It's often the electronic medical record (EMR) application that gets all the glory, whereas the actual network used to transfer patient data is forced to take a backseat. However, for Maimonides Medical Center (New York), a non-profit 705-bed medical center, finding a reliable network and Internet service provider (ISP) on which to run its EMR applications was a "top priority," says Walter Fahey, CIO.
In March of this year, Maimonides began the implementation of its new network, enabling the transmission of EMRs to provide physicians with patient medical histories, doctor's orders, prescriptions, lab results and radiology films. To ensure connectivity between the medical center's main campus buildings and the 24 remote locations throughout Brooklyn, Maimonides selected Verizon Business to design and deploy a high-capacity fiber optic network.
Verizon Business has also been employed by the organization to create a communications network, composed of 10 Brooklyn-based healthcare organizations, that supports the Brooklyn Heights Information Exchange (BHIE), a regional healthcare network scheduled for launch in 2008.
Location, location, etc.
When it came to selecting a vendor, Verizon (New York) and AT&T (San Antonio) were at the top of the list, says Fahey. Verizon has a great deal of experience with larger healthcare organizations, says Stephanie Atkinson, managing partner and principal analyst at Compass Intelligence, a decision analytics research and consulting firm based in Scottsdale, Ariz., whereas AT&T has a much stronger focus on the consumer and small businesses. In addition, Verizon has a very strong footprint on the East Coast—the company is headquartered in New York—while AT&T has a strong focus in the South, Southwest, and the West Coast, says Atkinson. "Location is an important factor when selecting a vendor," she explains.
Another benefit of Verizon's optical network is that it has built-in security features, so it's a good option for hospitals focused on ensuring HIPAA compliance, explains Atkinson. "There are many competing network solutions that don't provide this level of security," she says.
After analyzing both options, a clear winner emerged. "In the end, we felt that Verizon was a more complete solution for our facility," says Fahey.
Navigating the network
Verizon Business deployed a Dedicated Wavelength Ring service over a new fiber network, which in simple terms means that the entire capacity of the wavelength ring is dedicated to Maimonides. "This provided us with high-speed links between all of our locations, including the Maimonides data center," explains Fahey. Maimonides also had Verizon replace any copper wires that were still being used with optical fibers—glass strands used to transmit information as light pulses.
"Back in â€²96, we started with a SONET ring to connect us to our mainframe data center in New Jersey," says Fahey. A SONET (synchronous optical networking) ring, also known as a "self-healing ring," uses two or more transmission paths, so if there is a break in one link the other is still available. "This technology worked well for us, but we needed more bandwidth, so we upgraded to what's called a dense wave division multiplexing (DWDM) ring," he explains. DWDM is a transport technology that allows data transmission to be carried across a single optical fiber over different wavelengths.
The advantage of a DWDM ring, says Fahey, is that it allows users to add and drop various services or channels at each location. In other words, not only does it provide greater bandwidth, it also has a better capacity to scale.
"We felt that this technology would allow us to support a more diverse range of data applications," he contends. "It also allows us to access a variety of optical interfaces, protocols, and bandwidths, all from one solution. Installing discreet solutions for separate applications to run off can prove to be a nightmare," Fahey explains.
"The DWDM ring has increased our capacity significantly, which was very important to us considering that our imaging needs have grown considerably," says Fahey. A decade ago, imaging technology wasn't as advanced, he says, so there were far fewer images created. "An upgrade was essential, not only because images require a great deal of bandwidth, but because we're sending more of them, and physicians are demanding that the turn-around time for data be faster than ever," he says.
The biggest challenge of implementation was coordinating all the equipment to be delivered in a timely manner, says Fahey. Because Maimonides was building a new facility, there was no room to store anything onsite. "We needed thousands of feet of cable and backing-connectivity components in order to build the infrastructure. However, it was imperative we stage all the equipment deliveries so that we weren't overloaded, but, of course, we still needed to meet our deadlines," explains Fahey.
Maimonides constructed an implementation plan that scheduled deliverables at different times throughout the implementation cycle, he explains. "Initially the vendors thought that they could deliver us everything at once, which of course would have been much easier for them. But we finally convinced them to follow our timeline. Doing it this way was a lifesaver, who knows what elements would have gone missing or been lost if they'd just dumped the whole lot on us. We certainly wouldn't have been able to adhere to any kind of schedule," says Fahey.
The technology is working well for Maimonides. "We're receiving data quickly and efficiently, and we're operating at a 99.8 percent uptime. The only time we've ever lost communications was through human error or a scheduled down-time for maintenance," he says.
Words of wisdom
Atkinson suggests that selecting a vendor doesn't always come down to finding out which one offers the fastest transmission of data.
"When it comes to finding the fastest network, everybody says they're faster or more reliable, but to me all of these things are table stakes, which are the basic services that customers expect to receive. What it comes down to is branding recognition, customer satisfaction, and one of the biggest things in telecom—word of mouth. Talk to other facilities that have deployed a similar network, and see how it's worked for them," says Atkinson. She also points out that it's important for a facility to do the research and find out which applications work better on what networks.
When asked what advice Fahey would give providers looking to implement a wire-line communications network (transmitting data using a fixed, physical connection, such as metal wire or fiber optic cable), he says, "One of the most important things you need is diversity, in other words, you can't have single points of failure. What we have at Maimonides is two entry points coming into the buildings at opposite ends. We've built it out so that if someone was to dig up the street and break one piece of fiber, the ring can go in the opposite direction, which means that we're still intact and we haven't lost communication."
According to Atkinson, there are a few key questions that a hospital should ask before going with a particular vendor: "How large is their footprint, how much are they investing in upgrading their technology, and is this company going to be around tomorrow? Institutions have to really start thinking about when and who they make their investments with."