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Nortel Networks

When Johnson Memorial Hospital needed to upgrade its backbone network while enabling a cost-effective migration path to support Voice over IP (VoIP), management selected a networking solution from Nortel Networks to improve network performance while maintaining maximum flexibility to support future voice and data requirements.

Healthcare networks are under increasing performance pressure as data applications, user requirements, and business demands necessitate increased throughput and scalability. Johnson Memorial Hospital, located in Franklin, Indiana, is a 161-bed, not-for-profit hospital serving the healthcare needs of Johnson County and surrounding areas. When the hospital became overloaded with applications and users, management turned to Nortel Networks for a core network infrastructure that could relieve backbone pressures and enable future scalability to support high-bandwidth applications.

Johnson Memorial Hospital has been bringing quality healthcare to Central Indiana residents for more than fifty years. Some of its services include a 24-hour emergency department, maternity center suites, a freestanding outpatient cardiac and physical rehabilitation center, occupational health, home health, a sleep center, a rehabilitation and long-term care facility, and outpatient services. The hospital, located 20 miles south of Indianapolis, has about six hundred employees and competes successfully with much larger hospitals located within the nine-county Greater Indianapolis geographic area.

The hospital had a flat network, with 10 Mbps Ethernet distributed to about five hundred nodes to support both business and patient care applications. This legacy data network supported three buildings on a single campus. The network was becoming obsolete as the hospital expanded to support additional users and new software applications. The voice infrastructure is based on Meridian 1* Option 61C, an Enterprise PBX from Nortel Networks that continues to meet all the voice requirements of the hospital.

Identifying the need to upgrade

Johnson Memorial Hospital was faced with the challenge of upgrading the core data network to support new applications and provide a migration path to enable highbandwidth demands for potential video and multimedia applications.

Most of the traffic on the data network ran over IP, but this network had not been updated in years. Philip Roell, Network Administrator for Johnson Memorial, said, “We had a flat network, but it was being choked by server applications that were being distributed throughout the hospital facilities. We were not at the point where we were having downtime problems, but the equipment was at least five years old and the network was in serious need of an upgrade.”

The hospital was considering applications such as medical imaging to the desktop, but the network was operating nearly at capacity and had no room to support high-bandwidth applications. By the end of 1999, the Information Services (IS) Department had determined that the network was in dire need of an upgrade. Roell said, “The hubs in the data center looked like Christmas lights by the holiday season because we were experiencing so many traffic collisions on the LAN infrastructure.”

Johnson Memorial wanted to maintain its investment in its voice infrastructure but wanted to upgrade the data network to better support business and clinical applications and allow for expandability to enable new applications in the future. After careful evaluation, management selected a healthcare networking solution from Nortel Networks to alleviate the backbone congestion and enable future network growth support.

The solution was to deploy a Passport* 8000 in the core of the network and migrate from 10 Mbps shared Ethernet to dedicated 100 Mbps Fast Ethernet connections to all computers on the network. The hospital also decided to build a core Gigabit Ethernet backbone and connect all of the wiring closets over the core network.

The network was quickly deployed and it relieved the backbone congestion and eliminated performance issues. Johnson Memorial now manages the network using the Optivity* network management tools from Nortel Networks, and it now has the infrastructure in place to support business applications as well as critical patient care applications.

Improving network performance

The flat network was experiencing performance problems, and applications from MEDITECH – a provider of healthcare information systems software applications – were further burdening the network as they were becoming more broadly used throughout the hospital. The servers running the MEDITECH applications were also connected over 10 Mbps shared Ethernet, and the traffic between these servers was a source of major performance problems. Al Godsoe, Director of IS and Communications, said, “We knew we had a problem, but we weren’t sure what to do. We needed to partner with a network equipment vendor that understood the critical needs of a healthcare provider.”

Roell concurred, “Like most hospitals, we have a small IS staff so we had to figure out what to do quickly and select a partner who could help us improve the network performance. We invited both Nortel Networks and Cisco Systems to propose solutions, and after a careful evaluation we selected the solution from Nortel Networks because we felt it would be more cost-effective over the long term.”

Nortel Networks conducted an audit of the network and concluded that it was running at approximately 85% utilization – a very high rate for a “life-critical” network. Nortel Networks offered a solution that would increase performance, and improve the ease of use and management of the network. It would also provide the scalability needed to support new applications in the future.

“We foresaw the day when we might be running VoIP, but we wanted to leverage our existing voice infrastructure while preparing for the future,” said Roell. “Nortel Networks proposed a solution that would greatly improve data network performance while allowing us to continue to benefit from our Meridian 1 voice network and still retain a migration path to VoIP. The solution from Cisco Systems would have forced us to walk away from our existing voice network.” With this Nortel Networks solution, Johnson Memorial maintains several options for implementing VoIP in the future.

