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Although there are many types of communication systems in healthcare, they generally fall into three categories - provider-to-provider, provider-to-patient, and internal. Internal communications include all forms of staff messaging, from requests to cover vacant shifts to emergency notifications. His research interests include nonlinear dynamics, neural networks and adaptive filters and their applications in radar and communications systems. Haykin is the editor for a series of books on 'Adaptive and Learning Systems for Signal Processing, Communications and Control' published by John Wiley & Sons, Inc. Tactical handsets, headsets and communication systems are crucial for all military, Special Forces, homeland security and police (SWAT) operations. Reliable and secure tactical communications are imperative to maintaining command and control for ground, air and marine operations.
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08.26.10
When astronauts venture outside of a spaceship or the International Space Station, they must wear protective space suits to keep them safe from the harsh environment of space. While inside these pressurized suits, it's essential that they remain in constant communication with the rest of the crew in space as well as Mission Control Center on Earth.While wearing the current space suits, astronauts wear a Communications Carrier Assembly (CCA), or 'Snoopy Cap' — a fabric hat fitted with microphones in the ear area for listening and boom microphones in front of the mouth for speaking. These caps are worn under the helmet and visor that surround an astronaut's head.
A new Integrated Audio system, which enables astronauts to communicate in space, is being tested at NASA's Glenn Research Center in Cleveland in a test rig. Image Credit: NASANASA is in the process of completely redesigning their space suits, with the goal of creating a brand new space suit to be used starting in 2020. Redesigned and reinvented communications equipment will be an important facet of the new suit.
Integrated Audio
NASA's Glenn Research Center in Cleveland is working on different parts of the new space suit, including communications equipment. The Exploration Technology Development Program (ETDP) is involved with testing various proposed solutions to the communications requirements within the suit.
The Communications Carrier Assembly (CCA), while effective, has some logistical drawbacks. Multiple cap sizes must be available due to the difference in astronauts' head sizes. The caps cannot be adjusted once the visor of the helmet is in place and the astronaut is in space, which means that if the microphones shift, communication quality can decrease. The boom microphones can also interfere with feeding and drinking mechanisms during long-duration spacewalks. An additional problem is that astronaut sweat can negatively interfere with the performance of the electrical and mechanical parts in the CCA.
For several years, Glenn has performed research and development on a variety of communications technologies. About six years ago, teams at Glenn began working on integrated audio solutions to support extravehicular activities, like space walks. In 2008, Glenn signed a Small Business Innovation Research (SBIR) agreement with WeVoice Inc. of Bridgewater, N.J. Together, they began developing and testing an integrated audio system that is built directly into a space helmet.
'The integrated audio system is where the microphones and earphones are removed from the Communications Carrier Assembly and integrated into the structure of the space suit itself,' says Obed 'Scott' Sands, an electronics engineer at Glenn, lead for Configuration II Audio under Constellation and lead for integrated audio development for the Exploration Technology Development Program (ETDP).
The test rig for testing the Integrated Audio system includes a HATSMAN—Head and Torso Simulator. The HATSMAN has an electronic 'mouth' and 'ears.' Image Credit: NASAThe new integrated audio system solves many of the issues the CCA presents. As the integrated audio system is part of the actual space suit, there are no additional parts to worry about maintaining. The microphones and earphones are built into the suit, which means there are no moving parts to disrupt an astronaut's movements or become dislodged during activity. And the integrated audio system is a universal size — no separate caps are needed for individual crew members.
Rather than one boom microphone, the new integrated audio system uses an array of microphones — currently four, but the number could increase — that are located in front of where an astronaut's mouth is while inside the helmet. The integrated audio system features cutting-edge digital signal processing which helps the microphones overcome loss of fidelity on the outbound (speaking) part of the system.
The microphone array and associated signal processing are needed in the integrated audio system to overcome decreased sound quality. Sound quality can be negatively impacted because the microphones of the integrated audio system are positioned on the inside of the helmet — farther from an astronaut's mouth. This makes the microphones more susceptible to interference from noise created inside of the suit as well as noise from vibrations of the spacesuit structure.
The current technology development approach to solving these problems involves processing signals from each element in the array, known as Multi-Channel Noise Reduction. This new filtering approach features technology adapted from video teleconferencing systems. Advanced filters are used for each of the array's channels, and additional noise reduction is used to isolate the sound of speech.
