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For other articles and previous issues click here. December 20, 2004 Infrastructure
for Growth — A Strong Network Backbone An Arizona imaging center finds that multiple modalities and sites require serious networking hardware. One of the major recent developments in radiology is the emergence of the increasingly sophisticated full-service radiology imaging centers. Typically, these new businesses are structured around a central location and have a number of branch sites that provide service to patients and referring physicians throughout a state or region. To stay at or near the top in a highly competitive market, these organizations continually upgrade to the latest technologies and adopt the newest procedures. It’s essential that such organizations offer state-of-the-art services as patients have become more informed about diagnostic technology and physicians want access to the “latest and greatest.” To these organizations, patient and physician satisfaction are paramount. But maintaining such a high standard can be technologically complex. Infrastructures need to keep pace with increasingly ambitious business goals. Otherwise, systems won’t meet the challenges that come with implementing technical advancements such as more sophisticated modalities and filmless environments. Radiology Ltd., a Tucson, Ariz.-based imaging service, came face to face with such challenges. Network consultants and new network technology provided a solution. Meeting a Growing Demand As with other imaging services, Radiology’s primary customers are referring physicians who send patients to a site for conventional imaging procedures or more specialized procedures such as PET scans. The physician-owned group practice has provided imaging services to Tucson for nearly six decades, but in recent years it has become more technically sophisticated and aware, keeping pace by continually upgrading all technology and services beneath a spreading umbrella. The Tucson area has undergone increasing and rapid development, and as the population grows, Radiology Ltd. expands. By 2001, the company reached a point where a major network system upgrade was necessary, both to meet then-current demands and foster new business growth. “We had an explosion of demand,” reports Ben Armstrong, assistant director of IT. “The change in demographics required us to grow pretty rapidly.” The company’s network had fulfilled its needs, but when it started adding new modalities—such as advanced CT and MRI systems—and as its customer base increased, the company needed much more bandwidth and speed to transmit the growing amount of data. For the upgrade, Radiology Ltd. turned to Calence, Inc., a Tempe, Ariz.-based network consulting company that builds, manages, and optimizes customized networks. In providing its service, Calence partners with Cisco Systems, a global developer and provider of Internet Protocol (IP)-based networking technologies. For large medical institutions—as well as for businesses such as Radiology Ltd. that experience a hormonallike growth spurt—Cisco offers a Medical-Grade Network (MGN) designed to improve service delivery and lay the groundwork for business growth for healthcare facilities. Challenges To realize these goals, the organization needed to confront its most immediate and considerable need: bolstering its overburdened network. Radiology Ltd. performs more than 600,000 procedures per year—approximately 1 million images every five weeks—and expects to grow at a 15% annual rate. The original network linked eight sites with a microwave network that transmitted data from its core out to its other sites. A “filmless” environment had enabled expansion, but now its network was being overburdened by the enormous amounts of data being sent over its servers. Capacity had been surpassed. “We had a lot of network outages that caused a lot of lost revenue,” reports Armstrong. “It was like an IT ‘perfect storm,’ with a lot of things coming together all at once. There were new data flows coming over the network that the network couldn’t handle, and we had to switch router utilization rates.” Specifically, there were two issues, Armstrong explains. The first was a wide area network (WAN) problem involving overburdened T1 and wireless links. The second was a local area network (LAN) issue. Too much data was being pushed over the network, and the access-layer switches couldn’t keep pace. Insufficient reliability and redundancy between imaging sites resulted in the inconsistent transmission of data over the groaning network. The situation was critical. Not only was capacity taxed, but Radiology Ltd. had expansion plans based on forecasted growth rates. It wanted to open a new headquarters and new imaging centers. The network—with its limited port capacity and insufficient bandwidth—was not only inadequate for current needs; if something wasn’t done, the company would stagnate. CT and MRI Data Radiology Ltd., Armstrong says, needed to go back and redesign its network, starting from its central core. “We have a hub-and-spoke topology that includes the essential area and sites that shoot off from the center,” he explains. “We