Almost all businesses and industries have been transformed through technology to some extent in the past 20 years, but few have seen shifts as dramatic as those seen in the healthcare industry. Technology has affected the way in which patients are cared for as well as the way in which hospitals and other healthcare providers do business.

The automation and digitization of mission-critical applications — from recording a patient’s medical history, to performing diagnostic tests, to prescribing medication — is placing huge amounts of information literally at clinicians’ fingertips. When lives are at stake and every second counts, successful patient treatment relies on near-instantaneous access to patient data. This includes all medical imaging consisting of massive datasets exceeding thousands of images from CT, MRI and cardiac diagnostic instruments.

As a CIO in one of the nation’s largest and most technologically advanced healthcare systems, it is my responsibility to ensure that our clinicians have what they need — when they need it — to be able to do their job successfully. This includes surgical and diagnostic technologies as well as an advanced, robust, high-speed network for transporting and managing the data that clinicians use to care for their patients.

Leading Through Technology

Montefiore Medical Center is one of the nation’s largest healthcare systems, serving 1.4 million residents of New York, nearby Westchester County and persons referred from across the nation and around the world. At the center of the healthcare enterprise are three hospitals: the Henry and Lucy Moses Division; the Jack D. Weiler Division; and, The Children’s Hospital at Montefiore (located at the Moses Division). Combined, all of the hospitals provide care for more than 65,000 inpatients and more than 2 million outpatients annually. We also operate one of the largest hospital-based home health agencies in the nation, which makes more than 400,000 visits per year.

In addition to being one of the nation’s largest healthcare systems, Montefiore ranks among the top 1 percent of all U.S. hospitals for investments in medical innovation and cutting-edge technology. The medical center currently has one of the nation’s most advanced clinical and management information systems. At its center is a computerized clinical information system (CIS), which enables continuous, lifelong medical records to be accessible from anywhere and at anytime across our care delivery network.

The system provides computerized physician order entry (CPOE), an online integrated pharmacy system, an online integrated nursing documentation system, online laboratory, radiology, cardiology and nuclear medicine as well as a wireless network for
point-of-care computing, such as at a patient’s bedside. All together, there are more than 9,500 devices currently on the network. Our transition from paper charts to this computerized system occurred gradually over the last 10 years. As our hospitals grew and became more advanced, so did our use of technology, and our need for a network with the bandwidth, speed and dependability to implement that technology successfully.

In Support of EMR

    In the early 1990s, Montefiore established the objective of an automated electronic medical record (EMR) with 100 percent CPOE. In order to accommodate this transition to electronic records, we needed to substantially increase our bandwidth. In 1994, we contracted with Optimum Lightpath and another carrier to install two T-1s between Montefiore’s main Bronx campus and its Yonkers data center. This provided full redundancy and bandwidth. We chose this vendor based on its very good reputation in the New York metropolitan area. Additionally, the vendor’s pricing was very competitive. By 1996, we had upgraded our wide-area network (WAN) communications again and installed our first OC-12 ring. OC-12 is the abbreviated term for Optical Carrier level 12, used to specify the speed level of fiber optic networks, which are measured through SONET (synchronous optical network) standards.

With this technology in place and the increased bandwidth, we were able to implement a number of state-of-the-art IT systems including SAP solutions for the financial systems side, a full-function document imaging system and complete fulfillment of our objective of an automated EMR on the clinical side by 1998. As the hospital started to automate more applications, our need for bandwidth continued to grow. The SONET OC-12 was then upgraded to a more robust SONET OC-48 with T-3 lines by the end of 1999.

PACS at Light Speed

While our network capabilities had grown considerably at that point, Montefiore was planning the creation of a picture archiving and communications system (PACS) for our radiology department, which would require an extreme amount of bandwidth. We had been storing all of our digital images at our Yonkers data facility and wanted to mirror this at our Bronx facility and make these images available throughout all of our facilities for real-time access by our clinicians.

