This is our first newsletter in over a year as we really have not had time to put out a quality publication. We hope you agree that this issue addresses applications that you might want to consider implementing to make your hospital even more efficient.

 Please contact us if you have questions or want to discuss how you might benefit from using our consulting services. Visit our web site to review some of our consultancies.

THE WORLD IS FLAT

I recently finished reading a fascinating book by Thomas L. Friedman, titled The World is Flat. I do not agree with Mr. Friedman’s politics but he helped me understand that we really are in a global economy. This should be suggested reading for parents so they can direct their children on how to prepare to compete in this new market place. There really is a new set of rules. Our business, telecommunications, is one of the things that is responsible for the world being flat. A quote from the book that addresses IP

“--but when you put voice on an internet platform, all sorts of innovative options for collaboration become possible. You will have a buddy list of people and all you have to do is click on a name and the call will go through. You want caller ID? The caller’s picture will come up on the screen. Companies will compete over SoIP (services over the Internet protocol): who can offer you the best video-conferencing while you are talking on the computer, PDA or laptop; who can enable you to talk to someone while easily inviting a third or fourth person into the conversation; who can enable you to talk and swap document files and send text messages at the same time, so you can actually speak and work on a document together while talking.

 Most of the book does not address such technical issues but talks about how some of the technical stuff is responsible for us shifting jobs overseas while creating more jobs here; at the same time.

IP or VoIP

2005 was the first time that the telephone manufacturers shipped more IP lines than TDM. IP is here to stay and your job is to help determine the best time to deploy IP at your hospital. The fact is, there are not yet compelling reasons to shift from TDM to IP in many hospitals. There are two major exceptions to this statement.

  (1) If you have a new building or buildings, IP is an effective way to use the same cable plant to carry both voice and data. Since you have to purchase LAN electronics anyhow, IT can determine what is needed to handle both disciplines.

   (2) If you want to tie off-site locations back to the main campus via the existing data WAN, then you will have a case for IP. Not having two separate networks will provide monthly cost savings.

 Most times, we find that there will be a cost to replace at least some existing electronics that will not satisfy IP requirements when you use your WAN or LAN as the IP pathway. The accepted process is to perform an IP Check on the WAN or LAN which will provide a “pass, fail” reading. If the reading is “fail”, then a more in-depth WAN or LAN analysis will have to be performed. This last analysis indicates exactly what you will have to do to make your network IP ready.

 The chosen vendor may perform the initial study as part of the deal. The cost for this study should be less than $1,000. The formal analysis or in-depth analysis usually costs between $3.000 and $15,000 and is generally not a freebie from your vendor. 

 You should never plan or budget for IP without:

·         Involving the IT folks at your facility. Our experience indicates that they drive this IP decision

·         Having an IP analysis done to determine if the WAN/LAN can carry the voice traffic without changing electronics or other WAN/LAN elements.

 In our experience, it is often true that the additional communications capabilities inherent in IP do not justify the changeover to IP for a hospital. However, every new switch we have implemented in the last couple of years has been an IP/TDM Hybrid. This means the client is ready for IP when they inevitably must make the switch.

HOSPITAL PBX APPLICATIONS

There are several applications that a modern PBX will perform that would benefit many of your hospitals; and you do not need IP to do them. The vendors may not have told you about these applications because:

• The applications may not be worth implementing, because from a sales commission perspective, they are not rewarding
• The salesperson may not have hospital experience or may not know about a given application

Some of the applications are:

 Follow Me Number Assignment:  In many hospitals a patient is transferred at least once, often more than once, during their hospital stay. If you have DID, the callers to the patient who has been transferred interrupt the patient who is now in the previous bed. This is the reason some hospitals do not provide DID to patient telephones which in turn puts added workload on the attendants.

A solution is to install an application where the ADT system (admissions, discharge and transfer) is interfaced with the PBX data base. Once this is done a transfer in ADT tells the PBX that the patient is now in bed xyz and incoming calls to the patient DID number now go to the telephone at the new bed. It works every time. Part of the engineering arrangement is to first assign a non-DID to each bed so as to initially identify each bed.

 This application will require the full support of your IT department as the PBX portion of the arrangement is one of two components.

