Getting Your Wireless Infrastructure Ready for Secure Text Messaging 

Technology continues to expand care providers’ ability to communicate on the go in today’s hospital environments. While moving throughout the hospital, a physician or nurse can monitor a patient's vitals, check the electronic health record (EHR), reference drug interactions, review medical images, execute medical calculations, and perform many other patient-care related tasks. The exponential rise in mobile device usage has made the care provider more accessible and agile than ever before. Rapid growth in the use of mobile technologies has also put wireless networks to the test. Over the last five years, a combination of ‘bring your own device’ (BYOD) programs and mobile access to EMR has added new requirements for wireless networks. Many hospitals have made great progress in addressing new demand, but mobile use cases will only continue to expand going forward.

Many hospitals have made great progress in addressing new wireless network demand, but mobile use cases will only continue to expand going forward.

Meeting HIPAA Requirements

One sleeping giant that has been waiting to pounce on wireless networks for years now is secure text messaging. Many hospitals now feel a sense of urgency to implement secure text messaging solutions in order to maintain regulatory compliance (HIPAA) and improve communication. In fact, independent research firm KLAS predicts that 60 percent of hospitals will pursue a secure text messaging solution within the next year. Many IT leaders in healthcare are probably thinking that their efforts to beef up wireless infrastructure for BYOD and EMR will suffice for secure text messaging. However, many of these assessments will likely be proven wrong over the next few years.

doctor looking at phone

Why is Your Wireless Infrastructure Insufficient for Secure Texting? Two Reasons:

  • Secure text messaging is a business-critical service and your network may not be architected as a business critical service.
  • Secure text messaging will introduce new use cases that you have never seen before and will require ubiquitous, uninterrupted connectivity to deliver expected results.

Wireless Network Coverage Design Today

Most applications that are in use on wireless networks today are on-demand services. This means that care providers use these applications to retrieve data when they need it. Some of these applications may require excellent wireless coverage and a good bit of bandwidth, which many hospitals have made adjustments to accommodate. But crucial to the majority of mobile workflows that are used within healthcare today is this concept: When a care provider needs data, he or she knows about the need and takes action to go out and get it. Therefore, wireless network coverage areas can be designed with a broader margin of error. If a doctor or nurse needs to access medical records but fails on first attempt to retrieve the data due to lack of available wireless access, he or she simply walks down the hallway or makes adjustments to settings until access is available. Most mobile workflows today are also timely in nature, but not critical. While an interruption in wireless access may slow down patient care, in most cases it will not put a patient's life in jeopardy.

In contrast, the continuity of wireless networks should be elevated to business critical before supporting secure text messaging.

Secure text messaging presents a whole new use case that wireless networks don’t usually account for. As opposed to being an on-demand service, secure text messaging is an 'as it comes' technology service. The care provider has no idea when a message may be delivered, and therefore cannot make adjustments to his or her physical location or wireless settings to accommodate message delivery. If a message is in transit and the care provider’s device is not connected to a wireless network, the message could be significantly delayed. Messages sent via secure texting applications can be patient critical and cannot be subject to such delays. Before implementing secure texting solutions, wireless networks must be architected to provide near ubiquitous coverage within the hospital, particularly within critical (OR, ER), common (nursing stations, lounges), and transitional areas (hallways). If ubiquitous wireless infrastructure is not provided, significant messaging delays will be incurred, and the critical secure texting service will be degraded to an extent that will present significant risk to patient care.

doctors walking in hospital corridor

Discovering the Limitations of Wireless Networks for Secure Text Messaging

In addition to the need for wireless networks to be engineered for near-ubiquitous coverage, there are many wireless network limitations that can cause disruptions in network connectivity. Application owners and network engineers have yet to uncover many of these limitations. For those who have yet to implement secure texting and experience the use cases that come along with it, these limitations likely haven't caused too many problems. But when secure texting is implemented, they become very visible—so much so that they often threaten the validity of the secure texting service and the patient care that such a service intends to protect. 

