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
PART 1 : TROUBLESHOOTING
Individual: Troubleshooting a Configuration Problem
consider the following problem:
Your child must complete an after-school project in which she
must post her work to a moderated online forum specially set up
by her teacher. Your computer, which is using a newly installed
Network Interface Controller (NIC), is unable to access the
Internet and you suspect the problem may be in the TCP/IP

13. configuration. You want to determine the MAC address of your
network card.
Develop a mindmap or flowchart using Microsoft® Word,
PowerPoint®, Visio®, Lucidchart, or a flowchart tool of your
choice to map the process.
Create a 1-page Microsoft® Word document that addresses the
following questions:
How would you use the ipconfig command to determine the
MAC address?
What other configuration data can you view by using ipconfig?
Submit your mindmap and answers to the Assignment Files tab.
PART 2 Texas History Agrarian Revolt and 1900 Galveston
Hurrican
200 words What impact did the evolving frontier and its
eventual closing have on the culture of Texas? What role did
Texas play in the Agrarian Revolt? What about the state allowed
it to take a leadership role? How did the frontier and rural areas
influence the culture of Texas at the turn of the century?
Then in another 200 words
What was the economic impacts of such events as the 1900
Galveston Hurricane and the development of the oil industry in
Texas? Explain fully.
Pick a significant historical event and describe the effect upon
the Texas economy in the 20th century.
Summarize the event and contrast what the "before and after"
effects to the Texas economy were.
Be specific in your details. Give examples.
In 200 words Consider the historic events (WWII, and the Civil
Rights Movement of the 1960s) described in these chapters.
Chances are that someone in your family and community had
direct experiences in one of these historic events.
Compare and contrast what occurred in Texas (according to the

14. book or other reliable source) during your chosen period with
what may have been experienced by your family member or
someone in your community.
If you do not wish to share your family history, then pick a
community or culture not in Texas to compare with what
occurred in Texas.
If you know of anyone who lived in Texas during that period,
feel free to relate their experiences.
*MAKE THEM SEPARATE AS WELL
Part 3 Discussion 2
Watch the video on 'GOOGLE' (see link below). You may have
to cut and paste the link into your browser. After watching the
video write an essay (500 Word Minimum) about what you
learned as it relates to advertising/advertisers; how Google
utilizes advertising as a platform for companies to advertise
products or services. What is Googles strategy, how do they
monetize what they offer, and according to the video, how do
the companies mentioned benefit. Please be sure to also
incorporate what you've learned from the book readings and
classroom lectures into the essay discussion. Spell check your
work. Use Font Times New Roman, Font Size 12, Single Space.
Please put your name on your work and title the Essay "Google
Advertising; DQ #6" *This DQ will be worth 4 points because I
will eliminate a DQ later in the semester.
Here's the link:
http://www.viddler.com/embed/20b602dc/?f=1&autoplay=0&pla
yer=full&disablebranding=0l
PART
1 :
TROUBLESHOOTI
N
G

15. Individual: Troubleshooting a Configuration Prob
lem
c
onsider
the following problem:
Your child must complete an after
-
school project in which she must post her work to a moderated
online forum specially set up by her teacher. Your computer,
which is using a newly installed
Network Interface Controller (N
IC), is unable to access the Internet and you suspect the
problem
may be in the TCP/IP configuration. You want to determine the
MAC address of your network card.
Develop a
mindmap
or flowchart using Microsoft® Word, PowerPoint®, Visio®,
Lucidchart, or a
f
lowchart tool of your choice to map the process.
Create a 1
-
page Microsoft® Word document that addresses the following
questions:
How would you use the
ipconfig

16. command to determine the MAC address?
What other configuration data can you view by using
ipc
onfig
?
Submit your mindmap and answers to the Assignment Files tab.
PART
2
Texas History Agrarian Revolt and 1900 Galveston Hurrican
200 words What impact did the evolving frontier and its
eventual closing have on the culture of
Texas? What role did Texas play in
the Agrarian Revolt? What about the state allowed it to take a
leadership role? How did the frontier and rural areas influence
the culture of Texas at the turn of the
century?
Then in another 200 words
What was the economic impacts of such events as the 1900
Galveston Hurricane and the
development of the oil industry in Texas? Explain fully.
Pick a significant historical event and describe the effect upon
the Texas economy in the 20th
century.
Summarize

17. the event and contrast what the "before and after" effects to the
Texas economy were.
Be specific in your details. Give examples.
In 200 words Consider the
historic
events (WWII, and the Civil Rights Movement of the 1960s)
described in these chapters. Cha
nces are that someone in your family and community had direct
experiences in one of these historic events.
Compare and contrast what occurred in Texas (according to the
book or
other reliable source
) during
your chosen period with what may have been exper
ienced by your family member or someone in
your community.
PART 1 : TROUBLESHOOTING
Individual: Troubleshooting a Configuration Problem
consider the following problem:
Your child must complete an after-school project in which she
must post her work to a moderated
online forum specially set up by her teacher. Your computer,
which is using a newly installed
Network Interface Controller (NIC), is unable to access the
Internet and you suspect the problem
may be in the TCP/IP configuration. You want to determine the
MAC address of your network card.
Develop a mindmap or flowchart using Microsoft® Word,
PowerPoint®, Visio®, Lucidchart, or a
flowchart tool of your choice to map the process.

18. Create a 1-page Microsoft® Word document that addresses the
following questions:
How would you use the ipconfig command to determine the
MAC address?
What other configuration data can you view by using ipconfig?
Submit your mindmap and answers to the Assignment Files tab.
PART 2 Texas History Agrarian Revolt and 1900 Galveston
Hurrican
200 words What impact did the evolving frontier and its
eventual closing have on the culture of
Texas? What role did Texas play in the Agrarian Revolt? What
about the state allowed it to take a
leadership role? How did the frontier and rural areas influence
the culture of Texas at the turn of the
century?
Then in another 200 words
What was the economic impacts of such events as the 1900
Galveston Hurricane and the
development of the oil industry in Texas? Explain fully.
Pick a significant historical event and describe the effect upon
the Texas economy in the 20th
century.
Summarize the event and contrast what the "before and after"
effects to the Texas economy were.
Be specific in your details. Give examples.
In 200 words Consider the historic events (WWII, and the Civil
Rights Movement of the 1960s)
described in these chapters. Chances are that someone in your
family and community had direct
experiences in one of these historic events.
Compare and contrast what occurred in Texas (according to the
book or other reliable source) during

19. your chosen period with what may have been experienced by
your family member or someone in
your community.