Cable Serves Up Healthcare

Bright House Networks in Tampa, FL, isn’t concerned how healthcare customers use its pipe, just as long as they use it.

Bright House is one of several cable operators nationwide that has carved a niche for itself in the healthcare industry. In Tampa, Bright House has provided Bay Care Health Systems with a Metro Ethernet network for about five years.

"We provide a transparent layer 2 service," said Tony Garcia, enterprise product engineer with Bright House.

Bay Care uses the network for some voice, data backups and radiological imaging, among other uses. But how the customer uses the broadband is not a big concern for the operator, Garcia said.

"We’re just selling the pipe. We don’t look at [the applications]. We don’t touch it. That’s actually part of the HIPPA requirements."

The medical business has some stringent security requirements. Title II of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes rules for electronic health care transactions to ensure the security and privacy of health data.

Garcia explained that Bay Care has a main site for all of its connections. Bright House provides a 10 Gbps link out of that site into Bright House’s core. There’s a Cisco switch with multiple 100 Mbps handoffs to Bay Care.

Each connection is point-to-point and goes back to the remote site. The transport method differs based on the size of the facility.

For larger buildings such as hospitals, Bright House employs a Gigabit passive optical network (GPON) service with direct cable to their site.

"For small offices that don’t want to put in fiber, we do a VPN (virtual private network) connection," said Garcia. "We provide a cable modem with a Cisco 1811 router and a VPN tunnel that terminates on a (Cisco Catalyst) 6504 at their main site."

The Bay Care network has roughly 17 fiber locations and 130 coax VPN locations.

HIPPA and private networks

In a recent Communications Technology webcast titled "Healthcare: The Next Vertical Market" (available online here), Keith Grunberg, sales engineer with Charter Communications in Oregon, described some of the technological features of Charter’s private fiber-optic networks used by healthcare customers in his region.

Grunberg stressed HIPPA compliance. "If a file goes into the Internet cloud, we have no control over that," he said. "We offer an optical product that will encrypt that data if the customers don’t have a secure product."

Bright House supplies Bay Care with either a hardware-based or software-based security product.

"That’s the reason we use the VPN tunnel," Garcia said. "Anything that’s not straight point-to-point, the Cisco 1811 encrypts that data."

Not only is it important that medical data remain private and secure, but data integrity is also critical.

"Files can be gigabytes in size, and customers don’t like for files to be compressed because that can introduce errors," Grunberg said. "A misdiagnosis could happen, and then who’s responsible?"

Cable operators working in the healthcare market are looking forward to DOCSIS 3.0 to improve the transport of large files with security.

Redundancy, capacity

A top concern for hospitals is an outage, causing a disruption of service or loss of data. Bay Care stores all of its data in its own data center with backups in local storage facilities.

"One of the biggest things we get asked for is lots of redundancy," Garcia said. "Bay Care asks us for multiple connections. They’re installing a second set of equipment at their data center for disaster recovery."

Cox Business in Hampton Roads, VA, serves 15 hospitals and 500 medical facilities in its region. In 2008, Cox established a Metro Ethernet service, known as MedNet, which some of these healthcare businesses have joined.

Michael Braham, VP Cox Business in Hampton Roads, said Cox recognizes a need for higher bandwidth requirements, specifically for electronic medical records and medical imaging.

"After all the hurricanes in recent years, it was a further impetus to find a way to digitize medical records," Braham said.

Because of its big pipe, cable has been able to gain market share from telcos and establish itself in the healthcare vertical market.

In a June 2008 Communications Technology article, Grunberg said incumbent solutions were falling short. "Many high-end imaging picture archiving and communications systems (PACs) require a level of throughput that goes beyond traditional telco bundled T-1s or DS-3s," he said.

"We’re seeing a lot of customers come from T-1s and DS-3s and move to a Metro-E solution," Garcia said.

Up the value chain

While step 1 has been securing the business from medical providers and solving the technical problems associated with security, transferring large files and providing medical data redundancy, there are opportunities up the vertical ladder. But that will involve learning more about the healthcare industry.

"Cable has to wake up and see that telehealth is within their space," said Analyst Bruce Bahlmann, who’s worked in the IT department at an Iowa hospital. "Connectivity is a small piece of it."

After a healthcare business gets connected to broadband, it works with specialty vendors to connect necessities such as bedside computer carts where doctors can type medical records, or monitors in operating rooms where doctors can refer to radiological images. Cable operators could provide some of these same services.

"It takes a while to build up the expertise," Bahlmann said. "But then you can walk in the door of a hospital and say, ‘Here’s our telehealth package.’"

The participants in the Communications Technology webcast suggested several futuristic uses for cable in healthcare.

Cox is establishing its MedNet with visions of a much larger network, connecting hospitals, doctors’ offices, specialty clinics, pharmacies and insurance companies, as well as patients’ homes.

Cox’s Braham said he anticipates a demand for home monitoring of patients, the ability for doctors to review pre-op videos at their homes or offices, and the ability to take professional education courses via video on demand (VOD).

Charter’s Grunberg said rural healthcare issues are important in his region. Already, physicians who live as far as 20 miles from their hospitals have had fiber installed at their homes and can review radiological charts and make diagnoses in emergency situations without having to drive to the hospital.

Other operators

Bright House, Cox and Charter aren’t alone in their attention to this market.

Healthcare is one of seven verticals listed on the Time Warner Cable Business Class Web site, which touts its Platinum membership in the Healthcare Information and Management Systems Society (HIMSS) and features a case study describing a high-speed Internet service it provided to the Cincinnati Children’s Hospital.

On the Comcast Business Class Web site, healthcare is one of four industries listed under its small and medium business heading.

Perhaps the industry’s most experienced provider of telecommunications services to heathcare institutions is Cablevision, whose Optimum Lightpath unit has long served this market in the New York metropolitan area.

A promotional video produced by Optimum on the Westchester Telecom Network in March 2008 showcased the Westchester Medical Center and its Trauma Center. As with the Charter example of a rural-based physician, Optimum technology in effect has shortened critical distances.

"We’ve been able to communicate with hospitals that are an hour and a half away from here that send their patients to us by helicopter," said Tedd Tully, Director of Trauma and Emergency Services, Westchester Medical Center. "We can reach across the network and actually go into their PAC systems and see their imagery that they have taken of trauma patients."

The upshot is an emergency medical team with longer lead times. "We are definitely saving lives with this type of communication," Tully said.

Linda Hardesty is associate editor for Communications Technology. Reach her at [email protected].