Beth Israel Deaconess Medical Center (BIDMC) launched a project not too long ago in which it deployed EMRs to about 300 physician practices throughout eastern Massachusetts, hosting them via a private, cloud-based SaaS model.
Bill Gillis, manager of clinical application services at BIDMC, is helping oversee that project. About a year ago, he was speaking to a friend who happened to tell him about a new piece of technology his company had developed. Upon learning about it, Gillis says now, he had one thought: "I need that product."
Gillis' colleague, Adam Edwards, is director of systems engineering at Boston-based AppNeta, which seeks to offer a simple and affordable means of network performance management. The company's PathView Cloud service provides real-time visibility into any device across any network, including remote sites and third-party networks.
With more and more hospitals and physician practices making use of critical cloud-based applications and deploying those clinical functions across often-complex infrastructures, a smoothly performing network is more crucial than ever, said Jim Melvin, AppNeta's CEO.
"Up until the last three to five years there were very few, if any, patient-safety-critical or business-critical services on the network infrastructure in hospitals," said Melvin. "Infrastructure was largely being used for back-office operations and administration. Those applications were not what we call performance sensitive – billing apps, e-mail, they can put up with a lot."
But nowadays things are changing in a hurry. Hospitals and physician practices are rushing to implement EHRs and other apps that are far more performance sensitive – often needing to accommodate huge data drains such as large MRI files – that are quite often from some remote hosted application.
"At the same time, these providers are attempting to deploy VoIP to streamline costs – it could be videoconferencing, could be backup of critical services," said Melvin. "In a lot of ways, the network is truly under attack in healthcare organizations. It's been very, very difficult for our customers to deal with that."
AppNeta has some 1,400 customers, including big health systems such as BIDMC, Ascension Health in St. Louis, Memorial Hermann in Houston and Sunrise Health in Las Vegas.
Those healthcare organizations need to "assure themselves, on an ongoing basis, that their critical services will work," said Melvin.
At any given time, if an infrastructure is not capable of meeting the needs of the service, he says, AppNeta can alert the IT staff of that and provide diagnostics about what went wrong.
"We've grown out of the time when the concept of 'connectivity' meant that the network worked: you plug into it and get someplace," said Melvin. "That's a given, right? The question is, what are you getting for performance? What is the actual available bandwidth, what is the actual latency, loss and jitter."
For his part, BIDMC's Gillis says his physician practices sometimes run into problems, having acquired their network capabilities through commercial ISPs such as Comcast and RCN. If an application performs slowly or crashes, the practice might think there was a problem with the application itself.
"The application we run, it's not really bandwidth heavy, but it's bandwidth sensitive – very sensitive to latency and packet loss," said Gillis. AppNeta helped "determine what the network connectivity and stability was for these end-point physician practices."
In fact, he says, the tool even helped uncover some cases where clients were getting half the bandwidth they're paying for – recouping some valuable dollars for cash-strapped practices.
Whenever there were problems, he said, "it wasn't that they were capping out on their bandwidth, it was generally related to too many hops, or hops that were causing latency. Jitter was another big thing."
For those small practices – staffed by two to four physicians with no on-site IT support staff, AppNeta's PathView was "a low-cost tool that's pretty straightforward and readable for someone with at least a little bit of tech experience. It doesn't give you the deep down packet inspection of a network sniffer. But that's not what we need. We really just need measure – is that ISP performing the way it's supposed to?"
Gillis isn't the only staffer at BIDMC to like PathView. John Halamka, MD, the hospital's renowned CIO, named AppNeta's PathView microAppliance – a gadget, about the size of an iPhone, that can be plugged into any ethernet port, monitoring networking performance from that point – as his blog's "Cool Technology of the Week" several months back.
"In a cloud environment, debugging application issues becomes ever more challenging," he wrote. "A low cost, zero administration, cloud-based, network sniffer that is truly plug-and-play. That's cool!"
