Converged networks increase bandwidth, reduce costs

July 1, 1999

Converged networks increase bandwidth, reduce costsFirms target healthcare for combined voice, video, data offeringsDevelopments in networking technology such as converged networks—the integration of voice, video, and other data over

Converged networks increase bandwidth, reduce costs

Firms target healthcare for combined voice, video, data offerings

Developments in networking technology such as converged networks—the integration of voice, video, and other data over a single network pipeline—are opening up new business opportunities for vendors and providers in the healthcare field. Networking firms believe that the development of converged networks, which allow users to increase the amount of available bandwidth while lowering telecommunications costs and simplifying network installation and maintenance, will have significant implications for the teleradiology, PACS, and telemedicine markets. The draw of converged networks may also increase as more of these applications move onto desktop PCs and become increasingly tied into electronic patient record systems.

Healthcare information systems are currently configured in a number of ways to handle the variety of electronic data traffic they carry. Some facilities, like Fletcher Allen Health Care in Burlington, VT, combine several ISDN lines to achieve the desired level of bandwidth and transmission speed over their desktop-oriented network. Others opt for a combination of Fast Ethernet and T1 connections to satisfy their local- and wide-area network requirements. In each case, however, the telecommunications charges alone—especially for off-campus locations—can reach several hundred or even thousands of dollars each month. And at such sites as FAHC, the ISDN cabling is installed and maintained separately from the phone network and requires each point on the network to invest in a variety of additional hardware such as inverse multiplexers. Then there is also the issue of ensuring that the legacy systems at each site can adequately communicate with one another regardless of platform.

Thus, being able to run all of these applications over a single Internet Protocol (IP) connection that is already in place can greatly simplify network installation and maintenance and reduce monthly telecommunications charges. Converged network vendors also point to the technology’s ability to provide improved service quality and to set network priorities.

Several telecommunications and networking companies have begun to offer converged networks, and partnerships are beginning to emerge between networking firms and PACS and healthcare information systems vendors. For example, Cisco of San Jose, CA, is working with Shared Medical Systems of Malvern, PA, to develop healthcare-specific applications of this technology. Similarly, 3Com is collaborating with several PACS companies, such as Siemens Medical Systems, Agfa, and GE Medical Systems. And Nortel Networks of Brampton, Ontario, announced a partnership with McKesson HBOC of San Francisco at the Healthcare Information and Management Systems Society conference and exhibition in March to develop a single point of contact for healthcare organizations interested in taking advantage of current IP technologies—whether over local- or wide-area networks.

“There is much interest in enabling high-capacity remote access to the campus image-management system,” said Barry Rezaesoff, solutions manager in Nortel’s healthcare solutions group. “In the case of on-call radiology, where the physician is working from home, the ability to support high-quality, high-bandwidth image transfer with voice support would be desirable.”

Nortel also hopes to tap into customer interest in IP-based network-wide access to electronic patient information, including diagnostic images. The firm’s strategy is based on its Internet Communications Architecture (INCA), an open-standards portfolio approach that offers a choice of convergence paths for evolving data and business communication systems, particularly for wide-area networks.

The company is betting that its combined voice- and data-centric capabilities—acquired through internal development and its purchase of Bay Networks last year—will give it a leg up in the healthcare sector.

“In the next three to five years, we are all going to end up at the same point: a truly converged network,” said Luke Roy, director of enterprise campus product marketing for Nortel Networks, which already claims such major healthcare customers as Kaiser Permanente.

Trouble for teleradiology providers?While many networking and healthcare IT companies stand to profit from this multimedia technology surge, some networking vendor representatives believe that proprietary or single application image management software providers may suffer if converged networks become widely deployed.

“As more companies create Web server packages with their PACS products, we think the need for separate teleradiology software will go away,” said Rebecca Whitehead-Munn, healthcare-practice manager in the Internet Business Solutions group at Cisco Systems. “Physicians will be able to access images whether they are within the hospital system or at home, so the need for proprietary software will go away. Once you open up the environment and make access more readily available at fairly low costs, why have a separate proprietary network?”

Cisco has developed a number of Web-based and Internet-based solutions for the healthcare industry, and has formed a partnership with such PACS vendors as GE to incorporate Cisco’s IP networking architecture into the Milwaukee, WI-based firm’s PACS and related products.

Not everyone sees IP technologies as mortal threats to their business. While IP technologies could have a dramatic impact on the cost of telemedicine, users will still require demanding software tool sets, said Scott Sheldon, president of Access Radiology in Lexington, MA.

“Whether their applications are accessed via the Internet or otherwise, radiologists will still need a way to receive, render, manipulate, and exchange information on an image,” he said.

That said, Sheldon believes Internet technologies will positively benefit the practice of teleradiology and telemedicine, allowing users to tackle complex work-flow issues in a better fashion than conventional client-server technologies.

“The work-flow complexities that you can confront with Internet technologies are substantially greater than what you could do with conventional client-server technologies,” he said.

In the long run, many market watchers believe the movement to Internet-based networking technologies will help further justify the huge investment many healthcare organizations are making in networking infrastructure. And the increasing use of converged communication should move medicine away from its traditionally asynchronous practices.

