Three years ago, two major health care systems on Long Island merged.

The result was a collection of 18 hospitals, 47 facilities and a tangle of network technology. After an eight-month revamp, the tangle is now hasis now a unified network that puts it at the forefront of health care information systems.

The North Shore-Long Island Jewish Health System, Great Neck, N.Y. now has a data network that supports video conferencing, voice over Internet Protocol (VoIP), Internet protocol television (IPTV), remote access of large databases and enough redundancy in the system that network administrators are comfortable with having all the hospitals' communications run over the same backbone.

Richard Jerothe, director of enterprise infrastructure for the health system, said the new network is working beyond his expectations. "A database file that typically took a minute and a half to download from one facility to another now takes 15 seconds. All of the digital services are tremendous," he said.

The hospital undertook this $5 million project because it was simply not reaping the benefits of the merger.

"There was an enormous amount of redundancy. Eighteen hospitals were running 18 records departments," Jerothe said.

Communication nightmare

Each hospital ran its own departments in an autonomous way. Doctors in different hospitals could not share information with each other. The root of the problem was the inability to communicate, Jerothe said.

While this network has helped to increase efficiency in the massive health system, the goal was not to save money. The goal, Jerothe said, was to increase the effectiveness of the organization. And it was not an easy sell.

"One of the hardest things to sell is network infrastructure. You use it every day but you can't see it or touch it," he said.

But he was able to convince the management that this network would help the hospital reach its larger objectives of reaping the benefits of the merger.

The first step was to do an assessment of the existing infrastructure, said Gene Pategas a project engineer with NEC Business Network Solutions, Irving, Texas. NEC was the integrator for the project, which included equipment from Cisco, Cablevision Lightpath and Perot.

Many of the hospital's locations were using a frame relay system, which would simply not be able to work with the new system that Jerothe envisioned. All of the system's frame really circuits had to be converted to asynchronous transfer mode (ATM) circuits to accommodate the faster speeds of up to 10G bit/sec. Speed was needed for the high volume of traffic the hospital anticipated on the network.

The system uses Cisco 6509 switches. NEC BNS account manager Edward Garofalo said the switches give the network faster switching capability and make it better able to handle complicated video and data traffic.

Voice also added

Since the health system was putting in such an extensive network, it made sense to add voice to the mix, said Dan Spinosa, the health system's director of enterprise technologies who oversaw the voice side of the project.

NEC was able to add IP cards to the existing private branch exchanges (PBXs) in the network. And the heath care system is now working on decreasing the number of connections it has to the public telephone network. Since the hospital facilities are strung out from Staten Island to the eastern tip of Long Island it can realize savings from calls between facilities, said Spinosa.

There are other savings opportunities as well. In a traditional system, someone making a call from the Staten Island facility to a business at the far end of Long Island would be charged for a long distance call. With the VoIP system, that call would be sent over the network to the hospital closest to the call's destination. So, the call will not enter the public network until it reaches the end of Long Island. And the hospital is charged only for a local call instead of a long distance.

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The project raised some technical problems. Putting all of the hospitals' communication systems on one network was risky since all communications would rely on that network.

"Putting all of our eggs in one basket was a large concern," said Jerothe.

So the group designed the system with enough redundancy to lessen the concerns. The three main hospitals are all connected to each other and to the remote sites. They are the core of the network. They are also connected to each other by an ATM cloud in the center of the triangle. If any of the connections between the hospitals go down, the network will switch over to the ATM cloud and will continue to run, said Pategas.

And the hospital has retained enough local phone connections that if the network fails, the PBX can reroute calls off the network and onto the public phone system.

The hospital system also integrated an extensive intrusion detection system. With so much confidential data such as patient records on the network, it was very important to maintain a high level of security. Now, the challenge is to determine how to use all the data that these systems generate and to figure out how to respond to indications of intrusion. The health system is still determining how far network should be shut down in response to different levels of intrusion warnings.

While some issues are still being worked through, the bulk of the network is up and running. And already the benefits are apparent, said Jerothe. The video conferencing system is hooked up to microscopes, so one doctor can share a slide with physicians at the other hospitals over the network. Doctors at distant hospitals can work together on diagnoses. Billing systems are being integrated between the facilities. And the voice system is surprisingly clear.

"This is a great project. The health system's use of technology is far ahead of others," said Pategas.