Cisco Aironet 1200 Series

Double-digit growth and a commitment to remaining on the leading edge of children's healthcare is generating expansion at Children's Healthcare of Atlanta. The result of a merger between Scottish Rite Children's Medical Center and Egleston Children's Hospital in 1998, Children's Healthcare of Atlanta is ranked as the sixth leading pediatric hospital in the United States by Child Magazine. More than 5500 employees meet the majority of the Atlanta area's pediatric healthcare needs at two main hospital campuses and 16 satellite locations throughout the greater Atlanta area. A separate administrative campus houses 800 employees. Both hospitals are undergoing major expansion-enlarging emergency rooms, increasing diagnostic space, expanding surgical facilities, and increasing the total number of beds from 430 to 500.

"We're recognized as having some of the top pediatric cardiology, oncology, orthopaedic, neonatal, and transplant services in the country," says Jack Storey, Children's vice president and chief information officer. "Soon after the merger, we converged our networks, established standards, consolidated our data centers, and standardized our applications. The next major challenge we faced was making voice communication consistent across our locations."

The Children's telecom infrastructure was fragmented. Each hospital campus had a different private branch exchange (PBX) telephone switch and the 20 remote sites relied on local phone lines and key systems. Each campus and satellite office had its own set of telephone numbers assigned by the local telephone company, BellSouth. Complicating matters was the fact that Atlanta encompasses three different area codes and Children's had facilities in all three areas.

Three area codes, multiple exchange prefixes, and two separate voice-mail systems created a dial plan and voice messaging nightmare. "I had three people reporting to me in two adjoining buildings and they all had different prefixes," says Storey. "We wanted to institute a virtual telecom campus with a single set of numbers." Children's executives rely on voice-mail for important communications to team members. Executives with people reporting to them from different sites throughout the city could not relay one message to the team. Instead, they would have to call each person separately and hopefully be able to leave a consistent message for everyone. If the employee was on a different voice system than the executive, he or she could not simply reply to the voice mail, but would have to call the executive back to leave a reply. Not only was this arrangement time-consuming and inconvenient, it raised questions about whether everyone was receiving the same message.

System management was even more fragmented. Different switches required different technology training and each switch had to be programmed independently. With the hospital constantly changing and people moving between locations, coordinating changes in phone service was difficult. For example, when Children's wanted to move its rehabilitation scheduling and billing office to its main administrative campus, the telecom staff would work with BellSouth to either reroute or change all of the phone numbers. This required gaining an understanding of the functionality of the new location's switch, translating the routing to match the switch's capacity, and programming the switch. Physically moving the phones also required connecting each one to the proper switch port as the move happened. This process could take up to 45 minutes per phone, which could translate into hours or even days if an entire department needed to be moved.

One of the hospital's primary concerns was voice-service availability. The three main locations were served by two BellSouth central offices. Children's remote sites were supported by multiple BellSouth central offices. In the event that a central office supporting one of the three main locations failed, Children's wanted to help assure that all incoming calls could still be received.

"We had experienced trunk failures which caused lost connectivity to the separate hospitals," says Jim Atwood, director of technology at Children's. "When that happened, we'd have to use a manual process to remote call forward the hospital's main number to a different trunk. We wanted a solution that provided resiliency in the event of a trunk or central office failure. As a hospital, we cannot be down."

The hospital faced a difficult decision. Should it replace the PBXs with newer switches based on the same technology, or should it consider a new technology solution that would provide more flexibility, higher availability, and lower total cost of ownership? The Children's team turned to Cisco Systems® for a demonstration of Cisco® IP Communications solutions. Helping to ensure open and efficient communication for physicians, administrators, and clinicians was the single most important reason for implementing a Cisco Medical-Grade Network and IP Communications strategy.

"We believed that the industry was moving toward IP telephony, although we did not know of any other hospitals that were using this solution, " says Storey. "For us the Cisco Medical-Grade Network was more cost-effective to implement and maintain and it gave us significant flexibility for the future."

