C9-1 CASE STUDY 9 ST. LUKE'S HEALTH CARE SYSTEM Hospitals have been some of the earliest adopters of wireless local area networks (WLANs). The clinician user population is typically mobile and spread out across a number of buildings, with a need to enter and access data in real time. St. Luke's Episcopal Health System in Houston, Texas (www.stlukestexas.com) is a good example of a hospital that has made effective use wireless technologies to streamline clinical work processes. Their wireless network is distributed throughout several hospital buildings and is used in many different applications. The majority of the St. Luke’s staff uses wireless devices to access data in real-time, 24 hours a day. Examples include the following: • Diagnosing patients and charting their progress: Doctors and nurses use wireless laptops and tablet PCs to track and chart patient care data. • Prescriptions: Medications are dispensed from a cart that is wheeled from room to room. Clinician uses a wireless scanner to scan the patient's ID bracelet. If a prescription order has been changed or cancelled, the clinician will know immediately because the mobile device displays current patient data. http://www.stlukestexas.com/ C9-2 • Critical care units: These areas use the WLAN because running hard wires would mean moving ceiling panels. The dust and microbes that such work stirs up would pose a threat to patients. • Case management: The case managers in the Utilization Management Department use the WLAN to document patient reviews, insurance calls/authorization information, and denial information. The wireless session enables real time access to information that ensures the correct level of care for a patient and/or timely discharge. • Blood management: Blood management is a complex process that involves monitoring both patients and blood products during all stages of a treatment process. To ensure that blood products and patients are matched correctly, St. Luke’s uses a wireless bar code scanning process that involves scanning both patient and blood product bar codes during the infusion process. This enables clinicians to confirm patient and blood product identification before proceeding with treatment. • Nutrition and diet: Dietary service representatives collect patient menus at each nursing unit and enter them as they go. This allows more menus to be submitted before the cutoff time, giving more patients more choice. The dietitian can also see current patient information, such as supplement or tube feeding data, and view what the patient actually received for a certain meal. • Mobile x-ray and neurologic units: St. Luke’s has implemented the wireless network infrastructure necessary to enable doctors and clinicians to use mobile x-ray and neurologic scanning units. This makes it possible to take x-rays or to perform neurological studies in patient rooms. This min.

1. C9-1
CASE STUDY 9
ST. LUKE'S HEALTH CARE SYSTEM
Hospitals have been some of the earliest adopters of wireless
local area
networks (WLANs). The clinician user population is typically
mobile and
spread out across a number of buildings, with a need to enter
and access
data in real time. St. Luke's Episcopal Health System in
Houston, Texas
(www.stlukestexas.com) is a good example of a hospital that
has made
effective use wireless technologies to streamline clinical work
processes.
Their wireless network is distributed throughout several
hospital buildings
and is used in many different applications. The majority of the
St. Luke’s

2. staff uses wireless devices to access data in real-time, 24 hours
a day.
Examples include the following:
• Diagnosing patients and charting their progress: Doctors and
nurses use wireless laptops and tablet PCs to track and chart
patient
care data.
• Prescriptions: Medications are dispensed from a cart that is
wheeled
from room to room. Clinician uses a wireless scanner to scan
the
patient's ID bracelet. If a prescription order has been changed or
cancelled, the clinician will know immediately because the
mobile device
displays current patient data.
http://www.stlukestexas.com/
C9-2
• Critical care units: These areas use the WLAN because
running hard
wires would mean moving ceiling panels. The dust and microbes

3. that
such work stirs up would pose a threat to patients.
• Case management: The case managers in the Utilization
Management
Department use the WLAN to document patient reviews,
insurance
calls/authorization information, and denial information. The
wireless
session enables real time access to information that ensures the
correct
level of care for a patient and/or timely discharge.
• Blood management: Blood management is a complex process
that
involves monitoring both patients and blood products during all
stages of
a treatment process. To ensure that blood products and patients
are
matched correctly, St. Luke’s uses a wireless bar code scanning
process
that involves scanning both patient and blood product bar codes
during
the infusion process. This enables clinicians to confirm patient
and blood

4. product identification before proceeding with treatment.
• Nutrition and diet: Dietary service representatives collect
patient
menus at each nursing unit and enter them as they go. This
allows more
menus to be submitted before the cutoff time, giving more
patients
more choice. The dietitian can also see current patient
information, such
as supplement or tube feeding data, and view what the patient
actually
received for a certain meal.
• Mobile x-ray and neurologic units: St. Luke’s has
implemented the
wireless network infrastructure necessary to enable doctors and
clinicians to use mobile x-ray and neurologic scanning units.
This makes
it possible to take x-rays or to perform neurological studies in
patient
rooms. This minimizes the need to schedule patients for
neurology or
radiology lab visits. The mobile units also enable equipment to
be

