Rural Hospital Gets Wired

June 24, 2011
As if Sampson Regional Medical Center didn't have enough to contend with, the building was actually built on top of a bomb shelter. by Michelle

As if Sampson Regional Medical Center didn't have enough to contend with, the building was actually built on top of a bomb shelter.

by Michelle Grey

When a healthcare facility decides to implement and deploy a wireless network, a multitude of technological, financial and cultural factors need to be considered. The choice of vendor and type of network is often dependent on a facility's particular needs. For Sampson Regional Medical Center, Clinton, N.C., a 146-bed healthcare provider, lack of resources and building age were major considerations when it came time to choose a system.

David Ziolkowski, senior vice president and CIO at the rural facility, recently spoke with HCI Online Editor Michelle Grey about how the challenges associated with network selection, planning and implementation.

Why did you choose San Jose, Calif.-based Cisco to provide your wireless network?

The choice of vendor is usually dependent on the type of facility that will be running the network. We are a small rural hospital, and we have definitely implemented some advanced applications, but the reality is that Cisco has a pretty full complement of products, which allows us to benefit from an integrated solution.

What this means is that our maintenance costs and our service costs are a lot less, and I don't have a team of 20 or even five people that can work exclusively on wireless networks. So the standardization on the Cisco solution provided some downstream economies of scale.

What other vendors did you look at?

We looked primarily at Cisco and Meru (Sunnyvale, Calif.). I know that at a high level we felt like Cisco was safer, it was more industry standard, and we felt like we'd be able to support it more easily. We also felt that in certain areas we were getting better functionality.

Interestingly, with regards to price points, we felt that we could probably negotiate Meru down quite a bit, but when it was all said and done, we felt like standardizing the system on Cisco was something we could support a lot easier.

If you had an unlimited budget, would you still have gone with Cisco?

I think the fact that we are a small rural hospital with a more limited budget had nothing to do with our ultimate choice in vendor. I think if budgetary constraints weren't an issue it wouldn't have altered our choice. I tend to think that we still would have gone with Cisco. In fact, in terms of total cost of ownership for the network, Cisco is actually a little bit more expensive than the other systems we looked at.

What problems did you have with implementing your wireless network?

Getting real robust penetration throughout the hospital and all the various nooks and crannies was a challenge. We had to manipulate and re-distribute our access points quite a bit to get optimum coverage.

We're an old hospital, we were built in the 1950s, and the building was literally built to be a bomb shelter, which makes it very difficult to get penetration across the facility. The fundamental foundation of the constriction poses significant impediments to getting a good signal. Newer buildings just don't have that same issue. But the older buildings have thicker walls which really makes a difference. Wireless networks can penetrate modern materials much more easily.

How are you utilizing the wireless network in your hospital?

We gave wireless phones, made by Ascom (Berne, Switzerland), to all of our nurses, physicians, support staff, and security guards campus-wide. We integrated these wireless phones with several applications and systems within the hospital — our order entry system, our lab system, our radiology system, our PACS, our telemetry, our nurse call, our fire and safety, and our building maintenance system. We had over 20 integrations with our phones. What we can now do is send critical information directly to the phone of the person who needs that information.

Can you tell me about the infection control issues that come with implementing a wireless network in an existing building?

When implementing a network in an existing building you can only have two tiles open at once in the ceiling in patient areas, and every time you open a tile in the ceiling it has to be sealed off. That's a very arduous process that's required by the Joint Commission. Any time you put up an access point, you have to wire through the ceiling and, of course, there's no way of getting around this, seeing that research shows the best place for antennas in centralized locations is always in the ceiling.

What advice would you give to other rural hospitals looking to implement a wireless infrastructure?

It's imperative to pick a good vendor. For a hospital like ours, with limited IT resources, you really need to choose a vendor that's going to completely support the implementation. We outsource a lot of the stuff, so you need to be sure that they know what they're doing, and that the network is going to be configured the best way possible. Tweaking the network and getting all the different elements synchronized perfectly is not easy, and quite frankly, we don't even have that depth of skill. I think that we could manage and maintain it, but that initial configuration is something that we really needed help with.

I can't stress enough how important it is to do the research thoroughly. It's always a good idea to check references, and see how other implementations have fared. We called up the CIO of other hospitals, specifically ones that have been carried out in similar facilities. For us, we made sure to look at implementations in older buildings, making sure to ask in depth questions about the technologies that they were running, the performance of the network, the configuration, the overall robustness of the system, and any challenges they had with both the implementation and the up-keep of the network, and were they on-time and on-budget. We also asked if their vendor was easy to work with.

Think of your end user, what you're going to use your network for. I think if you're going to build an infrastructure, you should build it for the ability to scale. What we've experienced is once some of the users start utilizing applications on the wireless network, they no longer want to go back to a wired environment, which means that you have to have a network that's able to scale.

My advice is always to go big. If you're going to do it, put in a system that is scalable and, if possible, unified, and put in the infrastructure once, versus having to build and re-build several siloed systems.

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