Left then Right … then Right again ?

It is a running joke amongst my family and friends that I need a GPS to find my way around my own apartment. I am notorious for always going the wrong way, so much so that people feel confident in going in the opposite direction that I choose.

These days, major hospitals are huge and can have elaborate mazes of hallways, steps and elevators. I know that I have gotten lost multiple times trying to navigate the Jerusalem hospital, Hadassah Ein Kerem. Imagine what it is like for a patient with a neurological disorder that affects their memory, or perhaps an older patient who is suffering from occasional confusion. Also, there are people who need to know where wheelchair access is available, or need to find a faster route to the oncology department, which just took them 20 minutes to find. This issue of internal navigation needs a solution.

Most people today, especially those with smartphones, are aware of a technology called GPS (Global Positioning System). This technology is only a few decades old and not that long ago, was limited to the military. Today, it is so cheap and so readily available, that millions of people use it everyday to guide themselves through traffic or for finding lost articles and even people.

There is one key problem with using GPS – it tends not to work indoors. GPS is dependent on orbiting satellites, and the radio signals from the GPS device need a clear view of the sky to work properly. Within a huge building, surrounded by cement and steel, GPS basically fails.

There are alternative technologies that can be used indoors. One of these is WiFi. WiFi is well known to many as the means by which you wirelessly connect your phone or other mobile device to a network (either a private local network between some computers or to the entire Internet). Within people’s homes, a special device called a router allows for the occupants to roam freely while still staying connected to the router. The router in turn passes signals to and from the Internet. As such, the entire home is a “hot spot” (a location that provides wireless connectivity to the Internet).

WiFi devices can be used also as a means of identifying the location of a mobile device indoors. This is actually how Google and other mapping services identify your location in a place like the Mall of America (one of the biggest malls in the States). It is important to realize that identifying a location within a building requires great accuracy. If the location system is off by even a couple of meters, it could incorrectly say that you are in a different store or elevator or (in a hospital) hospital room or operating theater and so on. So when using such WiFi location technology, maximum accuracy is critical !!

In a hospital setting, tracking a patient’s location can become a very powerful component of an electronic medical record system. For example, imagine that you wish to order an xray for a patient. But the EMR pops up a warning that says that the patient is presently undergoing a procedure (and based on the procedure, the doctor knows that it will be an hour until the patient returns). The doctor can still order the xray but will know not to expect the result for a while. In this scenario, there is no need to start asking other staff or even family members of the patient “where is he?”.

The problem with in-hospital patients is that they usually do not carry their smartphones with them in the hospital, especially if they are undergoing a procedure. Therefore, the patient will need to have some form of device literally attached to them (like a hi tech bracelet) that will transmit signals to the WiFi system and thus provide their location. Please also realize that this bracelet would have to include the identity of the patient within the signal it sends to the WiFi system. And then, the WiFi system would have to save the patient identification along with the patient location.

Such systems also record the time at which the location was detected. In a hospital setting, this would allow a doctor to know how long a patient was in the xray department or in surgery. By combining this time information with other data, one could spot inefficiencies in the operations of the hospital. For example, the director of a hospital might find that a patient spent 2 hours in the xray department for a simple chest xray. Based on this, the director could pick up a phone to the xray department manager and ask why there was such a holdup.

This is still all passive detection of location, i.e., the system is tracking you. What if you want to be active, i.e. you want to ask the system how to get to the Oncology department or the closest bathroom? Of course, this would require some type of interface via which you could ask a question of the location system and then receive detailed directions. I personally think that this could be a “killer application” for the building wave of smart watches. A person could ask, via the watch, how to find a specific department, and the watch could speak or show the directions via the watch face. This would be much easier to handle than fumbling with your phone (especially if one of your hands is holding a cane or your hands are unavailable for any other reason).

Location detection will take time to become ubiquitous across all hospitals. But it will add important information about the overall healthcare management of patients. And it will allow for a digital personal assistant for every person (patient, worker and visitor) in the hospital.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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