5. brought to the bedside of patients that cannot be easily moved.
The
wireless neurology and x-ray units have also helped to reduce
the time
between diagnosis and the beginning patient care.
C9-3
Original WLAN
St. Luke's first WLAN was deployed in January 1998 and made
the hospital
an early pioneer in wireless health care applications. St. Luke’s
first wireless
LAN was implemented in a single building using access points
(APs) made by
Proxim (www.proxim.com).
A principal goal of this initial installation was to improve
efficiency.
However, sometimes the WLAN had the opposite effect. The
main problem
was dropped connections. As a user moved about the building,
there was a
tendency for the WLAN to drop the connection rather than
performing the

6. desired handoff to another access point. As a result, a user had
to
reestablish the connection, log into the application again, and
reenter
whatever data might have been lost.
There were physical problems as well. The walls in part of the
building
were constructed around chicken wire, which interfered with
radio waves.
Some patients' rooms were located in pockets with weak radio
signals. For
these rooms, a nurse or doctor would sometimes lose a
connection and have
to step out into the hallway to reconnect. Microwave ovens in
the
kitchenettes on each floor were also a source of interference.
Finally, as more users were added to the system, the Proxim
APs, with a
capacity of 1.2 Mbps, became increasingly inadequate, causing
ongoing
performance issues.
Enhanced LAN

7. To overcome the problems with their original WLAN and reap
the potential
benefits listed earlier in this case study, St. Luke's made two
changes
[CONR03, NETM03]. First, the hospital phased out the Proxim
APs and
replaced them with Cisco Aironet (www.cisco.com) APs. The
Cisco APs, using
IEEE 802.11b, operated at 11 Mbps. Also, the Cisco APs used
direct
C9-4
sequence spread spectrum (DSSS), which is more reliable than
the
frequency-hopping technique used in the Proxim APs.
The second measure taken by St Luke's was to acquire a
software
solution from NetMotion Wireless (netmotionwireless.com)
called Mobility.
The basic layout of the Mobility solution is shown in Figure
C9.1. Mobility

8. software is installed in each wireless client device (typically a
laptop,
handheld, or tablet PC) and in two NetMotion servers whose
task is to
maintain connections. The two servers provide a backup
capability in case
C9-5
one server fails. The Mobility software maintains the state of an
application
even if a wireless device moves out of range, experiences
interference, or
switches to standby mode. When a user comes back into range
or switches
into active mode, the user's application resumes where it left
off.
In essence, Mobility works as follows: Upon connecting, each
Mobility
client is assigned a virtual IP address by the Mobility server on
the wired
network. The Mobility server manages network traffic on behalf
of the client,
intercepting packets destined for the client's virtual address and
forwarding

9. them to the client's current POP (point of presence) address.
While the POP
address may change when the device moves to a different
subnet, from one
coverage area to another, or even from one network to another,
the virtual
address remains constant while any connections are active.
Thus, the
Mobility server is a proxy device inserted between a client
device and an
application server.
Enhancing WLAN Security
In 2007, St. Luke’s upgraded to Mobility XE mobile VPN
solution [NETM07].
This migration was undertaken to enhance security and
compliance with
HIPPA data transmission and privacy requirements. Mobility
XE server
software was deployed in the IT department’s data center and
client
software was installed on laptops, handheld devices, and tablet
PCs.
With Mobility XE running on both clients and servers, all

10. transmitted
data passed between them is encrypted using AES (Advanced
Encryption
Standard) 128-bit encryption. Mobility XE also serves as an
additional
firewall; devices that are not recognized by the Mobility XE
server are not
allowed to access the network. This arrangement helped St.
Luke’s achieve
its IT goal of having encryption for all wireless data
communications.
Mobility XE also enables the IT department to centrally
manage all
wireless devices used by clinicians. This allows them to monitor
the
C9-6
applications currently being used by any device or user, the
amount of data
being transmitted, and even the remaining battery life of the
wireless device.
If a Mobility XE device is stolen or lost, it can be immediately
quarantined by

11. network managers.
IT executives at St. Luke’s view wireless networking as key
lever in their
quest to increase clinician productivity and improved patient
care. Mobile
EKG units have been deployed bringing the total of wireless
devices in use to
nearly a 1,000.
Discussion Questions
1. Visit the NetMotion Web site (www.netmotionwireless.com)
and access
and read other Mobility XE success stories. Discuss the patterns
that
can be observed in the benefits that Mobility XE users have
realized via
its deployment and use.
2. Do some Internet research on the security implications of
HIPPA
requirements for hospital networks. Discuss the major types of
security mechanisms that must be in place to ensure hospital
compliance with HIPPA requirements.
3. Do some Internet research on the use of VLANs in hospitals.
Summarize the benefits of using VLANs in hospitals and