1 Architecture of the Network


When Access Points (APs) with multiple Service Set Identifiers (SSIDs) are too close to one another, they can cause devices to transition between networks frequently and drop connectivity. When APs are designed to hold on to IP addresses for too long, signal can be diminished to losing connectivity to the Internet. The architecture of the network itself can affect the Internet connectivity of mobile users and secure text message delivery.

2 Captive portals


Wireless networks with captive portals (networks that require that users accept terms and conditions each time before connecting) can wreak havoc on network connectivity. When a user connects to a network with a captive portal and accepts the terms, they will be connected to the Internet. However, when that device leaves the range of that network and goes back into range (or the connection times out), data connectivity will be lost until the terms are manually accepted again. This can cause significant disruptions in Internet connectivity without the user being aware, which consequently can prevent secure text messages from being delivered.

3 Restricted networks


Most secure texting solutions require that data is passed over multiple ports across the wireless data network for notifications and messages to be delivered. If any of these ports are blocked on a firewall, messages cannot be delivered. Many hospitals run into problems when care providers work out of multiple affiliate hospitals with disparate wireless SSIDs, where some networks may be restricted and some may not.

4 Simultaneous voice and data


Wi-Fi networks aren’t the only data networks that are leveraged for delivery of secure text messages—and are not the only networks with limitations to consider. Mobile data network connectivity is part of the equation too. Some devices do not support simultaneous voice and data on mobile data networks. This means that they cannot receive data while a voice channel is active. In other words, if an end-user is on an active call (and not connected to the Internet via Wi-Fi), secure text messages cannot be delivered.

Failing to work around these limitations will lead to degraded service and ultimately end-user distrust of the secure texting application, regardless of what application you choose. 

5 Sleeping devices


Many devices automatically turn off Wi-Fi when asleep to conserve battery. If this happens in an area where no mobile data connectivity exists, secure text messages cannot be delivered.

6 Device settings


There are many device settings that can cause issues with network connectivity and/or delivery of push notifications, such as airplane mode, turning off Wi-Fi, and low power mode.

The Solution: Addressing the Issue Before Implementing Secure Texting

Most of these limitations can be mitigated or worked around with a combination of wireless network provisioning and end-user education. Failing to work around these limitations will lead to degraded service and ultimately end-user distrust of the application, regardless of what application you choose. To repeat:  end-users will distrust the application, not the network, which is essentially invisible to them. As mentioned earlier, secure texting presents a brand new business critical,  ‘as it comes’ use case and end-users will perceive the application (which is most vulnerable to these limitations) as the problem. It’s hard to win back trust and these limitations could present risk to patient care, so these limitations need to be addressed before the service is implemented.

Need help building a plan to mitigate these limitations and provide ubiquitous wireless coverage? Contact Spok’s Consulting Services Group at consultingrequest@spok.com. We have been through this many times and would be happy to share our advice with you.

Looking For More Information About Secure Text Messaging and Hospital Communications? Check Out These Resources:

eBrief: From planning through post-implementation, follow these 10 steps to maximize adoption of your secure text messaging solution for improved care coordination and protected patient information. Ten Steps to Maximize Secure Text Messaging Adoption

WebinarSeven Steps to Optimize Your Hospital’s Wireless Network for Secure Text Messaging with Jason Stanaland, a mobility solutions expert at Spok. He has 10 years’ experience in systems architecture design, enterprise mobility management, IT service management, project management, consulting services, and product marketing. This includes designing and supporting the critical messaging system at a large hospital system, as well as deploying a secure messaging solution to over 3,000 users. 

Video: As hospitals today confront myriad communication challenges, they often find themselves cobbling together clinical communication systems from different vendors. Unfortunately, these pieces often have separate data sources that usually can’t talk to one another. Spok offers one unified technology platform that can solve multiple challenges across different areas and departments of the hospital. The Spok Care Connect® Story