• JULY 2007 FEATURE ARTICLES •
Wireless Case History
Do You Hear
What I Hear?
A large southern healthcare enterprise makes the leap to a modern wireless phone system.
By Debra Naderhoff
The situation is one in which many of today’s
organizations find themselves—purchase and
install the current technology or wait until the
new standards–based systems are ready. It’s an
all too familiar scenario, which Sentara Healthcare faced
in 2006 when considering installing wireless phones to
replace the obsolete, proprietary wireless phones in place
since 1998.
Sentara Healthcare operates more than 87 caregiving
sites, including seven acute care
hospitals with a total of 1,722 beds,
three outpatient care campuses, seven
nursing centers, three assisted living
centers, and more than 292 primary
care and multi–specialty physicians
serving southeastern Virginia and
northeastern North Carolina. Wireless
phones have been utilized in one
form or another in Sentara’s hospitals
since 1993. However, by 1998, a proprietary
wireless system was in place
at our Sentara Bayside hospital. This
set the standard for features and functionality
that all subsequent systems
had to meet, such as familiar handset
design for ease of use and training, as
well as dedicated direct inward dialing
numbers assigned to each phone
with integration to the wired phone
system. This feature allowed wireless
phone extensions to work like wired
phones and utilize the enterprisewide
voice–mail system. The new standard
put in place at that time was the integration
of a nurse call system with the
wireless phones, which enabled patients to communicate
directly and immediately with their caregivers.
Back to the Future
Though the technology and integration was great in
1998, by today’s standards the phones were bulky and
more than demonstrating their age. The batteries, which
snapped on the back of the phones, physically lost the
ability to maintain contact. Calls to physicians for instructions,
or to the lab for results, suddenly would get cut off Keeping them working was difficult and staff frustration
with their use grew daily.
The implications increased as the phones failed during
direct calls from caregivers to patients, leaving the
patients wondering if they’d been hung up on. Every call
from the outdated wireless handsets was unreliable. Once
the battery issue was discovered, staff devised their own
fixes employing rubber bands to keep the battery connection
stable. Often the phones had to be replaced, which
was costly.
At some locations, staff ceased using
the phones altogether. Calls to these
phones created constant complaints
from departments and physicians who
would call the numbers, get no answers,
and then call the nurse’s stations or the
hospital operators.
Callers never connected with the
persons they were trying to reach in the
majority of these cases. An inventory
of the phones assigned to the locations
revealed that more than half of the 300
phones were missing and had to be removed
from the system.
The proprietary wireless phone system
ultimately wasted more time than it
ever saved. That staff refused to use the
phones indicates the level of frustration
reached at that point. No matter what
value they originally brought, they were
not worth the trouble. Though October
2002 marked the end of the production
cycle for the proprietary wireless system,
Sentara continued to employ them
in multiple hospitals. The question was,
what technology should replace them and when?
Looking and Listening for a Solution
The answer came as Sentara embarked on multiple
expansion projects. New construction is one of a number
of avenues through which new designs, new processes and
new technologies can be adopted, and wireless phones
were definitely one of the coveted technologies. But which
one to choose? The complex decision meant first finding
a phone staff would embrace. We simultaneously needed a system that could continue to provide the functionality
and integration to which the staff was accustomed, while
also considering future requirements and cost.
Sentara looked at current proprietary wireless voice systems,
which bring advantages in hospital environments, but
decided that investing in a separate wireless network would
not be advantageous. A wireless IP system, on the other
hand, was appealing technology. We found that Sentara’s
IP network was robust enough to handle voice, and the
infrastructure’s configuration would allow us to integrate
the technology. We then faced the choice of which IP wireless
system to use.
During our decision process, the wireless Voice over IP
(VoIP) industry was on the cusp of implementing IEEE
802.11e quality of service (QoS) standards, however we
continued to hear of implementation dates that would
come and go. The IEEE standards such as 802.11b and
802.11g define bandwidth and compatibility, while the
802.11e standard controls the bandwidth by prioritizing
voice and other traffic and improving error correcting.
These controls reduce the delays to which voice traffic is
sensitive. If the standards are not in place, then wireless
VoIP systems will provide their own method of policing
these controls. The next questions were exactly how do those systems handle QoS and once the standards are in
place, what is the migration path? Will there be a need to
purchase new phones or other equipment when the standards
are in place and the vendor moves to embrace it?
Pilot Test Rollout
Though technology is a major consideration, staff satisfaction
also was an important component in deciding
to proceed with a pilot of potential IP wireless systems.
