Bandwidth: How much is enough?

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So, how much bandwidth does it take to ensure adequate capacity along a network line throughout a facility so that voluminous medical images and files have enough room to travel at near blink-speed with other non-patient-related data?

Ask healthcare IT people and their response more of than likely will be: How much can I get? And how much will it cost?

Right now, healthcare providers talk in gigabytes when they discuss bandwidth requirements.


There are many factors to take into consideration when determining adequate bandwidth, given the amount of data traffic on a healthcare provider's network.

"It's not a question of taking the number of images [facilities] plan to transmit and the size of the images, multiply those out, divide by the time in a day and figure out the size of pipe needed," says Janet Rogers, COO of bandwidth and managed services provider ANET Internet Solutions. "That would assume that utilization is spread evenly throughout the day."

Demand, of course, does not occur at a constant rate. The network will have greater traffic flow during the work day than in the evening or overnight. The question then becomes how to handle the peaks as efficiently as possible?

"One way to handle the peaks is to build a pipe that is big enough to absorb the biggest possible peak," Rogers adds. "Then you have to decide if you have the budget to do that, knowing that the rest of the time the pipe is 95 percent unused."


Health First has three main hospitals in Florida - Cape Canaveral Hospital in Cocoa Beach; Holmes Regional Medical Center in Melbourne; and Palm Bay Community Hospital - as well as some 40 outlying clinics and medical imaging centers.

"The challenge we have run into with PACS and imaging is that, because we have multiple hospitals, bandwidth could be an issue," says Health First PACS Administrator Frank Waszmer.

Health First also plans to break ground on a new facility in 2005 and build a state-of-the-art heart institute attached to the main trauma center at Holmes.

With the help of PACS vendors, Health First used a formula to estimate the workload per modality, as well as the historical image and file volume at each facility for each modality. IT personnel also anticipated how much storage space the facilities would need per year and how that amount would increase over time. (See chart on page 68.)

"Once we figured out each facility and what the load and daily demand would be on the network and scaled that to future use, we went back and addressed the infrastructure," adds Waszmer.

Health First chose Heartlab as its cardiology PACS provider and McKesson Corp. for its radiology PACS. The radiology PACS installation currently is underway. Starting this October, HealthFirst will begin to upgrade the channel to 2.5 gigabytes.

"When we bring in our PACS and roll out the equipment in June, our image volume with the new [multislice] CTs will skyrocket," says Waszmer. "Do we need gigabytes to the desktop? No, but from the CTs, if we have a one-gigabyte uplink switch, we can move these images around the network fairly rapidly."

Over the last two years, Health First has invested approximately $2 million in network infrastructure projects.

"Next year, I am sure we'll spend at least another $500,000 to $750,000 on the same type of costs," Waszmer says. "This initiative was to bring a 100-megabyte minimum [capacity] to the desktop of every user within Health First, as well as taking our core infrastructure away from ATM (asynchronous transfer mode) switches to Ethernet switches. It benefited our whole environment by upgrading our infrastructure."


North Bronx Healthcare Network is part of the New York City Health and Hospital Corp., one of the largest municipal health systems in the United States. North Bronx - through its two facilities, Jacobi Medical Center and North Central Bronx Hospital - and serves some 1.2 million people in its coverage area. With that amount of current volume and expected growth, North Bronx was concerned about its current and future bandwidth needs.

The system made the leap last year from a 10-megabyte network to a 10-gigabyte core. The upgrade was not inexpensive - requiring an investment of $3.5 million for the necessary IT equipment, plus additional money for installation and redundant fiber optic cable. The system started its upgrade in July 2003 and rolled out all the equipment by last October.

The gain in efficiency with the enhanced