A game-changer in the wireless communications industry, 5G represents the fifth generation of cellular connectivity and a significant leap forward in performance compared to 4G and LTE. However, in order to plan for its impact in industries such as healthcare, smart cities and commercial buildings, we have to understand its opportunities, limitations and design challenges.

 What is 5G?

First, it’s important to differentiate 5G from other wireless communication protocols such as Wi-Fi.

5G (along with previous standards like 3G, 4G and LTE) is a standard for wireless cellular communications, and uses licensed frequency bands which must be purchased by the carrier. Wi-Fi, on the other hand, refers to technologies commonly used for wireless local area networking – connecting users to a building or residential network which is often owned and operated by the building owner. Wi-Fi uses unlicensed frequency bands which are available for anyone to use, and which can result in an increased risk of signal interference. The new 5G standard augments existing Wi-Fi and LTE standards rather than replacing them – in fact, Wi-Fi 6 (802.11ax) is set to also dramatically change the performance of Wi-Fi communications.

With that in mind, let’s look at how 5G differs from previous generations of cellular technology:

  • Latency, or the amount of time it takes for information to travel from the sender to the receiver is reduced to a theoretical <1 millisecond end-to-end, which is on par with many wired networks. As a comparison, typical home Wi-Fi latency is 2-5 milliseconds, and cable/DSL connections can have latency up to 100 milliseconds. Reduced latency increases the responsiveness for applications like self-driving cars, and can help data speeds appear higher to the end user.
  • 5G supports a higher density of users (up to 1 million per square kilometre or 100 times the density of previous generations). This is a limitation of many existing networks and key to supporting the expansion of the Internet of Things (IoT) and the myriad connected devices carried by people all over the world.
  • Transmission speed, or the amount of data that can be sent in a given period of time, is increased from a maximum of 1Gbps with LTE to a theoretical limit of 10-100Gpbs with 5G. It is anticipated that actual speeds will be an estimated 200Mbps-1Gbps in the field, which is still significantly higher than what most users experience with LTE.
  • Ultra-high reliability of 99.999%, which translates into downtime of less than 5 minutes and 15 seconds per year, and meets the typical standard for mission-critical data centres and networks.
  • Reduced power consumption, which is key for extending the life of battery-powered field devices and IoT.

Although most users won’t notice the difference, 5G also uses different radio frequencies from past standards. Current cellular protocols typically operate on radio frequencies between 1900MHz and 2700MHz; however, 5G uses two distinctly different frequency bands: below 6GHz, which supports standard cellular connectivity (600-700MHz and 3.5GHz in Canada), and above 6GHz, which is focused on point-to-point data transfer (millimetre wave or 28-35GHz) and can only be used for line-of-sight applications. This change has implications for existing infrastructure, as radio frequency communications are highly dependent on the hardware that supports them.

When is it coming?

Frequency auctions are already happening across North America and Europe. Canadian 600MHz frequencies were auctioned off in early 2019, and higher frequencies, including 3.5GHz, are expected to be auctioned in late 2020 and early 2021. Bell Media and Rogers Communications are expected to be the major players at the 3.5GHz auction in Canada, while Ericsson, Qualcomm and other major US cellular carriers indicate that they are ready with 5G infrastructure and can deploy as soon as they own the rights to the frequencies. Some carriers in the US have already launched 5G networks on the 3.5GHz frequency band, and some frequency bands above 6GHz have been auctioned off as well, with more to come later in 2021.

What is the potential impact of 5G on the design, construction and real estate industries?

5G has the potential to support radical advances in technology, and is anticipated to become the new standard for wireless mobile connectivity. However, it doesn’t replace wired networks which still set the standard on data transfer and latency, or Wi-Fi, which uses unlicensed frequency bands to distribute wireless connectivity throughout a building, often at a significantly lower cost per gigabyte.

So where is 5G anticipated to have the greatest impact?

While typical cellular users will experience enhanced performance, better connectivity and higher data speeds, the impact of 5G will mostly be experienced by devices rather than people. Devices such as self-driving cars and robotics which must be able to analyze and react quickly to situations will benefit from the low latency of new technology, and high-bandwidth mobile applications such as virtual reality (VR) and extended reality (XR) will make use of the increased data transmission speeds. 5G also has the capability to connect to a greater number of devices and use less power than previous generations, opening up a wealth of opportunity in the effortless deployment of battery-powered, highly mobile and flexible networks of 5G sensors and devices without the need for additional wiring.

Healthcare: the reliability of 5G connections is well suited to supporting critical healthcare applications, such as continuous monitoring. Higher data transmission speeds will be instrumental in facilitating high-mobility communications for telemedicine, data collection, predictive analytics, machine learning and artificial intelligence. The ultra-low latency wireless connections will also support applications like mobile robotic surgery and virtual reality.

