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A New Bandwidth Prescription for Healthcare

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As the adoption of connected health solutions increases—including telehealth applications to enhance preventative, promotive and curative care—so do network performance requirements. To succeed, …

As the adoption of connected health solutions increases—including telehealth applications to enhance preventative, promotive and curative care—so do network performance requirements. To succeed, healthcare providers need reliable, secure and cost-effective high-capacity IP

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  • 1. INTERNET | VOICE | TELEVISION | NETWORK SERVICES | CLOUD SERVICES A New Bandwidth Prescription for Healthcare Michael Harris Kinetic Strategies
  • 2. A New Bandwidth Prescription for Healthcare Michael Harris, Principal Consultant, Kinetic Strategies Fueled by innovations in information technology and pressed by federal regulations, medical providers are transforming healthcare delivery with connected health solutions. By facilitating interaction between patients and providers and improving the exchange of medical information, connected health aims to make medical care more effective, efficient and convenient. “Connected health solutions increase healthcare effectiveness, efficiency and convenience for both patients and providers” Medical imaging and laboratory test results are digitally delivered to doctors in minutes rather than hours, accelerating diagnoses and treatment. Electronic health records (EHRs) help providers understand each patient’s complete medical history and better coordinate care. Remote and in-home monitoring applications improve outcomes for chronic or life-threatening conditions. E-prescribing instantly transfers prescriptions from physicians to pharmacies, increasing accuracy and accelerating the delivery of needed medicines. Through video conferencing, doctors can consult with patients and collaborate with specialists at remote locations. With industry and regulatory acceptance, telemedicine solutions will soon enable doctors to connect with patients wherever they live. On the Rise: Healthcare Bandwidth Requirements “Multi-provider healthcare organizations require broadband connections of 10 Mbps to 1 Gbps” As the adoption of connected health solutions increases—including telehealth applications to enhance preventative, promotive and curative care—so do network performance requirements. To succeed, healthcare providers need reliable, secure and cost-effective high-capacity IP access. A recent report by the U.S. Federal Communications Commission advises multi-provider healthcare organizations to deploy broadband connections of at least 10 Mbps, with larger facilities such as hospitals and academic medical centers requiring 100 Mbps or 1 Gbps (see Table 1). Table 1 Healthcare Bandwidth Requirements Average Upload Speeds Delivery Setting Recommended Bandwidth Small Primary Care Practice (2-4 physicians) 10 Mbps Nursing Home 10 Mbps Rural Health Clinic (5 practitioners) 10 Mbps Clinic/Large Physician Practice (5-25 physicians) 25 Mbps Hospital 100 Mbps Academic/Large Medical Center 1 Gbps Source: Healthcare Broadband in America, August 2010 1 www.twc.com/business Key Applications Enabled Management functions (billing, scheduling, etc.), email and web browsing Simultaneous use of EHR and high-quality video consultations Real-time medical image transfers Continuous remote monitoring Possible use of HD video consultations
  • 3. Understanding that applications like video conferencing, EHR and networked medical imaging dramatically boost bandwidth utilization, leading healthcare providers are upgrading their network connections accordingly (See Table 2). Table 2 Healthcare Technologies and Applications Technology Applications Streaming Video Employee and patient education/distance learning, preventive care, live surgery, intensive care monitoring Videoconferencing Collaboration with healthcare partners, affiliates, telemedicine, first responder support BYOD Access WiFi support for patient and employee mobile devices throughout facilities Medical Imaging Rapid diagnosis via digital file sharing, access to EHRs Social Networking Proactive patient preventive care Data backup Disaster recovery, regulatory compliance Providers Increasingly Turn to High-Capacity Connections “80% of patients opting for telemedicine believed it was as good as, or better than, a traditional office visit” “A T-1 connection offers a business less bandwidth than one doctor’s 4G smartphone” 2 www.twc.com/business Consider the case of Venice Family Clinic. With eight locations in the Los Angeles area, this clinic is the nation’s largest free community healthcare facility serving more than 25,000 patients. Each year the clinic handles more than 100,000 patient visits for primary care, specialty care, mental health, dental and health education services. As federal EHR mandates loomed and bandwidth usage surged for IT and clinical applications, the clinic urgently needed to upgrade its connections. Venice Family Clinic selected Time Warner Cable Business Class to link its facilities with a 20 Mbps fiber-optic Metro Venice Family Clinic Doctor and Patient Ethernet wide area network (WAN). With high-capacity connections, the clinic’s care teams benefit from rapid access to lab results, medical records and other vital information, improving both operations and the quality of patient care. J. Scott Patch, MD, a family doctor in Yarmouth, Maine, participated in a successful six-month trial of telemedicine video conferencing to connect with his rural patients at home. A small town of 3,500, Yarmouth is 10 miles from Portland, Maine’s largest city, and more than 100 miles from Boston. With a secure high-speed Internet connection from Time Warner Cable Business Class, Dr. Patch provided video-based consultations for patients who may not have required an extensive physical examination. Through follow-up research, Dr. Patch found that 80 percent of his patients who opted for video-based telemedicine believed it was as good as, or better than, a traditional office visit. They felt their interaction with the physician was not compromised through video conferencing and believed the time and transportation savings made telemedicine worthwhile. The pilot program demonstrated the potential for improving patient care with telemedicine and offered insights for operational improvements that will enable continued industry expansion.
