Besides summing up the crowded, often chaotic conditions in a big-city hospital; the technique also epitomizes the need for wireless networks in large healthcare facilities.
With large, mobile workforces and many different points of care where doctors and nurses interact with patients, hospitals have huge needs for real-time communications and information exchange. And many of them were built long before the need arose for easy-access cabling and wiring closets. And most hospitals ban the use of cellular phones within their walls because of fears about the devices interfering with medical equipment.
Those were some of the challenges faced by St. John's Hospital of Springfield, Ill., one of the largest Catholic hospitals in the U.S. with 700 beds, when administrators looked at installing a new wireless LAN in the 2.4 million square-foot facility.
St. John's wound up purchasing a converged voice-and-data WLAN from Sunnyvale, Calif.-based Meru Networks Inc. that enables seamless roaming of voice clients plus support for multiple applications using different security settings. The new network, currently in its second phase of installation, will eventually include 400 access points and some 300 to 400 total users. Gretchen Niehaus, IT and telecommunications manager for St. John's, estimates the year-one return on investment of the new network at more than $2 million.
The St. John's experience provides a useful case study in a large enterprise choosing among multiple vendors and competing networking technologies to enable new, more productive, and less costly forms of communication.
"We started this process two years ago," recalls Niehaus, "with a site survey, and a 360-degree spectrum analysis for the entire building."
Occupying a 12-story, post-World-War-II era building with what networking professionals like to call "complex building topology," St. John's had all of the challenges endemic to big hospitals as well as some unique needs of its own. Nurses were using Avaya Inc. (NYSE: AV) handsets that were reaching the end of their useful life but which the staff was loath to give up. The access points on the network had to be multifunctional, accommodating the 802.11a, b, and g bands, transmitting at 11 Mbit/s (b) and 54 Mbit/s (a and g). And St. John's sought a network that could deliver converged voice and data, enabling seamless roaming and supporting multiple applications with different security settings. All-in-all, a recipe for network chaos.
Niehaus and senior network engineer Bill Halpin first looked at Avaya's voice solution using Proxim Corp. (Nasdaq: PROX) wireless networking equipment along with handheld devices from Motorola Computer Group. In testing, however, it quickly became apparent that the access points in this network would not support all three technologies -- 802.11a, b, and g.
"It was also at this time that Proxim's financial situation began to deteriorate," says Halpin. "We thought, 'We need to look elsewhere.' "
That's when they benefitted from a bit of serendipity. The Proxim sales rep serving the hospital moved to a small, little-known networking startup called Meru Networks. Meru staff came out to Springfield and helped set up a testlab for its proposed network. According to Meru marketing director Joel Vincent, the advantages of the company's networking solution were readily apparent.
"The issues on the voice side were the number of users and the density of areas in which they wanted to deploy the network, without degradation of quality," explains Vincent. "The doctors and nurses needed to be reachable anywhere in hospital at any time, often in very crowded areas like nurses' stations. The ability to handle that overcrowding became a big differentiator for us."
Niehaus says the hospital doesn't expect to replace its landline voice system anytime in the foreseeable future. "This is just a supplement, for mobility. We will reduce our wired phones over time but I don't see replacing them completely. For me, as a conservative telecom person, it's just a concern over viability: Wireless doesn't offer 99.999 reliability, yet."
Supporting the three IEEE standards was no problem. "I don't think I've ever seen it on traditional access points where you can accommodate all three technologies," says Halpin. "I've never seen that work properly. With the Meru product, we've got all three technologies working at [the speeds] they're designed to work at."
By early summer, St. John's had settled on Meru as its provider, and in July the hospital purchased its first round of 140 access points. "We're ready now to go to the next phase of another 140 APs, which we're hoping to complete in January," explains Niehaus. "We'll complete the installation with 400 access points by next June."
Half the cost, twice the efficiency
At build-out the network will comprise 350 Vocera badges (lightweight, interactive voice-response units based on 802.11b) and 200 Avaya wireless handsets, plus at least 300 to 400 data users. The hospital also plans to provide access to the WLAN to around 50 guest users a day.
The cost: about $720 per access point including the control units, which average 140 access points per box, plus installation and technical support. "It's much cheaper than the other networks we looked at," says Halpin. "The Avaya/Proxim systems would have been almost $700,000, and with the other devices needed to run it, it would have cost close to $1 million. With this system we're looking at under $300,000."
The system has not been without flaws. In the early days, Vocera connections were being dropped between wiring closets -- a problem, says Halpin, that Meru corrected with its next release of firmware (software embedded in the equipment). In future upgrades, Niehaus would like to see more reporting capabilities, so that she can monitor network usage on a daily basis, plus enhanced triangulation features so that an individual badge or handset can be instantly located within the building.
The network has already begun to pay for itself. In its initial ROI analysis, the hospital estimated that the WLAN would save nurses an average of 30 minutes a day, for a total cost savings of around $2 million annually. In practice, that has proven to be a conservative estimate.
"Now we're up to almost $6 million a year based on other processes," states Niehaus. "For example, if we can get better turnover of our surgery suites, we can incorporate additional procedures. We realized that by shaving 10 minutes off our turnover time to get ready for the next procedure, we could add an additional 2,500 procedures a year. That's $1,500 per procedure."
What has the hospital learned from implementing the new network?
"This is a new technology for us, and we're trying to get on the cusp of networking for healthcare," Niehaus comments. "We needed a lot of patience to make sure we understood the thoroughness of what this enterprise solution needed to be. You can't rush it.
"It's a process improvement, and that's what we're all about: reducing healthcare costs and improving patient care."
— Richard Martin, Senior Editor, Unstrung