Network Security Without Clinical Disruption: Best Practices in Hybrid Care Delivery

Since the tipping point of the pandemic, healthcare organizations have embraced telehealth and virtual care models that bring innovative clinical workflows into patient care. Now faced with a nationwide workforce shortage, many leading health systems are once again leaning into virtual care to reduce stress on care teams and enhance patient coverage and safety, especially in inpatient settings.

Tele-nursing, tele-sitting, and tele-consults represent just a few of the remote workflows gaining prominence in hospitals. Enterprise telehealth is paving the way for inpatient virtual engagement at every patient’s bedside.

Under this new paradigm, healthcare IT teams are understandably looking to drive security standards across virtual workflows. The challenge is that many corporate IT initiatives around network security and performance can disrupt patient care in always-on virtual environments. IT standards that make perfect sense for many IoT devices can seriously impede healthcare delivery.

Common Security and Network Factors that Impact Virtual Care

Login expirations

It’s common for cybersecurity teams to force users to log out at certain intervals. That means tele-sitters may need to log back in multiple times during a shift, interrupting patient observation.

Device timeouts

To keep unused devices from overloading the network, sometimes idle systems that are on for a certain number of hours are automatically disconnected. If you’re in the middle of observing a patient and that connection drops, that creates a safety risk for that patient.

Firewall port restrictions

Firewall updates frequently disconnect virtual care applications. If you’re a sitter watching a patient, your system disconnects, and you can’t call back in, the time it takes to regain access to a high-risk patient can feel like an eternity.

DHCP registration requirements

When managing IP addresses, enterprises often reset assigned addresses, sometimes as often as every 30 minutes. This can cause disconnects. If many systems are trying to renew their IP lease, it can cause congestion. If you’re a doctor trying to call into a patient room that’s still in queue to get an IP address, that call will not connect.

Wi-Fi over-subscription

You can have excellent coverage when you evaluate your Wi-Fi heat map, but it’s really about network congestion: How many devices are connected to your access points transmitting data? That can really impact care.

Bandwidth restrictions

Most networks are designed for data applications, not two-way video. This leads to bandwidth strain during peak usage times when concurrent session rates are high.

These traditional approaches to security and network management warrant reassessment in clinical environments where devices need to be available 24/7 to support virtual care programs. Spending millions of dollars on your network doesn’t mean your network can effectively support virtual care. It’s critical to ensure that your network is designed to handle bidirectional video communications.

Network and Security Best Practices for Virtual Care

As hospitals seek to amplify the reach of staff resources and improve the speed of clinical intervention, virtual care holds immense potential. However, the success of your hybrid care programs hinges on the ability of the network to support uninterrupted, high-quality video communications on a 24/7 basis. It’s essential that clinical and IT teams connect early on, collaborate, and compromise to ensure that security and network support are done in a way that improves rather than disrupts virtual patient care.

Here are best practices to ensure your network is optimized to support the critical nature of hybrid patient care.

• Compromise on staff login expirations by having automatic logouts coincide with shift changes.
• Avoid automatic disconnection of devices used in hybrid care models.
• Use static IP addresses if you can. If not, at least have the IP lease last a full shift.
• Measure the experience of your Wi-Fi-connected devices and calculate how many devices are within a wireless access point. How much are they being used? Can they be hijacked?
• Calculate your peak bandwidth. Look at your fleet of devices and review your network capacity and give an estimate of the number of concurrent connections that you can comfortably do. Then design your network to what that peak bandwidth threshold would be.
• Empower patients to connect with their family, care team, and interpreters but consider that impact on call volumes when multiplied across the entire hospital. Factor this into peak utilization because what you don’t want is to have a lot of patients socializing with their families while your doctors can’t access the tele-ICU because of bandwidth limitations.
• Consider utilization all the way through to clinician workstations. Ensure nurses have enough throughput to support multiple concurrent connections.
• Isolate high-intensity connections like tele-ICU traffic to a VLAN virtual network where their bandwidth is protected. Leave concurrency available for high-profile locations and only allow so many ad-hoc calls to happen simultaneously to ensure high-priority sessions are maintained.
• Isolate video traffic in a VLAN if possible or create a wireless environment that’s only for virtual communications. This is going to become particularly important as customers deploy video systems in every patient room to support enterprise-wide virtual nursing and engagement.
• Get feedback from your clinical team. The easier you make virtual care to use, the less it becomes technology and the more it becomes a tool for clinicians to provide better care.
• Bring the cybersecurity team, the network team, and technology partners in early on. Talk about the impact of virtual workflows on the clinician and patient experience. Understand what you need to do to meet the cybersecurity and network demands within that environment.

The most important thing is to be willing to compromise. Any virtual care program will need this, whether you’re exploring your first tele-sitting program or building the Hospital Room of the Future. Virtual care is a high-demand application that you need to take the time to design. Like most of healthcare, one size doesn’t fit all and there’s no silver bullet. Considering these factors up front and finding balance through a multidisciplinary approach significantly contributes to greater success.

About the Author
Michael Brandofino is the President and COO of Caregility where he drives efforts to expand and enhance the company’s telehealth service offerings to improve operational efficiency and drive satisfaction on behalf of healthcare providers.