great thing about an open PBX is you can customize the software to suit your needs. There is also plenty of online help to get you going and even to help you once you have started. The only negative thing about the open PBX is it may be more difficult to get paid support.

A proprietary SIP PBX may not interoperate with another proprietary SIP PBX. Many times companies add proprietary SIP extensions to their code, which prohibits some interoperability with other proprietary SIP PBX’s. Proprietary PBX’s may not completely follow the IETF standard either, which also adds to interoperability issues, especially with other proprietary PBX’s. A proprietary PBX will often limit you to purchase other peripheral hardware just from that one vendor. The nice thing about proprietary PBX’s though, is they normally have a paid support staff to aid you when you need assistance.

In conclusion, the open source SIP PBX will be much less in expense compared to the proprietary PBX. There are no licensing fees and you do not have to sign contracts for support. As long as you have a knowledgeable staff and want to save on costs, the open source SIP PBX is certainly the way to go. A proprietary PBX is just that, proprietary, and often keeps your selection down to just the one vendor.