The numbers were worse for children living in areas with high concentrations of low-income residents. Spread across five boroughs and 350 developments, 600,000 residents live in public housing. Children living in the South Bronx or Harlem were much more likely to be hospitalized for asthma than children living in the Upper West Side of Manhattan, an affluent neighborhood.
Three years ago, asthma among children in some of New York City's poorest neighborhoods was at epidemic levels. Boys and girls in the Bronx, Harlem and other low-income areas in the city were three times more likely to be hospitalized for asthma than children in the United States as a whole.
City health officials knew infestations of pests, such as cockroaches and vermin, could trigger asthma; the use of highly toxic pesticides also contributed. So the city's Department of Health tackled the problem head-on, launching a pilot study aimed at reducing children's exposure to infestations and highly toxic pesticides used in poor neighborhoods.
That required sending teams of workers to repair apartments and teach tenants how to use nontoxic pesticides. Additional teams were sent to collect data -- to find out if the changes in pest management reduced pest problems and improved the environment for asthmatics.
Working with the Warshaw Group, a data-collection and management software design firm, the department developed a wireless data-collection application, which involved several teams of workers visiting several hundred apartments to collect data from the field. The application used Fujitsu's 3500 and 4500 series tablet PCs, and transmitted the data using encryption for security via Verizon's Express Network to a secure server hosted by Warshaw.
The Department of Health distributed the tablet PCs to field workers, who wirelessly transmitted large amounts of data to department headquarters in downtown Manhattan. At headquarters, officials sorted and analyzed the data on a daily basis -- something they could not do in the past.
From his Manhattan office, Dan Kass, director of evaluation and research for the city's Childhood Asthma Initiative, managed the project and analyzed incoming data. He knew exactly when repair teams reached an apartment, how long they were there and what they did. The data enabled him to build a database that included every detail, such as costs to repair each apartment, and reduction of pest infestations because of the work in comparison with apartments where no work had been done.
Kass explained that by having the data relayed to him wirelessly, he ascertained how repair work proceeded and reported to the teams immediately, allowing them to keep abreast of the project as well. He added that total costs for the hardware and software were just over $50,000.
In addition to helping him manage the project more effectively, Kass said the constant in-flow of data helped him provide the department's commissioners with rapid progress updates. A further advantage came from the data being collected directly onto the tablets rather than on paper. "We were able to eliminate several steps in the workflow process and improve the accuracy of the data," he explained.
For the first time, city officials had data -- and results -- that supported a program as it evolved, rather than having to wait months or even years down the road -- well after the work was completed. More importantly, the data was accurate, coming directly from the field rather than through a paper process, which is often rife with errors.
"Using wireless technology on this project has made an unbelievable difference," Kass said. "The instant availability of data made me much more involved and allowed me to bring the results back to the people in the field, so they could see just how their work was progressing."
Health Care Isn't Stationary
New York City's experience with wireless technology is an example of how an industry where mobility is crucial, such as health care, can work well with the right computer tools. Visit any kind of health-care facility, and people aren't sitting in cubicles doing heads-down data entry; doctors, nurses and other professionals are on the go. That makes wireless technology, especially a wireless network that can support a variety of mobile devices, a vital tool for the work they do.
The health-care industry has begun to embrace solutions that use 802.11b, the industry standard for wireless LANs. They are interested in faster data transmissions than current speeds of up to 11 Mbps (megabits per second). Why? Because health-care professionals need to send graphics, such as x-rays and patient records that may contain scanned documents, as well as text data.
Public-sector health-care programs show a strong interest in wireless solutions as well. While just beginning, primarily as pilot test projects, these efforts at the state and local level provide a glimpse of where health care could be -- wireless tools in hand.
In Oklahoma, the Department of Human Services installed a wireless LAN at one of its largest facilities. Using technology from Cisco, including wireless bridges, the agency connected 200 caregivers spread over 25 buildings at the Developmental Disability Services Division (DDSD) Resource Center in Pauls Valley. The center's physicians, dentists, nurses and therapists are constantly connected while on the go. They also have access to the agency's mainframe and to the Internet.
In addition to advantages wireless brings caregivers through mobile connectivity, the technology also saves the agency money. A number of facilities weren't networked in the first place. Because some buildings are old, wiring them would have proven extremely expensive in terms of labor and equipment, according to Sally Hill, data services coordinator for DDSD. The center also saves on Internet access; prior to the wireless LAN, physicians and psychologists did Internet research from stand-alone PCs, each having a separate account with an Internet service provider. That expense has now been eliminated, Hill said.
Records on the Run
At New York's Office of Mental Health (OMH), the issue is records management. The state agency, which oversees mental health programs affecting nearly 500,000 state residents, uses a client-server, three-tier application for patient tracking and records management. While robust enough to support nearly 60 servers and 6,000 PCs, the Mental Health Automated Record System (MHARS) has been deficient as far as supporting mobile applications for patient care, according to Chip Felton, CIO and deputy commissioner for OMH.
In particular, OMH's health care professionals need to access information from MHARS to screen patients, manage incidents and report outcomes. Originally, they used PDAs for mobile record access. But as Felton explained, the devices lacked the "horsepower" to do the job adequately.
In August 2002, OMH began pilot testing Microsoft's new Windows XP Tablet PC operating system on Fujitsu's line of tablet PCs. Felton compared the tablets to high-end notebooks that do a decent job of handwriting recognition, and sending and receiving information. The pilot is still underway and results have not yet been analyzed, but Felton said preliminary indications show the wireless application had a positive impact on the more than 60 professionals currently using it. "I've been quite pleased at how readily it [wireless technology] has been accepted by the workers," said Felton. "Clearly, it's a tool that helps."
Security Concerns Under HIPAA
All government agencies are concerned about security when it comes to wireless applications. Security is of special concern in the health-care arena because of the Health Insurance Portability and Accountability Act (HIPAA), which sets regulations -- and backs them up with fines -- for keeping records secure and private.
Wireless applications have proven vulnerable to security breaches, but just how insecure when stacked up against HIPAA and government regulation remains unclear, according to industry experts. The explicit wording of HIPAA reveals little focus on the kind of encryption that would destabilize security for wireless networks, according to a report from research firm Frost & Sullivan. The report adds that there is some confusion over the implementation of conventional security tunnels for wireless devices under HIPAA's proposed regulations.
Frost Analyst Amith Viswanathan recommends health-care organizations be diligent in tracking all security provisions instituted, as well as installing virtual private networks wherever a wireless LAN is used.
The New York OMH has been working for some time to meet HIPAA requirements for information security. With policies and procedures already in place for wired applications, it was simply a matter of applying them to the wireless pilot application, according to Felton. One unique aspect is the physical security of wireless devices, which are small, mobile and easy to misplace or have stolen. "You need to take extra precautions," said Felton. "You need clear procedures on who can access the device and where they are going to use it."
For Felton, who has done his homework when it comes to HIPAA, the security hurdle sounded less than daunting. For other government agencies, which haven't outlined all procedures or considered all probabilities, the opportunities for wireless may not come so easily.
Felton already is looking to the next phase. The OMH plans to deliver health care into the community, along with wireless technology that can help caregivers manage cases in ways never thought possible. Other prospective additions include equipping workers who certify and license mental health programs with wireless technology, allowing them to do a better job minus the hassle of paperwork.
