Last month, we touched on the origins of clinical networks and device security. It was a very safe and secure environment, but it was not very versatile. Information technology (IT) has established a robust and versatile network domain that encompasses the entire hospital enterprise and connects us to the external world. Now, these worlds are closer than they have ever been, making it essential for us to collaborate and work together to educate one another in this changing environment.

As hospitals move toward implementing the electronic medical record (EMR), more and more clinical devices will be connected to the hospital network. This may be to simply add physiological data—such as heart rate, respiration rate, and blood pressure—to the patient’s chart in order to eliminate data-input and transcription errors. Imagine the positive implications to patient safety and risk management.

As decision-support software evolves, it may also be the source of information that will be combined with other data. This will result in smart alarms and predictive systems that process many different data points over periods of time to predict events, such as heart attacks or other life-threatening events, before they occur, allowing clinicians to take pre-emptive steps or precautions to prevent a life-threatening event.

Organizations such as the Joint Commission on Accreditation of Healthcare Organizations, the Leapfrog Group, and the Institute for Healthcare Improvement will drive health care organizations to develop and implement these predictive protocols to improve patient care and clinical outcomes.

When IT personnel talk about network applications, they typically refer to these applications as mission critical or business critical. Our clinical systems add a new level of criticality to the network. This additional distinction is life-critical data and systems. At the North Carolina Biomedical Association Annual Symposium in December 2005, Ron Trombley, product support engineer for Philips’ patient-monitoring division, presented this new model for network interconnectivity. Let’s discuss the distinctions.

Life Critical is any data whose delay or corruption can delay diagnosis or treatment. This is near-real-time data when a delay of a second or the loss of critical information can affect the way that clinical systems react. This would include critical alarms and data used to determine a diagnosis and course of action by a clinician.

Mission Critical is the term IT personnel use to discuss their most important data. It is vital to the operation of the hospital and typically describes applications required for day-to-day operations. Disruption of these systems or applications would have a detrimental effect on the organization. These systems could include admission, discharge, and transfer (ADT) systems, lab systems, or others that are necessary for clinical workflow.

Business Critical refers to data that is used in the daily operation of the hospital. Interruption of this data would have little or no effect on the overall operation of the hospital. These are systems that are typically controlled within the realm of IT. This would include the Internet connection to allow access to Web-based or browser-initiated applications.

Your IT colleagues may not fully understand the difference between mission-critical and life-critical data, or the implications that life-critical data has on clinical decisions and patient outcomes. After all, to IT a lethal arrhythmia alarm and an e-mail are nothing more than a series of data packets making a journey on the hospital’s network infrastructure. Let’s break these down on a hierarchical structure.

Life Critical
Level 1: The Patient Connection Level contains the infrastructure that connects directly to the patient to collect physiological data. This includes both invasive and noninvasive electrodes and sensors.

Level 2: The Monitor Connection Level contains the infrastructure that connects the patient to his or her primary monitoring device. This can be through traditional hard-wired lead sets or through developing technologies like wireless lead sets.

Level 3: The Monitoring LAN Connection Level contains the infrastructure that transfers patient data to the monitoring segment of the LAN. This data can be transferred between monitors in an overview situation, or to the central monitoring station for centralized monitoring and alarms. This is the transition level between where the true distinction starts to blur between life critical and mission critical.

Mission Critical
Level 4: The Central Station Connection contains the infrastructure that connects the central monitoring station to other devices on the network. This level allows central monitoring stations to share real-time data with remote viewing clients.

Level 5: The Clinical Systems Connection contains the infrastructure for clinical devices, such as IV pumps, electrocardiogram systems, and other general biomedical devices.

Level 6: The Hospital Systems Connection contains the infrastructure that connects other clinically relevant systems within the hospital structure. These systems are necessary for clinical workflow and contain systems such as ADT, remote paging, and lab systems. This is the transition level between where the true distinction starts to blur between mission critical and business critical.

Business Critical
Level 7: The Intranet Access Connection contains the infrastructure that connects the hospital’s internal network systems—most likely to be considered mission-critical operations. This access layer allows for the interconnection of the monitoring network to additional computers throughout the hospital, such as physician’s offices or remote viewing stations.

Level 8: The Internet Connection contains the infrastructure that connects the patient to the outside world for review and near-real-time data. This is typically used as a Web-based or browser-initiated application.

You will need to spend time working with your IT group to educate them as to what the true implications are to life-critical data. We have worked in that environment for years, but this concept may be very new to them. Make sure the requirements are clear, and help them understand what this real-time data is used for and that any delays could result in catastrophic results. This data must have priority on the network. You may be able to tolerate a network delay opening an e-mail or accessing business applications, but the delay of this critical data must be prevented.

When working with IT, please remember that not everything we may want or need to add to the network needs priority handling. IT has the ability to prioritize data on the network. Their term is quality of service (QoS). QoS is the ability of a network to provide a particular service availability ranging from best effort to dedicated bandwidth. We must be realistic and reasonable when we request a particular QoS.

Next month, we will look at some of the new technologies currently available that are fueling the need for us to be more network savvy.

Dennis Minsent, MSBE, CCE, CBET, is the director of clinical technology services at Oregon Health & Science University, Portland, Ore.

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