August 18, 2004

By Charles Waltner, News@Cisco

Jefferson Memorial Hospital faces an all too common challenge for community health care providers these days. The 114-bed facility in Ranson, W. Vir., has big city standards for its medical services but a small town budget. But by turning to Cisco Systems, Jefferson Memorial was able to create a communications system that is markedly boosting the quality of its care while saving the organization money.

The extensive communications system upgrade included an overhaul of it its local area network, new remote communications, improved security, a new Internet Protocol (IP) telephone system, and a new wireless network. Jefferson Memorial started its project with a revamp of its local area network (LAN) by replacing all of its older, "layer 2" switches with Cisco Catalyst 4500 "layer 3" switches. Besides bringing far greater bandwidth processing capabilities, the Catalyst 4500 switches let the hospital divide its LAN into various segments for easier management while providing more options for maximizing bandwidth across the network.

Jefferson Memorial also installed the Cisco VPN 3005 Concentrator. The Cisco VPN 3005 Concentrator enables secure remote access for Jefferson Memorial doctors, as well as doctors who work at affiliated sites, significantly improving the hospital's ability to provide sophisticated health care. With the secure VPN connection, the hospital can now remotely share patient x-rays and other medical images with experts at the University of West Virginia. If a doctor at Jefferson Memorial wants a second opinion about a diagnosis, a specialist at the university can access the hospital's iSite PACS system (a digital imaging storage and management application from Stentor) to look at the relevant medical images. The VPN ensures the image's security, while the Cisco Catalyst 4500 switches deliver the bandwidth to easily transport such large files. The system also provides electronic signature capabilities so university staff can sign for prescriptions or treatments based on their analysis of images viewed via iSite.

The Cisco VPN 3005 Concentrator also helps Jefferson Memorial connect with its network of doctors. Now seven doctors' offices are securely accessing information from Jefferson Memorial's patient care system over high-speed DSL connections. Previously, doctors could only access the hospital's network with slow dial-up links. Such connections lacked the bandwidth to quickly download large amounts of data or medical images. The hospital plans to connect up to 30 doctors over the next year. The VPN 3005 Concentrator can manage up to 200 simultaneous connections. And for added security the 3005 Concentrator lets Jefferson Memorial limit "visitors" to specific areas on the network.

"Because of the advanced configuration capabilities of the Concentrator, I can control the access privileges of anyone coming into the network," says Todd Smoot, chief technology officer for the hospital.

Along with the new virtual private networking links for expanding secure communications, Jefferson Memorial also installed the Cisco PIX 515E Security Appliance. The Cisco PIX 515E Security Appliance is a reliable, easy-to-maintain platform that provides a wide variety of methods for configuring, monitoring, and troubleshooting. Thanks to the Cisco PIX Security Appliance, the Cisco VPN Concentrator and other Cisco security technologies, Jefferson Memorial is exceeding compliance requirements of HIPAA (Health Insurance Portability and Accountability Act of 1996).

Another key driver to Jefferson Memorial's network upgrade was its phone system. Until the switch to the Cisco IP telephony system, the hospital relied on the local phone company to manage its internal phone system, known as Centrex service. The Centrex system, while popular in the 1980s before the advent of Internet technologies, had several drawbacks. Most of all was cost, to the tune of $17,000 a month for equipment and management fees. The service was also inflexible, requiring three to six months for the phone company to complete any requested changes to the Centrex system's IVR automated attendant application. Also, such basic conveniences like speakerphones cost an extra $200.

Smoot says the new Cisco IP telephony system saves the hospital $5,000 a month compared to the previous Centrex system. Just moving phones around as personnel changed offices was costing Jefferson Memorial $1,000 a month and each change took a week or so for the phone company to complete. Now with the Cisco IP PBX system in place, all Smoot needs to do to move a phone is pick it up, carry it to the new location, and plug it into the nearest data port. Just like a laptop computer, the Cisco IP phones maintain their identification settings so call traffic can always find them. Also, Smoot can easily make changes to the voice mail system or run a variety of usage reports, such tasks that previously often required months-long waits for the phone company.

"Things change constantly in a hospital," Smoot says. "So it's important our communications systems can change just as quickly."

Possibly Smoot's favorite feature of the hospital's Cisco IP telephony system is its wireless capacity. Smoot is now testing a Cisco wireless IP Phone 7920G, which provides all the convenience of the wired phones but with mobility.

"It's great because you have your office on your hip," Smoot says.

He notes that the wireless IP phone reaches places in the hospital where cellular phones can't be used or walkie-talkies don't work. And since Cisco provides a gateway link to the hospital's paging system, anyone with a wired or wireless phone can receive a page, a crucial function for reaching the right personnel during a medical emergency.

New Cisco Aironet 1200 Series access points, make the hospital's Cisco 7920G wireless IP phone and other wireless networking possible. The Cisco Aironet wireless network, which runs at up to 54 megabits per second (Mbps) bandwidth, replaced some of the hospital's older wireless infrastructure, which was limited to 2 Mbps capacity. The new wireless network, for example, brings far greater bandwidth and mobility to the "chart carts" used by nurses and other hospital staff. The "chart carts" are mobile stations equipped with a modified computer running applications and tools for testing and recording patient information, such as blood pressure, pulse rate, temperature, and other vital signs. Once recorded, doctors or nurses anywhere in the hospital can view the patient information on a network computer.

The greater bandwidth and dependability of the Cisco Aironet wireless network is even bringing wireless communications to the operating table. With the new wireless capabilities, Jefferson Memorial is now using a 17-inch flat-panel monitor on a swing arm so surgeons can view any medical images they need to reference during operations.

The new network has not only improved Jefferson Memorial's ability to help its patients, but it has made it easier for Smoot and his staff to manage the organization's communications needs. "We only have three IT staff members, so we have to wear many hats," Smoot says. "We don't have the expertise or time to be trouble-shooting network operations. That's why I've been so happy with the new network. Once it was set up, the work was done."

And if Smoot has any configuration or management questions, he has confidence that Cisco or AAA Networks, the Falls Church, Vir., Cisco value-added reseller (VAR) that set up Jefferson Memorial's new communications system, will provide dependable service.

"I know if I have problems, it will be addressed right away," Smoot says.

As the final bonus, the new network and communications systems are saving Jefferson Memorial over $2,000 a month from lower equipment costs, reduced monthly service charges, and lower maintenance expenses. In fact, all of the new network components-from the LAN infrastructure, the IP phone system, the VPN connections, security components, and the wireless network-now cost the hospital less per month than just the previous Centrex phone system.

"We're a small hospital, so we have to watch our costs," Smoot says. "In previous years we tried to save money by buying the least expensive equipment, but that led to reliability and management problems. But with the new Cisco network the hospital is getting cost-savings, reliability, and more communications sophistication rolled into one. We're getting it all."

Charles Waltner is a freelance journalist in Oakland, CA.