Children's existing Cisco data network provided an excellent foundation for the new Cisco Medical-Grade IP Communications solutions. With a solid data network infrastructure already in place, Children's did not have to update the infrastructure to implement its new Cisco IP Communications solution, which reduced its total cost of ownership and the migration cost.

The new Cisco infrastructure's comprehensive switching and routing services and built-in resiliency now extend call processing and advanced voice features to all three main campuses and each remote location. Cisco Catalyst® 6509 Series switches connect the three main campuses using a metropolitan area ATM network ring. Cisco Catalyst 4006 and 4507 switches comprise the distribution layer. Traffic is switched to each remote location through a Frame Relay service and delivered to Cisco Catalyst 3550 switches.

Using DSL connections and Cisco 1700 Series routers, the Cisco Medical-Grade Network also connects approximately 30 nurses who staff the hospital's triage and physician referral call center. The call center solution is based on a 12-node Cisco CallManager cluster. Cisco CallManager software extends enterprise telephony features and functions to packet telephony network devices such as IP phones, media processing devices, voice-over-IP (VoIP) gateways, and multimedia applications. Additional data, voice, and video services such as unified messaging, multimedia conferencing, collaborative contact centers, and interactive multimedia response systems interact with the IP telephony solution through Cisco CallManager`s open telephony application programming interface (API).

One 72-port Cisco Unity® server is installed at each of the three main campus locations, providing advanced, convergence-based communication services on a platform that offers high reliability, scalability, and performance. The Cisco Unity solution integrates with desktop applications such as Microsoft Outlook and Lotus Notes, helping users to listen to e-mail over the telephone and check voice messages from the Internet.

Cisco IPCC Enterprise, which provides intelligent contact routing, call treatment, network-to-desktop computer telephony integration (CTI), and multichannel contact management is also deployed over the data network for the hospital's 60-member nurse triage call center.

Because medical centers require always-on telephone capabilities and to make voice services available for everyone, Children's also implemented Cisco Survivable Remote Site Telephony (SRST). A unique, industry-first capability embedded in Cisco IOS® Software running on Cisco routers, Cisco SRST provides feature-rich call processing redundancy for centralized CallManager deployments, while using the existing network infrastructure at the remote office. If the WAN link to the remote office fails and the connection to the Cisco CallManager is lost, branch location phones are automatically redirected to the Cisco SRST branch router. This router provides a core subset of the functions provided by Cisco CallManager, helping to minimize impact to the business.

Hospital employees use Cisco 7960 IP phones-4600 are currently in use-which guide them through call features and functions and can support additional information services, including Extensible Markup Language (XML) capabilities. Children's also maintains 1600 regular analog phones in patient rooms and public areas, which connect to the network through a Cisco VG248 Analog Phone Gateway.

Additional voice service redundancy was achieved through Signaling System 7 (SS7) connectivity. Using Cisco AS5400 Series Universal Gateway, Cisco PGW 200 Softswitch, and the Cisco SLT 2600 Signaling Controller, Children's gained SS7 connectivity with BellSouth public telephone network. In the event of a central office failure, the Children's voice network can automatically route incoming calls from one BellSouth central office to another and then on to the hospital to help assure business continuity. Also incorporated into the solution was the use of Cisco Aironet® Access Points and Cisco 7920 wireless 802.11b phones to deliver wireless access throughout Children's two hospitals.

Communication was drastically improved with the Cisco IP Communications solution. All of the Children's numbers now start with 404-785, with one centralized point for voicemail, menus, and management. With Cisco Unity, personnel can now check voicemail over the Internet and listen to email messages over the telephone. It is now a simple matter to transfer or forward calls to other staff members in a different facility, as well as forward voice-mails to e-mail. Small groups of staff can easily initiate conference calls on demand, without having to reserve more costly conferencing services. Caller ID features allow staff to prioritize calls, and having a directory of missed, placed, and received calls displayed on the telephone itself is a time-saver for staff. According to nursing staff, these greatly improved communication capabilities give them more time to provide quality care and greater communication effectiveness.

