Electronic health records, medical imaging and telemedicine are making broadband connections an essential part of healthcare operations. Let’s take a look at what’s needed for today’s EHR environment.
There are two types of bandwidth services that you’ll want to consider. These are private lines and the public Internet. Both have their place.
Private lines are used by all sizes of businesses and organizations for internal communications. The fact that these lines are “private” means that they are not used for communication with the public at large or anyone not directly connected into the network.
Physician and hospital groups may well have large amounts of electronic data that they want to keep in-house under strict access control. Think of private lines as a way to extend your network.
Point to point private lines include such familiar options as T1, DS3, SONET OC3, OC12 and OC48, Ethernet over Copper and Ethernet over Fiber. Each of these options gives you a fixed amount of bandwidth that is dedicated to your use only and is inaccessible by anyone else. They differ in the technology to implement the service and the amount of bandwidth available.
For instance, T1 lines have been around forever, are available just about anywhere you can get a phone line installed, are highly reliable and are very reasonably priced. What’s not to love? The bandwidth is their limitation. While 1.5 Mbps was considered high speed in the days of dial-up modems, 1.5 Mbps is entry level broadband today. You probably won’t want to wait around for the time it takes to transfer large files with both text and images.
You’ll find a good discussion on healthcare provider bandwidth needs on the Health IT. gov site. The minimum bandwidth recommend for a single physician practice is 4 Mbps. That’s enough to support practice management functions including email and web browsing, plus simultaneous use of electronic health records (EHR) and high quality video consultations. It also is enough for non real-time image downloads and remote monitoring.
A small physician practice with 2 to 4 physicians will want to move up to 10 Mbps for the same functions. The extra bandwidth assumes more than one physician using the service at a time. The 10 Mbps level is also considered suitable for nursing homes and rural health clinics.
When you consider the needs of a clinic or large physician practice with 5 to 15 physicians, the bandwidth requirements increases to 25 Mbps. A hospital will need 100 Mbps and a large or academic medical center really needs 1000 Mbps.
The FCC publication “Health Care Broadband in America” goes into more detail about what drives bandwidth requirements. An Xray is about 10 MB and needs 60 seconds to download at 1 Mbps or 5 seconds at 16 Mbps. An MRI at 45 MB needs 72 Mbps to download in the same 5 sends or 300 seconds or a full 5 minutes at 1 Mbps. A 64 slice CT scan at 3 GB needs 4800 Mbps for a 5 second download or 80 Mbps for a 5 minute download time.
As you can see, there is a tradeoff between the amount of bandwidth you have and how long it takes to transfer files of various sizes. I’d suggest taking these requirements as a minimum, as the report was published in 2010 and technology is only getting more sophisticated with larger file sizes.
In addition to the bandwidth of the line, there are other technical parameters to consider. These include whether the service is symmetrical (same upload and download speeds), dedicated to your use only or shared between your practice and other users, the latency or time delay in transmission, and the amount of jitter and packet loss. All of these are quality of service metrics.
Dedicated private lines are almost always symmetrical, with low values of latency, jitter and packet loss. You can bond T1 lines together to increase bandwidth from 3 Mbps up to about 12 Mbps. That’s important for rural practices where there may be few other options. In metro areas, DS3 offers 45 Mbps, OC3 is 155 Mbps, OC12 gives you 622 Mbps and OC48 is 2.4 Gbps. These are all delivered over SONET fiber optic carriers.
Alternative landline services include Ethernet over Copper with bandwidth from about 3 to 50 Mbps, depending on location. Ethernet over Fiber service starts at 10 Mbps and goes up to 10 Gbps, with service to 40 or 100 Mbps in select areas.
Dedicated lines are also popular for connecting to the Internet to get the highest performance available. You don’t have the same level of control of what’s actually traversing the Internet, but it does have offer nearly universal connectivity.
For Internet access, you also have the option of option of connecting via shared bandwidth services. Popular options are DSL, Cable, satellite and 3G/4G wireless. Generally, these are asymmetrical, with higher speeds on download than upload. Also, they are offered on an “as available” basis without any service level agreement regarding availability, bandwidth, latency, jitter and packet loss.
The tradeoff in performance between the dedicated and shared services is that the shared services are for using the Internet and they are considerably less expensive. Internet security doesn’t begin to measure up to dedicated private lines, but it can be made workable using encryption such as VPN and SSL at each end.
The best solution for many practices may be a combination of private lines and Internet service. The Internet is valuable for communication with patients at home and using mobile apps, and also to establish WiFi service for visitor use. Private lines are beneficial for high speed communication between medical facilities and physician offices.
Is your medical practice running out of bandwidth in today’s EHR environment? You may be able to afford much more than you think with multiple bandwidth options and providers available at your location.