Commercial and Smart Buildings: the explosion of connected devices within buildings will rely heavily on the increased density of connections available under the new 5G standard. Buildings are becoming more connected, IoT devices and sensors are becoming more ubiquitous, and occupants have higher expectations around connectivity and performance. The lower power requirements of 5G also makes it easier and more cost-effective to deploy highly mobile, battery-powered devices throughout the building without significant infrastructure costs. This, along with enhanced reliability, will also support mission-critical applications such as monitoring of building systems.

Smart Cities: navigation systems and self-driving cars will benefit significantly, as will increased density of sensors and users – particularly in areas like stadiums and transit terminals. However, higher frequencies necessitate high density of end-points compared to previous generations, which could have aesthetic implications as antennas move from towers to street level.

In all of these examples, properly designed distributed antenna systems (DAS) will become increasingly critical in the extension of 5G coverage throughout buildings and other areas with limited signal coverage; however, the building itself can have a significant impact on the operation of these systems and must be carefully considered in the early stages of design.

How  do we design differently for future technologies like 5G?

When technologies change every five to ten years but buildings can last anywhere from 30 to 50 years (or even more), designing infrastructure to adapt to evolving requirements is critical to ensuring the building will be able to meet the needs of its occupants both today and for decades to come. One of the key changes with the evolution to 5G is that the new standards rely heavily on optical fiber infrastructure to achieve the required data transmission speeds, rather than traditional copper infrastructure. This means that legacy buildings may need to replace their existing infrastructure in order to deploy 5G throughout their building, and new construction should not only plan for the latest fiber infrastructure, but also install spare capacity to accommodate future generations of technology. It also means that 5G networks are not able to take advantage of Power over Ethernet (PoE) which supplies both data and power over a single cable, since PoE requires copper cable in order to deliver the power component. That being said, there are significant opportunities for PoE and other types of low-voltage distribution to work in conjunction with 5G by powering end-use devices and sensors.

From a building perspective, DAS that supports 5G requires a different topology from previous generations (known as a centralized radio access network or C-RAN topology), which may require changes to pathways and spaces compared to traditional DAS infrastructure. When designing 5G systems, it is also important to consider that higher frequencies do not penetrate buildings or obstructions as well as lower frequencies due to the inherent nature of the electromagnetic signal. Past generations such as 3G, 4G and LTE have used frequencies in the range of 1.9 to 2.6GHZ which had reasonable penetration, but the proposed 5G bands in Canada are significantly higher at 3.5GHz. While 3.5GHz provides better bandwidth and data transmission speeds than lower frequencies, it will also experience higher signal degradation and will require a higher density of antennas. This, along with the requirement for the latest fibre optic infrastructure, can create some unique challenges when performing upgrades in existing buildings which weren’t originally designed to accommodate 5G infrastructure. There are a number of solutions on the market to help ease the transition – and, in some cases, it is worth evaluating whether there are other technologies which could serve the same purpose with a lower capital investment.

Finally, the move towards more energy-efficient buildings can have a significant impact on deployment of wireless technologies of all types, and must be addressed early on in the design of the system. Many modern building materials have a negative effect on wireless signal penetration, meaning that a higher density of antennas is required to provide sufficient coverage. Additional testing may also be required after installation to optimize the system for the unique building environment.

Leveraging 5G in a Data-Connected World

5G has the potential to radically change our experience of connectivity and how we design the built environment. From smart cities to virtual reality, the world is becoming more connected every day – and technologies like 5G are playing a key part in the evolution of our environment. Designing buildings and systems to support these changing technologies in the decades to come will be critical as users increasingly expect a seamless integrated experience, no matter where they are.

Author:

Kim Osborne Rodriguez,P.Eng., RCDD

kim.osbornerodriguez@hhangus.com

On January 13, Toronto’s Emerging Leader Forum (ELF) hosted an engaging discussion on Digital Health focused on informing young leaders in healthcare. The event was led by Dr. Darren Larsen, Chief Medical Information Officer at OntarioMD, who facilitated the discussion with:

  • David Denov, Senior Manager, National Health Services at Deloitte
  • Dr. Trevor Jamieson, Virtual Care Lead, Women’s College Hospital
  • Laurie Poole, VP, Telemedicine Solutions at Ontario Telemedicine Network
    Throughout the discussion, key themes of patient-driven care, improved outcomes, reduced cost and better coordination of care emerged as central drivers for the adoption of digital health.

What is Digital Health ?