Communication Systems Examples
Several speakers are installed in the helmet, which are designed to focus the sound towards the astronaut's ears. These speakers also isolate other sounds so that crew members can effectively hear. This solves the issue of occasional unclear inbound communications (listening).
The test rig is fitted with acoustic panels, to isolate noise. It is also pressurized to the same level as NASA space suits. Image Credit: NASA
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Brocade Communications Systems
Testing with a TorsoIn order to assess the effectiveness of the new system, the conditions inside a space suit must be replicated. Then the integrated audio is tested by using a specialized piece of equipment that creates human speech. This equipment, shaped like a human torso, is called HATSMAN — Head and Torso Simulator. It is manufactured by Brüel & Kjær, a company based in Denmark.
'It listens like a person and talks like a person,' Sands says. 'It's got microphones in its ears and a speaker in its mouth, and the radiation patterns conform to international standards for mannequins that emulate human speech and hearing.'
The testing involves taking advanced measurements of the noise produced by HATSMAN and received by the integrated audio system and vice versa. This anthropometric measuring helps Glenn researchers refine their design, using data created by machines that accurately represent the needs of the humans who will eventually use the completed system.
The HATSMAN at Glenn is installed in a testing tank that is carefully designed to mimic the environment inside a space suit. It is lined with acoustic absorbing foam that isolates extra noise that the tank itself might create. Then a noise source simulates the sound created by space suits, which is generated from a recording taken inside an actual space suit. Special microphones that do not create their own static pressure are installed, which take measurements without affecting the readings.
'The biggest reason we're in the tank is that we can create a static pressure environment that simulates the inside of the actual suit,' says Dave Pleva (DB Consulting Group, Inc.), an IT Project Analyst at Glenn who supports audio development work for ETDP.
The HATSMAN creates and receives vocal sounds. This determines the effectiveness of the Integrated Audio system. Image Credit: NASAThe tank recreates the pressure inside of the suit, not the pressure of the entirety of space — because the integrated audio system is made for use inside a helmet. The positive pressure inside a space suit is about 4.3 PSI (equivalent to about 35,000 feet altitude) so the team tests with this as its base. They also explore other variations in barometric pressure. The test rig also includes an acrylic dome to simulate the helmet. The team explores how speech and sound bounce off of the surface of the helmet.
A specialized device, called Digital Speech Level Analyzer (DSLA), provides vocal tracks for use in testing. Various utterances comprise the test speech to make it phonetically balanced — including all of the patterns and pairs that, statistically speaking, would show up in the English language. Both male and female voices are used.
'We generate a signal, it goes through an amplifier that powers the speaker in the HATSMAN, and then the array picks up the speech. The array then processes the speech and sends out the process signal to the DSLA. The DSLA then does a comparison of what it sent and what it receives,' Pleva says.
The primary performance concern is speech intelligibility. Although quality of sound is also important, the main interest is that as many words as possible be successfully transmitted both ways. This can be effectively measured using the equipment in place.
'The next step would be to build an even higher fidelity version of this integrated audio system. Then we'll do another round of these tests. Eventually, we'll have a human being tested inside a pressure chamber,' says Dave Irimies, a computer engineer and ETDP lead at Glenn.
Advancing Technology
The ongoing research, development and testing of this integrated audio system is part of the Space Audio Development and Evaluation Laboratory at Glenn.
'Our direction is replacing the current suit on the space station and shuttle. The current certification runs out in ten years, in 2020, so… this is an opportunity to use even more advanced technology,' Irimies says. 'This work is pressing forward.'
The team hopes that the integrated audio system can commence testing on the space station in 2016. The technology may also be useful for communicating inside the station as well as during space walks. There may also be the potential that the technology can help on Earth. WeVoice Inc. is currently working with the University of Pittsburg on one potential spin-off: developing a teleconferencing system using microphone arrays for operating rooms in hospitals.
The team looks forward to working together to continue testing and evolving their integrated audio system, with the goal of significantly influencing how the next generation space suit will work.
'We all challenge each other in different ways, all the time,' Sands says. 'It's a lot of fun, getting new concepts infused into space systems. That's what NASA is all about.'