Godsoe said, “Nortel Networks offered a solution that would give us a stronger backbone for the same price, and we were more comfortable with the speed and reliability of this option. An added bonus was the potential interoperability with Meridian if in the future we decided to evolve toward a converged IP solution. We did not want to extend our data network at the expense of throwing away our existing investment in voice infrastructure, so the ability to upgrade our data network while preserving a migration path toward a converged network was very appealing.”

Deploying the network upgrade

Nortel Networks brought in Exp@nets – a distribution partner – to help implement the network upgrade. The legacy shared-media hubs were replaced with BayStack* 450 switches to provide dedicated 100 Mbps Fast Ethernet to each node. A Passport 8000 Routing Switch was deployed in the core of the network. It leverages the unmatched experience of Nortel Networks in delivering high availability systems for critical networks and features a highly fault-tolerant chassis so it can deliver unprecedented levels of resilience and availability. The Passport 8000 Series also provides investment protection by enabling seamless integration of routing switch technology and IP telephony. Passport would provide the segmentation needed on the network while also offering a potential migration path to support the convergence of voice and data over a single integrated network.

The servers running the MEDITECH applications were connected directly to the Passport to reduce congestion. Johnson Memorial can potentially further segment the network by adding additional blades to the Passport, thus providing a migration path to ease any future performance burdens.

The Optivity suite of network management tools can now control and manage the network. “The network runs very smoothly, but Optivity gives us the potential to monitor performance when needed and to centrally troubleshoot and maintain equipment throughout the hospital,” said Roell. Network management tools are important to hospitals because of the inevitable limitations on hiring network operations staff. By enabling centralized management and control, Johnson Memorial is prepared to efficiently troubleshoot and manage the network and to proactively monitor the network to avoid any future problems.

The network installation went well, and users quickly noticed the improvement. Roell said, “It was like we went from driving on a dirt road to driving on an eight-lane superhighway, and the performance improvements made everybody happy. We have not even had to use any of Optivity’s robust prioritization or queuing features yet, since everything is running so smoothly and we have no performance issues.”

The network – which had previously been operating at roughly 85% utilization – was measured at running at a 1.5% utilization rate shortly after the upgrade. The hospital immediately benefited from the increased speed and performance, and Johnson Memorial was able to establish a Clinical Data Repository (CDR) much faster than planned because of the superior performance. Godsoe said, “A consultant thought that getting six years of data from our MEDITECH applications over the network in short bursts would take two to three months. This was based on our older network, but when we migrated the data, we completed it overnight. We had to call MEDITECH to ask why the data wasn’t transmitting anymore, and we found out that the transmission had been completed.” The high-performance network infrastructure had allowed Johnson Memorial to establish the CDR ahead of schedule with no performance drain on the day-to-day use of patient care or business applications.

This network solution conformed to the requirements of the Health Insurance Portability and Accountability Act (HIPAA), which mandated regulations that govern privacy, security, and administrative simplification standards for healthcare information. This law will require major changes in how healthcare organizations handle all facets of information management, and the network for Johnson Memorial will be fully compliant with HIPAA standards as they become finalized.

Moving forward

The hospital is considering adding routing blades to the Passport to further segment the network, and the IS Department is working closely with other departments throughout the hospital to plan for future applications. Roell said, “We are helping our departments understand the potential impact on network performance of applications that they are considering. We’ve designed the network so that we can expand it if needed to support any new applications while still leveraging the new equipment. We work with the planning organization so we can project future demands. For example, if the hospital decides to add a new building, we’ll help them understand the impact on network performance and work with Nortel Networks to suggest an upgrade to support these new users. We’ll also be able to incorporate LANs that had previously been separate onto our network.

For example, the Radiology Department runs a separate LAN because of the performance demands of the high-bandwidth imaging applications they require. We’ll now be able to add this Fast Ethernet LAN segment onto the core network.”

Customer satisfaction has been the primary measurement of the success of the network upgrade. According to Godsoe, “We went from having constant complaints about network performance to getting zero complaints. Our users are more than satisfied with the network improvement, and this infrastructure is helping the hospital compete with larger hospitals in Indianapolis. Johnson Memorial is an asset to the community, and the network makes us more effective at managing our operations and satisfying the treatment requirements of our patients.”

Godsoe and Roell regularly participate in the MEDITECH users group and have been explaining to other mid-size hospitals the advantages of deploying a Passport solution with BayStack switches to alleviate congestion problems on legacy data networks. Johnson Memorial is now considering a Nortel Networks Contivity* Virtual Private Network (VPN) solution that will allow the hospital to cut down on remote access charges by enabling remote locations and users to connect to the central network over the Internet.

Godsoe said, “Nortel Networks understands the challenges of building and managing healthcare networks, and the company has been a partner to us in building and maintaining our network infrastructure. We’ve been very pleased with Nortel Networks and with how well their employees understand the demands of a healthcare network. As we continue to evolve our network to support clinical or business initiatives, we will look to Nortel Networks to help us deploy solutions that help us meet the hospital’s objectives.”