The Missing LINK: All Internet Connections Are Not Created Equal Never before have long-term health care providers been confronted with so many emerging technologies that would seemingly improve nearly every aspect of operations and quality of care. Yet while nearly all of these advancements are dependent on Internet connectivity, few of the suppliers offer any research or advice relative to selecting an ISP (Internet Service Provider) or choosing the appropriate Bandwidth (speed). WHY? Because they realize there is no simple solution. First of all, there is no ubiquitous nationwide broadband service provider or product offering so each physical location will have different access availability. Additionally, unlike the long-term health care industry, internet service providers are basically non-regulated with very few barriers to entry and almost no supervision or recourse regarding quality of service or consumer protection. Consequently there are literally thousands of internet service providers with various degrees of stability, security and reliability offering hundreds of product with multiple specifications in their own specific geographic footprint. When considering an internet connection, you will first need to qualify what size or speed of service you will require, considering the number of users and the application or types of information that will be transmitted while being very cognizant of anticipated growth demands. Below is a brief description of connectivity types: DSL or Digital Subscriber Line runs over standard copper phone lines and is therefore usually offered only by your local telephone company. The availability and speed of your DSL connection is dependent upon the distance and quality of the lines between your facility and the nearest Central Office. The provider will offer an estimated range of speeds, but not guarantee any fixed level of throughput. Under the right conditions, download speeds can reach 3—6 mbps (megabits per second), but upload speeds are generally limited to 384 kbps (kilobits per second) which may not be enough considering the anticipated number of users and the advanced applications. Cable Modem Service runs over coaxial cable and cable TV providers are the only source for cable modems but not all providers offer the service. Cable customers should note that while the service can offer impressive speeds up to 10 mbps downstream and 1.5 mbps upstream, the network is shared by a group of users. Not only does this present a potential security issue, but the speed will slow as more users sign on. As with DSL, there is generally no guaranteed quality or service level agreement that would offer monetary or other compensation for congestion or interruption. Wireless and Satellite access are excellent options for secondary or backup connectivity as they are not as susceptible to the most common of catastrophic land based network outages, however speed and reliability issues prevent them from being considered as primary source at the present time. T1 (1.544 mbps) – T# (40+ mbps) internet connections are delivered on very fast and reliable fiber optic lines which can be integrated with regular phone service, data and video transmissions. T1 connections are certainly the most popular connections for business, offering fully managed network performance and quality of service guarantees. Unlike DSL and Cable where providers are limited, T-1 internet connections may be available from multiple carriers and in many different flavors like Full T1, Fractional T1, Burstable T1, Integrated T1, Bonded T1 and Multiple Megabyte T1 lines to name a few. A number of clients are now gaining increased functionality and receiving substantial savings by converging data and voice applications over T-1 connections like Voice over IP (VolP), Virtual Private Networks (VPN) and Multiprotocol Labeling Switching (MPLS). The initial set up of the hardware and software is more complex and on-going support for configuration issues is frequently required. The customer almost always requires a “Customer Service Unit/Data Service Unit.” (CSU/DSU) which is a piece of hardware that translates the data traveling over the leased line into usable data traffic and a “router,” which serves as a “traffic cop” between the customer’s Local Area Network (LAN) and the Carrier’s Network. After you have determined the appropriate connection type, you can then refer to the Yellow Pages and contact ISP’s in your service area to identify which will support your requirements. Remember, that they will most likely only be willing or able to discuss their service offerings and not what else might be available in your area by other providers. Be sure to check their product specifications against your requirements and inquire about service level guarantees. How do they measure performance? What recourse is available if the specifications are not met? What is the network uptime and mean time to restore? Also, ask if they are a Tier One provider with direct access to the internet or if they gain access through “peering” arrangements with other carriers. Another option is to contact a “carrier neutral” telecommunications consultant, like National Energy Services Company, Inc., whose years of nationwide technology experience with the long-term care industry will assist you in navigating through the maze of providers and products with only your best interest in mind, generally at no cost to you. Remember that PRICE is immaterial in the absence of throughput reliability.
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