Cable and Telemedicine

Success is linked to opportunities. That is certainly the case with business services.

The proliferation of cellular towers presented one initial and much talked-about opportunity to cable operators. Cell backhaul could remain a wise move, since demand will only grow as technologies such as Third Generation Partnership Project (3GPP) with its higher capacity continue to gain speed.

To see success breed success, however, operators must be ready to move quickly. What could be the next business services vertical? Efficiency and costs With Baby Boomers reaching retirement age and focusing on check-ups and pro-active health monitoring, demand for health care is on the rise. Moreover, technology is booming in the medical field, as events such as the annual Healthcare Information and Management Systems Society (HIMSS) conference and exhibition make abundantly clear. HIMSS President and CEO Stephen Lieber said this year’s gathering in Tampa, FL, was record-breaking, with more than 28,400 attendees and 900 exhibiting companies.

With many of the technical advancements comes the need for capacity – lots of capacity. That creates an opportunity for cable operators, who can play a significant role in the burgeoning, multi-billion dollar telemedicine industry, which focuses on patient care and the delivery of medical data and communication.

Telemedicine utilizes interactive video, patient record data storage and transport, and connects healthcare professionals, patients, educators, and administrators in different locations, expanding service capabilities, saving time, and controlling costs. That last point, cost control, is far from trivial. Today’s healthcare is predicated on the ability of technology to provide savings and increase productivity for healthcare institutions.

A good example comes from the field of radiology, or medical imaging. Hospitals and clinics are purchasing radiology information systems (RISs) and picture archiving and communications (PAC) systems (see Figure 1), types of IT that assist in streamlining the workflow of radiology departments. PAC systems with integrated reporting capabilities afford medical providers the means to manage medical images in a digital format on a variety of computer networks. Changing the way images are collected, displayed, reported and stored within a department demonstrably increases the efficiency of a healthcare system.

Many high-end imaging PACs, however, require a level of throughput that goes beyond traditional telco bundled T-1s or DS-3s. These imaging systems are so detailed that compression is not an option because it could result in a flawed image and an incorrect diagnosis.

Cable operators who are engaged in business services can offer the high-throughput transport solutions that such imaging technologies require.

With increasing and aging populations come increased medical specialization and large patient loads. Most healthcare systems today support multiple facilities within a metropolitan area. Some locations are treatment facilities, laboratories, or administrative or teaching facilities. All these facilities need to share extremely large files, such as X-rays (RIS) and CAT scans (PACs), as well as research results.

As a result, healthcare providers need metropolitan area network (MAN) services that provide a high-capacity backbone linking the local area networks (LANs) to various locations. Optical fiber network services provide transparent LAN services delivering a high level of secure, reliable throughput whenever doctors, nurses, administrators, researchers or insurers need it, while reducing management and administrative overhead.

Scalable optical network solutions also can offer the capacity required to support digital voice or primary rate interface (PRI) to help contain costs while offering the latest telecommunication services to healthcare professionals. Cable networks are highly qualified deliver this content. Fiber to the premises Available network tools include coarse wavelength division multiplexing (CWDM), the improved efficiency and lower costs of which can gain a competitive advantage for the cable operator in the recruitment and retention of new customers. (See Figure 2.) There are multiple facets to a CWDM deployment. Optical fiber from a residential node is deployed to the premises (business or healthcare facility) with mux and demux filters to create multiple wavelengths that support multiple customers on either a single or dual fiber transport. Using CWDM technology and wavelengths from 1,430 nm to 1,610 nm gives cable operators an affordable means to deploy the Metro Ethernet solutions that healthcare providers increasingly request.

Optical switches as customer premises equipment (CPE) offer cable operators the capability to provide multiple services to a single customer site. Delivering customers wide area network (WAN), Internet and PRI in one type of optical-to-IP device is convenient and flexible.

Such devices also favor the business services provider, strengthening margins within ROI models. There is no investment in new equipment or an upgrade in CPE for the operator. Margins – and profits – become larger. Delivering a new service via remote management access reduces truck rolls and operational costs.

Revisiting the customer to upsell a new service or provisioning additional capacity is fast and simple. Time to market can be a positive factor for operators getting this new monthly reoccurring revenue. Competitors may take several weeks to deliver greater throughput for transport, Internet or additional phone lines.

Having optical Gigabit Ethernet (GigE) transport in place from the outset of the first service deployed gives the business services provider an advantage by being able to deliver additional services within minutes to hours.

An optical switch or CPE offers additional network management capability. Management is key because healthcare providers aware of capacity utilization can prevent services from being over-subscribed or degraded in quality.

Needless to say, nothing is more annoying to a valued customer than paying a premium for services that cannot stay connected or a network that runs slowly. The pain runs both ways, since any operational costs that a provider may have saved on the front end are now negated with a truck roll and service call. Network monitoring with the right simple network management protocol (SNMP) agents allows everyone to track the trends. Tactics and advice Because the customer in the case of the healthcare industry is typically a medical IT manager, it is critical that cable operator representatives not only understand networking, but also healthcare networking. Without such knowledge, there is no confidence and likely no sale.

Of utmost concern for the medical IT professional is the security and the integrity of patient data being transported from facility to facility, in accordance with the U.S. Department of Health and Human Services’ Privacy Rule to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). A cable operator’s fiber-optic networks to these multi-facility opportunities fit the HIPAA requirement for patient data privacy.

Rural healthcare is one sector where tele-heath is playing an increasingly important role. Many rural communities are underserved. Cable operators have infrastructure that passes medical facilities. Advancements in virtual private networks (VPNs), layer 2 tunneling protocol (L2TP) tunneling and multi-protocol label switching (MPLS) offer means for operators to reach these markets.

DOCSIS 3.0 represents an important advantage cable operators will also have over their competitors. Interaction with patients who are residents in assisted living facilities are increasing. Tech-savvy seniors who are emailing and sending and receiving photos over the Internet may use this more efficient way of checking in with their physicians.

The use of RFID bracelets that provide remote monitoring in senior centers creates the opportunity of tracking patient movement with sensors relaying back to a cable modem VPN solution to a facility’s network operations center (NOC).

Cable operators could be on the verge of integrating two-way patient communication via a set-top receiver. The set-top box would replace the need for home health personnel monitoring a patient on site. This interactive provision of tele-health could benefit millions of cable’s customers.

Providers can take advantage of several programs to engage or obtain new small or medium business (SMB) customers, such as the Rural Health Care Program of the Universal Service Fund (USF). Administered by the Universal Service Administrative Company, this support program provides reduced rates to rural healthcare providers for telecommunications services and medically related Internet access charges.

This program of funding assists the tele-health customer by reimbursing the cost for those transport or Internet services being provided. A service provider must obtain and file for an E-Rate SPIN number from USAC using FCC form 498. Next vertical Opportunity is knocking. Cable operators should familiarize themselves with the relevant medical technology and related IT languages in order to demonstrate persuasively that cable’s own technology advancements, increased speeds, expanded bandwidth, faster delivery, and greater reliability and scalability are good fits for this market.

From coaxial cable and advancing DOCSIS technologies to optical multiplexing, MANs and backbones, the cable industry’s business services units have the tools it takes to seize this opportunity and help medical enterprises accomplish their critical goals.

Keith Grunberg is a sales engineer with Charter Communications’ Charter Business and outgoing Region 3 SCTE director. Reach him at [email protected].