Developing a reliable medical informatics network

Healthcare Financial Management, Jan, 1999 by David Kovach

The rapid increase in the use of systems medical informatics is placing great demands upon computer network resources. In addition to widely established functions, such as e-mail, internet access, and teleconferencing, the expanding needs of networks soon could include but not be limited to the following advanced applications:

* Networkwide, bedside access to a patient's medical history;

* Point-of-care data collection and retrieval;

* Clinical decision-support work stations;

* Electronic archiving of diagnostic images within the local network and image transfer outside the local network;

* Pathology-specific practice and outcome protocols, with physician alerts;

* Networkwide tracking of patients and resources used by those patients; and

* Networkwide appointment and resource scheduling.

Ensuring the long-term reliability of medical informatics will require healthcare organizations to implement fully integrated network services that can be upgraded cost-effectively. Healthcare organizations, therefore, need to evaluate the requirements for an integrated network and anticipate how to phase in any freestanding departments and work groups; implement the network by investing in upgradable equipment compatible with industry standards and relying on experienced contractors; and maintain the network by minimizing the potential for downtime, training support staff, and hiring a knowledgeable network manager.

Developing the Informatics Network

Be proactive in planning improvements. A healthcare organization should begin making plans to improve its network when the current network cannot handle new applications or begins to show problems, such as frequent downtime and inordinate slowdowns. Before these problems become chronic, the healthcare organization should inventory. its current communications network thoroughly, evaluate options to expand and develop the network, and devise a three-to-five-year plan to phase in upgrades. The plan needs to be flexible to allow for modification as new technologies become available. A phased-in approach will leave much of the organization's current network intact and ensure compatibility as each change is introduced.

Much of the success of the effort will depend upon the selection of the people who will design and implement the informatics network, such as the general contractor, who will help design the expanded network, suggest the software and hardware that will be needed, and recommend experienced technicians to install, for example, the necessary cable, wiring, and telephone lines. The in-house information technology staff also should be included in all decisions affecting the network.

Combine freestanding departments and work groups. When computerization was introduced, decisions about which computers to install, how to install them, and which software programs to use frequently were made at the departmental level to serve departmental needs. These centers of isolated information processing continue to fulfill their functions as separate entities. In time, however, such information silos will need to be integrated into the network. Planning which freestanding departments should be incorporated initially and which can be phased into the network at a later time should be decided by management based on information and advice from the information technology staff.

Invest in upgradable equipment. The ability to upgrade equipment should be a primary consideration in developing the informatics network and will require investing in the best available current equipment. Opting for older equipment for immediate savings can lead to high life-cycle costs that eventually will undercut the low purchase price. Because information technology advances quickly, leasing network equipment, when possible, may be a practical strategy. Also, as protection against possible technological obsolescence, terms for automatic equipment upgrades should be included in the sale or lease contract.

Select system components that support industry standards. The computer industry has confronted the issue of the incompatibilities of equipment made by different manufacturers by developing uniform standards for interfacing technologies, such as those endorsed by the American National Standards Institute (ANSI). Examples of areas in which such standards have been implemented include digital imaging communications (DICOM) technology, which transmits graphics, and asynchronous transfer mode (ATM) technology, which allows for the simultaneous transmission of data, images, voice, and video. Healthcare organizations that invest in technology that complies with current industry standards can be reasonably sure that their developing networks will be expandable and upgradable.

Rely on experienced network contractors. Health communications networks require both high transmission quality and large bandwidth capacity to handle the large number of transactions generated and the size of the data sets transmitted within a healthcare organization. Therefore, healthcare organizations should contract with infrastructure planners who have experience with medical and healthcare data systems and who can combine disparate communications requirements into a single, reliable, integrated network.