Cisco Catalyst 4500 Series Switches

Committed to excellence in patient care, education, and research, Clarian Health Partners' hospitals are leading healthcare facilities in Indiana and the Midwest. Located in Indianapolis, Indiana, Clarian incorporates Methodist Hospital, Indiana University Hospital, and Riley Hospital for Children. Clarian ranks among the top 10 transplant centers in the United States, and was the site of Indiana's first kidney, liver, heart, intestine, and bone marrow transplants. Riley Hospital for Children is ranked among the nation's top 20 hospitals by Child Magazine, and first in the United States in treating complex illnesses. Together, Clarian Health hospitals have 1391 beds with more than 55,500 admissions and more than 877,300 outpatient visits per year. They employ 11,088 staff members and 1327 physicians.

To continue delivering leading-edge care and successfully meet the increasing healthcare demands of a growing population, Clarian opened Clarian West Medical Center in 2004, which includes medical offices and diagnostic services. A new pathology laboratory and a new cancer center are underway, and the new Clarian North Medical Center is expected to open by the end of 2005. As Clarian adds facilities and extends innovative new procedures to patients, its operations increasingly rely on its network.

The organization's existing data network was a legacy infrastructure built over time on a variety of platforms from multiple vendors. When the three hospitals merged, so did their disparate networks. The resulting infrastructure was prone to instability, especially as users increasingly needed immediate access to patient data, real-time monitoring capabilities, and network access from three separate campuses. Users began experiencing frequent downtime, making charting applications, financial systems, and the GE PACS system (picture archiving and communication system) unavailable. The network's legacy connectivity links would become so congested with traffic during virus or worm outbreaks that occasionally entire buildings would lose connectivity. The hospital also did not have the underlying infrastructure it required to implement new features for security, cost-saving capabilities, and real-time clinical applications. These issues hindered productivity.

"Downtime is not acceptable for a healthcare facility," says Rich Johnson, chief information officer for Clarian. "In addition to affecting the clinical environment, it begins to affect staff morale and ultimately, the hospital's reputation. We needed a stable, robust network that provides a reliable base for delivering the best patient care possible-not just for today, but to assure that we are able to attract the best caregivers, administrators, and researchers for future innovation."

Working with its IT outsourcing partner, Capgemini, a leading provider of consulting, technology and outsourcing services, Clarian began a formal evaluation process to identify the best networking vendor and solution for its needs. The goal was to create a consistent metropolitan area network (MAN), with high availability, security, and manageability, as well as the scalability required to accommodate rapid growth and new capabilities. After extensive research, technical evaluation, and discussion, the Clarian team chose a networking solution from Cisco Systems® and AT&T's Metropolitan Area Network (MAN) optical networking service, which is also based on Cisco® equipment.

"We chose Cisco for its market leadership," says Johnson. "Its equipment capabilities were superior to what Clarian had been experiencing and we knew that the Cisco platform offered high levels of security. Cisco is very involved in developing standards for the networking community, and as a Cisco Strategic Alliance Partner, Capgemini has a close working relationship with Cisco."

The Clarian decision committee selected Cisco and AT&T to help Clarian accelerate the development of its end-to-end networking solution and to realize measurable, value-added results. The committee felt that a Cisco networking solution would be easiest to manage and maintain because of the vast knowledge base of information and certified technicians available.

Clarian's new MAN connects six large sites and five small sites over the AT&T-owned fiber. Dual, redundant Cisco Catalyst® 6506 Series switches are deployed at the large sites while dual, redundant Cisco Catalyst 4507 Series switches are deployed at the smaller sites. Additionally, 10-Gbps links connect four of the large sites over Clarian-owned fiber. Clarian's switches connect to AT&T-owned Cisco ONS 15454 Multiservice Provisioning Platforms (MSPPs). The IT team rate-limits bandwidth across the entire MAN to help assure maximum bandwidth availability as needed without exceeding the network's capacity at any given point in time.

To help assure high availability, Clarian configured its Cisco 6500 Series switches with Stateful SwitchOver (SSO). SSO enables the standby route processor (RP) in a redundant pair to transparently take over in less than 3 seconds if the active route processor fails. Thus, connections are not dropped during the switchover.

In the network's distribution layer, Cisco Catalyst 6509 Series switches are linked to the redundant core switches using dual 10-Gigabit Ethernet connections. Where security policies dictate, distribution switches also include a Cisco Firewall Services Module (FWSM). The FWSM is a high-speed integrated firewall that allows any port on the Cisco Catalyst 6500 to operate as a firewall port and integrates stateful firewall security inside the campus network.

