I know VOIP is great Technology, but would it make sense to go completely VOIP in a Medical Center?

Kevin

I am sure you will agree that voice communications is a mission critical application in the medical facility?

Given the implied need for reliability, availability, flexibility and security, I would not suggest running a pure VoIP system from an off-site switch, whether you own the switch in a collo or it is a shared tenant service from a carrier or Service Provider.

Lets start off with why would you want to run VoIP? Save LAN infrastructure capital investment and work-site LAN operating cost sounds good. It is faster, cheaper and better are always good considerations. These two claims, even if true, are not necessarily important consideration in mission critical applications.

My rational it relatively simple. Pure VoIP is a call and connectivity protocol running on an unreliable protocol (IP) that has no session controls (layer 4) nor layer 2 data link management functionality, versus the current IP-PBX and hybrid TDM/IP-PBX models, for running voice datagrams over Ethernet as the underlying layer 2 protocol and VLAN segmentation and policies for security, failover, reliability, Quality of Service control and recovery from failures.

This virtual service VoIP-PBX overlay on site actually runs over the same same infrastructure needed to support pure VoIP over Ethernet. If both site LAN infrastructures were engineered for the same voice, data and video traffic and site management, I would think there would be very little, if any, difference in the LAN infrastructure cost.

Outbound and inbound voice traffic to/from the site generally needs to be a mixture of pure VoIP - Voice over Cable modem, voice over DSL, Voice over ATM, Voice over un-channalized T1/T3 (Ethernet carrier services are typically not available to most buildings and the current Ethernet services presuppose dedicated hosted data centers to gateway into the Rest of the Wolrd). Given the low quality and high price per line from the US carriers, you may need to have a mix of facilities to minimize connectivity costs and maximize uptime, reliability and provide the site with service protection.

Having the IP-PBX or TDM/IP-PBX hybrid on site enables you to dual home the IP site. This redundancy (sheath, facility type, route and separate carrier) is not typically available from a collo or shared Tenant VoIP vendor. You can also have failover to analog lines and cellular lines that can be used to dial around the IP network when necessary.

As mentioned by others, you should also pay some attention to HIPPA and PCI needs given the size of the medical tickets and mission critical health history stuff, I will make it simple, nothing that goes over the Internet can ever be HIPPA compliant, unless they change the law and chain of control requirements (spoof a server or client is kids stuff, compared to spoof an x-Ray, MRI, cat scan, DNA diagnostic or paternity test). It is a little worse and just as easy to spoof an diagnostic report and IP cannot maintain a chain of control using the Internet Protocol). PCI financial processing will probably evolve in this same kind of security direction.

I hope this helps and gives you some things to consider when thinking about a medical facility.

Howard Gunn

Interesting question, Kevin. There's no reason not to, but the biggest wildcard for me would the demands on your data network. If you're running a lot of data-intensive applications or file transfers - X-rays, diagnostic imaging, scans, etc. - that could impact the performance of VoIP. Not only do these apps take a lot of bandwidth, but if their use is intermittent, that could cause spikes in your network, which could compromise VoIP service.

That said, you can mitigate this by using a provider that runs over a private IP network, especially if it's their own. That's the best way to ensure QoS and prioritization of voice over data. Related to this, btw, is HIPPA, which may require you to have dedicated VoIP service for compliance. These are all solvable issues, and if your network is properly optimized for voice, going all-in for VoIP can certainly work for you.

Kevin,

I agree with Jon that there are HIPPA and also PCI compliance that you have to consider. I would recommend that you bite the bullet and pay to have a network assessment done so that you know exactly what your network can handle and where you need to pay more attention.

With that said, VoIP can certainly benefit any type of business if it's deployed correctly.

The devil is in the details, but there is no reason that VOIP couldn't be 100% deployed in a medical environment. And, there are some great reasons why you could benefit from it.

Wireless telephony is probably a good example. As you deploy wireless devices throughout the campus, integrating voice into that wireless network will allow for increased mobility of your workforce.

There are some products that are designed for deploying VOIP in an environment such as a hospital. For instance, with the extremely high cost to wire older patient rooms with cabling to meet your network needs, there are products such as Phybridge that will allow you to run ethernet, including voice, over your existing cat 3 cable, providing QOS and Vlan tagging within the product to assist in our QOS design, withouth the messy cost of cable upgrades. With that, you have now enabled the rollout of other ethernet bases serves to teh patient room.

This is one example of products that help in a healthcare environment, and allow the deployment of a unified network.