“We are just now seeing customers embrace a one-network mentality,” said Whitehead-Munn. “But now people have choices, and they can apply the appropriate technologies for their particular needs, whether phone, Internet access, one- or two-way interactions, or whatever.”

Competition heats upWhile these technologies have only begun to scratch the surface in the healthcare field, the potential advantages are proving too attractive for many hospitals and healthcare providers to ignore. In addition to lower long-distance costs, converged networks offer these customers the potential for higher productivity, improved patient care, simplified training and maintenance, faster image transmission and retrieval, better image quality, more efficient network management, and higher quality of service.

“In addition to superior performance, our new network is easy to manage and cost- efficient,” said Steve Clark, CIO of University Hospital (part of the University of Colorado Health Sciences Center), which is employing IP technology and products from 3Com throughout the new patient-oriented healthcare campus it is building in Denver. “Just by eliminating the need for parallel voice and data networks between the two campuses, we’re gaining significant monthly telecommunications savings, which means we can devote more resources to patient care.”

Using a variety of 3Com products—including CoreBuilder ATM switches, Fast Ethernet and switched Ethernet/ATM interface cards, and PathBuilder ATM WAN access switches—University Hospital has created an IP network that combines voice, video, and other data on a single pipe to deliver a number of electronic-imaging applications. Physicians across the hospital’s two campuses can now conduct real-time consults while simultaneously viewing patients’ x-rays, MRIs, and CAT scans.

“You can overprovision the LAN and provide so much bandwidth that you are giving your customers real-time service,” said Bob Roman, director of business development for 3Com. “You can run data, video, audio, or imagery over that network and have it be virtually seamless. What we are trying to create is an internal real-time network that can handle very high quality images.”

Northwestern Memorial Hospital in Chicago is also using 3Com IP products to implement a “patient first” model of healthcare delivery in its new 2 million-square-foot inpatient and outpatient facility, which opened in May. More than 100 of the company’s CoreBuilder enterprise switches and supporting systems have been installed, enabling near-real-time access to patient-critical medical applications and data over high-bandwidth networks.

3Com also offers IP capabilities over WANs. One advantage of this approach is that “quiet” WAN time—and, thus, bandwidth—can be leveraged into other applications as needed.

“If you buy one big pipe, you get a lot more bandwidth for a lot less money,” Roman said. “And if you have that capability, the ability to stream audio, video, and data to remote facilities dramatically increases. One of the difficulties with (remote) facilities is to deliver the same level of healthcare as on the main campus. And convergence allows this to happen.”

For example, images stored in the hospital’s PACS network (supplied by GE Medical Systems) can be accessed and evaluated using a standard Web browser, whether a radiologist is in the hospital or at home. In addition, these and other diagnostic images are stored in a patient-record database, where they can be retrieved from any workstation on the network.

“3Com systems furnish our staff with up-to-the-minute patient records and diagnoses and the most sophisticated medical services available,” said Paul Barry, NMH’s director of networking and communications. “(This network) is 80 times faster than the old one, and its open architecture lets us use standards-based software solutions instead of costly customer applications, saving us considerable time and money.”

Adoption of EPR systemsThe growing adoption of electronic patient record systems is another prime motivator for hospitals to invest in IP technologies. This burgeoning trend has also prompted several companies to explore the role of wireless networks in freeing up doctors and nurses while still providing them with the information they need to have access in real-time and near real-time.

One company that hopes to carve a niche for itself in this market with its wireless expertise is Lucent Technologies. The Murray Hill, NJ-based company already offers a comprehensive portfolio of voice-over IP solutions and has now developed converged-network wireless prototypes that are undergoing clinical evaluation at two healthcare facilities.

The Lucent/Bell Labs technology enables voice to travel over Lucent’s WaveLAN wireless LAN, or any compatible wireless LAN, without loss, delay, or poor voice quality. Bell Labs developed an algorithm that determines gaps between the transmission of data packets and gives any real-time packet the priority to move within those gaps without adversely affecting data performance, said Barry Weinbaum, director of Lucent Enterprise Wireless Networks.

The University of Maryland in College Park and Penobscot Bay Medical Center in Maine are currently testing the WaveLAN wireless prototypes, which feature a palm-sized (Palm Pilot) computer that can deliver simultaneous voice and data calls over wireless IP networks. At Penobscot, for example, physicians are using the device to put patient information into the hospital’s dictation system, which is accessed by medical staff to update records. In addition, the emergency room staff is using the system to handle bedside registration, while employees handling patient discharge are using it to input reports and reach the patient discharge database. The university and Penobscot are also testing the company’s Quality of Service algorithm, which ensures image and data integrity.

“(Penobscot) wants to give this prototype to nurses and doctors to give them simultaneous access to voice (capabilities) and patient records—including electronic images—while they are walking the floor,” Weinbaum said. “The challenge is to be able to move voice applications onto IP networks and retain quality. But anything you can do to increase efficiencies will get the attention of hospital administrators.”