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Evaluating EMI in a Multi-Hospital Facility

Barry Bruns and Shawn Dimantha
ith the integration of wireless communication technology into hospital infrastructures across the nation, many hospitals are concerned about the impact of radio frequency (RF) electromagnetic interference (EMI) between wireless technologies and medical equipment. Such interference may cause undesirable effects to medical equipment, possibly, resulting in misdiagnosis, mistreatment, and/or patient injury. These wireless communication devices include wireless LAN, Bluetooth, wireless PBX, telecommunications, paging, two-way radios, telemetry devices, Blackberry, wireless Personal Digital Assistants (PDA), and PC tablet/laptop. While most medical instruments are manufactured now with a recommended 3V/m (10 V/m for life support devices) immunity level against interference from RF emissions (IEC 60601-1-2), older equipment may have inadequate shielding and, therefore, be more susceptible to interference.1 Wireless devices are becoming main stream in todays society. The prevalence of such wireless devices in the medical field is inevitable and probably here to stay. So, what is a hospital to do? One option is to do nothing and deal with the interference if it happens. Another option is to test every microprocessor-based medical device in the hospital to understand the potential interference issues. Unfortunately, it is virtually impossible to test every combination of transmitting wireless device and
Barry Bruns is the director of biomedical engineering for Genesis Technology Partners. He has a Masters in System Engineering from Wright State University, Dayton, OH, and a Masters in Business Administration from Xavier University, Cincinnati, OH. He works at the GTP account with the Health Alliance of Greater Cincinnati. The Health Alliance is a system comprised of six hospitals in the Greater Cincinnati area. Shawn Dimantha worked as a summer intern for Genesis Technology Partners. He is an engineering student with the University of Pennsylvania.

Testing of the hospital environment should begin with a RF survey, particularly before the installation of new medical telemetry.
microprocessor-based medical device. Genesis Technology Partners took a midline approach and tested a variety of medical devices with some mainstream wireless devices. We tested a sample of the most commonly used medical devices in the hospital. These devices included basic vital signs monitors to life support devices.

Where to Begin
Testing of the hospital environment should begin with a RF survey, particularly before the installation of new medical telemetry. RF surveys should be done for all hospitals that need to deal with radio and TV stations in close proximity. The FDA has written communications regarding digital television and potential interference with medical telemetry systems.2 Such interference from RF sources is a function of power, frequency, and distance. Fortunately, radio and TV stations are physically stationary; therefore, the distance a hospital is situated from a stations antenna is relatively constant. A frequency survey will help define the current interference potential. In addition, information about future plans of local TV stations to broadcast digital signals are needed to determine if the potential exists for EMI issues between TV digital signals and medical devices. Digital TV signals are transmitted at very high output powers and transmit at or near frequencies that have been traditionally used for medical telemetry (e.g. 460470MHz range).1

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Hospitals still operating medical telemetry at those frequencies may be at risk for EMI between the station and telemetry systems. As a result, the FCC has dedicated frequency bands for medical telemetry use known as the Wireless Medical Telemetry Spectrum (WMTS). Registration of these telemetry devices with the American Society of Hospital Engineers (ASHE) is necessary. Testing for EMI between mobile wireless communication and medical devices should also be performed. We tested wireless devices such as laptops, tablet PCs, and PDAs, which communicate using internal wireless access points and wireless network cards. Hospitals have set up distributed access point systems to help improve signal strength between the access points and the network interface cards (NIC). These wireless access points are typically fixed near the ceiling and tend to operate at 0.1 watts or lower. The devices most vulnerable to EMI from the access point are telemetry antennae. Fortunately, the access

points operate at different frequencies beyond the WMTS band and pose little threat. However, the associated wireless network cards for mobile computers used in systems for computerized physician order entry (CPOE) and electronic medical records (EMR) can potentially come in close contact with medical devices. Despite the low power, we did test for EMI between wireless network cards and medical devices. The wireless devices, which do not rely on internal antenna systems, include cell phones, Blackberry, and Wi-Fi devices. Cell phones and wireless PDAs in general have an average power output of 0.6 watts, but they can increase to 2 watts when there is relatively low signal strength.3 Most cellular wireless devices do not generate much EMI at distances greater than 50 cm from the unit. However, their mobility increases the chance of a close encounter (less than 50 cm) with a medical device. Coupled with an increase in output power (1W) due to low signal strength, the chance for EMI does exist. Despite the low power, cell phones in close proximity to