I think you probably need to do a bit more homework before you really ask this question. Certainly VoIP technology can adequately handle the demands the of a hospital. But you will need to assess the total picture of what your requirements are. For example, All circuits will go down at some point, so you will need an adequate backup infrastructure in place to seemlessly fail over. The consequences can literally be life or death in this situation. Aside from backup, as mentioned above, hospitals are rapidly expanding the use of data intensive tools, so you will definitely want to engineer you network to separate the massive data requirements from your VoIP applications. We are auditing a hospital now and are having our eyes opened up a bit as to what can be done in this setting. Sorry for long drawn out answer, but in short, VoIP can certainly be used in a Medical Center, but it needs to be engineered properly.

If you have mission critical needs then I would suggest VoIP with SONET (T-1 or better) connectivity. There's no gaurantee POTS (analog) lines will work any better than VoIP. And yes, you should have a reputable telecommunications consultant evaluate your needs before you do anything.

Paul, one benefit to POTS lines in a redundant setup is that if the power to the building goes down, the POTS lines won't. Most better premise-based VOIP phone systems have analog ports and many VOIP providers are now offering devices that will accept both IP and analog connections to promote redundancy. Definitely agree on your point about using a reputable telecommunications consultant.

Hi John,
If everything worked on copper pairs from the CO then what you saying would be true. The fact is most POTS lines are provisioned on SONET carriers today and they are dependent on battery back up in case of power failure. That will provide 4 hours without power at best. It's been my experience that companies who run mission critical sites have back up generators standing by. It's also been my experience that in today's world, a failure on POTS lines can take 2-4 days for service to be restored. SONET on the other hand has a guarenteed MTR (Mean Time to Repair). Maybe it's just me, but I would never recommend POTS as a redundant strategy.

Utilization of bandwidth is definitely a concern. You should have a clear understanding of bandwidth requirement by any of the applications utilizing the infrastructure. Saturation can cause your uilization to peak and create problems on the network that you cannot afford. QOS is definitley a must in the design. You may want to look at keeping tradition TDM in place as a backup to the VoIP solution in the event of a failure. Quality and redundancy of the infrastructure is a must.

All of the above answers make a lot of sense. You have to be very careful with VoIP as now the calls are going through a completely different pipe (the internet) that needs power to stay up and running.

However, the key to ANY telecom deployment -- traditional or VoIP -- is to have a good backup plan. With any disaster recovery plan, it seems that telecommunications is always left to the carriers. True, they can forward the lines, but where? To a cell phone? Hardly. It's up to you to make sure you have some way to continue to take calls from your customers even when you're down -- especially for the medical community.

Find a reputable consultant that can take you through the different telecom disaster recovery schemes and weigh the pros and cons. Telecom disaster recovery can take the form of simple forwarding to another phone system (capital costs), to a different site (capital and real estate costs), or a hosted phone service (no capital or real estate, but a monthly or annual cost).

Howard,

You have made excellent points for consideration by Kevin.

One thing that I am noticing is some of the comments here are leaning towards answering as a hosted solution. I've not seen anything mentioned directly about this question being a hosted system. And in fact, I made the wrong assumption that is NOT a hosted solution question.

I would never recommend a hosted solution for a healthcare environment, and in fact, an on site system needs to be built around engineering principals to design a 5 9's reliable product and network to support it.

Kevin, Absolutely not. If you have a 100% VOIP system and you lose your internet connectivity, the medical center is without phone service and you are likely open to a world of lawsuits and violations of regulations. Your two biggest enemies here are loss of internet and loss of power. VOIP is a good idea in a medical setting as long as you have redundant internet circuits and backup POTS lines so that no matter what disaster happens, the center has the ability to maintain voice and data connections with the rest of the world. Any communications technology plan should be developed by IT, Compliance, and Business Continuity staffs in addition to finance and operations.

Todd,
If you ever want to install a greet VoiP system for Hospitals Look at VCX by HP, All redundant and the SIP Phones and system can be program with a internet connection. I have installed many hospitals and Large Enterprise TDM from Rolm/Siemens/Avaya/Nortel/Ericsson These old Big bulk Boxes need to go to New Data Switches /Router/ Servers you can even leave the old phones and connect using Citel if the Cost of the old handsets are the issue. SIP phones will drop in price with even more features.

