HOSPIARCH 2012, CHENNAI

Niranjan Kumar
Invest2Care Challenges in Hospital IT & Networking Design
21- 01 2012
Todays discussion

IT & Networking in Hospital - Overview Transitioning from Paper Records to EMR

A typical three-tier Network architecture First Things First Clear the basics

Architecture for Hospital Networks What to look for during IT Implementation?

Considerations for the Dynamic Changes Follow the 5 Ps

Integrating Unified Communications Transition Process

PACs and DICOM Imaging Access Implementation - Check list

Mobility Using Wireless Applications Conclusion

IT & Networking in Hospital - Overview
u Rapid changes in next-generation wired and wireless healthcare applications
mean that the network is no longer an option, but a necessity.
u Electronic Medical Records (EMR) , wireless monitoring, handheld devices
and broader imaging distribution etc improve patient care and drive down
spiralling healthcare costs.
u This drives the need for network upgrades to provide a more robust, higher-
performing, and secure network infrastructure.
u This infrastructure is critical to reduce staff wait times and allow staff and
patient mobility, equipment tracking, and broader integration of data systems.
3 Tier Architecture for Hospital Networks
u Depending on the size and function of the institution, hospital network
architectures can vary significantly in complexity and scope.
u Most medium and large hospital complexes typically need a traditional three-tier
network design with edge, aggregation, and core layers, with the edge including
both wired switches and wireless access points.
u This three-tier architecture accommodates the large number of diverse
workstations, laptops, PDAs, phones, monitoring equipment, imaging modalities,
and other hospital equipment at the network edge.
u These devices, in turn, are brought into the central network via an aggregation
layer, which ties the network edge to the network core.
Network Considerations for the Dynamic Changes in Healthcare

u With the exception of building new facilities, few institutions have the luxury or
budget to design an optimal data network from scratch.
u Most hospital networks have evolved over time to meet different challenges and
they include several generations of equipment and technologies.
u These are often expensive to maintain, some products may no longer be
available, and existing solutions may prove incapable of meeting current and
future demands.
u In particular, IT staff must be able to solve challenges such as
Transitioning from paper records to Electronic Medical Records (EMR)
Meeting regulations and securing patient data
Increasing productivity through staff mobility and WLAN applications
Integrating Unified Communications
u The introduction of Unified Communications (UC) for VoIP, Web conferencing,
nurse call, patient video monitoring, and IPTV is another significant cost savings
initiative that poses additional challenges for hospital network designs.
u VoIP, for example, requires low-jitter data delivery for voice clarity, while
multimedia applications require multicast support and adequate end-to-end
bandwidth.
u As hospitals collaborate across medical centres, the need for higher-quality HD
video conferencing is also becoming a requirement.
Expansion of PACs and DICOM Imaging Access
u PACS technology is an integral part of todays healthcare delivery
system. Created in response to the inefficiencies of physical film-
based medical imaging record management, PACS is part of a
broader effort to digitize all medical and diagnostic information to
more easily store, and manage patient information.
u The modalities are also changing as high-speed CTs produce
significantly more image slices than prior generations of scanners.
u PACS relies on a common image format as defined by the Digital
Imaging and Communications in Medicine (DICOM) standard.
u Because DICOM uses TCP/IP as a communications protocol, PACS
data can be routed within a hospital campus network, between
hospitals for record transfer, and to remote sites for archiving and
disaster recovery.
Mobility Using Wireless Applications
u Tracking throughout the hospital with Radio Frequency ID (RFID) tags and sensors,
reducing the amount of lost equipment and allowing it to be quickly found.
u Patient Internet access, especially for long-term care patients, is also becoming an
expected service, further burdening the network from both a bandwidth and security
perspective.
u Increasing Productivity through Staff Mobility and WLAN Applications
u Many hospitals have started to migrate some healthcare applications from wired
workstations to wireless access devices such as mobile PC carts, laptops, tablet
PCs, PDAs, and other wireless equipment.
u This both enhances staff productivity and speeds patient diagnosis and treatment.
Transitioning from Paper Records to EMR
u One of the major contributors to cost, inefficiencies, and errors is the continued reliance on the
generation and transport of paper records.
u The healthcare industry has responded to this challenge with standards initiatives such as
Health Level 7 (HL7), which creates uniform templates for the generation and retrieval of
electronic medical records.
u As more and more critical patient information migrates to the network, the network must
provide adequate bandwidth, security, and data availability to ensure timely delivery of patient
information to medical staff and doctors.
u Patient records may contain more than just text, as images, audio notes, and rich multimedia
data are integrated into the system.
u Combined with other healthcare applications, they can overwhelm existing networks or cause
critical slowdowns, impacting patient care and staff efficiency.
First Things First Clear the basics

u Make a clear business case

u Learn from the leaders
u Partner with your vendors
u Its less about technology than it is about process
u Partner with your clinical leadership; you cannot succeed without their
commitment
u Competitors are also colleagues, all may have the goals in common
u A healthier populace and improved access to quality care at affordable cost
u Ask questions, lots of questions; share your experience
IT infrastructure is a journey, not a destination!!
What to look for during IT Implementation?

u Ease of implementation, Upward migration

u Performance, backup and recovery
u Audit, monitoring, error mgt and security
u Application, testing and development experience
u Technology - Ease of development across all types of interfaces
u Total cost of ownership
u Service and support
u Documentation
Follow the 5 Ps

u Well-defined goals can avoid: Unrealistic expectations, Inadequate

Purpose customization of system, Loss of productivity & Ultimate abandonment
of system

u Change Management: The key players in EMR implementation project

People are Physician champion, IT Staff or Consultant & EMR Committee

u Involvement of key people from the beginning, set realistic deadline to

Planning go live, use dynamic planning tools, break down current work flow and
the fitment as well, Plan out a training, test those skills prior to go live
day.

Purchase u Components & Infrastructure : Network hardware /software & EMR

software, wiring, Peripherals & devices.

Plunge u Set and track: Tight deadline, feedback program, communication line,
bugs analysis & let the champions track everyone regularly
Transition Process

u Purchasing and setting up hardware

u Setting up software
u Building out the network infrastructure
u Configuring the IT Solution
u Testing
u Creating the training plan
u Reviewing the process
u Planning the roll-out
Implementation - Check list
u Safety and security of personal health information through policies
u Access to complete medical records (paper, electronic or a combination of both) are
accessible at all clinical decision points
u EMRs must be able to be printed promptly if required.
u Physical security and robust backup procedures for the data server
u Best and suitable IT Solution with
u Audit trail for information entry;
u Capability of physicians to provide signoff on documentation, orders and
u prescriptions using electronic signatures or equivalent authentication;
u Regular backup of data; and
u Effective recovery protocols.
u Protection though firewalls and antivirus software.
 A project is complete
when it starts working
for you, rather than you
working for it.
- Scott Allen

Reference:
White Paper: Dynamic Changes in Healthcare Create Challenges in Hospital Campus Networks Brocade

Niranjan Kumar
I n v e s t 2 C a r e Te c h n o l o g i e s P r i v a t e L i m i t e d
Invest2Care
21- 01 2012
info@invest2care.com