HealthCare IDS

Staten Island University Hospital
HealthCare IDS

HealthCare IDS, Staten Island University Hospital

Staten Island University Hospital Infrastructure Enables High-Speed Imaging to the Point-of-Care

The Challenge:
Develop a network that supports the rapidly expanding continuum of care that helps the hospital adapt to deregulation, stem the migration of patients to Manhattan hospitals, and streamline operations.

Service Area:
Staten Island, New York and neighboring communities

Network Challenge:
Design and deploy a flexible and scalable ATM network infrastructure that can deliver high-performance network services throughout the hospital locations while allowing secure remote connectivity to care locations and business partners.

Bandwidth-intensive healthcare applications require high-performance network infrastructure, and Staten Island University Hospital rapidly developed a network infrastructure that can now support the delivery of medical imaging applications to the desktop. By building a reliable, high-speed network infrastructure based on Asynchronous Transfer Mode (ATM), the hospital now supports mission-critical, client/server applications, including the online delivery of medical images from central servers. The hospital is now deploying ATM-to-the desktop, allowing healthcare practitioners to download and review imaging modalities at the point-of-care.

Staten Island University Hospital is an Integrated Delivery System (IDS) and is one of the most efficient inpatient centers in the state. A member of the North Shore LIJ Health System, Staten Island University Hospital is a 643-bed not-for-profit teaching hospital that leads the New York area in its percentage of managed care patients. In less than three months, Staten Island University Hospital built an ATM network based on the Centillion 100™ from Nortel Networks, a Nortel Networks business.

Later, the hospital expanded the network to deliver ATM-to-the-desktop. In this phase, the hospital installed Nortel Networks System 5000 BH™ hubs in the data center and redeployed the Centillion 100s to serve as edge devices that feed data onto the high-speed backbone.

By expanding the backbone and increasing capacity, Staten Island University Hospital has driven 155 Mbps multimedia connectivity to ATM local area networks (LANs) throughout the healthcare facility.

ATM Network Designed to Support IDS Requirements [ TOP ]

The hospital is aggressively forging alliances to create a vertically integrated continuum of care that links the hospital with physicians, nursing homes, home health providers, pharmacies, and medical equipment providers. This linkage requires a physical network that connects users throughout the continuum of care. Since each affiliate has different computing systems with different operating systems and protocols, the computing network needed to be flexible. "Our CEO and President, Rick Varone regards the network as something that both attracts physicians to our group and serves as a barrier to exit," said Patrick Carney, the hospital's Vice President and Chief Information Officer. "With capitation, integration between the hospital and the physicians is critical to a successful risk contract. The robust and scalable network we have built helps us provide value to the physicians, as it will help them integrate and access important patient data. Managed care has resulted in tighter hospital/physician relationships. The technology infrastructure is the glue that keeps them together." The hospital decided to focus first on building the necessary infrastructure and deploying new client/server applications that would improve patient care and business efficiencies.

Hospital Selects Nortel Networks and HBOC [ TOP ]

Hospital executives and the Board of Directors signed off on the proposed Information Technology (IT) Delivery Model, and the IT department had to rapidly implement the plan. The first step was to install backbone switching, and after evaluating products from 3Com, IBM, and Nortel Networks, Staten Island University Hospital chose a complete network solution from Nortel Networks.

According to Rick Jerothe, Director of PC LAN Services, "Flexible and scalable ATM switches were our top priority, but we also needed hubs, routers, network management, and remote access servers. Nortel Networks offered the only product line that met all of our requirements-from the backbone out to the remote office. We had prior experience with Nortel Networks and were impressed with the company's products and services, so we chose the network solution from Nortel Networks."

ATM Network Provides High-Performance Connectivity [ TOP ]

Staten Island University Hospital has three main campuses in the same county spread out over a 10-square mile area, and over 200 other locations where network connectivity is provided throughout other regions of New York. On Staten Island, there is a North Site Hospital and a South Site Hospital, each with several buildings concentrated around the main hospital. The third campus site is One Edgewater Plaza, which houses hospital administration and the data center. Previously, the hospital had islands of Ethernet LANs at each facility and a few Token Ring local area networks (LANs) in the data center. The three locations were connected over T1 lines, which were primarily used for voice but also carried AS400 traffic to support over 1,000 dumb terminals.

Because the hospital had an extremely short time frame for implementation, management selected HBO & Company (HBOC) to install the network and establish network management processes. HBOC provided most of the software applications, and was also contracted to help develop and refine the organization's network upgrade strategy and install the network. HBOC worked closely with IT staff and Nortel Networks engineers and established a detailed network design and installed the core ATM network in less than three months.

The network - code-named "StatNet" was originally based on Centillion 100 switches located in each of the three sites and connected over a switching fabric of 155 Mbps ATM. The LAN traffic at each site was standardized onto 10 Mbps Ethernet LANs, which were consolidated onto BayStack hubs, which in turn were connected to System 5000 intelligent hubs for access to the backbone network. Backbone traffic was routed through a Backbone Concentrator Node® (BCN) multiprotocol router from Nortel Networks, which also provides Internet access.

