• December 2008 FEATURE ARTICLES •
Data Management: Case History
Light Speed Data
A New York medical center utilizes fiber optics to leverage its extensive IT infrastructure for near-instant data transmission.
By Jack Wolf
Almost all businesses and industries have been
transformed through technology to some extent in the past 20
years, but few have seen shifts as dramatic as those seen in the
healthcare industry. Technology has affected the way in which
patients are cared for as well as the way in which hospitals and
other healthcare providers do business.
The automation and digitization of
mission-critical applications — from recording a patient’s
medical history, to performing diagnostic tests, to prescribing
medication — is placing huge amounts of information literally at
clinicians’ fingertips. When lives are at stake and every second
counts, successful patient treatment relies on
near-instantaneous access to patient data. This includes all
medical imaging consisting of massive datasets exceeding
thousands of images from CT, MRI and cardiac diagnostic
instruments.
As a CIO in one of the nation’s largest and
most technologically advanced healthcare systems, it is my
responsibility to ensure that our clinicians have what they need
— when they need it — to be able to do their job successfully.
This includes surgical and diagnostic technologies as well as an
advanced, robust, high-speed network for transporting and
managing the data that clinicians use to care for their
patients.
Leading Through Technology
Montefiore Medical Center is one of the
nation’s largest healthcare systems, serving 1.4 million
residents of New York, nearby Westchester County and persons
referred from across the nation and around the world. At the
center of the healthcare enterprise are three hospitals: the
Henry and Lucy Moses Division; the Jack D. Weiler Division; and,
The Children’s Hospital at Montefiore (located at the Moses
Division). Combined, all of the hospitals provide care for more
than 65,000 inpatients and more than 2 million outpatients
annually. We also operate one of the largest hospital-based home
health agencies in the nation, which makes more than 400,000
visits per year.
In addition to being one of the nation’s
largest healthcare systems, Montefiore ranks among the top 1
percent of all U.S. hospitals for investments in medical
innovation and cutting-edge technology. The medical center
currently has one of the nation’s most advanced clinical and
management information systems. At its center is a computerized
clinical information system (CIS), which enables continuous,
lifelong medical records to be accessible from anywhere and at
anytime across our care delivery network.
The system provides computerized physician
order entry (CPOE), an online integrated pharmacy system, an
online integrated nursing documentation system, online
laboratory, radiology, cardiology and nuclear medicine as well
as a wireless network for
point-of-care computing, such as at a patient’s bedside. All
together, there are more than 9,500 devices currently on the
network. Our transition from paper charts to this computerized
system occurred gradually over the last 10 years. As our
hospitals grew and became more advanced, so did our use of
technology, and our need for a network with the bandwidth, speed
and dependability to implement that technology successfully.
In Support of EMR
In the early 1990s, Montefiore established
the objective of an automated electronic medical record (EMR)
with 100 percent CPOE. In order to accommodate this transition
to electronic records, we needed to substantially increase our
bandwidth. In 1994, we contracted with Optimum Lightpath and
another carrier to install two T-1s between Montefiore’s main
Bronx campus and its Yonkers data center. This provided full
redundancy and bandwidth. We chose this vendor based on its very
good reputation in the New York metropolitan area. Additionally,
the vendor’s pricing was very competitive. By 1996, we had
upgraded our wide-area network (WAN) communications again and
installed our first OC-12 ring. OC-12 is the abbreviated term
for Optical Carrier level 12, used to specify the speed level of
fiber optic networks, which are measured through SONET
(synchronous optical network) standards.
With this technology in place and the
increased bandwidth, we were able to implement a number of
state-of-the-art IT systems including SAP solutions for the
financial systems side, a full-function document imaging system
and complete fulfillment of our objective of an automated EMR on
the clinical side by 1998. As the hospital started to automate
more applications, our need for bandwidth continued to grow. The
SONET OC-12 was then upgraded to a more robust SONET OC-48 with
T-3 lines by the end of 1999.
PACS at Light Speed
While our network capabilities had grown
considerably at that point, Montefiore was planning the creation
of a picture archiving and communications system (PACS) for our
radiology department, which would require an extreme amount of
bandwidth. We had been storing all of our digital images at our
Yonkers data facility and wanted to mirror this at our Bronx
facility and make these images available throughout all of our
facilities for real-time access by our clinicians.
