New technology innovations have clearly captured the imaginations of clinicians and patients alike, and provider organizations will see big demands on bandwidth, which will put pressure on provider organizations to upgrade their IT infrastructure. At the same time, hospitals, medical groups, and health systems will need to continue to maintain data security and privacy. The upshot is that patient care organizations can’t afford not to make investments in infrastructure—often a tough sell to the hospital boards that control budgets—just to stay one step ahead of new demands.
Amanda Hammel, system executive of Memorial Hermann Health System, a 12-hospital provider organization based in Houston, has seen growing demand for electronic data across the entire network. “It’s like a big city that is growing. We need to expand the infrastructure to allow more traffic on the highway,” she says. Hammel adds that sources of that demand cuts across all areas: from electronic health records, to an increase in bedside devices that transmit data electronically, to a growing demand for video conferencing, she says.
Because of the increasing demands, the hospital system began to see signs of a bottleneck in its data center, where data is backed up at night. “We were doing backups of over a petabyte of data, and were starting to run into operational hours,” she says. This led the hospital to make a decision to upgrade its network (supplied by Brocade, San Jose, Calif.) with high-speed data multiple gate data interconnects to alleviate the bottleneck in the datacenter, explains Mike Romero, Memorial Hermann’s director of network infrastructure. “We decided to look at what we could do to alleviate the bottleneck, not just for one point in time, but going forward,” he says.
Nonetheless, the growth in the volume of data running through the network has been increasing steadily, even to the point of putting pressure on software vendors to keep pace with the network upgrades. This can lead to performance issues when some software applications are not able to take advantage of the higher speed network in the datacenter, Hammel says.
Big Uptake of Mobile Devices
Bill Spooner, vice president and CIO of Sharp HealthCare in San Diego, says the principle emerging network infrastructure issue is the rapid uptake of personal mobile devices for enterprise applications. “Currently we enable them through Citrix, but as native iPhone and Android apps for our core systems like EHR mature, we will have to open the door wider,” he says. He adds that the hospital is in the early implementation stages with a mobile device management utility.
Chuck Podesta, senior vice president and CIO of Fletcher Allen Health Care, Burlington, Vt., agrees, saying that “mobility will be huge” as more employees will put pressure on hospitals to accommodate personal computing devices. He notes that technology is available now that partition personal devices to separate corporate and personal applications on the same device. He also notes that electronic health record vendors are developing Web-based presentations, which allow the user to maneuver through the application better, and will change the size and font to match the mobile device.
Podesta also predicts that data security and patient privacy will grow in importance, particularly with the increase in mobile device usage. Fortunately, there are software tools that will help hospitals meet the security challenges, including data loss prevention systems that map personal health information on the servers, mobile devices, and desktop computers. One benefit of these tools is that enable rules to be put around where data is sent, taking the task of encryption out of the hands of the individual. In addition, security event and incident managers (SEIMs) help manage a perimeter network detect and log attempted cyber attacks and allows early responses.
“It’s really a whole safe harbor privacy and security program that needs to be in place, Podesta says. “It costs a lot of money, but if you don’t do it, you are going to be in the headlines” with unwanted publicity because of a data breach, he says. He acknowledges that making the required investments in network security is often a tough sell, but adds that it’s the CIOs responsibility to make sure that money is earmarked in the budget. A single breach can result in monetary damages to a hospital that can match the outlay, plus damaged credibility.
In Podesta’s view, a third technology trend will be patient experience and patient engagement, which will continue to be driven by both meaningful use requirements and will be an important part of any accountable care strategy—especially since reimbursements will be tied to patient satisfaction scores.
'Keeping the Lights On'
Despite those pressures, budgeting for infrastructure investments is a challenge, according to Hammel. At Memorial Hermann, how capital dollars are allocated is determined at an annual meeting. The items that are up for consideration have been prioritized by leadership across the organization, in addition to investments that need to be made to keep the operations up and running. “There is always more that people want than we have money for,” she says.
According to Podesta of Fletcher Allen, there is always a portion of the capital budget to keep the infrastructure running, which he terms “keeping the lights on.” He estimates that just keeping the IT infrastructure current accounts for about 20 percent of the capital budget, and which must be in place before considering new investments. That’s a greater portion of the budget dollars than just a few years ago, and it will continue to take an even greater share in the foreseeable future, he says. But he cautions that organizations that push off making incremental infrastructure investments today run the risk of facing huge expense when something needs a major replacement down the road.