  • 4. Ohio-based AVITA Health System operates two community hospitals and five specialty medical centers. AVITA recently upgraded its network with Dedicated Internet Access from Time Warner Cable Business Class to support an EHR rollout. “Without the added bandwidth and speed from the cable network, our ability to transfer vital records among offices would be hampered,” explains Andy Daniels, AVITA’s Chief Operating Officer. “We just grew too large for T-1 services.” Measuring Up: Bits, Bytes and Mbps “Unlike email and data backup, video streaming and IP voice services require a continual flow of data to ensure quality” While a T-1 connection was once considered sufficient for many medical offices and healthcare facilities, times have dramatically changed. With T-1, a mere 1.5 Mbps is shared by all the workers at a business site. That is less than the bandwidth accessible on one doctor’s 4G smartphone. When considering the bandwidth requirements of common connected health applications—from EHR access to video conferencing and medical imaging file transfers—it is easy to see why a minimum of 10 Mbps is recommended today for most healthcare providers. Other IP applications, including cloud-based business productivity tools, video and audio streaming, social networking, web browsing, and wireless Internet access for patients, also add to the bandwidth burden. An analysis by ACG Research finds that using high-quality video conferencing for telemedicine, such as a Cisco TelePresence, may require 4 Mbps per user. Even a basic high-definition Skype video call consumes 1.1 Mbps per user, while collaboration via WebEx with video uses 1.5 Mbps. Together, social networking, audio streaming and Web browsing require 1.4 Mbps per user (see Figure 1). Figure 1 Network Application Bandwidth .60 Mbps Per User 5 4 3 2 1 1.0 5.0 .60 .60 .40 1.14 4.0 1.5 Di Vid Au d So W eb Sk Te le W eb sta nc eo eL ea rn ing St re io am ing St (H re cia D) am ing lN et wo r Br kin ow s g ing yp /S eH tre D Vid Pr e eo am se Ex nc e www.twc.com/business (w BY OD /V 1.0 Da ta Us ide ag o) e Ba ck u p( Cl ing Network Applications 3 .025 ou d) Source: ACG Research, 2013 It is important to remember that bandwidth use differs based on the applications. For example, email and data backup traffic has “bursty” characteristics and can perform adequately with “best-effort” bandwidth provisioning by the service provider.
