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Starved for Bandwidth

July 1, 1998
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Changing business needs and hungry applications continue to beleaguer the healthcare network infrastructure. Throbbing with vital bits of data, images, voice and video, the ideal healthcare network is silent, strong and capable of whatever users push across through its channels. For most users, it is simply taken for granted--until, of course, it’s down.

The network not only needs brute strength, it must be well planned and well organized if it is to stand up to the many new and bandwidth-hungry applications on the market. Unfortunately, many networks are faltering under the current load, let alone future loads. Whether or not the problem is an antiquated infrastructure or information silos that must be pulled together, managing the overhauls and upgrades with an organizational view is a monumental task. "Many organizations are linking islands of networking more through crisis than by good management," says Andrew Rushmere, president of Aviant Technologies of Simi Valley, Calif.

The fundamental changes in the market have made it hard enough for IT to maintain what they have, let alone look at new technology. In addition, there is a lot of confusion in the marketplace about what minimum technology capabilities are necessary. Much of it has been created by our industry--by manufacturers who push technology for technology’s sake, says Rushmere. "Technology should follow the business plan, not determine it," he says, adding, "Many CIOs are caught up in a technological bandwagon that is leading to a dead-end."

From its backbone to its most remote point, the network carries the organization’s most valuable asset--information. Increased information flow naturally adds more burden to the network--just as it does to IT--but the vision and the business plan must come before you expand your network capabilities: What do you want to do with your business and what type of network is necessary to support it? What services do you plan to offer?

Shotgun networks
Consultants, analysts and vendors alike point to mergers, acquisitions and consolidations as a major source of problems in bringing together data and people. The diversity of technologies and disparate systems in any given organization is a monumental challenge in connectivity--not to mention the extensions necessary to the continuum of hospitals, clinics, physician offices and homes. For years, health networks started and stopped at the physician’s desktop, says Gail Gulinson, VP health networking solutions, IBM Global Healthcare Industry in Chicago. That is changing as the network rapidly expands outward to reach health plan members and consumers. Decreasing technology costs plus the increasing numbers of provider and payor networks is fueling the rapid growth of extranets to provide organizations such as the VHA and Blue Cross access to nonpatient specific information such as best practices and cost benefits.

The problem of connecting many disparate healthcare information systems is real, but what is less often considered, points out Gulinson, is that many of them are not asset-based--they’re contractual relationships. And, even though partners are often in the position of bidding for care against each other, they still must behave as one system. Sharing data is a problem. No one is willing to put all the information or all of the data into the middle of the systems. So, networks with a database of identifiers in the middle are emerging across the private network to resolve the problem.

Heavyweight contenders
For the long haul, Ann Thryft of Electronic Engineering Times magazine foresees three technologies vying to be data transmission trunk lines: synchronous optical networks (SONET), asynchronous transfer mode (ATM) and all-optical networks. As LANs and WANs continue to move toward convergence, expectations for voice, video and data transmissions across a common network are revising technology projections. Since ATM is not optimal for LANs, says Thryft in the December 1, 1997 edition, many are looking to Ethernet and Internet Protocol as the future for network foundations.

Del Jenkins also sees a trend in all networking toward Internet Protocol (IP) but sees no silver bullet. "The Internet Protocol Suite (IPS) will support a lot of quality of service over plain IP protocol with less need for ATM," says Jenkins, VP and general manager North America of GTE Data Services, Temple Terrace, Fla. Although some of the ATM and SONET technologies lack widespread implementations and the related proof of service, they are much more sophisticated. "ATM has definite advantages and is not going away," he says, "but it is not an either/or for ATM or SONET. I think you will see a mixture of these protocols." He emphasizes that data and application types should determine the protocol.

The services you plan to offer will determine whether ATM makes sense for your organization, says Mary Verhage, director of healthcare information systems for Boston-based Aberdeen Group, an IT research and consulting firm. If the organization is considering realtime information transfers such as videoconferencing and telemedicine applications, and/or integration of many, geographically dispersed points of care, then it’s time to consider ATM and more sophisticated networks. ATM also makes sense if the organization is considering replacing voice trunks and doing voice over data and voice over IT, adds Aberdeen’s David Dines, manager of network technologies. It is more robust, more scalable, provides needed bandwidth and has bandwidth guarantees.


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