Hospitals Remedy Telecom Woes

Merger chaos offers opportunity to explore cutting-edge VOIP technology.

The merger of two hospitals in Atlanta to form one of the largest pediatric health care systems in the country presented a long list of logistic and technological challenges, not the least of which was creating a smooth communications system. Those challenges, in turn, presented the hospitals CIO with an opportunity to deploy the latest in IP-based telephony.

When Egleston Childrens Health Care System and Scottish Rite Childrens Medical Center merged in 1998, 20 satellite sites around Atlanta were incorporated into the new complex. The locations stretched across the city, comprising three area codes and dozens of prefixes, making it impossible to transfer or forward calls among sites.

"We had a variety of different phone systems between the campuses—we had different voice mail systems, which made communications somewhat broken," said Jack Storey, CIO at Childrens Healthcare of Atlanta.

Deploying a uniform data network was the first IT priority, but about three years ago the hospital began working with BellSouth Corp. to examine ways to tie the myriad telephone systems together. Storey said he reviewed a traditional switch system from Nortel Networks Ltd. but opted for VOIP (voice-over-IP) technology from Cisco Systems Inc. because it presented a lower overall cost, more options for upgrading and a more efficient operation overall. The hospital estimated that a VOIP deployment would cost 40 to 50 percent less than installing a traditional system.

BellSouth, like most phone companies, is moving aggressively into the business market, targeting large enterprises in education, government and health care. For hospitals, BellSouth offers packages that emphasize security, improved customer relations and cost savings.

The VOIP implementation has been a gradual process that will end up taking about two years by the time it is completed this summer, Storey said. He began with the satellite sites—mostly specialty centers, rehabilitation clinics and primary care centers in underserved areas—because they had the greatest need for upgraded technology. They were outfitted with direct business lines and simple call routing systems with no voice mail or phone trees.

"They were much smaller with fewer people to train, and they gave us time to get our arms around our training process," Storey said. "Weve been going slowly and making sure that we have each area secure before we take the next step."

One factor contributing to VOIPs relatively low overall cost is that it could be built on the data infrastructure already in place. The network consisted of a Synchronous Optical Network ring connected to a WAN, with remote sites linked through frame relay. To add voice traffic, the hospital deployed Ciscos Architecture for Voice, Video and Integrated Data switches and servers.

More recently, Childrens Healthcare began implementing a unified messaging solution on the VOIP platform, using Ciscos Unity technology to deliver voice messages as .wav files. While satisfied with the implementation, Storey said it was not without glitches. For one, the additional traffic running over the e-mail servers slowed the system until the hospital upgraded its servers.

"We didnt do as good a job as we could have done on our first site, so we got a lot of feedback [from staff]," Storey said, adding that employees often resist telephone changes. "People arent really happy that youre replacing their phone system. Its kind of an interruption in peoples lives."

The most obvious advantage to the new technology is that the hospital complex now uses a standardized telephone numbering system. But for Storey and his staff, one of the greatest benefits of VOIP is the relatively low burden of adding, moving and changing phones.

On a traditional system, moving an employee from one building to another required documenting all aspects of a phones functions, connecting the appropriate wires in the wiring closet and reprogramming the switch. The employees phone number would be changed.

"With this VOIP system, your phone is just another device on the network," Storey said. "You can unplug it and move it to another building, and it just comes up."

For new-building deployments, Storey estimates that VOIP saves the hospital $680 per station.

Eventually, Storey said he would like to see more phone functions integrated into computer systems, allowing staff to work more effectively with e-mail and become less reliant on telephones.

"As we move forward with implementation in clinical areas, where we may give nurses wireless computer tablets, we may also include phone software on that device," Storey said. "That would be one less device that they would have to keep up with."

Childrens Healthcare has been piloting wireless phones in its intensive care units over the same network, enabling nurses to call doctors, who can call them back directly. Storey said he is considering communications badges, which would let staff make hands-free calls.

Childrens Healthcare is not the only hospital implementing VOIP technology, but it is moving more aggressively than most. Many are incorporating VOIP as a supplemental system, often at remote sites, while maintaining the primary legacy telephony switches. If not for the magnitude of the merger, Storeys organization would likely have moved more cautiously as well.

"Would we have done this without the merger?" asked Storey. "Probably not for the main hospitals, but we might have looked at it for some of the remote locations."