Robust network and services boon to OTN

TORONTO - As Canada's largest and busiest telemedicine organization, the Ontario Telemedicine Network (OTN) has been designed with sufficient scale and interoperability to meet future demand for health services and to provide round-the-clock health services, says its chief information officer.Speaking here at a healthcare technology and medical devices forum last month, Ron Riesenbach, OTN's CIO told attendees that technical integration and a system of unified network architecture allows OTN to provide 2,600 patient encounters and 450 educational events per month. OTN has 780 videoconferencing endpoints and 380 hospital and community sites, including public health units, community care access centres, and specialized clinics. It also has many partnering organizations, such as the Keeywatinook Okimakanak telehealth program, an independent First Nations telehealth provider. Enabling this kind of service on such a broad level wasn't easy though. The OTN was born from the merger of three distinct entities: CareConnect based in eastern Ontario, North Network based in northern Ontario, and VideoCare, based in the southwestern portion of Ontario. This created challenges regarding the requirement to develop systems and network capable of delivering high-quality care. With healthcare being a commodity that is in continual demand, the OTN technical staff established a services desk to meet that demand, as well as forged service level agreements. "One of the first technical challenges we did was to ensure reliable and available service," says Riesenbach. "We had to make sure we could manage things centrally, so that we could also manage things remotely at small sites. We set up a service desk, so that we could provide 24/7 emergency services."A model was created to ensure new sites could implement key services such as videoconferencing, diagnostic image exchange, and ultrasounds. That meant the development of a centralized network with security, video, and voice infrastructure with fail-over redundancy. Building the infrastructure"We had to configure the network for rapid growth," says Riesenbach. "The needs of our member sites have been great, and we have been growing fast. Consequently, we needed to develop a sophisticated infrastructure."The design includes a four-layer architecture that would serve existing needs and accommodate scaling of future needs. The architecture includes a Smart Systems for Health Agency (SSHA) data centre, which provides emergency services, even in the event of a power blackout or pandemic, stresses Riesenbach.Three linked service desks control the data centre services. The SSHA MPLS network has 250Mbps level 2 services with Internet access from HydroOne at 100Mbps, as well as access to the publicly switched telephone network. The architecture's virtual private network overlay will accommodate an increasing amount of patient traffic running over the network, ensuring secure tunnels can run over a possibly unsecured network. The tunnels converging at the data centre. "While the existing networks of the three organizations were quite private, functioned very well, and had their own security measures, we treated them as untrusted and even built yet more security over them," says Riesenbach. "We wanted to make sure that as we expand and come into contact with different networks and have to encounter other levels of security, we would be guaranteed of having security."Network in actionThe OTN provides specialized care to ensure best practices are carried out in acute-care situations. For instance, its telestroke program, part of the province's regional stroke strategy, ensures that neurologists in a tertiary centre in Toronto view the results of a brain scan of a patient who suffered a stroke in North Bay ON. The technology permits the results to be transmitted as soon as possible, so the specialist in Toronto can determine if it's appropriate to administer a life-saving drug, which has to be given in a three-hour window from the onset of a stroke.Similarly, a patient in Peterborough ON who has Parkinson's disease and needs to be regularly seen by a specialist can participate in teleconsults with that specialist, by taking a substantively shorter trip to a member site in the city instead of a longer trek to Toronto. Clinical encounters involve not only physicians, but also other healthcare providers such as nurses, dieticians, psychologists, and physiotherapists.Some of the priorities of OTN have included the development of a comprehensive scheduling portal to enable online scheduling and studio management, publication of available educational events, as well as webcasting services to view educational or administrative events in real-time or at a time convenient for participants."We are providing services on a rural, remote, and urban basis," says Riesenbach. "Physicians no longer have to travel even within an urban area like Toronto to do clinical grand rounds. We can use videoconferencing, so that clinicians at a hospital in the north end of the city can link to the (University of Toronto's) University Health Network."Merging the three organizations may have had its challenges, but they are paying off. "The three organizations in Ontario were successful individually, and the goal of amalgamating the entities was to leverage the experience we already had," says Riesenbach, an engineer who had been with Ontario's North Network. "We have now combined our expertise through merging."

Robust network and services boon to OTN

News | April 10, 2007

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