Tori Woods, SGT Inc.
NASA’s Glenn Research Center
Although there are many types of communication systems in healthcare, they generally fall into three categories – provider-to-provider, provider-to-patient, and internal. Internal communications include all forms of staff messaging, from requests to cover vacant shifts to emergency notifications.
In 2006, Dr. Enrico Coiera published an article in the Clinical Biochemist Review – Communication Systems in Healthcare – in which he wrote “if information is the lifeblood of healthcare, then communication systems are the heart that pumps it”. Inasmuch as the article was ahead of its time, it is unlikely Dr. Coiera could have conceived how quickly communication systems in hospitals would evolve.
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Three years after the publication of the article, Congress passed the HITECH Act which incentivized the meaningful use of Electronic Health Records (EHRs). Linksthe mechanic. As a consequence, EHR adoption increased from 3.2% per year to 14.2% per year within six years. Then, in 2013, the HIPAA Omnibus Rule resulted in covered entities implementing communication systems that ensured the security and integrity of ePHI.
Communication Systems in Hospitals Continue to Evolve
Communication systems in hospitals continue to evolve in order to improve the delivery of healthcare and enhance productivity. For example, there are now systems for processing referrals, test results, and prescriptions; and systems for collaborating on patient care and aftercare with the objective of reducing readmission rates – which are also incentivized under the Hospitals Readmission Reduction Program.
Generally the different communication systems in healthcare fall into three categories. There are provider-to-provider systems used (for example) for patient transfers, external clinical procedures, and insurance transactions. There are provider-to-patient systems such as telemedicine consultations and appointment reminders; and there are internal messaging systems which cover a wide range of scenarios from requests to cover vacant shifts to emergency notifications.
Provider-to-Provider Communication Systems
In most cases, provider-to-provider communication systems in healthcare fall under the administrative, physical and administrative guidelines of the HIPAA Security Rule. This means covered entities have to protect the security and integrity of ePHI when it is sent or received in an electronic format and ensure the ePHI is not disclosed, amended, or deleted without authorization.
The rules regarding this category of communication systems in healthcare are extremely rigid. They include the necessity to implement ID authentication mechanisms, audit trails, and data encryption. The Department of Health and Human Services can issue substantial fines if the guidelines of the HIPAA Security Rule are not complied with – even if no data breach results from the HIPAA violation.
Provider-to-Patient Communication Systems
Lathe mechanic. The most common provider-to-patient communication systems in healthcare have already been mentioned – telemedicine consultations and appointment reminders – and, although these systems do not require the same security measures as provider-to-provider, their use falls under the HIPAA Privacy Rule inasmuch as patient consent must be sought before any of these systems are used to communicate PHI and, when consent is receive, communications are subject to the Minimum Necessary Standard.
Communication Systems Mn
In addition to provider-to-patient systems, there are also patient-to-provider systems. These can range from remote clinical consultation services (i.e. consultation by email) to nurse call systems that alert healthcare professions to changes in patients´ conditions. Patient-to-provider systems can also be integrated into EHRs in order to automatically update patient records – in which case they are subject to the technical safeguards of the HIPAA Security Rule.
Communication Systems In Organizations Affect
Internal Communication Systems
Communication Systems Used In The Trenches
Whether or not internal communication systems are subject to the HIPAA Security Rule can depend on how they are configured. For example, systems that are protected by a firewall can be used to communicate unencrypted ePHI provided the Minimum Necessary Standard is complied with. In all cases, internal communications are subject to the HIPAA Privacy Rule – which can create challenges during emergencies, when patients have to be evacuated or a post-disaster surge occurs.
In these cases, healthcare organizations will be required to activate CMS´ mandated Emergency Preparedness Plans, which should stipulate how communications during an emergency are conducted. Unless the Department of Health and Human Services has waived HIPAA compliance, it is better for internal communication systems to support audit trails in order that accountability is ensured. This also applies to internal communication systems that automatically activate code calls.
Compliant Use is Just as Important as Compliant Systems
Regardless of which category communication systems in healthcare fall into, their compliant use is just as important as the compliance of the system. Effective training and safeguards can reduce the risk of a HIPAA breach; and for further advice about using each of the systems mentioned above in compliance with HIPAA, it is recommended healthcare organizations seek professional advice.