Health information exchange is a key enabler of improving our health care system. The future of health care will depend on the effective incorporation of digital technologies to help streamline the practice of medicine and to lower costs. Regardless of whether we represent a public agency, for-profit or nonprofit health care facility or provider, the pressure to do more and better with less is a common denominator. The new nationwide health care model that is developing will force us all to think about how our facility, community and state will connect to the health care delivery system via information technology. Reliable, high-speed, high-quality connectivity is the crucial, but often overlooked, component for success. This is why OHN and the other national FCC Rural Health Care Pilot Programs are working to expand existing or build new necessary broadband infrastructure across the country to support the health IT requirements of the next generation health care delivery system.

In the Columbia River Gorge area of Oregon, we have seen some great benefits from having a broadband infrastructure in place. Judy Richardson, MD, president of Mid-Columbia Medical Center’s medical staff, cites examples of improved patient care in rural areas by having the ability to share data over long distances, connecting MCMC in the Gorge with the Oregon Health and Sciences University (OHSU) in Portland.

[OHN's 12 health IT best practices, part 2: Collaboration.]

Dr. Richardson was caring for a very sick 5-year-old on an icy winter night, and was able to order an x-ray that was transmitted digitally to a leading pediatric specialist at OHSU for evaluation. This saved costs, a dangerous trip down the Columbia River Gorge, and a delay in much-needed therapy. The ability to share diagnostic images is an important component to a telemedicine initiative. A vigorous robust broadband infrastructure is required for the high-bandwidth requirements for sharing these images.

The demand for ever increasing bandwidth is only going to increase. We must think strategically about what we will need over the next few years, and stay ahead of the curve. Some of the innovations ahead requiring robust and integrated network connectivity include:

• Remote patient consultations and monitoring of patients’ vital signs and conditions;
• Sharing critical health information for analysis and diagnosis (e.g. diagnostic results, electronic health records, etc.)
• Provision of specialized services over long distances (e.g. telestroke, telepharmacy, telepsychiatry, and more)
• Wide availability of health information to patients and caregivers

With the increasing adoption of electronic health records (EHR), and the efforts on health information exchange (HIE) beginning to flourish, the need is growing. Broadband also enables telemedicine and the delivery of critical health care services to remote and home-bound patients, which could facilitate incredible cost savings. But the widespread use of telemedicine will require greater collaboration between technologists and clinicians to ensure it delivers on its promise.

[Feature: The 5 roadblocks HIEs face. Q&A: On the trials and tribulations of unlocking patient data.]

New and innovative ways of delivering care will be reliant upon high-speed, high-quality, scalable connectivity to successfully meet the growing demands of health information, technology, coordinated care models and telemedicine services. Providing the right information, in the right place, at the right time requires robust connectivity.

Strategic checklist for connectivity

As one of the core 12 health IT best practice areas, we’ve outlined some general how-to’s when considering how to better integrate your connectivity needs into your greater health IT strategy and efforts:

• Support a health IT strategy and plan that aligns with and leverages the pressing Federal/State initiatives, mandates, incentives and funding streams: Consider how you can/better interact with the local/state health information exchange (HIE), improve upon the meaningful use of electronic health records (EHR), and lead or participating in an Accountable/Coordinated Care (ACO) or Oregon’s Coordinated Care Organization (CCO)
• Obtain knowledge of surrounding community/regional/statewide networks in which to connect to or leverage to support your program/needs
  
• Build with the end in mind (nationwide interconnectivity and operability): Anticipate demand and use five years out—and don’t invest in connectivity to support your needs now through two years or those that encourage silos of information and care models
• How much bandwidth is enough/too much? When in doubt – get more. As part of the FCC national broadband plan (http://download.broadband.gov/plan/fccomnibus-broadband-initiative-(obi)-working-reportsseries-technical-paper-health-care-broadband-inamerica.pdf) that addresses health care in the US, page 6 of the report supplies some guidelines on the appropriate bandwidth for primary practices at > 4 mbps all the way through Hospital system/educational institutions at 1 gbps. Additionally, they reference HIT application bandwidth requirements that range from basic email/web browsing at 1 mbps through Image Transfer (PACS) at 100 mbps.
• Manage a true partnership with your telecom provider to achieve better performance/results (SLAs, peering, partnership etc): With lives on the line, connectivity for health IT should not be negotiated like a standard internet connection. Therefore, health care providers require much higher service level agreements (SLAs), scalability and reliability than your average business or organization. If you’re part of a larger network, such as the Oregon Health Network, the entire community can contractually clarify with the vendor what those service standards are, and together have more clout/influence to ensure that the vendors are invested in delivering upon those SLAs.

[See also: OHN's 12 best practices for health IT, part 1: Strategy and planning.]