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.

IP WAN over MPLS Advantages

When we think of IP wide area networks, the first thing that comes to mind is the Internet. While the Internet does have almost universal connectivity and modest cost to access, there are some serious issues when it comes to business applications. Bandwidth, latency, jitter and packet loss have no guarantees and few expectations. Security is a joke. But aren’t other methods to interconnect business locations costly and hard to manage?

It is possible to set up a private IP network that lets you use your familiar IP addressing schemes and avoid encryption, firewalls, tunnels, and additional hardware. You’ll gain a performance advantage compared to using VPN techniques over the Internet and save yourself the administrative headaches of trying to manage a WAN with inherently indeterminate characteristics. Who offers something like this? It’s TelePacific, one of the nation’s largest competitive carriers.

TelePacific’s 1Net is an IP VPN running on a private MPLS network, not the Internet. Since MPLS or Multi-Protocol Label Switching can transport almost any protocol, it can be set up to mimic the Internet while keeping your data private. Only the locations that you set up can exchange traffic. No one outside of your user group can capture or view your data. You’ll have any to any connectivity within the group with security sufficient to address HIPPA or similar government regulations.

In fact, TelePacific set up just such a private IP Network for a medical imaging organization with 6 locations. They use it to transport patients’ private medical records among their location. Referring physicians can access patient imaging results within hours at their own computers. The system is also used for claims processing, patient scheduling and registration. Interestingly, this system also allows dedicated Internet access through a single firewall at corporate headquarters.

The TelePacific 1Net IP VPN has both cost and performance advantages over other secure networking solutions, including private line, ATM and Frame Relay. You can specify up to six different Classes of Service (CoS) to support sensitive real-time services such as VoIP telephone and teleconferencing. On Net, latency for all CoS is specified at 50 msec. That rises to just 100 msec for extended reach locations off the TelePacific network but still within the US. Network availability is 99.999% (5 nines) both on and off network locations.

The Classes of Service are CoS 1 for VoIP real time traffic, CoS2 for video conferencing and real time data traffic, CoS3 for high priority, delay sensitive business data like Ecommerce and Citrix, CoS4 for medium priority delay-sensisitive business data such as CRM and WebEx, CoS5 for general less delay sensitive business data like ERP, and CoS6 for best effort traffic with no prioritization. That’s typically Email and FTP.

Are you cringing at the cost and effort involved in linking your business locations by private lines or frustrated by the highly variable performance and difficulty in securing the Internet? Perhaps the best solution for your business needs is a private IP VPN based on MPLS networking. Check prices and features to compare with your other choices.



Note: MPLS network diagram courtesy of Wikimedia Commons.

DS3 Router Included With Service

Are you thinking about upgrading your voice or data bandwidth? DS3 service will give you 45 Mbps for both upload and download. That's enough for bandwidth intensive uses such as video transfer, medical imaging or call center operations. But what do you have to do about getting a DS3 router to make the connection to your network?

Relax. DS3 is a mature technology and equipment is readily available. Prices for DS3 service are coming down, too. With more and more companies making the jump from T1 lines to DS3 bandwidth, you should find implementation fairly straightforward. In fact, there's a new DS3 option available that you might want to consider. It's line service with a managed router.

Why a managed router? For one thing, it gets you out of the business of having to manage DS3 connectivity yourself. If high bandwidth telecom circuits are your expertise, then by all means order the cheapest DS3 circuits you can get and handle the interface and service issues yourself. But if you'd rather not be in the middle of a finger pointing exchange between the telecom carrier and the router manufacturer, consider staying well out of that loop.

A managed router is one that is provided by the carrier who transports your DS3 signal. The router is installed on your premises and connects to your network through your own switching and routing. The port to your network is demarcation point where you take responsibility. On the other side, including the DS3 router itself, the service provider takes responsibility for the equipment and line operation.

The beauty of this arrangement become apparent even before a piece of gear in the carrier's network fails or some ham fist chops through an underground cable. The managed DS3 service provider monitors the circuit to and including the DS3 router on your premises. If something goes wrong in the middle of the night, they'll find out about it right away and perhaps have service restored before you know it ever went out.

Managed router service is growing in popularity as companies are forced to run with thinner IT staffs at a time when they are getting involved with higher bandwidth line services as technology advances. You can often get a router included with both T1 and DS3 services, if you wish. In many cases, the competitive environment will hold the cost down so that you'll pay little if any premium for this extra service.

If managed router service is of interest or you just want to see if you can save money before you renew your existing line contract, check DS3 service prices quickly and easily now.

10 Gig E WAN Comes To The Enterprise

Amazing as it sounds, 10 Gigabit Ethernet wide area network connections are now possible for business applications. Perhaps even more surprising are the number of businesses that can actually use this level of bandwidth.

Gigabit Ethernet is just starting up the growth curve for major corporations and high technology companies who's products and services depend on creating enormous data sets and being able to deliver them instantly to their customers. What kind of companies are those?

For anyone engaged in video production or editing, Gigabit per second pipes are no extravagance. Even short video productions chew up hundreds of Megabytes in a matter of minutes. Uncompressed high definition video can do that in seconds. It matters not if you have Terabytes or Petabytes of storage available if there is no practical way to transfer those productions in any reasonable amount of time.