 

Digital health is empowering people to better track, manage, and improve their own and their family’s health, live better, more productive lives, and improve society. (Wikipedia)

 

 Despite having a relatively straightforward label, the concept of digital health encompasses a complex set of ideas that differ greatly between sectors and people. While many associate digital health with smartphone apps and telehealth, Dr. Trevor Jamieson is quick to differentiate between virtual health and digital health, noting that “how you use data to drive better decision making” forms the core of how digital health impacts how we care for patients. Many would agree that data has become critical in the delivery of healthcare across varying sectors from acute to primary care, and the ability to manage and apply data efficiently will likely become future differentiators for providers in the healthcare market. 

Unfortunately, one of the primary challenges of delivering on this definition of digital health is a lack of interoperability and integration both within and between healthcare organizations, which means that data cannot be leveraged to maximize its value. It’s not just enough to have astronomical amounts of data; it has to be delivered to the right person at the right time.

What’s holding back the adoption of digital health?

A combination of limited funding and a conservative approach to technology seem to be the biggest obstacles to the adoption of digital health in Ontario, but Laurie Poole is optimistic: “Technology used to be an afterthought, so there has been a big shift from even four years ago.”
However, funding models that reward physical presence rather than virtual care, and privacy legislation that limits how organizations store and share data are two big barriers noted by David Denov and Dr. Jamieson. “Hospitals and providers have convinced themselves that change has to be incremental, and that disruption is undesirable,” says Dr. Jamieson. “You will never have innovation without a bit of risk.” Clearly innovation needs to be balanced with the risk and potential consequences for patients and their data.

How can Canadian hospitals become leaders?

Looking to other health systems that have achieved widespread adoption of technology and digital health, it appears that that big changes have to be driven (or at least strongly supported) from the top down – and not just within the hospital, but from health systems or regional leadership in healthcare. Poole points out that integrated health systems in the US have leveraged their power as a closed system with a single HIS to drive mainstream adoption of virtual care, but that a lack of integration in Ontario has been a key challenge in achieving the same adoption. Many G8 countries are facing similar challenges of constricted spending, limited infrastructure and an aging population, and consolidating leadership at a regional or provincial level may help coordinate adoption. “Every [Ontario] hospital has an independent board of directors,” Dr. Jamieson adds, which may contribute to the challenges in achieving widespread adoption.
This might imply that Ontario hospitals are stuck in siloed information systems without a strong mandate from provincial leadership, but momentum is building and there are a number of initiatives which are working towards broader integration. Initiatives such as ConnectingGTA and the current [as of 2016] provincial hold on new Hospital Information System implementations may be the first step towards standardization.

Where do we go from here?

From the patient perspective, there is a growing expectation of digital health integration throughout their healthcare journey regardless of care location. Many of our Ontario hospitals have been able to leverage digital health effectively within their own organizations and work with healthcare partners on a community level, but growing pressure from patients will likely continue to push for provincial and even national initiatives which improve on inter-organizational integration. It is certainly clear that digital health has the opportunity to transform how care is delivered to the patient – from improved data analytics & big data to driving better patient outcomes through 360-degree healthcare coordination, digital health is becoming an essential part of effective healthcare.

 

Author: Kim Osborne Rodriguez,P.Eng., RCDD

Asset tracking targets efficiency to reduce hospital costs, improve patient car

Patient safety and outcomes have traditionally been key performance indicators for hospitals in Canada, but recently value and efficiency have emerged as increasingly important performance metrics. The introduction of new devices and technology that contribute to clinical and financial targets provide an opportunity for hospitals to leverage strategic investments. 

Real-Time Locating Systems

In 2012, Canada spent $60.6 billion on hospitals alone, up more than $10 billion from 2009. Although total healthcare spending (encompassing hospitals, drugs, physicians, administration and capital) has grown steadily in the last two decades, the percentage share of funding allocated to hospitals has steadily dropped in the last 40 years, from nearly half of total healthcare spending in 1975, to less than one-third in 2012. Hospitals have had to deliver the same services to more patients without significant increases in funding to match demand. As a result, there is a greater emphasis on efficiency alongside patient safety and satisfaction.

Hospitals have had to deliver the same services to more patients without significant increases in funding to match demand

American hospitals are considered by many to be at the forefront of embracing cutting-edge technologies aimed at reducing costs and improving efficiency. Other countries often follow-suit once there are proven U.S. hospital business cases that substantiate the benefits.
A recent example of this is the widespread adoption of real-time locating systems (RTLS), which are used to track patients, staff and assets. RTLS typically uses Wi-Fi or proprietary technology, or a combination of both, to triangulate the location of radio-frequency tags within a building and then display the locations on a map. Tags are attached to people or items to be tracked. Authorized staff are able to easily search for the location of a specific tag or category of tags. RTLS is now being implemented in the majority of new build and redevelopment hospital projects in Canada.

