How networking is transforming healthcare

Internet2's Health Network Initiative points to a future of telesurgery, telepsychiatry

Mike McGill, program director for Internet2's Health Sciences Initiative, talked with Network World about how he believes gigabit-speed networks and telemedicine applications such as telepathology, telesurgery and telepsychiatry can transform the healthcare industry.

Michael McGill, PhD

The Obama Administration's push towards health IT -- including electronic health records and a nationwide health information network -- has one important prerequisite: reliable, high-bandwidth Internet connectivity.

Internet2, a consortium of 200 U.S. universities, 70 corporations and 45 government agencies, has been applying advanced networking to medical research, education and clinical practice for several years. With its Health Network Initiative, Internet2 is underpinning the Federal Communications Commission's Rural Healthcare pilot program, which promotes the use of telehealth and telemedicine services nationwide.

Mike McGill, program director for Internet2's Health Sciences Initiative, talked with Network World's Carolyn Duffy Marsan about how he believes gigabit-speed networks can transform the healthcare industry. Here are excerpts from the conversation:

Describe the Internet2 Health Network Initiative.

Medical researchers, educators and clinicians are all looking to Internet2 to show them what is possible to do with a network in the medical environment.

Let me give you a couple of examples in the clinical area. I live in Columbus, Ohio, and Columbus has a very good children's hospital downtown. The children's hospital has relationships with a number of rural institutions, particularly for being able to take care of neonatal babies. Initially, the protocol for babies that weighed one pound was to immediately put them on a helicopter and fly them to the experts at the children's hospital. But that's expensive because helicopters are expensive to fly, and the family has to get to the baby. They started to experiment with using the regional network that's a counterpart to Internet2. With relatively inexpensive video equipment that's capable of high-resolution imagery, the remote hospital sends video to an expert physician who can determine the color of the baby and determine the baby's ability to move. Fifty percent of the time they are not transporting the baby. When they don't transport the baby, the outcomes are better for the baby and the family. And every time they don't put a baby on a helicopter, they save $5,000.

Another example is with the Department of Veterans Affairs. The VA has responsibility for taking care of the wounded warriors when they get back. Many of those end up in rural areas, and an increasing number come back with post traumatic stress disorder. The psychiatrists with expertise in post traumatic stress disorder are almost always in urban areas. We've demonstrated the ability to put a patient up on a telepresence environment with a remote psychiatrist. The psychiatrists said that the kinds of things they look for -- eye color, signs of drinking, sores in the patient's mouth, tics -- couldn't be seen with normal video conferencing. But with telepresence, you can see all of that and a lot more. Telepresence offers the kind of clarity that we normally see face to face.

How much of Internet2's traffic is related to health sciences?

We have 125 medical schools in the United States, and 120 of them are members of Internet2. That means all of the traffic between those institutions and their associated researchers and medical centers flows over Internet2. Health sciences are a substantial portion of our traffic.

Is there anything new in terms of what Internet2 is doing for the health sciences community?

Two-and-a-half years ago, the FCC made its awards for its Rural Health Care Pilot Program. We are the designated national backbone that the rural healthcare pilot projects use. The Iowa project is on our network, and the South Carolina project is about to come on.

As a result of these projects, we started calling this Internet2's Health Network Initiative. We're focused on the network, and what it could do for healthcare. We've got several groups that have risen out of this effort. We have one focused on security, one on the technical aspects, one on the resources in our network, and one on education.

How is Internet2's Health Sciences Initiative changing with the Obama Administration's push towards electronic health records?

We have regular conversations with the Office of the National Coordinator for Health IT, which is where the push is coming from. The current push is for electronic health records with very limited capability. The textual record doesn't really need Internet2. But that's not the end point that anyone down there or any of my colleagues are talking about. We are working on electronic health records that are backed up by lab tests and images, and that's a whole lot richer of an environment than just the textual record. The existing Internet is probably not going to be sufficient to do the kinds of things we are talking about.

Can you be specific about the kinds of health-related network applications that you envision besides electronic health records?

The big one we see happening is improving access to medical care that is remote from where you are. Sometimes it will be telemedicine. Sometimes it will be a consult. Sometimes it will be focused on access to extended health records. When we're talking about clinical care, access is the [focus]. But access to researchers and educational activities are equally important.

In terms of research, we are creating the cancer biomedical informatics grid that is connecting all of the 33 cancer centers in the U.S. with the intention of making it a much more unified research environment to share data. They are connecting over Internet2.

All of the physicians in the country are required to take continuing medical education. The way they do that is to drive to some class. The ability for them to get high-definition medical education at their desktops through Internet2 and regional networks is a huge win for doctors who are not in urban locations. This is the dominant [healthcare application] of Internet2 right now. We've got a physician in Puerto Rico who regularly trains other physicians in the U.S. in endoscopic procedures using Internet2. We've got a physician at Johns Hopkins who trains physicians in India on HIV in clinical practices.

What do you see as the key networking challenges when it comes to electronic health information sharing?

The last mile is constantly a challenge for us. We also have cultural challenges. People are still learning how to effectively use telemedicine. As you get further away from urban areas, the issue is how to get the technical know-how into the rural areas.

Are you engaged in any network-oriented research that applies to healthcare?

A. With our new network, we have dynamic circuit networking, which means you can set up a dedicated circuit for a period of time. That's important because for physicians their number one issue with telehealth is the stability of the network. They want the network to be there when they need it. The extreme example is telesurgery. If you're going to do surgery at a distance, the network has got to be there. The ability to set up a circuit for a dedicated period of time is important.

What exciting new applications might evolve for high-speed networks in healthcare?

For the medical community, catching up to the 20th century and current networking capabilities is a challenge. But I can envision a lot of things like remote instrumentation where you can do diagnoses at a distance. The other big thing that I think is going to happen is using the network for chronic care, which is a huge expense in healthcare. The network may allow you to monitor people with chronic conditions, but that will create a huge quantity of traffic.

We expect a significant amount of growth on Internet2 as a result of telehealth. The medical resources in the U.S. are poorly distributed, and telehealth offers us the ability to more effectively use the resources we have through telepathology, telesurgery and telepsychiatry. With these applications, we need to focus on network security and reliability.

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