Don’t Call It a Cell Phone

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When Northwestern Memorial Hospital opens its new Prentice Women’s Hospital this month, nurses there will be carrying wireless communications devices. Some of them may look like cell phones, but they’re not. The phones—and other communication devices the Chicago-based hospital has been testing for two years—run on voice over Internet protocol, or VoIP.

To users, the devices operate like any other phone, only with more advanced features. For example, when patients hit the nurse call button at their bedside, the call is routed directly to a small voice badge affixed to the nurse’s lapel. Among a handful of early healthcare adopters, Northwestern is looking to build on its VoIP intrastructure, offering advanced wireless communications capacity to caregivers in the new hospital, says Timothy Zoph, vice president and chief information officer. “Voice over Internet is a platform for innovation,” he says.

VoIP can be a good fit for the hospital environment, now that the technology has matured, early adopters say. Web-based telephony offers more flexibility than conventional PBX phone networks, which distribute analog data across dedicated lines. In addition to saving money once spent on an analog phone system, VoIP supports features beyond the reach of conventional phone systems. Because the Web-based phone is a digital device that rides on Web infrastructure, VoIP telephony sets the stage for expansion of the clinical data network.

Moving to VoIP is not without risk, however, as some CIOs who have endured network downtime have learned. That said, CIOs like Zoph are looking to expand their use of VoIP, noting that the technology fits well with the highly mobile hospital staff they serve. “With VoIP, you go from managing phones to managing data and network connections,” observes Praveen Chopra, chief information and supply chain officer at Children’s Hospital of Atlanta, a two-hospital health system with more than 4,000 VoIP phones in use.

Although VoIP technology has been around for several years, until recently it could not pass the reliability test needed for mission-critical communications in the healthcare setting. When it built its new campus in 1999, 744-staffed-bed Northwestern Memorial opted for standard PBX phones, recalls Zoph. “We wanted to make sure VoIP was rock-solid technology” before deploying it, he says. “Quality of service and reliability were the issues.” Despite advances in the technology, a VoIP system does require a high-bandwidth network. Children’s Hospital of Atlanta opted for VoIP in 2003, following the merger of two hospitals, Chopra recalls. “We were growing fast, had many satellite locations, and had a lot of disparate phone systems,” Chopra says. “We needed to streamline our phone system. We could either stick with our PBX system, or try something new. That something new was VoIP.”

In simple terms, VoIP systems run on the hospital’s intranet, or private Internet. The phones plug into the network like a PC. Voice messages travel in the same “data packets” that carry traditional e-mail—which is why a high-speed network is required to support voice transmissions. With a slower network, Web-based calls can echo or break up.

But digital voice communications enables numerous features, early adopters of VoIP say. “The phone is now a device that hooks into the data network,” explains Chopra. At Children’s, for example, staff retrieve their voice-mail messages right from their e-mail inbox. The VoIP system enables users to search through and save voice messages just like e-mail.

Features like that have been a big hit at Erlanger Health System, a five-hospital network in Chattanooga, TN, that is in the midst of a VoIP roll-out, says Laurene Vamprine, interim CIO. With some 1,500 VoIP phones deployed, Erlanger’s administrative staff tout the technology’s desktop management features, Vamprine says. In addition to the voice-mail capability, Erlanger staff members can send and receive faxes right from their desktop using the VoIP system. In contrast, conventional fax machines required dedicated lines, she explains.

Consolidating voice communications on the hospital’s network is also a big money-saver. Northwestern Memorial is saving approximately $1 million annually by converting to VoIP, according to Zoph. The hospital runs all voice, video and data across one network. Because of the way VoIP network switches are set up, they are more reliable and easy to maintain than conventional PBX telephony, Zoph adds. “The risk of failure goes to the edge of the network, rather than a central switch like you have in older voice networks,” he says.

That’s not to say that VoIP is risk-free. Once voice communication resides on the central hospital computer network, uptime becomes more critical than ever, says Chopra. “If the network is down, your phone system is down,” he says. That happened during a software upgrade at Children’s last year, Chopra recalls. “We had a complete blackout for 30 minutes.” Having a disaster plan in place is a must when relying on VoIP phones, Chopra adds. At Children’s, clinical departments keep back-up cell phones and maintain a small number of phones that can plug directly into an analog line. Because phone directories are stored on phones and PCs as part of the Web-based system, the hospital also maintains print copies of hospital directories.

But the potential of network downtime is not curbing the enthusiasm of early VoIP adopters. Erlanger is looking to expand its communications productivity tools, Vamprine says. Its VoIP phone system will support sophisticated call-forwarding features, including tailored routing of calls. In a similar vein, Erlanger is developing technology that can push alerts across the VoIP network. In addition, the health system is building a specimen notification-tracking system that will work in conjunction with VoIP. Currently, alerting calls from the lab to caregivers are tracked manually. With Web-based telephony, the phone system could keep track of when calls were made, Vamprine says.

For its part, Northwestern will distribute data directly from physiological monitors to hands-free voice badges, from Vocera, in the neonatal intensive care unit and operating rooms at the new women’s hospital, says Zoph. “The natural state of technology is a wireless state,” he says. “We will figure out ways to bring intelligent information to wireless voice devices.”

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at

VoIP Not a ‘Tech project,’ CIO Cautions

Erlanger Health System began deploying VoIP phones in 2005, but the project quickly stalled. Although the Chattanooga-based health system has deployed some 1,500 VoIP phones, it has 6,000 additional phones to install, a project that should be finished by 2009, says interim CIO Laurene Vamprine. The problem, Vamprine concedes, was that the VoIP system was perceived as a “tech project, not a business project that was an organizational objective.”

Erlanger underestimated the staff it would take to deploy the new technology. Later, as the installation began, other projects took priority. These included a new picture-archiving system and enterprise scheduling. “If we had sold the organization on the benefits of VoIP, it would have maintained its priority,” Vamprine says. “When you don’t tie IT initiatives to organizational goals, they will always be questioned.”

VoIP also can change the nature of once inwardly focused IT jobs, Vamprine adds. “One of the differences VoIP has made is with our technical staff,” she observes. “Some of our network engineers felt like they didn’t contribute to patient care. Now they are much [more] involved with clinical staff and see the value of what they do.”




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