Many of the financial benefits of RTLS come from the ability to track assets and equipment in a hospital. Other benefits include increased staff efficiency and satisfaction, improved maintenance, reduced capital replacement costs and evidence-based decision-making.

Increased Staff Efficiency and Satisfaction

Data from the Canadian Institute for Health Information suggests that worker compensation makes up more than 60 per cent of total hospital costs and the majority of this goes to nurses. Other studies have shown that nurses spend between seven and 20 per cent of their shift searching for equipment and supplies, taking time away from patient care and other responsibilities. Asset tracking significantly reduces “wasted” time locating items, which improves nursing efficiency. It also benefits patients since outcomes improve when nurses are able to spend more time at the bedside.

Improved Maintenance

The efficiency gains extend to biomedical and facilities staff as well. Preventive maintenance is not only important for maintaining warranties and extending the useful life of equipment, but also has a critical impact on patient safety by ensuring that medical equipment is functioning properly. Research by the World Health Organization indicates that globally, up to 60 per cent of hospital medical equipment is not maintained properly, potentially leading to premature failure or adverse patient outcomes. Given that significant time is often spent locating equipment for maintenance or recalls (with mixed success), asset tracking improves operational efficiency, capital replacement and clinical metrics by ensuring that support staff are able to easily find it.

Reduced Capital Replacement Costs

A study by the American national care network VHA, Inc. (formerly “Voluntary Hospitals of America”) found that, on average, U.S. hospitals spend $4,000 per bed per year replacing lost or stolen equipment and supplies, leading to a total capital cost of approximately $2 million per year for a typical 500-bed hospital. Furthermore, research suggests hospitals buy 20 to 50 per cent more equipment than required, and most equipment has only a 40 to 50 per cent utilization rate.
Asset tracking reduces the required fleet size by making equipment more available and increasing its utilization, a benefit which the Ottawa Hospital leveraged to reduce an upcoming infusion pump deployment by approximately one-third after implementing a RTLS on its 3 million-square-foot campus.

Evidence-Based Decision-Making

When it comes to making purchasing decisions, there is generally a lack of clear information related to hospital needs, which can lead to an inefficient use of capital funds.
Asset tracking provides the data required to assess equipment usage, maintenance and failure rates in order to drive evidence-based purchasing decisions. This eliminates unnecessary equipment purchases and improves the overall usefulness of the hospital’s assets.

Building a Business Case

The return on investment (ROI) for RTLS is typically based on three areas of cost savings: improved clinical efficiency (operational/labour savings); increased utilization/fleet reduction (capital equipment savings); and reduction in loss/theft (capital equipment savings).

There are a number of different methods used to estimate the ROI for a given area of cost savings.

For operational efficiencies, ROI can be estimated using time studies, which track the amount of time spent finding equipment and supplies. These time studies should target assets that are routinely needed or those that take a long time to find, such as stretchers, wheelchairs, infusion pumps and IV poles. 

Savings in capital expenditure can be estimated using industry averages. When considering the savings associated with fleet reduction, equipment fleets can generally be reduced by up to one-third. Theft can be reduced up to 50 per cent, depending on the current theft rate in the healthcare organization.

ROI calculations should take into account both the operational and capital expenditure savings anticipated through the implementation of asset tracking by calculating a total annual savings and estimated payback period based on information available within the organization.

 Maximizing the Investment Value

Although asset tracking is an effective tool for improving hospital efficiency, maximizing the investment value requires looking beyond immediate cost savings to understand how the solution fits with the overall strategy and goals of the healthcare organization. For example, automatically making the real-time information available (through asset tracking) to other hospital systems helps reduce manual data entry, 

Maximizing the investment value requires looking beyond immediate cost savings to understand how the solution fits with the overall strategy and goals of the healthcare organization.

freeing up additional resources and improving the quality and availability of information. To identify and maximize these opportunities, design and implementation of the RTLS should include consultations with clinical, support and facilities staff. The Angus Connect group facilitates this process by providing clinical and technical input to the design and planning for a real-time locating system, and how its functionality fits with the overall organizational strategy.
Ultimately, asset tracking provides an opportunity for healthcare organizations to reduce costs and provide better quality care for patients by improving hospital efficiency. The outlook is still optimistic: There may be unprecedented financial pressure on hospitals but there is a parallel unprecedented opportunity in the availability and effectiveness of new technology.

Author: Kim Osborne Rodriguez, P.Eng., RCDD

Published July 2015 in the Canadian Healthcare Facilities Magazine