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Health care IT infrastructure burdened by new technology

Replacing legacy networks, servers and printers -- not to mention integrating messaging and mobile technology -- hits health care IT infrastructure hard. But spending is on the rise.

Health care personnel’s demand for iPads, iPhones and Androids is increasing, despite the host of other pressures on the sector’s IT infrastructure.

“We get a lot of physicians asking, ‘Why can’t I connect my iPhone, or my iPad when those come out?’” said Carl Labbadia, director of information systems at Grove Hill Medical Center PC in New Britain, Conn. “The next thing I’m going to hear is, ‘Why can’t I connect using my Xbox or PlayStation?’

“We do a lot to let [doctors] connect for email and Epocrates [a drug-reference application] and nonclinical things,” Labbadia said. “[But] we have concerns about security that will mean we’re not going to move in the direction of supporting clinical data on everything they might want to use.”

Like many large, distributed health care centers, Grove Hill has had to upgrade much of its most basic IT infrastructure. The demands of electronic medical record (EMR) systems, large image files and other bandwidth-intensive requests from such departments as radiology are adding up, according to Leo Carpio, vice president for the health care information technology and services practice of equity research firm Caris & Company Inc. in Del Mar, Calif.

Labbadia’s biggest project was replacing Grove Hill’s standard network backbone cabling with fiber that could support files of any size, while future-proofing the hospital’s network as well. The next project on Labbadia’s list is a secure, dual-channel wireless network that will give physicians and employees secure wireless LAN connections while dedicating a certain amount of bandwidth for patients or relatives who want to log on while they’re waiting.

AOL and other 'new' technologies in health care

No medical center can support every technology the clinical staff wants to use, but it shouldn’t ignore those requests either, according to Jack Santos, an executive strategist at Burton Group Inc. in Midvale, Utah. His resumé includes stints as CIO of two hospitals and senior IT positions at Aetna Inc., Liberty Mutual Holding Company Inc. and other health care insurers.

“I had a doc right out of school ask me why he couldn’t use AOL Instant Messaging to talk to radiology,” Santos said. “On the one hand, you know, forget it. But, really, why not? What was the risk if he was just talking to radiology? We ended up building a secure IM system internally.”

[T]he thing that will be driving spending on health care IT [infrastructure] is the need to capture billing data in real time so hospitals can charge insurers as quickly as possible.

Leo Carpio, vice president, health care IT and services practice, Caris & Company Inc.

During the past five years, there has been a major shift among physicians, who have traditionally resisted the intrusion of computers and other technology in health care, Caris’s Carpio said. Members of a whole generation has been trained with computers on hand through every step -- and they don’t understand why they can’t use the same technology they’re familiar with at home to make clinical work easier.

“That’s faster on the electronic records front,” Carpio said. “But the thing that will be driving spending on health care IT [infrastructure] is the need to capture billing data in real time so hospitals can charge insurers as quickly as possible. That’s going to be the real pressure on IT.”

The networks made a big difference, but at least as important to improving Grove Hill’s overall efficiency was a project to replace legacy dot matrix print systems with centralized laser printers, Labbadia said.

Not only do most big hospital centers need upgrades just to get up to what most companies would consider “normal” IT capabilities, but they also have to deal with EMR conversions, cutting-edge medical and surgical systems, and integration projects caused by consolidation all over the health care market.

“When you have one of these larger, academic-affiliated hospitals buying smaller hospitals, that’s when you get a big company going digital in some big way,” Carpio said. “They’re shocked at the tech these smaller companies are using, so they make large-scale upgrades in EMR and other systems.”

Spending to improve health care IT infrastructure on the rise

A recent survey from Milford, Mass.-based Enterprise Strategy Group (ESG) showed that 67% of large health care companies plan to increase IT spending in 2010 from 2009, compared with 52% of all companies.

In addition, health care IT led the list for companies that planned to add staff positions (50%), and ranked highest in the number of IT jobs gained (332,000) during the past 12 months and in the average expected IT budget increase (2.4%).

The bulk of that spending on technology in health care will go not to gadgets and handhelds that get much of the attention and press coverage, but to the IT infrastructure projects that will support them.

“All the hospital IT folks I speak to agree that their primary responsibility is patient care, so that, along with the compliance and regulation pieces of the puzzle, gives them a uniqueness from other types of businesses,” said Mark Bowker, an analyst at ESG.

At the top of the list of specific applications are billing and business intelligence systems. Inherent in the overall responses is the need to build health care IT infrastructures that can not only support a range of unique medical technologies, but also reinforce the infrastructure to deliver levels of reliability never required of health care companies before, Bowker said.

That need, and the variety of pressures on IT to get health care up to speed and moving forward, is fueling incredible growth in the market for IT consultants and integrators who specialize in health care, Caris’s Carpio said.

“Three quarters of the work a hospital IT group does is on legacy stuff -- maintaining older applications and support and that kind of thing,” Carpio said. “The one quarter they have left, they have to divide among everything else. So they end up hiring consultants, and IT supervises the work.”

Kevin Fogarty is a contributing writer based in Boston. Let us know what you think about the story; email

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