Although wireless networks are proliferating in many public places and small businesses, medical practices have been slow to adopt the technology, according to both Lubrano and Gregg Malkary, the founder and managing director of the Spyglass Consulting Group (Menlo Park, CA), which focuses on wireless and mobile technology for the healthcare industry. Most have fixed workstations connected by stable wired networks, and don't have a compelling need to change -- yet. But, says Malkary, some resistance to EMRs is breaking down simply because doctors in solo or small group practices are using their hospital affiliation(s) as an inexpensive way to use and access EMRs and other electronic health records via a hospital's web-based portal.

"Physicians are (increasingly) using wi-fi to access clinical information at both their private practices and the hospitals they're affiliated with. This enables them to aggregate relevant clinical information, which can improve decision making," says Malkary. And being able to access information in multiple locations can also improve efficiency, which benefits both the private practice and the hospital.

The wireless products most commonly used by physicians are wifi-enabled tablet or laptop PCs that provide access to EMRs, practice management software, and other clinical information, says Lubrano. Also popular, says Malkary, are smartphones -- he cites the Palm Treo , the Blackberry , and Apple's iPhone as devices of choice. "They're being used primarily as a communications device," he says. "Secondarily, they're being used as a way to organize clinical and personal workflows through PIM (personal information management) tools. They're also being used to access reference-based materials." But the small screens of the smartphones make them impractical to use as access points for clinical information or to run clinical applications, says Malkary.

Both Malkary and Lubrano are seeing wide adoption, in group practices, of wireless LANs (local area networks) at the same time they adopt EMRs. "Without EMRs, there's really no compelling need for it," says Lubrano. He adds that most new practices -- he estimates about 85 or 90 percent -- are installing wireless networks.

Home and Office Are Different Environments
While it's relatively simple and inexpensive to set up a home wireless network, Lubrano says setting one up for a practice can be more complex, and the equipment more costly. He suggests that practices use an enterprise-strength wireless access point, such as the Cisco 1130 . While the enterprise solution is much more expensive (about $450 compared to consumer devices, which typically cost between $50-$150), for four reasons:

1. Enterprise solutions are more reliable -- they're less likely to falter sporadically, and are typically more durable, lasting longer than consumer access points.
2. They have a wider range than consumer products, enabling physicians to pick up a signal at a greater distance from the main access point.
3. They're compatible with a wide variety of network cards (those in the tablet or laptop).
4. The Cisco 1130 and similar products enable practices to set up multiple access points in a larger office, and to move between the access points seamlessly. "You should never drop the signal when you go from one access point to another," says Lubrano. "None of the consumer-grade products are really going to be able to do that."

Both consumer wireless access points and enterprise access points typically have enough security features to be HIPAA-compliant. And although tech-savvy physicians can, and sometimes do, set up their own wireless networks, they need to be cautious -- for security reasons. Security is "typically not enabled by default," says Lubrano, so it may be prudent to hire an IT consultant to make sure that security is actually turned on and meets minimum standards. Lubrano, who admits he's seen physicians who've set up secure and reliable networks on their own, still generally recommends a professional setup because in a practice setting, wireless setup can be more complex than it appears on the surface.

Among the complexities, he says, are:

1. "It's a site-specific endeavor."
   In other words, the ability of wireless networks to function well can be affected by many factors. For example, interference can be created by nearby networks outside of the office, but can be worked around by using different frequencies or even different equipment. In addition, signals can be blocked or weakened by walls, and the placement of access points to work around that issue can be more of an art than a science.
2. Things change.
   The network may become unreliable, and because there are many variables, "It really takes someone who knows how the variables interact to [fix the network] with some kind of efficiency."
3. Password protection.
   Although this can seem like a simple matter, it's prudent for practices to have a password retention policy that requires all users to change their password at fixed intervals -- between three and six months is typical. It's also crucial to set a minimum password length, to require that passwords include at least one special character and one number, that passwords can't be easily guessed, that they're not revealed to others, and that they're not written down.

Know Your Specialization
Hiring an outside consultant may seem like an unnecessary expense to some practitioners, but should be considered in the context of the potential pitfalls and the time a practitioner would spend on a Do-It-Yourself solution.

Although the wireless products most commonly used by physicians -- wireless networks, tablet and laptop PCs, and smartphones -- are mature in the sense that they're robust, secure, and user-friendly -- wireless in a practice setting can be more difficult to set up, secure, and maintain than it appears on the surface. Practices considering the switch to wireless should give strong consideration to business-strength products, despite their high cost compared to consumer products. They would also be wise to consider using healthcare information technology specialists to advise on product selection and to set up the network.