needed much more robust equipment in that central core that could better handle the data flows.” In addition, points out Ron Cornett, Radiology Ltd.’s PACS administrator, “with a hub-and-spoke operation, there is a unique situation in each spoke—and, of course, within the hub as well. Each needs to be customized to what is needed.” With the help of Calence expertise and Cisco technology, Radiology Ltd. would eventually have in place a highly reliable network that would meet current and future needs in areas of reliability, bandwidth, and scalability for future applications—and one that had several added layers of network redundancy. The Cisco Solution Among its many offerings, Cisco provides healthcare solutions, and at the heart of this business area is the MGN that provides a secure, resilient, and highly scalable technology platform that’s especially useful for data applications. The MGN is a suite of products, services, and supporting material aimed at offering healthcare providers an end-to-end foundation for the delivery of high-quality medical care. The solution uses core routing and switching technologies combined with supporting technologies such as integrated security, wireless, storage networking, and IP communications. The MGN is designed to provide a four-pronged solution
that emphasizes the following: Armstrong describes the process as progressive. As it does with each client, Calence first performed an initial network assessment to determine the scaling and data requirements. Then, based on radiology’s huge amount of data, it determined the options to meet current and future network requirements. A complete network makeover proved necessary. Even though it was one of Calence’s smaller clients, Radiology Ltd. had the infrastructure of a larger hospital. The data requirements were considerable. As part of the solution, Calence brought in another Cisco partner—Time Warner Telecom—to implement the network. Time Warner Telecom installed fiber and T1 lines to the Radiology Ltd. headquarters and remote sites, enabling the firm to connect all its locations over a high-bandwidth, resilient optical transport. This choice enabled Radiology Ltd. to increase its network performance for rapid delivery of digital images and high reliability. “We had a very unreliable wide-network area, which is basically the network between our locations,” explains Armstrong. “It was a wireless network that was just not working properly. Before redesign, we had a lot of outages due to the bad wide-area network links. The Time-Warner Ethernet solution has been very powerful.” The other important component was Cisco’s
routing and switching solutions. So essentially, after the upgrade,
Radiology Ltd.’s network was redesigned to include the following: In the end, Calence had helped design and implement for Radiology Ltd. a networking solution that maximized availability of mission-critical applications for the increasingly busy organization. Calence upgraded the WAN design, which improved the central and remote office network infrastructure—increasing overall availability, reliability, and performance of the company’s business applications. Finally, Calence installed and configured Cisco routers and switches at the central and remote sites to create the secure, scalable, and redundant network necessary to Radiology Ltd.’s future growth. Overall, the deployment process went very smoothly, with no major production problems. Cisco supplied a local team to ensure the efficacy of the plan and design. Improved Productivity Performance and efficiency have increased significantly. “In the past, it might require a day and a half to deliver films to the referring physician,” reports Armstrong. “Now images can be available within five minutes of the examination.” Radiology Ltd. also experienced other benefits: “To be able to grow, we needed a data network that would let us add new modalities and new services very quickly,” says Armstrong. The speed was essential, he adds. “In most businesses, you have time to test and see how a network will be impacted. We don’t have that luxury. When doctors buy a new CT, they want that thing making money the next day. So the network has to be able to accommodate new data flows and big data flows right out of the box. There’s no time to test the viability. You need to build it out and scale it very quickly, and Cisco really does build some beefy boxes that can really handle that.” From the PACS perspective, the impact has been huge, indicates Cornett. “Our PACS system works with real-time information, so there is a continuous push of information back and forth between the server and the clients.” Moving Forward “Since the redesign, we have opened up three new scanning centers and a new corporate office,” reports Armstrong. In September, the company opened a new facility in Tucson, the Wilmot Center, that it says is one of the largest imaging facilities in the country. The facility is not only filmless, but the network has enabled it to go paperless as well. — Dan Harvey is freelance writer based in Wilmington, Del. He is a frequent contributor to Radiology Today. |
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