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Evaluating EMI in a Multi-Hospital Facility

experience a medical device shutdown on a legacy nonventilators have been documented to trigger Vent invasive blood pressure device as a result of operating a Inop modes.4 With this knowledge, it is imperative to test wireless units with legacy two-way radio at a distance of devices. less than 10 cm. We did not Depending on model, twonotice measurable EMI with Hospitals still operating way radios can transmit at outcell phones, wireless NICs, or medical telemetry at those put powers above the 5-watt access points. This data in range. This also includes radios frequencies may be at risk for coordination with other pubused by emergency medical EMI between the station and lished data validated the staff. These communication importance of testing various telemetry systems. devices are also the solution for medical devices and provided many disaster teams because support for a cellular they are mobile and easy to phone/two-way radio policy. deploy. Two-way radios will carry the largest risk to Conclusion medical devices, particularly within 1 meter distance. In conclusion, not every single device in a hospital needs Additionally, since these devices are mobile, finding the to be tested for potential interference. Life support interfering device can be difficult. These devices pose equipment along with typical diagnostic devices should the greatest threat only in the talk or transmit mode be tested against various wireless units to mitigate the and do not transmit continuously. interference. If possible, devices should be tested in areas Measuring Interference where the equipment is used and where device failure In order to quantify the potential interference, Genesis results in the largest problem. Technicians should look Technology Partners tested various combinations of cell for erroneous operation, display and system failures. The phones, wireless network cards, PDAs, two-way radios, combination of this data will help in determining the hosand medical devices. The method of testing was similar pitals stance on cell phone and two-way radio usage. to Cicso Systems testing of wireless network cards.5 A Every hospital should take the time to investigate the test lab was set up to mimic real-life situations. In addipotential interference problems associated with the fretion to the test lab, various testing was performed directquency spectrum of wireless devices in their environment. ly in the operating environment for the medical device. This investigation should include a survey of the local Test points were set at distances 10 cm, 20 cm, 50 cm, 1 area for TV and radio stations, including those TV stameter, and 3 meters from the medical device in question. tions positioned to transmit digital signals. Finally, hospiAt each given distance, the wireless device was tested at tals should register their telemetry frequencies with locations 360 degrees around the medical device. ASHE to help mitigate future interference problems. Devices were tested in normal operating modes with all References the necessary accessories. At each testing point, both 1) Guidance of Electromagnetic Capability of Medical devices were operated for 5 minutes. Devices for Clinical/Biomedical Engineers- Part 1:RadiThe medical device was monitored for device failure. ated Radio Frequency Electromagnetic Energy. Arlington, Va: Association for the Advancement of Medical InstruThese failures ranged from minor changes, such as screen mentation (AAMI), Technical Series; August 1997. flicker and color changes to more serious interference, 2) FDA. FDA Public Health Advisory: Interference such as erroneous digital display, failed operation, system Between Digital TV Transmissions and Medical Telemetry Systems (March 1998). Available at: reset and shutdown. Pass/fail documentation was noted at http://www.fda.gov/bbs/topics/NEWS/NEW00630.html. each distance, along with the specific failure. Accessed November 2005. While minimal to no interference was seen at distances 3) Home Store Newsletter. How Cell Phones Work (1998). Available at: www.howstuffworks.com. Accessed Novembeyond 1 meter, some minor interference was detected at ber 2005. distances less than 50 cm. This was demonstrated with the 4) Close Range EMI Sends Nellcor Puritan Bennett 840 two-way radios in talk mode. The interference stopped in Ventilators into Vent Inop Mode. Health Devices. March 2003;32(3). stand-by mode. This minor interference included screen 5) Cisco Systems. Wireless LAN Equipment in Medical Settings: flicker and dropout on some digital readouts. We did Addressing Radio Interference Concerns (2002).
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