Figure 1 FStaten Island University Wide Area Network

A Nortel Networks Access Node (AN®) was installed in each site for backup and to provide Internet connectivity.

The hospitals were connected over the wide area network using OmniStream ATM Services from Teleport Communications Group. Staten Island University Hospital uses Nortel Networks Optivity® network management solution running on an RS6000 workstation. Optivity allows network administrators to automate the management of distributed network resources. The network staff administers user moves, adds, and changes from the management console by dragging and dropping icons on the computer screen.

The network went live to support over 2,000 users who immediately recognized major performance improvements. The hospital then began further deployment of distributed client/server applications to improve patient care and business operations. The name StatNet was chosen, not because of the Staten Island location, but rather for the medical term "stat" (which means immediate). StatNet's objective is to provide clinical information throughout the continuum of care rapidly and reliably.

StatNet Supports Distributed Computing [ TOP ]

Once the backbone infrastructure was initially in place, the hospital began deploying the new client/server applications. Most are based on Windows NT servers, but some reside on UNIX RS 6000 minicomputers and can be accessed from PCs at all locations. The hospital purchased HBOC's Pathways 2000® product line and immediately began implementing several applications. These data warehousing applications provide a high level of security and will allow physicians to easily create custom queries to the central repository. Intelligence is built into the system allowing physicians to perform online analysis.

Nava Birnberg, Director of Health Information Management, said, "We work closely with physicians, nurses and the IT department to define data requirements, develop, and implement systems that improve the quality of care with a focus on the availability and security of health information. The network allows us to make healthcare information and medical records easily available to authorized caregivers throughout the hospital. In fact, we have found that the network provides a higher level of patient information security than our previous paper-based medical records offered."

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She continued, "In the past, information could have been lost in transit or it might have been difficult for the caregiver to access a particular item of information in a patient's file. We are moving toward standardized information which will be readily available to authorized caregivers over the network infrastructure. We continuously improve electronic access to healthcare information to make network access user-friendly, secure, and efficient. Our objective is to provide clinicians with information at their fingertips yielding positive outcomes on quality and continuity of care to our patients."

Pathways Health Network Management™ integrates clinical and operational applications by creating a master patient index that allows data to be entered on a patient via any PC on the network. This allows the hospital to more efficiently serve patients by eliminating redundant data collection and streamlines registration and benefits processing.

Financial applications are being migrated from AS400 so they can be closely integrated with the clinical applications. Accounts payable, purchasing, inventory, general ledger, fixed assets, and time-and-attendance packages were also brought online. Manual payroll was dramatically reduced because hourly employees can now swipe identification badges through card readers at each location. Each card reader is connected to the network and generates payroll data automatically.

StatNet Upgraded to Deliver Images to the Desktop [ TOP ]

Since Staten Island University Hospital had developed a flexible and scalable network architecture, migration to high-speed desktop connectivity was fast and cost-effective. Higher capacity System 5000 BH ATM switches were deployed in the network core, and Centillion 100s were pushed out onto the hospital floors. "We recently pushed the Centillion 100s from the core network out to the wiring closets to serve as edge devices that can switch either Ethernet or ATM traffic to LANs throughout the hospital," said Jerothe. "This strategy allows us to minimize network costs since we re-use the installed network devices in productive manner. It also gives us the flexibility to deploy ATM LANs initially to those segments that require access to centralized radiology applications."

The PC's on these hospital segments were upgraded with ATM adapter cards, and they can now get real-time access to images stored on servers in the data center. This allows physicians to rapidly diagnose and treat the patients, since healthcare practitioners have online access to images that would have previously been hand-carried on films to the point of care. "We're real proud that we built the network right the first time," said Jerothe, "The upgrade was easy and went smoothly, and we have an infrastructure architecture that allows us to scale to meet new applications or user requirements."

Remote Access Now Available to Over 200 Locations [ TOP ]

Remote access was deployed using Nortel Networks remote access servers and frame relay services from the Teleport Communications Group (TCG) to allow Staten Island University Hospital to expand its service area while creating tighter links with affiliated organizations. Staten Island University Hospital uses Teleport's Frame Relay Services to connect physician practices, clinics, nursing homes, home health services, and pharmacies. There are over 200 locations now connected to the enterprise healthcare network, allowing Staten Island University Hospital to support the entire continuum of care. The hospital also allows dial-up analog and ISDN remote access for off-site departments, smaller physician offices, remote departments, business partners, and staff members working from home.

As the hospital aggressively introduces new applications, Carney is confident that the network infrastructure is in place to support any future requirements for local or remote access. Carney said, "Our users are continually adding new applications that improve clinical care or operational efficiency, and we know we have built the infrastructure that provides both the flexibility and scalability to meet any future requirements. With Nortel Networks and HBOC, we've built a network that can support just about anything I can plug into the network - and that gives us tremendous flexibility to meet the needs of our patients."