12. identify
examples of how St. Luke’s could further enhance its wireless
network
by implementing VLANs.
Sources
[CONR03] Conery-Murray, A. “Hospital Cures Wireless LAN
of Dropped
Connections.” Network Magazine, January 2003.
[NETM03] Netmotion Wireless, Inc. “NetMotion Mobility:
Curing the
Wireless LAN at St. Luke’s Episcopal Hospital. Case Study,
2003.
Netmotionwireless.com/resources/case_studies.aspx.
[NETM07] Netmotion Wireless, Inc. “St. Luke’s Episcopal
Health System: A
Case Study in Healthcare Productivity.” 2007. Retrieved online
at:
http://www.netmotionwireless.com/st-lukes-case-study.aspx
http://www.netmotionwireless.com/
http://www.netmotionwireless.com/st-lukes-case-
study.aspxCASE STUDY 9Original WLANEnhanced
LANEnhancing WLAN SecurityDiscussion QuestionsSources
How to Get More Women to
Work in Tech
Role models and reassurance about potential success can impact
women’s career decisions.

13. ‘What made you decide to join your profession?’
When people are asked this question, they often
give answers such as: “I liked such-and-such subject
in school”, “I was inspired by so-and-so” or “It pays
well”. In most cases, there is an unspoken
assumption: They also believed that they had a
reasonably good shot at succeeding in this career.
According to the classic Roy model, individuals
choose their occupation based on a rational decision
process. They try to maximise their income, taking
into account their skills and relative rewards in
different sectors. It’s all about optimisation: People
go where they believe they will have the greatest
comparative advantage.
In the case of women, assumptions that certain
sectors do not welcome them may limit their
willingness to join. Consider the coding profession
in Peru, where women represent only 7 percent of

14. the workforce. Is this under-representation strictly a
matter of personal preference, or is it at least
partially due to stereotypes and social norms that
dissuade women from choosing this sector? Could
some women shun a career simply because they
don’t believe they could thrive in it?
In two field experiments in Latin America, we
observed that advertisements that included a female
role model and also corrected misperceptions about
women’s ability to pursue a career in tech
significantly increased the number of suitable female
applicants to a software coding bootcamp.
A bias-correcting intervention
We partnered with a non-profit organisation that
helps young women from low-income backgrounds
become digital coders via an intensive five-month
training programme. This international organisation
was interested in increasing application rates.

15. In our first experiment, which took place in Peru, we
created two versions of the programme registration
webpage. Both included basic information about the
training as well as the application form. However, in
one version, we added a message to correct biased
perceptions and beliefs about the role of women in
tech. This short message had three core
components:
1. It asserted that women can be successful in the
tech field.
2. It emphasised that the training gave access to a
network of women in the sector.
3. It told the story of a recent graduate (role model).
Though we did expect our intervention to have an
impact, we were stunned by the results.
Reassurance about career prospects more than
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l.-williams-heidi-14.662
doubled the number of applicants: 15 percent of
women exposed to our bias-correcting message
applied for training vs. only 7 percent of those who
visited the basic webpage.
In addition, when we compared the top 50
candidates in each group, those from our treatment
group garnered significantly higher scores on
cognitive and tech-specific ability tests
administered during the selection process.
What makes the needle move
We then ran a second experiment, this time in
Mexico, to figure out which of the three components
of our bias-correcting message resonated most with
applicants. To do this, we created four versions of

17. the training provider’s registration webpage. The
control one included the full message. In each of the
three other versions, we skipped one component:
One didn’t mention how women can be successful in
tech, one didn’t emphasise the existence of a peer
network and one didn’t feature a role model.
Based on this second experiment, we concluded that
the presence of a role model and the assertion that
women can be successful in tech are most important.
Their absence reduced applications by 23 and 18
percent, respectively, vs. the control group. (The
version that didn’t mention the peer network
yielded about the same application rate as the
control one.)
Deflecting self-segregation due to biases
By now most of us have heard that women earn 79
cents on the dollar compared to men. While it’s
true that women with full-time, year-round jobs

18. make less money than their male counterparts, most
of this gap isn’t due to straight-up sexism by
discriminatory employers. To a larger extent, it
reflects the fact that women tend to work in lower-
paid, female-dominated sectors.
Although not a panacea (and none exists), one way
to lessen the gender wage gap, over time, would be
to nudge more women towards better-paying
careers. The tech industry is only one example. Not
all women will be interested in such careers and
that’s fine. The idea is to ensure that gender norms
and self-segregation biases do not unnecessarily
steer away women, notably those who do show
interest and aptitude, from certain careers.
Our results indicate that in a male-dominated sector,
simple tweaks to the ‘selling message’ can
significantly impact women’s career decision
making. HR departments, policymakers and schools

19. may want to take note. Meanwhile, all of us should
cultivate an awareness of how social identity cues
and prescriptions can have subtle yet far-reaching
consequences on women’s behaviours.
Lucia Del Carpio is an Assistant Professor of
Economics at INSEAD.
Maria Guadalupe is an Associate Professor of
Economics and Political Science and the Academic
Director of the Randomized Control Trials (RCT)
Lab at INSEAD.
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