Look, the bottom line VoIP will change the way a hospital communicates. Just think video conference across the campus. Move adds and changes is just log-In and change the extension your there. I think when you have not ever install a real VoIP system you don't know how amazing it can be. It can keep you staff better connected at a much lower cost ( Accept Cisco Call Manager}. Now with Smart Cell Phones you be connected at all times to your extension.with a SIP Client. Nothing really changes as far as a hospital other than the need to install CAT 5 cable for the intercom and making sure and data devices siwtches/Routers & Servers in the IDF or MDF either have Battery or generator backup power Source. When you can connect Voice/Video/Data/Surveillance it all a big plus.

Now! Lets talk about the outside world; T1- PRI/PSTN always have backup for a PRI this is a solid role for any critical services from 4 to12 C.O. Lines depending on the size of the Hospital as far as SIP trunks great Idea for PRI between sites with QoS. Some carries like ceybond can build you a private network with great backup features. You can also backup to CDMA/4G wireless.

The one thing I will say Technology has changed so much in the past 4 years make sure you go with the latest Switches/ Routers/ Servers when deploying VoIP . I believe that HP/VCX is the strongest product for Enterprise VoIP. HP is a proven company with leading products for the Medical field.

You can have Hosted and On-site as long as you have Both in other words you put your backup in the cloud that's saying the building burn down and I redirected the calls off site.

Emanuel A. Miller
Consultant
A-Techtelco.com

Todd

I guess when I hear 'completely Voip' I think of hosting off site. I have been involved in a couple of cases where the hosters have made the case of keeping servers off site saves money. I have never really tried to validate or debunk the savings. In the medical community, I would just say, if you really want to save money, get rid of the phones, buy some leaches and go back to blood letting as a curative method;)

As you suggest, engineering the site for voice, data and video services uptime seems to preclude hosting at a remote site, but, I can tell you I sold a lot of centrex lines back in the good old analog days when leaches were considered a medical breakthrough;)

Emanueal has identified a new box from HP. I have not tried it nor do I know of anyone who has, but maybe 3 Com and Microsoft have helped them get it right this time. He also points out you could also have some hosted lines for backup and recovery and that makes some sense if you can afford the carrier charges and don't build your own carrier bypass.

Howard

Hi Kevin,

First of all, just to be clear, I work for Cisco, and we do provide VoIP solutions. That said, I will try to be unbiased!

There are many hospitals using Voice over IP today. Just to clarify some of the answers imply VoIP = Internet voice. This is a common mistake. VoIP does not have to equal Voice over the Internet, it is Voice over IP , which is a protocol used for private networks as well as the Internet. In hospitals it is typically voice packets over a private hospital network with Quality of Service designed to be secure and highly available. QoS ensures that different traffic types on the network are given the appropriate priority, which ensures voice quality. In many cases the connection to the regular public switched telephone network (PSTN) is via what is called a PRI circuits, from the telephone company (e.g. AT&T/Verizon). These are connected to your private network via gateway devices, So the voice calls in and out of the hospital are not going across the Internet. You can use the Internet for VoIP calls, but it does not provide QoS, and so is best effort (e.g. Skype, Yahoo). Some companies offer IP based trunking, which has cost benefits. There are Telco's offering hosted VoIP, but you should verify what SLA's and QoS levels they will commit too before heading down this path.

VoIP by the way has really moved to Unified Communications, which incorporates more functionality that a traditional TDM PBX offers and adds IM, presence, video, collaboration to voice capabilities. I really suggest that if you do not have the expertise in house, engage a good unbiased consultant or have multiple companies put a proposal together for you. If you do go the consultant path, I would try and select one that is familiar with the healthcare market, as there are specific vertical solutions (Nurse call for example) that leverage VoIP and WiFi.

One final point, a VoIP system designed and implemented badly without the right network in place will be a nightmare, so you need to ensure your staff are up to the task, or use a certified partner for which ever solution you chose, with the appropriate ongoing support services for trouble tickets, and future upgrades and changes.

Best Regards
Colin

I have been involved in VoIP for a long time (long history at Intel and Dialogic dealing with thing things from gateways to system implementations using Microsoft UM, IBM SameTime or a bunch of other things) and personally, in an environment as critical as a healthcare installation, I would not do an installation without offering some kind of raw TDM cut through system.

Honestly, I know the internal stuff is good quality, but something always makes me itchy about a completely 100% VoIP solution when it is so easy for someone to open an email and all of a sudden you have the equivalent of a malignant tumor running through your network and at any time you can lose connectivity to the world.

Sure you can say you are addressing this via policy, procedure and training, but in reality, nothing is more secure or reliable than a good old fashioned POTS line connected to a nice AT&T desk set.