Better interconnectivity minimizes redundant--and expensive--tests such as X-rays, MRIs, and blood work. Easily accessible electronic health records minimize patient office visits and facilitate quicker diagnoses. Rare cases can be more easily recognized and outside specialists consulted with electronic health records. Treatment therapies can commence sooner and are more accurately delivered, as electronic handoffs to healthcare treatment professionals minimize miscommunication.
Optical networking
Improved interconnection among hospital groups not only results in improved care but also reduces malpractice risk for hospitals, insurance carriers, and physicians and lowers costs for insurance providers. For this reason, many hospitals are deploying optical networks to satisfy the bandwidth, security, and storage needs that better interconnectivity requires.
Traffic volume
Because the benefits are so substantial, many hospital groups are actively deploying medical IT initiatives such as Picture Archive and Communications System (PACS), Computerized Physician Order Entry (CPOE), and Electronic Health Records (EHR). The National Research Council has outlined some of the healthcare applications that are enabled by improved interconnectivity among healthcare professionals (See Table). These initiatives individually and collectively require tremendous amounts of bandwidth between healthcare professionals.
| Application domain | Types of applications |
|---|---|
| Clinical care | • Medical literature searches • Decision support systems • Consultations among physicians (perhaps involving manipulation of digital images • Transfer of medical records and images • Remote and virtual surgery |
| Administrative and financial transactions | • Videoconferencing with real-time sharing of documents • Patient enrollment • Appoinment scheduling • Billing for services, payment of providers • Clinician credentialing • Access to information about health plans, participating providers, eligibility for procedures, covered drugs in formulary, etc. |
| Public health | • Videoconferencing among public health officials during emergency situations • Incident reporting • Collection of information from local public health departments • Surveillance for emerging diseases or epidemics • Transfer of epidemiology maps or other image files for monitoring the spread of disease • Delivery of alerts and other information to providers and health workers |
| Professional education | • Accessing reference material • Distance education with real-time transmission of lectures or prerecorded videos • Real-time consultations with experts about difficult cases • Virtual classrooms, distributed collaborative projects and discussions • Simulation of surgical procedures • Virtual exploration of three-dimensional environments |
| Health services, biomedical, and clinical outcomes research | • Health services research using administrative and clinical data • Searching of remote databases and professional literature • Collaboration among researchers, peer review, interactive virtual conferences • Control of experimental equipment, such as electron microscopes, visual feedback from remote instrumentation • Real-time monitoring of compliance with protocols • Transfer of large file datasets between computers for high-speed computation and comparisons • Enrolling of populations in clinical trials |
For example, medical images (e.g., X-ray, MRI, CT, ultrasound, and mammogram) typically are multiple Megabyte-size files. A sample of PACS imagery is shown in Figure 1. Because the Health Insurance Portability & Accountability Act (HIPAA) requires every physician's manipulation of an original image to be stored and easily retrievable, multiple Gigabytes of data must be sent back and forth on even the most modest of hospital networks. Only optical networking can support the traffic volumes needed for the storage and retrieval of high-resolution medical digital images. Many organizations try to employ Internet Protocol (IP)-routed WAN solutions but find that they cannot elegantly handle traffic volumes over 100 Gigabytes per day--a level most hospital networks easily exceed.
Physical layer security
HIPAA also mandates patient privacy. WDM is a Layer 0/1 networking technique that provides physical layer isolation of traffic streams. Higher layer network architectures increase exposure to security risks.
Application transparency
Moreover, WDM is an application-transparent networking solution. Application transparency allows hospital groups to deploy applications faster than with application-aware networks. With transparency, there is less time-consuming and expensive applications tuning and debugging--not just for the initial deployment but for every subsequent software update (e.g., service packs, bug fixes, version upgrades). The application transparency of a WDM network minimizes IT costs for hospital groups.
Access to economic fiber
For most hospital groups, the vast majority of their traffic travels between buildings within a metropolitan area, commonly a cluster of downtown hospitals, suburban hospitals, ambulatory care centers, affiliated doctors' office buildings, and the data center (See Figure 2. Since most of this infrastructure is located within a metropolitan area, fiber is generally accessible and WDM can be economically employed.
Storage system connectivity
Hospital networks also need to interconnect their backup data center, which should be some geographic distance away from the primary data center. WDM is generally uneconomical at distances greater than 300 km. Fortunately, there are asynchronous database mirroring solutions that operate over long distances with SONET services.
A significant amount of hospital network traffic entails storage systems. SONET and WDM equipment has proven to be a reliable storage networking solution for many companies' mission critical applications. Higher layer networking solutions (such as an IP-routed WAN) often do not carry the same assurances.
In summary, only WDM can support the traffic volumes and satisfy the performance parameters that hospital networks require. Because they are application transparent, WDM networks enable hospital groups to deploy medical applications more rapidly and avoid the time-consuming tuning required by alternative application-aware network architectures. And the inherent security of WDM physical-layer isolation is more compliant with the patient privacy concerns of HIPAA regulations.
Michael Mullaley is director of enterprise marketing at Ciena (Linthicum, MD). He may be reached via the company's Web site at www.ciena.com.