To support this application, the medical center upgraded its network from an OC-48 SONET ring to a multi-gigabit Ethernet network using redundant dual paths including Optimum Lightpath’s and another carrier’s dense wave division multiplexing (DWDM) core optical backbones. The multi-gigabit carrier-class Ethernet network links the hospital’s Bronx-based Moses Division, Medical Park and Weiler Division facilities to its data center in Yonkers, which houses more than 600 application servers. The WAN network upgrade enabled us to implement the PACS, enabling storage and distribution of digital medical images that can be retrieved remotely or transmitted over the network.

The enterprise PACS benefits clinicians and patients by dramatically speeding the transfer of large images and files such as mammography, cardiac videos and 3-D post-processed images. During surgery, or at any location, the clinician can immediately pull up digital images that physically reside at the Yonkers facility. For example, if a patient is admitted to the emergency room and tests are taken, such as an echocardiogram, the surgeon can review the images and prepare for surgery before the patient arrives at the catheterization lab. Without the advantages of fiber optic technologies, the X-rays would need to be physically sent or delivered to the clinician, which could take hours or even days.

Enterprise Communications

The increased bandwidth Montefiore gained from upgrading its network to a DWDM-based solution eliminated numerous obstacles related to inter-campus communications, and decreased our cost-per-megabit expense to a fraction of what it was only a few years ago. This allowed us to streamline our IT operations and redeploy our assets to provide even greater services to our patients. It also helped accommodate the sub-second transmission of extremely large files that are of critical importance to our organization since moving to a 100 percent CPOE-based system.

Montefiore is now moving closer to eliminating paper charts entirely. All lab, medical record and radiology, as well as, cardiology, radiation oncology and billing-related documents, and even nutrition, run over the 600 servers in our data center, making high bandwidth, reliability and redundancy not only beneficial, but essential.

Furthermore, the network allows us to move a colossal amount of data each day. We have successfully implemented CPOE, PACS and advanced cardiology systems, new clinical systems running on VMware, document imaging and simultaneous back up in both Yonkers and the Bronx. We now have the capability to transmit more than 30 gigabits of data in the fraction of a second — amounting to the transmission of hundreds of terabytes of data daily.

Our ambulatory remote sites were also upgraded, in many cases to optical Ethernet 100 Mb connections to support instantaneous physician access to the images. This would have been an impossible feat on our previous network. Additionally, the redundancy and reliability of the network has addressed our organization’s reliance on real-time data — the most pressing issue facing the medical center since the move. It is absolutely critical that the network is up at all times, as there is absolutely zero tolerance for downtime whatsoever.

Future-proofing Your Network

As any CIO knows, justifying the investment in upgrading your network infrastructure is no easy task and is often met with great consternation and resistance from the larger organization.

However, in today’s rapidly evolving communications environment, technology investments can quickly become outdated.

In contrast, since Montefiore’s investment in the implementation of a fiber optic network, conversations about new projects and justifying new communications costs have been all but eliminated. In fact, not only does the network allow for a “future-proof” backbone that can accommodate any application, it also enables the network operations center to run a rigorous, dynamic network management system that anticipates problems or issues and self-corrects without interruption.

As we continue to grow, we know this network will continue to be a key partner in driving the success of the hospital and its partnering facilities. This hospital has 10 times the amount of bandwidth that it had five years ago with the capabilities to grow another hundred-fold, and I fully expect it to require at least 10 times more, five years from now.

For example, Montefiore Medical Center is looking to leverage high-definition video for procedures in the hospital as well as for video “outpatient” visits where doctors can interact with patients in their homes. This type of communication could revolutionize how patients are monitored and treated for conditions that require routine visits to the hospital, such as those suffering from obesity or diabetes. Applications like this would not be possible without the capacity, speed and reliability of our network.

Whatever applications and technological advancements the decades bring, there’s no doubt that one of the keys to success will be the technology infrastructure’s ability to grow alongside the innovation of its organization. Our initial investment in the network, and the upgrades we continue to make today, have taken us far beyond our original vision and continue to advance with a tremendously positive impact on patient care.