Automatic Directory Updates: Multi-campus healthcare systems long ago gave up publishing a paper directory; they are outdated before they can be published and distributed. Instead, an electronic directory is compiled, using Microsoft Outlook or another software program. Even then the directory is generally out of date if personnel changes are made manually.

 There is an application where the PBX data base can be interfaced with the Human Resources software and the electronic directory software. Any change affecting numbers in the PBX data base or a change in the Human Resource software adding or deleting personnel will automatically update the directory.

Even with this arrangement in place for the larger entities comprising your facility there will probably be some sites that may have key telephone systems, etc. that are not tied into the automatic update arrangement. These locations will still require manual input for directory updates but the heavy lifting will be done automatically.

 Please note that this is another application that cannot occur without the cooperation and full support of your IT department. Are you starting to get the idea that voice and data are no longer “moving toward integration”? It has already occurred.

Multi Media Messaging (MMM): This inexpensive application is one that can be implemented easily if you have a voice messaging system that is running current software.

Once a person has been assigned a seat on MMM, they can access voice mail, e-mail or fax messages (if fax is via a fax sever) from a telephone, PC or wireless PDA.

E-mail and faxes are converted to voice messages if you use a telephone to access messages and conversely, voice is converted to text if your access is via a PC or PDA.

 Software licensing usually comes in packages of 20 or 25, depending on your voice messaging system.

 This feature is one that Administration really likes and we suggest that your first assignments go to the Administrative staff.

 You have probably already surmised that the implementation of this application requires IT involvement, although not as much as the first two applications.

Centralized Attendant Service (CAS): Many of you are in healthcare systems that consist of more than one hospital or have off-site locations that have telephone attendants at other than the main campus. With the push to cut costs in your healthcare system, you may have been asked about consolidating attendant positions at a central location; the main thrust being to cut back on attendant staffing.

A problem with centralizing attendants is that they perform multiple duties at most hospitals. In addition to answering calls to the central number, they also issue codes, stat calls, monitor multiple alarm systems and panels, etc.

The easiest function to engineer is having calls from multiple sites come to a central location, having the attendant answer and give the name of the “called” facility. Even dispatching the call to the proper person is routine.

The major problem remains; “Who is going to perform the multiple monitoring functions that the attendants performed at the old location”?

 Until recently, it was very expensive or in some instances, not possible, to send the signals from the ancillary alarm systems to the CAS location.

 We were involved in a CAS operation 12 years ago where the client spent almost $100,000 to redirect all alarm systems and enunciator panels to a different location within the hospital that lost their attendants. Having Engineering and Emergency Room now monitor certain alarms was fiercely resisted by those departments.

 Due to modern technology, there are at least two ways to transmit the signals from the off-site locations to the CAS location and identify where the signals are coming from and from what system. The first is to have all alarms go into a server at the initial facility and have the server recognize what is being sent. That information is then sent to another server at the CAS location and that server interprets the content of the transmission and shows on the Intelligent Console or on a PC, the nature of the alarm.

 A second and proven method of directing the identified alarms is to have the alarm go to a wireless telephone and have the LED panel identify “what and where”. We have seen this work and it works well.

A critical component of either described method is to build in a backup arrangement so that a secondary alarm occurs at the affected facility in case the primary method of notification fails.

 A final concern is that your Engineering department will have to be sold on the new solution as they generally have to respond to most of the alarms. 

JIM RIGSBY & ASSOCIATES, INC.

We hope you know who we are and will contact us if we may be of service. If you do not know us, check our website or give us a call or e-mail and we will send you our 16 page brochure. It discusses our major services and provides background on the company. The main E-mail address is jerigsby@jimrigsbyassoc.com and the main telephone number is 330-854-9820. 

Our pure telecommunications consulting firm has been in business since 1975 and to date we have completed over 600 hospital projects in 38 states. If we have not worked for you, we have probably worked for a hospital you know, or know of.

Our consulting services include, but are not limited to:

• Preparation of Telecommunications Planning documents.
• Design and redesign of telephone systems.
• Design and redesign of IT systems.
• Network design and implementation; LAN, WAN (IP, data, video and plain old voice).
• Project Management
• PAS Business Planning and Implementation.
• Migrating toward IP.

 Send me an e-mail and take the opportunity to provide opinion on content.