  • 5. That is, there may be peaks and valleys in usage, but a guaranteed minimum data flow is not required to ensure the quality of the experience. Video streaming or IP voice services, by comparison, require a continual flow of data to ensure quality while the application is in use. “Bandwidth-hungry smartphone apps can chew up 100 megabytes of data per hour” Figure 2 Digital Imaging File Sizes Average Exam File Size (MB) Radiography 38 Ultrasound 20 Echo 350 CT 35 MRI 23 Angiogram 225 Interventional Radiology 22 Nuclear Medicine 2 Fluoroscopy 20 Source: Frost & Sullivan “Videoconferencing usage for healthcare is forecasted to grow at 18% CAGR through 2016” Source: TechNavio The Value of Video Leapfrogging the limitations and expense of the legacy public switched telephone network (PSTN), IP voice and video communications enable rich and cost-effective telemedicine collaboration between doctors, patients and, increasingly, remote healthcare teams. 22% Medical Imaging Modality The mix of applications used by a healthcare provider location, as well as the number of employees and devices connecting to the network, drive bandwidth requirements. Rightsizing the connection is essential: once available bandwidth becomes congested, not only do access speeds slow for providers, so does healthcare delivery. Therefore, high reliability and availability are a must. A closer look at the applications driving connected health bandwidth follows. Surgeons and other specialists can make virtual bedside visits to check on patients without leaving the office. First responders can connect with physicians from the field, delivering life-saving expertise to the front lines of emergency care. Hospital nurses and doctors may use video to better monitor maternity and intensive care units. Given its power to enhance the presentation of critical content, streaming video usage is also spiking for patient education, medical resident education and employee training. IP-access network bandwidth and latency performance are essential to ensure both streaming video and call-session quality. As healhcare video conferencing usage expands, research firm TechNavio forecasts a compound annual growth rate (CAGR) of 18% through 20161. BYOD Access With smartphones, tablets and laptops so essential to personal productivity, many healthcare facilities are offering their employees and patients bring-your-own-device (BYOD) wireless Internet access. For example, many hospitals now offer wireless broadband access in patient rooms and common areas like lobbies and cafeterias. Patients with extended stays can stay connected with their office as well as family and friends. While the value of BYOD wireless Internet access for patients, family members and employees is significant, so are the bandwidth implications. A study by one wireless carrier found that the average smartphone app consumes more than 10 megabytes (MB) of data per hour, equal to 119 MB a month or 1.4 gigabytes (GB) per year. Some popular bandwidth-hungry apps can chew up ten times as much2. Medical Imaging 4 www.twc.com/business Nearly 400 million medical imaging procedures are performed annually in the U.S.3 Delays in the delivery of results prevent the rapid diagnosis and treatment of potentially life-threatening medical conditions. With digital file transfers, doctors have instant access to magnetic resonance imaging (MRI), positron emission tomography (PET), computed axial tomography (CT), radiology, cardiogram and mammography results. However, because of the fine detail in these images, the files can be extremely large. For example, an average CT scan file totals 35 MB, while an echocardiogram (ECG) file is 350 MB (see Figure 2).
  • 6. “Through social networks, patients may more actively engage with their prevention and treatment regimens” With a T-1 connection downloading a CT scan takes three minutes, while an ECG requires more than a half-hour. With a 10 Mbps connection the download time for a CT scan drops to 30 seconds, and a massive ECG file can be transferred in under 5 minutes. With 100 Mbps access, download times drop to a mere 3 seconds and 30 seconds, respectively (see Figure 3). Figure 3 Image File Download Time by Connection Speed CT (35 MB) ECG (350 MB) T-1 (1.5 Mbps) 3 min 31 min 10 Mbps 30 sec 5 min 100 Mbps 3 sec 30 sec Source: Kinetic Strategies Not only do high-bandwidth connections transfer medical imaging at blazing speeds, they also prevent the flow of large digital files from becoming a bottleneck for other applications. Syracuse-based St. Joseph’s Imaging was the first medical facility in Central New York to connect all of its office locations with a high-capacity WAN to distribute digital image files. “Our radiologists read close to a thousand exams a day,” explains Olga Stanton, Director of Radiology at St. Joseph’s Imaging. “The files are huge. Time Warner Cable Business Class helped us set up a network that gave us sufficient bandwidth to send the images.” “We are always trying to maintain some kind of competitive edge,” Stanton added. “If we can give the results of the study before you leave the doctor’s office, then that’s a significant benefit.” “Facility-based providers with their own fiber networks simplify pricing and reduce costs—and provide a single point of contact for sales and service” Social Networking Increasingly, social