Medical imaging is another high demand generator of data. MRI, CT, and X-Ray images create large files for each picture and image set. As the medical profession moves more and more from physical to electronic files, the amount of data will surely multiply and then multiply again. It's now possible to have a physician in Asia read a medical image from the U.S. during what is the middle of the night for us, but standard business hours in India or China. Being able to use medical consultants worldwide depends on having rapid communications for both text and images.

Scientific research and Engineering are fields that have moved away from notebooks and analog gauges to computer-aided drawing, manufacturing and modeling. Complex projects, such as new building design, collaboration on aircraft design, and drug research increasingly use faster and faster supercomputers. The faster computers generate data that much faster. Can you really expect to use yesterday's bandwidth solutions to maintain cutting edge productivity?

It is high bandwidth applications such as these that are driving companies and organizations to faster LANs within their operations and faster WAN connections outside. With Ethernet the common denominator among network protocols, it stands to reason that Carrier Ethernet solutions are a better match than the traditional SONET fiber optic services. They are also often cheaper. Competitive carriers with regional and nationwide networks optimized for IP services such as Ethernet and MPLS, are highly efficient at delivering high bandwidths over fiber connections. Gigabit Ethernet is often a given for any lit building. But 10 Gigabit Ethernet, 10 Gig E, is now emerging as a reasonable service to install for high volume and multiple users.

Do you have a high bandwidth demand that you can't meet or feel you are paying too much for? If so, check out the availability and pricing of 10 Gigabit Ethernet connections for your business location.

Are Your Pipes Fat Enough?

As the resolution of data increases, WAN bandwidth can quickly become a choke point. Think of what happens when you get a kink in your garden hose. The data is the water and the pressure is the bandwidth demand. Any kink causes flow to decrease to a trickle, while the pressure or demand remains. A data link is like a water pipe in this way. Even when the kinks are removed through diligent network engineering, you can only move so much data though the pipe. If you want to move data more quickly, you need a fatter pipe.

Fat data pipes are becoming a necessity as electronic business data increases in quantity and resolution. An example of resolution is medical imaging files. They can easily be many Megabits, even Gigabits, per image. Try transmitting those through a 64 Kbps ISDN BRI channel and you'll feel like you're trying to fill a swimming pool with a kinked garden hose. Engineering firms are also switching from sending large drawings through the mail to transmitting them electronically to branch offices or customer locations. FAX transmissions need only small pipes, like telephone lines. Detailed blueprints and 3-D models that can be printed or modified remotely need fat pipes to transmit them in any reasonable time frame.

Video post production is another field where the medium has gone from film to video tape to digital data on disk. Sure, you can load the production onto video disks, hard disks, or magnetic tape and physically transport them from location to location. But that burns precious time. If you are on a tight production schedule or need to support live programming, a courier service isn't going to cut it. You need to be able to press the send button and have the file transfer in seconds or minutes to another location.

So what is a fatter pipe in the telecommunications vernacular? Serious bandwidth starts at the T1 level with 1.5 Mbps bidirectionally. A T1 line will send files of a few Megabytes in seconds. Often this is fine for text based contracts and specifications, low to medium resolution photographs, smaller CAD files general accounting and inventory updates, and many real-time IP security cameras. If you want to transmit more files in the same time, transmit larger files without having to wait hours or longer, or speed up the transfer of what you are doing now, you'll need a fatter pipe.

You can fatten a T1 pipe by bonding in more T1 lines. Bond a second line and you double your bandwidth from 1.5 to 3 Mbps. Bonding works up to 10 or 12 Mbps in many locations before it gets more expensive than moving up to a single fatter pipe.

The next fatter pipe is the T3 line at 45 Mbps. That's a substantial jump of 28x the capacity of a T1 line (the bandwidths mentioned are rounded figures). T3 lines are often used for real time video transport, high resolution images, large engineering files, and data backups to remote data centers. You can get this same bandwidth on a fiber optic carrier, where it is called DS3 service. In fact, DS3 over SONET fiber is more commonly found now than coaxial T3 lines.

If your facilities are wired for fiber, there is practically no limit to the available bandwidth. It's primarily a matter of budget, as fiber optic services start in the thousands of dollars per month and go up from there. But, when time is of the essence or team collaboration can multiply efficiency, even massively fat pipes may well justify their cost. With fiber optic services, you can get OC3 at 155 Mbps, OC12 at 622 Mbps, or OC48 at 2.5 Gbps. In many metropolitan areas you can also find native Ethernet services at 10 Mbps, Fast Ethernet at 100 Mbps and GigE at 1,000 Mbps or 1 Gbps. At these line speeds, the WAN bottleneck can disappear as the speed of the entire network becomes equal.

So, are your data pipes fat enough or are you feeling the "pinch" of data slowing down as it leaves your LAN network for transmission to other facilities? The good news is that WAN bandwidth prices have come down greatly in the last few years. The cost of an upgrade to meet the transmission speeds you need now may be much less than you suspect. Why now let our team of bandwidth professionals take a look at your application needs and offer you a suite of competitive options?