Physicians heal their telecom problems themselves

July 1, 2007

by Stephen Hardy

Like most health care organizations, the Iowa Health System (IHS) has seen its bandwidth requirements grow significantly over the past five years, to the point where member institutions generate a total of 5.5 million transactions daily. Unfortunately, also like many organizations with facilities in rural areas, the high-speed telecommunication options the local incumbent operators offered clearly would not enable IHS to keep up with its members’ needs. So, as if heeding the biblical charge to physicians, the IHS decided to cure its telecom woes itself through the creation of a 2,100-mile optical communications network that leverages Carrier Ethernet technology.

The IHS comprises 11 hospitals and 128 clinics, as well as other medical and educational facilities, throughout Iowa, western Illinois, and eastern Nebraska, according to Jim Mormann, chief information officer at IHS. It serves roughly 27% of Iowa’s patient population-a task that has become increasingly data intensive with the advent of electronic health records and more sophisticated medical equipment. As an example of the latter, Mormann points out that three and a half years ago, a new computed tomography scanner generated eight “slices” (images) per scan; two new ones bought this year provide 124 slices per scan. Mormann estimates that over a five-year period, bandwidth demand had grown 26% annually.

“So we’ve got that fundamental issue, that the applications and the technology are rapidly driving our communications needs differently,” Mormann explains. “Then the secondary issue is that there are very serious holes in the telecommunications space from where we can actually move data back and forth to because… there’s a lot of copper in the ground. But how much bandwidth can we get across some of the copper?”

IHS determined that it required optical connections to its facilities to maintain the level of customer care its institutions wanted to provide-and that it wasn’t likely to find such infrastructure everywhere it needed to go. The health care organization purchased 2,100 miles of optical fiber infrastructure and decided to build its own regional network. It hired Fiberutilities Group ( to help it set up and manage the network, including determining what equipment to buy and which supplier to choose.

Mormann reports that IHS and Fiberutilities Group looked at nine vendors in shopping for equipment for what they decided would be a network based on Carrier Ethernet principles. The list of nine quickly shrank to two: Cisco Systems ( and World Wide Packets (

IHS chose World Wide Packets. “We just felt that their strategy was so much stronger. Their technology was a lot more robust; it was not [dependent] on a technology strategy that was based upon, in our minds, very complex algorithms and things that were inherent with Cisco,” says Mormann of the World Wide Packets proposal. “So we opted to stay away from that direction and try to keep it as simple and as pure as we possibly could, and still get all the value add of the product-the redundancy, the reliability-that we needed out of that product set.”

The network architecture also follows IHS’s desire for simplicity. The ring-based network leverages World Wide Packets’ Rapid Spanning Tree algorithm for redundancy, with LightningEdge 427 platforms for aggregation and LightningEdge 311s for demarcation at each facility. “We’ve opted to keep it as simple and yet as complex as we needed it to be to give us full redundancy across the board,” explains Mormann. “The interesting thing about our network is that it’s ringed within [each] city but it’s also ringed within regions of the state. So we pushed hard so that there wasn’t a single point of failure that we could get ourselves into.”

The rings connect IHS facilities to a central data center in Des Moines (the vast majority of traffic involves patient records and other data), as well as to a secondary data center approximately 125 miles away in Cedar Rapids that is equipped for disaster recovery. Connections to individual facilities can range beyond 1 Gbit/sec, Mormann reports.

Dave Curry, chief executive officer of World Wide Packets, doesn’t see the situation IHS faced as unique. “It’s particularly an issue in rural America. We’re on the eastern side of the State of Washington; we’re not on the west side, we’re not in Seattle. So we play second fiddle on the east side of Washington as well,” he says. “We have remote communities within a couple hundred mile radius of the city of Spokane. We’ve got wonderful health care facilities here in Spokane-if you happen to live in Spokane. But how do we connect to the communities? It’s exactly like the State of Iowa in terms of the demographics and the issues.”

The problem for health care organizations that serve constituencies outside of major metropolitan areas involves “aligning the interests of those that have the problem and those that are prepared and willing to solve the problem,” Curry states. “This is not a pejorative statement about the carriers, but it’s just simply not always in their interests to do what Iowa Health has done.”

Needless to say, companies such as World Wide Packets stand ready to help health care and other organizations with wide-area telecommunications requirements to meet those needs themselves. How large a market the health care industry will become for Carrier Ethernet and other optical communications equipment depends in large part on how active individual institutions become in circumventing their incumbent carriers.

“I think it’s a daunting challenge for the industry, frankly,” concludes Mormann. “The industry has got to be ready to take on the responsibility.”

Stephen Hardy is the editorial director and associate publisher of Lightwave.

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