Prepared by: Helena Geraldes, Nicole Holden, and Hunaid Sulemanji

Instructor: V. Sridhar

Case Study:2 – CLECs Provide Alternative Medicine

1. Who are the users of SIUH information services and what are their telecommunication needs?

The hospital (SIUH) has to link two major campus sites and an administrative site, dozens of satellite clinics throughout New York City, and a Community Wellness Center in Staten Island Mall. In addition, links are required to connect doctors and medical practices throughout the area to SIUH information center. The hospital has to exchange data with medical practices that has a formal business relationships with SUIH - as well as other practices that are not directly tied to the hospital’s core IT services but are loosely affiliated with the hospital.

Proper networking is important for the day-to-day business operations of the hospital in the areas of purchasing, registration, and health data systems. It is also required for better healthcare information management, since the government imposed new regulations concerning Medicare and Medicaid. Furthermore, SIUH maintains an Intranet, an Extranet, and other external links through which the suppliers could be reached. The hospital provides 800-number dial-up connections to 100 other clinics and practices in the surrounding area.

 

2. How did SIUH benefit by choosing a CLEC (Teleport) instead of the ILEC (Bell Atlantic) for meeting their telecommunication needs?

Nynex (Bell Atlantic) was offering a "precanned" service, which involved putting DS3 circuits with multiplexers. In addition to being expensive, the system did not ensure that the telecommunication needs of the hospital would be met or that Nynex was able to manage the system.

Teleport was able to offer a variety of services at a more competitive price (about 15% less) and a more personalized service, which was a very important factor for SUIH. A smaller company, Teleport was able to respond faster to the service requests and give them a faster mean to repair.

Teleport, with a tier 1 ISP with direct access to the Internet network access points, is able to provide various Internet services, long distance, 800 number services, etc. which were quite beneficial for the Teleport’s undertaking.

 

3. Why was ATM chosen as a technology platform for the backbone network? What are its advantages and disadvantages?

1. Allow external connectivity to exchange data between medical communities that have a formal relationship with SIUH.
2. Allow bandwidth on demand as the information traffic grows (such as medical imaging, etc.).

• Supports voice, data, and video allowing multimedia and mixed services over a single network.
• High evolution potential.
• Provides best multiple service support.
• Supports broad range of burstiness, delay tolerance and loss performance.
• Capable of supporting both connection-oriented and connectionless traffic.
• Ability to use all common physical transmission paths such as SONET
• Cable can be twisted-pair, coaxial or fiber-optic.
• Ability to connect LAN to WAN and is backward compatible with Frame Relay for virtual private network compatibility.
• Efficient bandwidth utilization statistical multiplexing
• Scalable technology
• High aggregate bandwidth and high speed (Mbps and Gbps).

• Flexible but to user's expense.
• High initial costs (economies of scale has not been effective yet).
• New user premise hardware required
• Competition from other technologies such as STM, 100-Mbps Ethernet and Fast Ethernet.
• Technology is still under standardization process.

1. Discuss key players (telecommunication carriers, software developers, hardware manufacturers) and their role in the SIUH telecommunications project.

For the development of an efficient SIUH networking business, the hospital incorporates several different telecommunications providers, software developers and hardware suppliers.

Teleport, the chosen CLEC by SIUH to develop their network, proposed two different primary components. First, the use of a backbone networks to connect the three main medical and administrative buildings. Second, a frame relay WAN to connect remote clinic and practices.

To implement its proposed plan, Teleport used its own OmniStream ATM Service to provide the necessary backbone network connections. Teleport used HBO&Co, medical systems integrator, as the main IT because of their knowledge of the SIUH's existing legacy applications and implementation of those applications. Bay Networks provided the cutting-edge ATM hardware that would plug into Teleport’s ATM switching fabric, which could provide immediate connectivity over Teleport’s 155 Mbps and offered the possibility for scaling up to speeds of 622 Mbps.

Furthermore, the hardware allowed SIUH to use technologies such as virtual LAN and LAN emulation, and create sub-networks for faster switching between the different departments of the hospital based on need.

Besides its 40 affiliated physicians to whom SIUH offers services through its frame relay network, it also provides other physicians and more than 100 clinics with 800-number dial up connections. For the provision of those services it uses ISDN lines from the ILEC Nynex, in order to be able to provide with good quality images for its teleradiology system. Besides these telecommunications providers, SIUH still maintains a separate Internet connection through its Internet Service Provider InterStat and an ISDN connection for its EDI - GEIS, through which the hospitals does business with a variety of suppliers and IBM Advantis WAN through which HBOC manages remote healthcare applications.

2. Discuss the costs incurred (both recurring and capital) in this project. What are the tangible and intangible benefits to SIUH due to the implementation of the new network services.

• Addition of sites based on need without incurring extra costs.
• Integration of all services into a single network, thus benefiting from economies of scale.

• Increased number of patients outside the traditional area of service of the hospital. This is due to a good reputation, in part, owed to its efficient information technology and the ability of its network to be connected to its affiliates throughout the New York area.
• Increase in business and new accounts in the health care industry with potential for improvement.
• AT&T's acquisition of Teleport will eventually lead to a possibility of delivering a true end-to-end business communication solutions as a single provider.

• Ability to eliminate duplication of services and paper work, thus controlling costs and speeding response time.

• Learn about the changing needs of hospitals.