Bandwidth Options for Healthcare Providers

By: John Shepler

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.

Different Types of VPN Providers

Your network is private and you work hard to keep it that way. What about when you connect to the outside world? Do you open your castle gate to let in everybody and everything festering on the Internet? Or, do you protect your network over long distances by using a private or virtually private network?

Before there were VPNs (Virtual Private Networks) there were private networks. There still are. Some situations require so much security that the only way to be sure you maintain control and avoid all intrusion is by using private line point to point connections. You might even go one step further and encrypt the data traveling on those private lines on the odd chance that someone has figured out how to tap in.

Private lines make the most sense when you have only two locations to connect. You can order order a “nailed up” T1 line from point to point. By “nailed up” I mean that the connection is hard wired and stays that way as long as you pay the monthly lease. There is no traffic other than yours on this circuit. Whatever you aren’t using to full capacity simply idles while waiting to be used day and night.

Need a lot more bandwidth? You can order DS3 private lines at 45 Mbps or move up to fiber optic service starting at 155 Mbps. An alternative is Carrier Ethernet over copper or fiber. With Ethernet you have many more bandwidth options and the cost is generally lower than with traditional telecom services.

Note that these circuits are dedicated to your locations, but your data may be multiplexed with data from other users while it is on the line. SONET fiber service and Ethernet over Fiber has so much bandwidth that it doesn’t make economic sense to use an entire strand or even a wavelength for 50 or 100 Mbps of traffic.

This is the beginning of virtual private networking. In this case, the provider divvies up the available bandwidth by TDM (Time Division Multiplexing) time slots or virtual private circuits. Since the network is privately operated, you have the protection that the general public has no outside access to any of this traffic and no way to snoop on your data stream or cause trouble.

If you need really massive amounts of bandwidth, you can rent wavelengths on fiber circuits at typically 5 Gbps or rent dark fiber strands themselves that can support nearly unlimited bandwidth. These offer an increased security in that only your traffic is on the wavelength or fiber strand.

Another VPN methodology is the MPLS network. MPLS or Multi Protocol Label Switching also runs on privately operated networks. It transports IP traffic as well as other protocols but doesn’t use IP labels for routing. Instead MPLS switches install special tags on each packet upon entry to the network and remove them before egress. This is where the virtual private designation comes in. You share the network with other users, but the proprietary MPLS technology protects the privacy of your data while it is on the network. You’ll hear this service referred to as MPLS VPN.

The most common application for VPN is when using the Internet as your connection from point to point or to the general public. If you do business on the Internet, you don’t really have a choice. You may also want to have home workers or traveling employees connect to your business systems without the expense of private lines. The challenge is how to make an inherently risky network like the Internet into something your can trust with sensitive date.

The answer is “tunneling.” This is a concept for creating private channels through a public network. The tunneling is accomplished by encrypting each packet so that it makes no sense to anyone but the intended parties. There are two software methods commonly used to accomplish this.

The legacy method is IPsec or Internet Protocol security. This requires special software to be installed on the company server and client computer. IPsec does the encryption and decryption and must be specially set up to create the virtually private tunnel. One installed, you have a VPN connection from wherever you want to use that particular computer. Other computers must have the same software installed or they won’t work on the VPN.

A competing method is called SLL or Secure Socket Layer. This is the technology you use when accessing your bank account or secure email. It’s become so standard that it is built into all Web browsers and many email programs. With SSL, you need a user account ID and a password to access your remote account. The nice feature is that you an access your account from just about any computer, private or public, and know that your data is securely encrypted.

Are you in need of a business-grade private or virtually private network connection? If so, check out the options and decide which works best for your applications.