By Chris Janson, Nokia IP and Optical Networks
For at least the past 10 years, healthcare providers have invested in tools that utilize computing and information technology to better control patient outcomes. Several large hospital systems in the U.S. have reported meaningful improvements in metrics such as length of inpatient hospital stays, need for post-operative antibiotics and 30-day re-admissions. These positive outcomes are credited to the increased use of predictive analytics that model patient scenarios as part of a real-time connected healthcare system (RTHS). A cornerstone of the RTHS is connectivity among patients, healthcare providers as well as devices and systems that generate, process and store real-time data.
Big Changes In HIT
Adoption of electronic health records (EHRs) has reached near universal levels. By 2015, almost all U.S. hospitals reported possession of technology to support certified EHR technology. Adoption was delayed in some hospitals due to interoperability issues. Still, that 2015 figure included a significant increase in EHR functionality beyond simple patient information; it also included 40 percent with comprehensive EHR capabilities, including clinician notes, computerized provider order entry and decision support capabilities. This progress over a seven-year period is a remarkable example of technology adoption by well-established organizations with strongly entrenched processes. In the U.S. as well as elsewhere, EHR adoption sets the table for further advances that improve patient care. Accurate electronic patient data not only ensures consistent record logging but also allows for interpretation through analytics, giving clinicians better tools to make care giving decisions.
Advances in imaging modalities have led to an increase in average file size for a typical study. PACS was a great leap forward in packaging together images from various modalities for a unique study. More recent imaging advances such as computed tomography and digital tomosynthesis have given clinicians powerful tools but have increased image file sizes, taxing the healthcare provider’s IT networks and storage systems. With a single patient study file often exceeding 5Gb, some exceeding 30Gb, compounded by hundreds of studies per week, it’s easy to imagine the impact this has on a hospital system’s needs for storage capacity, network bandwidth, and latency.
Another interesting development is the addition of internet connected devices that track patient vitals and other diagnostics, creating an Internet of Medical Things (IoMT). These sensors can provide rich data that is fed back into analytic systems, which can aid doctors in continuing patient care. These devices need not be limited to use in the hospital setting as patients can wear these devices at home or in their daily activities. Much like EHRs and imaging systems, the IoMT requires a reliable, secure network to connect patients, computing platforms, storage systems and doctors. Together these elements form the foundation of the RTHS.
While all this progress has been underway in technology adoption, other shifts are affecting hospital systems’ financial health. Navigant reported recently that 47 percent of U.S. hospitals reported a reduction in operating margin of 39 percent between 2015 and 2017. This reduction in margin is the result of weakening top-line revenue growth in the face of increasing operating costs. Topline weakness was attributed to four factors:
- Lowered demand for core hospital services, such as in-patient surgery
- Reduced collection rates in non-ACA expansion states
- Medicare payment rate erosion
- Value-based insurance payments and their impact on patient volume
Value-based healthcare is a delivery model where providers are paid based on patient health outcomes – essentially, results – rather than individual fees per service. Value-based healthcare should motivate everyone in the value-chain to seek efficient healthcare delivery rather than reward tests and procedures which may not all be needed. For this to work, the provider needs IT infrastructure capable of seamlessly integrating a patient’s health records, on-going clinical procedures or diagnostics and patient monitoring. With these pieces connected, analytic tools can provide evidence of patient progress against chronic conditions or recovery from acute illness or injury.
Enterprise Private Optical Networks And Real-Time Healthcare
EHRs, very large imaging studies, IoMT, analytics and changing economics are all factors affecting change in the networks connecting healthcare systems. As in most industries, the traditional reaction to additional applications or users was to add capacity. In some cases, leased connectivity to public cloud services is adequate. But healthcare has unique requirements for accessibility, security and other factors. Adding incremental services from a communication service provider often results in unsatisfactory performance and cost. This is why a recent healthcare IT leader survey reported that private cloud is the preferred architecture, and only 10 percent expected to be using public cloud by 2022.
In the age of the RTHS, better control, scalability and security can be realized through an enterprise private optical network. These are simply optical networks that connect data centers, hospitals, labs, offices and clinics through a fiber optic infrastructure controlled (not necessarily owned) by the healthcare provider. In constructing a private cloud, healthcare operations are connected to remote data centers through Data Center Interconnect (DCI) links. These links often utilize leased dark fiber and connect to co-location data centers. Immense scale, security and economy can be returned to the healthcare system because these co-location centers are purpose-built for these very reasons. Taking control of the DCI also returns value through dedicated fiber facilities, ready for quick capacity scaling and use of economical, enterprise-owned optical transport equipment.
It’s a certainty that healthcare will continue to generate increasing quantities of data and rely upon that data to deliver better patient care. Taking advantage of the affordability of optical networking technology is just the latest step in the RTHS journey.
About The Author
Chris Janson is Product Marketing Manager in Nokia’s IP and Optical Network business unit where he follows trends in optical networking technology and its application to finance, healthcare, utilities, government and educational network operators. Over the past 30 years, Chris has held product development, management and marketing roles in the communications equipment and semiconductor fields. He has been a speaker at many conferences including Interop, Internet2, and other executive forums. He also has shared his work through many webinars, written publications, online videos and articles, and serves on the board of directors of the Rural Telecommunications Congress and the nonprofit OpenCape Corporation. Chris holds an MBA from Boston University and Bachelor of Science in engineering from Wentworth Institute of Technology.