The hospital processes approximately 100,000 calls per day on average; however, during a recent fund-raising telethon, call volume peaked at 127,000 without a problem. Not only does the new Cisco IP Communications solution support almost 5000 handsets, it can also scale to meet the hospital's aggressive growth projections. The hospital can now grow without compromising its high levels of customer service.

"In addition to reliably handling high call volumes, our distributed CallManager systems and SS7 connectivity provides us with all of the high-availability capabilities we need without requiring outside trunks or lines," says Atwood. "Even if we lost SS7 connectivity at one of the hospital campuses, the Cisco solution would reroute all of our calls in through the data network. And because our old PBX switches serve as an emergency back-up system, the SS7 would also allow us to reroute our main department numbers to the emergency phone system."

Managing the new telecom system is much easier as well. All of the phones are connected to the data network, which makes moving them as easy as unplugging the phone, walking it to its new location, and plugging it back in again. Children's estimates that the Cisco IP Communications solution has reduced the work and labor costs associated with adds, moves, and changes by more than 50 percent.

"Centralized management is a tremendous advantage to us," says Atwood. "Instead of having to manage disparate multiple systems, we can manage everything from one place. In the past to add a phone line we'd have to go out and re-program the PBX, then visit the user and re-label the phone. Now, we add the line in Cisco CallManager and perform a quick restart on the phone. We use basic troubleshooting to help users resolve issues in minutes. The Cisco solution allows us to maintain high service levels without adding staff."

The hospital will also greatly reduce its telecom new construction costs. With a traditional telecom installation, hundreds of copper pairs must be installed to connect the switches, riser cables, and wiring closets on all upper floors. The Cisco IP Communications solution eliminates the need for installing wire, with significant savings for the hospital. The hospital estimates that it will save approximately US$250 per new workspace or cubicle in outfitting costs because only one set of wires and access to one router port is required.

The Children's nurse triage call center, which handles approximately 40,000 calls per year, now runs on Cisco IPCC Enterprise. Call center representatives answer questions for callers in the Atlanta community, provide physician referrals, and take off-hours calls for pediatricians. Approximately 30 nurses work out of their homes through a DSL connection between the hospital network and their telephones. This allows them to be on the same call queues and access the same data as an in-house staff member.

"These nurses have no commute," says Storey. "If call volumes escalate, we can call a nurse at home and in ten minutes they can be online to take calls. This gives us tremendous flexibility and it's also a strong recruiting and retention advantage." In addition, Children's has deployed a Cisco wireless communications solution that allows nurses to have phones with them and receive calls or have calls transferred to them directly anywhere in the hospital.

Storey and Atwood have plans for taking network security to the next step with Cisco Security Agent. The Cisco Security Agent will be able to alert IT staff to unauthorized changes, filter Internet traffic, and provide intrusion detection monitoring on the Cisco network at branch locations to help enforce security policy. Because Cisco Security Agent is not signature-based, it protects the network regardless of the location's last antivirus update. Storey and Atwood are also evaluating access control technologies for the data network.

As Children's Healthcare grows at double-digits, the primary challenge is to keep high-quality information immediately available to caregivers and physicians across all of its locations.

"The Cisco IP Communications solutions give us flexibility for reacting to today's changes and accommodating tomorrow's growth," says Storey. "Having voice and data information readily available to our physicians and clinicians has taken us a long way."

To learn more about Cisco healthcare solutions, visit: www.cisco.com/go/healthcare.

To learn more about Cisco routing solutions, visit: www.cisco.com/go/routing.

To learn more about Cisco switching solutions, visit: www.cisco.com/go/switching.

To learn more about Cisco IP Communications solutions, visit: www.cisco.com.

To learn more about Cisco security solutions, visit: www.cisco.com/go/security.

To learn more about Cisco wireless solutions, visit: www.cisco.com/go/wireless.

To learn more about Children's Healthcare of Atlanta, visit: www.choa.org.