To support this application, the medical
center upgraded its network from an OC-48 SONET ring to a
multi-gigabit Ethernet network using redundant dual paths
including Optimum Lightpath’s and another carrier’s dense wave
division multiplexing (DWDM) core optical backbones. The
multi-gigabit carrier-class Ethernet network links the
hospital’s Bronx-based Moses Division, Medical Park and Weiler
Division facilities to its data center in Yonkers, which houses
more than 600 application servers. The WAN network upgrade
enabled us to implement the PACS, enabling storage and
distribution of digital medical images that can be retrieved
remotely or transmitted over the network.
The enterprise PACS benefits clinicians and
patients by dramatically speeding the transfer of large images
and files such as mammography, cardiac videos and 3-D
post-processed images. During surgery, or at any location, the
clinician can immediately pull up digital images that physically
reside at the Yonkers facility. For example, if a patient is
admitted to the emergency room and tests are taken, such as an
echocardiogram, the surgeon can review the images and prepare
for surgery before the patient arrives at the catheterization
lab. Without the advantages of fiber optic technologies, the
X-rays would need to be physically sent or delivered to the
clinician, which could take hours or even days.
Enterprise Communications
The increased bandwidth Montefiore gained
from upgrading its network to a DWDM-based solution eliminated
numerous obstacles related to inter-campus communications, and
decreased our cost-per-megabit expense to a fraction of what it
was only a few years ago. This allowed us to streamline our IT
operations and redeploy our assets to provide even greater
services to our patients. It also helped accommodate the
sub-second transmission of extremely large files that are of
critical importance to our organization since moving to a 100
percent CPOE-based system.
Montefiore is now moving closer to
eliminating paper charts entirely. All lab, medical record and
radiology, as well as, cardiology, radiation oncology and
billing-related documents, and even nutrition, run over the 600
servers in our data center, making high bandwidth, reliability
and redundancy not only beneficial, but essential.
Furthermore, the network allows us to move a
colossal amount of data each day. We have successfully
implemented CPOE, PACS and advanced cardiology systems, new
clinical systems running on VMware, document imaging and
simultaneous back up in both Yonkers and the Bronx. We now have
the capability to transmit more than 30 gigabits of data in the
fraction of a second — amounting to the transmission of hundreds
of terabytes of data daily.
Our ambulatory remote sites were also
upgraded, in many cases to optical Ethernet 100 Mb connections
to support instantaneous physician access to the images. This
would have been an impossible feat on our previous network.
Additionally, the redundancy and reliability of the network has
addressed our organization’s reliance on real-time data — the
most pressing issue facing the medical center since the move. It
is absolutely critical that the network is up at all times, as
there is absolutely zero tolerance for downtime whatsoever.
Future-proofing Your Network
As any CIO knows, justifying the investment
in upgrading your network infrastructure is no easy task and is
often met with great consternation and resistance from the
larger organization.
However, in today’s rapidly evolving
communications environment, technology investments can quickly
become outdated.
In contrast, since Montefiore’s investment in
the implementation of a fiber optic network, conversations about
new projects and justifying new communications costs have been
all but eliminated. In fact, not only does the network allow for
a "future-proof" backbone that can accommodate any application,
it also enables the network operations center to run a rigorous,
dynamic network management system that anticipates problems or
issues and self-corrects without interruption.
As we continue to grow, we know this network
will continue to be a key partner in driving the success of the
hospital and its partnering facilities. This hospital has 10
times the amount of bandwidth that it had five years ago with
the capabilities to grow another hundred-fold, and I fully
expect it to require at least 10 times more, five years from
now.
For example, Montefiore Medical Center is
looking to leverage high-definition video for procedures in the
hospital as well as for video "outpatient" visits where doctors
can interact with patients in their homes. This type of
communication could revolutionize how patients are monitored and
treated for conditions that require routine visits to the
hospital, such as those suffering from obesity or diabetes.
Applications like this would not be possible without the
capacity, speed and reliability of our network.
Whatever applications and technological
advancements the decades bring, there’s no doubt that one of the
keys to success will be the technology infrastructure’s ability
to grow alongside the innovation of its organization. Our
initial investment in the network, and the upgrades we continue
to make today, have taken us far beyond our original vision and
continue to advance with a tremendously positive impact on
patient care.
Jack Wolf is vice president,
MIS for Montefiore Medical Center. Contact him at
jwolf@emerginghealthit.com .