networking tools are helping healthcare professionals and patients better connect and share information. Through social networks, patients may more actively engage with their own prevention and treatment regimens. A recent study found that the costs for patients who were more knowledgeable, skilled and confident about managing their day-to-day healthcare were 8 percent lower in the base year and 21 percent lower in the following year.4 When used effectively, social networking may improve care for patients and outcomes for providers. Productivity, Storage and Backup While it is easy to see the bandwidth impact of video and multimedia, basic business productivity applications can also tax healthcare network capacity. For example, Microsoft estimates that 100 heavy users of its Outlook Web Access application for email and calendar scheduling require more than 1 Mbps of bandwidth alone.5 When file sharing, storage and backup functions for healthcare organizations move to the cloud, the requirements can be even greater. File sharing and storage services essentially act like lockers for digital files, offering options for sharing and collaboration with other authorized users. Backup services are utilized for data archiving and disaster recovery. 5 www.twc.com/business
  • 7. In either case, Internet access speeds dictate how quickly users can upload and retrieve files. For example, with a meager 1 Mbps connection, a full day is required to transfer 10 GB of data. Or, stated differently, each 10 GB of data that is to be stored or retrieved each day chews up 1 Mbps of Internet access bandwidth. Quality Service “Facility-based providers with their own fiber networks can simplify pricing and reduce costs, while providing a single point of contact for sales and service” It is just as important for healthcare providers to receive excellent service as it is to deliver it. Healthcare organizations may be challenged to find flexible and responsive service from incumbent local exchange carriers (ILECs). When organizations turn to competitive local exchange carriers (CLECs) or Internet Service Providers (ISPs) for relief, they may find more responsive service in some cases. However, because CLECs and ISPs may use ILEC last-mile connections to provide their services, they can have less control over the reliability of their networks and flexibility in their offerings. Therefore, choosing facility-based providers with their own fiber networks can simplify pricing and reduce costs, while providing a single point of contact for sales and service. Staying Ahead of the Curve To succeed in a connected health environment, healthcare providers need to stay ahead of the bandwidth curve. When a provider’s network connections falter, so may the quality of care. The growing importance of electronic health records, video conferencing, multimedia collaboration, and mobile devices in the workplace are creating a “new normal” for bandwidth usage. While T-1 used to be sufficient for many organizations, a minimum of 10 Mbps is now needed for small offices to keep up with traffic growth. Larger healthcare organizations and imaging centers require far more. Not only are healthcare providers upgrading their connections to the public Internet, they are also adding capacity to the links among their affiliates and branch offices. Service providers that can meet today’s network requirements for connected health and seamlessly scale to deliver tomorrow’s are essential to the delivery of high-quality and cost-effective patient care. About the Author Michael Harris is principal consultant at Phoenix, Arizona-based Kinetic Strategies, Inc. Applying more than 15 years of experience as a strategist, research analyst and journalist, Michael consults with select clients in the networking, Internet and telecommunications industries. About Time Warner Cable Business Class Time Warner Cable Business Class, a division of Time Warner Cable (NYSE: TWC), offers a full complement of business communications tools to small-and medium-sized businesses and enterprise-sized companies. Its phone, Internet, Ethernet, cable TV and security solutions are enhanced by award-winning customer service and local support teams. Through its NaviSite subsidiary, the Company also offers managed and outsourced information technology solutions and cloud services. Time Warner Cable Business Class was founded in 1998. Today, it serves over 550,000 business customers throughout Time Warner Cable’s markets. © 2013 Time Warner Cable. All Rights Reserved. 6 www.twc.com/business
  • 8. ¹ http://www.fierceenterprisecommunications.com/story/cisco-polycom-logitechs-lifesize-lead-healthcare-videoconferencing-m arket/2013-06-02 ² Apps driving mobile data traffic growth, accessed at http://www.virginmediabusiness.co.uk/News-and-events/Business-blog/2011/Apps-driving-mobile-data-traff/ ³ American Society of Radiologic Technologists, accessed at http://www.asrt.org/main/standards-regulations/federal-legislative-affairs/state-and-federal-licensure-issues Judith Hibbard and Jessica Greene, “What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs,” Health Affairs, February 2013, vol. 32 no. 2, 207-214 Microsoft Online Services Company Network Requirements, accessed at http://www.microsoft.com/online/help/en-us/helphowto/3dea7174-a521-4442-a7c5-5d540e09b20d.html 4 5 7 www.twc.com/business