Industry Focus: Healthcare
To the healthcare industry, the combination of networks and privacy regulations are at opposite ends of the spectrum. Networks are used for key functions such as accessing patient records, test ordering, transporting test results, and the back-end financial and business functions. On the other end of the spectrum are laws such as the Health Insurance Portability and Accountability Act (HIPAA) that require protection of health records from unauthorized access and disclosure. Increasing use of wireless, connectivity to neighboring health care organizations, and connectivity to home offices of doctors are all adding to network complexity and increasing compliance and security concerns. It is a challenge to take advantage of networks while still protecting patient information.
The Network Environment and Challenges
Healthcare networks are much like other large enterprises, with some variations. Accepted best practices, such as the core, distribution, and access layer building blocks are used in the design, implementation, and administration. Depending on the history and age of the network, it may be transitioning from a switch-based design to a routed-based design. The transition also has to incorporate financial factors, so some parts of the network may be using older equipment and scheduled for re-design with newer gear.
Wireless is a key technology. The emergency room of a hospital I visited recently used wireless computers on carts to handle admissions. Patient data was entered at bedside. Wireless telephones are popular because cellular phones often don’t work deep in the building or are restricted. Some hospitals are now using voice activated lapel phones that allow the wearer to call for assistance while both hands are busy handling an emergency. Wireless is also used at bedside to allow easy updates of patient records. Keeping patient data safe in a wireless environment requires consistent network configuration. Similar to other enterprises, non-technical people often have flawed perceptions of wireless. At one site, the facilities people mentioned that they liked wireless because “we don’t have to install any wires,” not understanding the need to run wires to access points.
Link speeds are constantly increasing. Radiology has a reputation for big images and the doctors like to be able to move through a series of images quickly, typically no slower than one every few seconds. While each image may only be a megabyte or two in size, there may be hundreds or thousands of images in a single series. Being able to play it back like a movie requires much more bandwidth than the size of one image would imply.
Redundancy is important. The cost of a doctor’s time and the timeliness of the data for patient care implies that redundant data pathways are incorporated into the design. Technologies like ether-channel, dual chassis, backup system controllers are in widespread use. The challenge is to monitor and identify failures in redundant configu-rations before a combination of failures occurs.
Clusters of healthcare providers use metro-area and wide-area networks to share and update patient records. The expectation is that the access will be similar to what exists within the hospital. The combination of LAN, MAN, and WAN technologies increases the complexity of the network. The connectivity and application access to consistent patient data between healthcare groups translates into improved healthcare.
Of course, back office processing of bills, lab results, patient record archiving, and myriad other things are necessary to keep the hospital competitive and efficient. In this respect, it is much like most any other large enterprise.
Finally, QoS configuration is an absolute requirement. With large images and video traversing the network, queueing and transmission latency can have a big impact on the quality of time sensitive applications like VoIP. How many queues are needed to support the important applications? Who determines which applications are important? Layers 8 and 9 (political and financial) of the network protocol stack are especially important in resolving these questions.
Budget
Speaking of layers 8 and 9, there are continual pressures on fiscal performance of healthcare organization, especially as the cost of healthcare continues to rapidly rise. Network audits must accurately determine what equipment is in service as well as the utilization of that equipment. Audits are used to select the equipment that must be upgraded in the next phase of the technology refresh cycle. An “age of the fleet” report is essential to planning each year’s equipment upgrades. Similarly, an End-of-Life report showing which devices a vendor has declared at end of life can identify where maintenance of equipment is no longer possible or where it costs more to maintain it than to replace.
For further reading, go to http://www.netcordia.com/tnm/tnm71, where you’ll find links to related articles.
