For 100 years, Cornwall Community Hospital has been caring for the people in and around Cornwall, one of the largest cities in eastern Ontario, Canada. In 2013, the hospital opened a new 95,000 sq ft wing with state-of-the-art diagnostic, emergency, and surgical services, designed to improve the healthcare experience.
The hospital also decided to invest in a Wi-Fi solution that would not only provide its primary communications network, but also help it to reach its strategic goals of full clinical integration and HIMSS Stage 6, while also improving care and enhancing staff efficiency.
Achieving Healthcare Information & Management Systems Society (HIMSS) Stage 6 is a feat very few hospitals have achieved. This strategic roadmap calls for full integration of clinical information systems through a fully integrated system (FITS), for which Cornwall is turning to the cloud.
‘When complete, we’ll be the first hospital in Canada to deploy a cloud-based FITS,’ reports Mario Alibrando, Director of Information Technology at Cornwall Community Hospital. The hosted solution will integrate every clinical system that the hospital offers – admitting, emergency, operating rooms, laboratory, pharmacy, radiology.
‘We are trying to build an infrastructure that will allow us access to the whole patient record, by any means possible, whether that be a desktop computer at the nursing station, wall-mounted viewing station in the hallway, smartphone in the nurse’s pocket, tablet that a doctor brings to the bedside, or some other device that hasn’t been invented yet,’ says Alibrando.
‘That is where the wireless network comes in. You can’t move up the HIMSS scale and get to full integration without a wireless network – but it has to be as reliable and available as your wired network,’ he says. And that’s where many hospitals are going to run into trouble, he contends.
‘A lot of hospitals think of wireless networks the way hotels do. Let’s give everybody access to the Internet so they can check their webmail. When they try to run real-time, heavy-duty clinical applications on that network, they’ll have a difficult time. Many will have to rip out and re-evaluate,’ predicts Alibrando.
Right first time
Cornwall started with the premise that it should build an infrastructure capable of being the foundation for everything that’s coming in the future. That meant getting the design and network architecture right first time.
‘Anybody who has put in a wired network knows that once you’ve put in a topology, changing it later is very expensive. So, you try to get the topology right the first time. That’s what we did,’ says Alibrando.
Because the quality of care and even patients’ lives are at stake, an important characteristic of that infrastructure is availability. ‘Our data centre and wired network have to be available 99.999% of the time. Hence the wireless infrastructure was put in place to reach that same level,’ adds Alibrando.
In addition to high availability, Cornwall’s requirements for a solid wireless infrastructure to take them into the future included:
• Accessibility: coverage for the entire hospital with no dead zones.
• Bandwidth: the ability to run the most sophisticated applications with acceptable response times.
• Scalability: the ability to keep up with new applications, new devices, and new protocols.
Meru wireless technology
For its future-ready wireless infrastructure, Cornwall selected Meru’s Uninterrupted Care Network (UCN). ‘The single most important deciding factor for Meru is the bandwidth and the scalability of the solution. Other options were “hub” topologies, where the more people you put on the system the more the performance deteriorated,’ says Alibrando.
‘Meru demonstrated how we could keep adding people and be able to maintain the bandwidth to run the application. Meru’s single channel architecture, Air Traffic Control and Airtime Fairness Technology make that possible,’ he says.
Meru was the only solution that was set up to work almost like a wired network.
‘Although it’s wireless, it runs much like our switch technology does on the wired side,’ he says. Other solutions he evaluated ‘would be great for searching Internet sites and Facebook, but could not really establish that they could run true high-bandwidth applications.
‘With the Meru architecture we have the option to blanket the entire hospital with one channel and then layer channels if we want to separate or isolate certain applications. We aren’t layering channels yet because we have had no bandwidth issues.’ Channel layering gives Cornwall the flexibility to triple the bandwidth of the network as their needs grow in the future.
The Meru UCN installed at Cornwall consists of an MC4200 controller for large enterprises, with a Meru Virtual Mobility controller for VMware environments providing redundancy for the high availability that the clinical environment requires. Meru AP320 access points are installed throughout most of the hospital and parking structures.
But in the new wing of the hospital, a 95,000 square-foot contemporary health care space, AP832 dual-radio, dual-band 802.11a/b/g/n/ac WLAN access points are being deployed. The new wing houses the modernised emergency department, six new operating suites, and diagnostic services.
The AP832s can operate in the 5GHz band to support 802.11ac and deliver a maximum data rate of 1.3Gbps per radio. ‘We are building for 11.ac and it’s going first in the new wing where the high bandwidth needs are greatest,’ says Alibrando.
The Wi-Fi is enabling dieticians to enter menus on tablet devices at the patient bedside, while an electronic whiteboard and bedboard app notifies transport when patients need to be moved, and housekeeping when rooms are ready for cleaning.
‘We are able to turn rooms faster, reduce waiting, and get patients into rooms more quickly,’ says Alibrando. Using Salesforce.com, maintenance personnel receive and update service requests on mobile devices. Staff carry Wi-Fi-enabled Sony Xperia smart phones for communication from anywhere in the hospital.
A major benefit of the wireless infrastructure is untethering clinicians from the congested nursing station, by providing access to the patient record on any mobile device. ‘Nursing stations have very little capacity or real estate for all staff to use a computer. The best way to expand the real estate is through mobile technology,’ says Alibrando.
‘Many new tools are coming that enable staff to take the nursing station everywhere and access the clinical record on any device wherever they happen to be.’
For example, Cornwall is installing wall-mounted clinical viewing stations in various locations, but the cost of cabling has been a hindrance. ‘We’re going to try micro-desktops with integrated wireless network cards. By going wireless, we can save $400 per viewing station. The UCN gives us accessibility on all types of devices anywhere.’
PACS flies without wires
Wanting to test network bandwidth and performance, Alibrando decided to try the most demanding application in the hospital, the picture archiving and communications system (PACS) that stores all patient diagnostic and treatment planning images.
The question was: could the Meru infrastructure pass the test of running the most bandwidth-hungry clinical applications? ‘In order to measure how quick the network was, we tested it by running PACS over it. We were able to produce huge images over the wireless network,’ Alibrando reports.
Summing up, Alibrando says: ‘Right now we’re using very little of the network capacity. Meru technology is so robust that we barely feel any traffic on it. We are confident that we have the infrastructure to take us to HIMSS Stage 6.’
Wi-Fi Deployment Summary
• Full wireless coverage throughout hospital and its parking area
• 802.11ac in new state-of-the-art wing where high bandwidth is needed for diagnostic, ER and OR services
• Redundant virtual controller for high availability.
• Robust wireless infrastructure with availability comparable to wired networks, and which enables HIMSS Stage 6
• Clinical care staff untethered from the hard-wired nurses station
• Access to all electronic healthcare record (EHR) from anywhere
• Improved efficiency in care delivery.