The access layer is comprised of Cisco Catalyst 4507 switches and Cisco Catalyst 3750 Series switches with 10/100/1000 connections, depending on the location, and a portion of the access layer provides 802.3af Power over Ethernet (PoE).

Clarian has also deployed a storage area network (SAN) using Cisco MDS 9500 multilayer director switches. These switches provide intelligent network services that help eliminate the need for the hospital's IT staff to manage manually a wide range of network services. The Cisco MDS 9500's multiprotocol and multitransport integration will allow Clarian to integrate Fibre Channel in one system while allowing for iSCSI integration in the future. Now the IT team can allocate applications to the transport media that will deliver the best application performance in the most cost-effective way.

Clarian uses the SAN for its GE PACS system; CareWeb, an electronic medial records application; Lawson financial applications; and a variety of directory, e-mail, and other services running on UNIX and Windows servers. Virtual SANs (VSANs), comprehensive security, advanced traffic management, sophisticated diagnostics, and unified SAN management features save time and improve application performance.

"This decision was easy," says Johnson. "Cisco is applying the same networking innovation that has promoted advances in data networking into the Fibre Channel switching arena." The SAN significantly improves application responsiveness for physicians, radiologists, and other caregivers by handling large data files and bandwidth-intensive imaging applications with ease.

With its new infrastructure in place, Clarian is able to improve the performance of its current applications while building new capabilities designed to improve staff productivity, enhance communication, and promote higher levels of patient care. For example, Clarian has deployed Cisco Aironet® 1200 Series access points in the Clarian West Medical Center, using IEEE 802.11a, IEEE 802.11b/g radios for wireless coverage. The wireless solution helps staff stay connected wherever they are in the building, including conference and meeting rooms. When it opens, the Clarian North Medical Center will be based on Cisco IP Communications solutions, utilizing Cisco IP Telephony, Unity Unified Messaging, IPCC Express, and MeetingPlace.

"The single largest improvement we've seen is uptime," says Tom Jones, technology architect from Capgemini. "We had formed an executive committee to manage downtime situations, and now they're not always on the phone or spending their weekends onsite. With our Cisco Medical-Grade Network, we can act proactively to avert customer-experienced downtime."

The positive impact on clinical applications has also been significant-both in terms of coverage and cost. When a network outage occurred, for example in the pathology department, the hospital would have to scramble to bring in additional staff to handle the load. This increased costs from having to pay additional staff and overtime, and to operate facilities under emergency procedures. The new network provides a powerful tool for containing costs while simultaneously providing highly secure, responsive application performance for all users.

The Cisco Medical-Grade Network provides access to hundreds of applications used by clinical and administrative staff. A critical application for Clarian is Cerner PowerChart. Currently midway through a campus-wide implementation, the Cerner application will eventually provide a comprehensive health-information system covering all Clarian Health locations and users.

"This deployment gives us scalability that we did not have before," says Jones. "We would have had a difficult time trying to scale our applications in the old environment. Now, we are in a position to handle high application and physical growth. We've built an infrastructure that will certainly scale with our business plans." According to Jones, Clarian is also considering adding IP telephony capabilities, which is something the old network would not have supported.

The Cisco wireless access points provide wireless connectivity to the Cerner Point of Care application in selected patient care areas within the three main hospitals. Now nursing staff and other authorized caregivers can access patient data, such as test results, vital signs, and prescribed medications, from the patient's bedside. Using a computer cart or a tablet, they can perform patient charting and medical documentation at the point of care, rather than having to take handwritten notes and later manually enter that data into a terminal.

Clarian continues to deploy access-layer switches, delivering the same high application performance and reliability to all of its locations. Eventually there will be 14 locations running on the MAN. Plans are also underway for incorporating additional security and quality of service (QoS) features into the network to provide the Clarian system with added capabilities for remote physician access, network traffic prioritization, and mobility.

To learn more about Cisco Medical-Grade Network, visit: http://www.cisco.com/go/health.

To learn more about Cisco routing solutions, visit: http://www.cisco.com/go/routing.

To learn more about Cisco switching solutions, visit: http://www.cisco.com/go/switching.

To learn more about Cisco security solutions, visit: http://www.cisco.com/go/security.

To learn more about Cisco wireless solutions, visit: http://www.cisco.com/go/wireless.

To learn more about Cisco storage networking solutions, visit: http://www.cisco.com/go/storage.

To learn more about Clarian Health Partners, visit: http://www.clarian.org.

To learn more about Capgemini, visit: http://www.capgemini.com.