Not Your Father’s VoIP

Voice Over IP (VoIP) has been commercially available to the consumer market since 2004. Business users soon followed and acute care hospitals became heavy users of VoIP for internal phone systems. Given the history, why does VoIP pose such challenges to mobility deployments of smartphones into hospitals? And more importantly, how do you overcome them?

Challenges – it’s all about the roaming

The wireless infrastructure in most hospitals is robust enough to handle the organization’s data needs – but VoIP makes unusual demands. For example: my laptop’s wireless connection may be perfect at my desk as well as in all of the conference rooms. In each location, I’m stationary before putting a demand on the wireless network. But what happens when I walk between the locations? Does everything still operate properly while I‘m in motion? Now add on the demands of a voice call where the callers instantly notice interruption or loss of connectivity. Finally, put the phone in the hands of the clinician who may even be running through the facility on a critical call. To overcome these “in motion” challenges, your mobility platform – wireless infrastructure, smartphones and software – all have to handle roaming properly. In other words, a user in motion on a phone call needs to stay continually connected to the best access point within your wireless network.

Two Standards – 802.11k and 802.11r

Time to get a bit technical. In order to make wireless devices work effectively in a complex environment, the IEEE has established two standards, namely:

802.11k – this standard enables the wireless devices to connect to the best available access point. For example, an access point with the strongest signal may be overloaded with traffic, but a nearby access point with additional capacity may be available. So when implemented by both the access points and the smartphones, a smartphone in motion will roam to the best available connection.

802.11r – this is known as the “fast roaming” standard. When implemented  by both the access points and the smartphones, a smartphone in motion will roam and then connect to a new access point as quickly as possible.

Think of these two standards as the “seals of approval” for your mobility system.


Healthcare mobility means smartphones – and that means devices that were initially designed to make calls over the cellular network. Until recently, the ability for smartphones to make commercial-grade VoIP calls while in motion was not a focus of the smartphone manufacturers. However, a number of smartphones now include the above standards, so before you procure phones, make sure that both the WiFi hardware and the operating system of your preferred device have implemented these standards.

Wireless Infrastructure

Fortunately, the wireless infrastructure manufacturers have been leaders in adopting 802.11k and 802.11r. You want  to make sure that the current firmware version of your wireless controllers and access points are compliant. If not, consider an update before you deploy.

Clinical Communications Software

The final checkpoint is your clinical communications software. Since the software places, receives and keeps alive the VoIP phone calls, it needs to be developed and optimized for hospitals. Ask the following questions about your mobility vendor’s software:

  • How does your software handle devices leaving WiFi coverage (such as when going into an elevator) and then re-connecting?
  • Is your software optimized for connecting directly to your PBX or does it require an additional component, or even a completely separate phone system infrastructure, in order to provide VoIP?

Deploying smartphones at your hospital will yield tremendous value. However, the information above is important if you actually want to use a phone to make a quality phone call.

Beyond HIPAA Compliant Secure Text Messaging

If you are like many people today, text messaging is a predominant means of communication. Although convenient, sending a text message as a healthcare provider can be a risky proposition. Fortunately there are dozens of secure text messaging vendors that provide a solution to that problem. Mobile Heartbeat is one of them.

HIPAA compliant secure text messaging is basic core functionality for Mobile Heartbeat, but it doesn’t end there. Mobile Heartbeat is an enterprise class, mobile clinical communications solution for acute care hospitals and all clinical practitioners. That includes nurses, CNA’s, technicians, and physicians, both inside and outside the four walls. Imagine purchasing a smartphone only for the purpose of texting and making phone calls. It would be like purchasing a laptop only to do word processing. That just doesn’t happen anymore. While there are dozens of secure text messaging apps available today, there are only a few that go beyond texting and take full advantage of all the smartphone has to offer.  Smartphones have the capability to become mobile extensions to medical devices, EMRs, nurse call systems and other hospital systems that require critical urgent communications.

The underlying technology that supports clinical communications is a segmented market and is evolving rapidly, becoming much more sophisticated as mobile apps begin to catch up with hardware,  middleware and network capabilities in the healthcare provider setting. We’ve gone from yelling at each other down the halls, to antiquated phone handsets (tin can and strings), to Apple iPhones and Android smartphones capable of handling integrated apps that create new dynamic and mobile clinical workflows. These workflows truly mobilize caregivers, putting them back at the patients’ bedside where they belong.

Mobile Heartbeat is a unique solution that does take full advantage of all the capabilities inherent to the smartphone and goes way beyond voice and text. Some have defined this solution as “deep messaging” or “extended messaging” as Tim Gee does in his article on Messaging Middleware Market Segmentation & Adoption. According to Tim, the clinical messaging solutions that take advantage of smartphone capabilities are also broad in functionality. They include features such as dynamic care team directories, role-based messaging, medical device alarm notification and critical test result management, allowing for greater care team collaboration and patient safety. They integrate mobile communications with the EMR, nurse call, telemetry and other hospital systems that require critical urgent messaging and provide for mobility without having to walk back to a workstation to retrieve information. This results in substantially improved efficiency in clinical workflow, patient throughput and improved employee satisfaction – read our case study on Henry Mayo Newhall Hospital to find out more.

So, the next time you think of Mobile Heartbeat, think HIPAA compliant secure text messaging, and beyond.

Read more about how our customers take full advantage of smartphones as part of a complete mobility strategy here.