We chose two hospital locations: Sentara Leigh Hospital
(SLH), in which the current aging technology was still
in place; and, Sentara Virginia Beach General Hospital
(SVBGH), in which wireless phones would be a new
technology. We chose to pilot the Ascom FreeNet system,
which uses the new IEEE QoS standard and a comparable
solution from another vendor.
The pilot phase allowed the staff to test the new wireless
phones and compare them with the existing wireless
phones. It also allowed us to work with the administration
and system support via PBX interface. In addition, the differences
in QoS and call control could be tested with our
IP network components.
We found distinct technological differences between the
two test systems in both phone operation, administration and network interactions. The Ascom i75 Medic handset
functions like a cell phone, which the staff liked. However,
administration of the Ascom system was completely new
and non–intuitive. The Ascom system is intended to operate
as a stand–alone system, and as such, is set up as a true IT
network via a series of LAN connected servers based on
customer and application needs. Understanding how to
use the corporate voice mail systems, for example, would
have to be learned. Once installed, we also would have to
learn how to use the application’s server, and how to set
up phones in conjunction with our Avaya PBX, so it could
utilize the same voice mail system. (Incidentally, EC500
capabilities on the PBX are required.)
Conversely, while the second pilot–vendor’s system was
familiar and easy to manage, the phones operated similar to
wired desk phones and much of the clinical staff expressed
discomfort with the technology.
Finally, a huge factor in the decision–making process was
the integration of the long awaited IEEE 802.11e standards
into Sentara’s existing network and the FreeNet system.
By integrating this new standard, phones can mark their IP
packets, which the network detects and uses to prioritize
the voice traffic on the network. Regardless of how many
data and voice devices are in operation, traffic on the network
flows uninterrupted and without bandwidth loss.
The successful testing of this standard, and how it
worked in our environment, was key in convincing us that
the Ascom system positioned us for the technological
future of IP wireless phones.
Pilot Feedback
Both locations had two weeks to pilot the systems, with
training provided for the staff on phone use and feature
functionality—long enough for any issues with battery life,
durability and functionalities to surface. Both staffs found
that the Ascom phones provided good call quality and were
lightweight, durable and easy to operate.
The biggest change for the SLH staff was the way the
new system handled the interface to nurse call. The new
interface displays the patient’s call information from the
nurse call system on the caregiver’s phone. However,
pressing the button that would normally answer that call
places a call back to the patient room, which the patient
can answer via nurse call. This adds five seconds to the
process not experienced with the old technology, however
it is the way all nurse call/phone interfaces are handled
today. Ultimately, the time delay should decrease as technology
advances. This was an acceptable change for the
staff, given that the old, unreliable phones may not have
answered the call at all.
System Implementation
The first Ascom solution installation at Sentara took
place at SVBGH, and was as successful as a first installation can be. The nurse executive and nurse managers were, and
continue to be, fully engaged in the decisions determining
both the number of handsets needed per floor and how the
phones will be utilized. Both of these considerations are
based on their workflow and in conjunction with how the
other Sentara hospitals were using the old phones.
The pilot allowed them the opportunity to experience
the system functionality and to receive feedback from
the staff. They were ultimately responsible for doing
all the hard work determining
how many handsets and who
will have them—from RNs and
LPNs to care partners and ESD
staff on the floor. This also determined who would be
trained. In addition, they determined such issues as how
voice mail will be used, policy on how to use the phones
when in a patient room and what happens if a phone is
mistakenly taken home or lost.
The involvement of senior management at the hospital
ensured the system install, handset deployment and customer
training went well. Unfortunately, the integration
to the PBX via T–1s did not progress so smoothly. After
days of working the issue with all levels of engineers, we
concentrated on the timing source for the circuits. Once
we worked to provide the same timing clock for the
circuits, PBX and FreeNet system, everything worked
as designed.
Today, the FreeNet system is deployed at three of our
seven hospitals, with two locations using i75 handsets
across our network from those hospital systems. A cost
consideration of the Ascom system, as with any wireless
IP system, is the value of utilizing a network that is already
in place and successfully managed for data traffic today.
This is in contrast to the old proprietary system needing
its own network.
The cost of Ascom was approximately 5 percent less
than the others we looked at or piloted. However, the real
benefit is realized from the relief of staff frustration and
additional work due to the unreliability of the old phones.
Two additional hospitals will install and deploy the system
this year, while the remaining two are working on the budget
to install in 2008 or beyond. After more than a year of
working with the Ascom system, current customer surveys
indicate the phones continue to be the correct choice for
providing clear and uninterrupted communication, which
enables our staff to provide the best possible care.
Debra Naderhoff is communications technologies
director at Sentara Healthcare.
Contact her at dlnaderh@sentara.com.
