Case Study

Send to a colleague

Clarian Relies on Information in its Drive for Better Healthcare

Industry Focus

Regional hospital cooperative

Size

Five major hospitals and a staff of more than 12,000; more than 50,000 admissions and a million outpatient visits a year

Networking Solution

A robust and reliable fiber optic metropolitan area network provides ample bandwidth for applications that deliver instant, accurate and complete patient information for nurses and doctors

Business Value

Industry-leading use of medical information technology helps Clarian meet its commitment to provide premium patient care

About Our Customer

With roots in central Indiana that go back to 1908, Clarian Health includes Methodist Hospital, Indiana University Hospital and Riley Hospital for Children, as well as the new Clarian West and Clarian North medical centers. A third new facility, the Clarian Arnett Medical Center, is now under construction. Long among the leaders in U.S. healthcare, Clarian Health and its predecessor organizations have set records for innovation in a wide range of healthcare disciplines. Clarian units have been recognized among the best hospitals in America eight years in a row by U.S. News & World Report.

Situation

Created in 1997 through the union of three leading Indianapolis-area hospitals, Clarian Health has won national recognition for the quality of healthcare it provides. But there were no awards four years ago for the organization's data infrastructure. Repeated network outages triggered by power problems and other issues kept the Clarian information systems (IS) team on the defensive. A "downtime committee" met regularly to manage the problems. Stuck in the role of network fire fighters, the IS team could not work on vital initiatives key to Clarian's future, such as electronic medical records and clinical information systems.

Solution

Today a powerful and dependable AT&T fiber optic network links 14 Clarian healthcare locations in the Indianapolis area. The network's ring design provides redundant communication paths that increase reliability. Its vast bandwidth can handle all the new applications Clarian has in mind, including voice over Internet protocol (VoIP) and medical record systems that reach right into patient rooms. AT&T manages the network, freeing the IS team to focus on gathering vital patient health information and delivering it to doctors and nurses in ways that support the best possible outcomes for patients and providers.

Seeking the Cure for an Ailing Infrastructure

Communications and information technology have been fundamental to Clarian's leadership. As they entered the 21st Century, however, it became clear that the network serving Clarian locations could not keep pace with growing needs. Indeed, network and information system troubles were taking time away from developing new capabilities.

"We had an ATM backbone and as an IT shop, we did not give it the proper care and feeding that it needed," said Rich Johnson, Clarian Senior Vice President and Chief Information Officer. The trouble went beyond the network. Power problems disrupted service and damaged data processing equipment. "We were constantly in a fire fighting mode," Johnson added. "We had outages a couple of times a week in different locations."

The problems threatened Clarian's operations and held back the effort to implement electronic medical records and other next-stage information ideas. "It was a tough situation," said Johnson. "My vision of the organization is to put the data in the hands of the clinician, but I was looking at the infrastructure and saying it's too fragile, you can't do it. Achieving such a vision is hard enough when you have a rock solid infrastructure." The cure would require strong medicine: building a whole new data center, supported by a new network linking Clarian's multiple locations. That foundation would have to accommodate Clarian's growth for new data applications and three new hospitals in the planning stages.

As there was no new building available for the new data center, Johnson had to build a new center almost three times its size around the existing facility, even as the old center kept running. It was a two-year project that Clarian completed in 18 months of non-stop work.

For the new Clarian network, Johnson turned to AT&T. "They were willing to work with me and be part of the solution and not mandate what was required," he said. "Instead they listened, and together we designed a solution that met the needs of all of our facilities. I had a solid trust in AT&T, and our team approach worked well." A fiber optic metropolitan area network (MAN) connects five hospitals, clinics, administrative offices and the consolidated Clarian laboratory facility. Configured with a ring design, the network provides each location with two communication paths, ensuring that a mishap such as a cable cut will not stop the flow of information. The network's OC-192 backbone speed provides all the bandwidth needed to accommodate Clarian's continuing growth while taking advantage of new communication applications.

Clarian Goes for the Lead in Healthcare Information

Clarian has built a reputation as Indiana's premier healthcare institution and one of the USA's finest. It is equally well known as a leader in using information and communications to improve patient care. As early as 1969, Clarian's predecessors pioneered the use of videoconferencing as part of what Clarian now calls Telehealth. Clarian is still pushing the frontiers of medical information technology through expanded Telehealth initiatives, image storage and retrieval, electronic health records and IP telephony.

For instance, radiology images are available everywhere at Clarian, but you won't find a single sheet of X-ray film. Those images are captured and stored electronically and transmitted across the Clarian network to doctors who need them. Clarian operates the nation's largest enterprise-wide Picture Archiving and Computerized System (PACS) installation, providing real-time Internet availability of images for referring physician consultations.

In addition to such "store and forward" applications, healthcare providers also use "real-time" capabilities such as Tele-echocardiology where an on-call cardiologist provides ECHO interpretation via a laptop. With Telepsychology, patients interact with counselors "face-to-face" over video, a technique which has proven especially effective with children.

Clarian's leadership in healthcare information has won wide recognition. In 2007, for the sixth time, The American Hospital Association's Hospitals & Health Networks magazine named Clarian one of the 100 Most Wired hospitals and health systems. Health Imaging & IT magazine agreed, declaring Clarian to be "one of the nation's Top 25 connected healthcare facilities." For Johnson, however, the goal is not national recognition. It is to give doctors, nurses and patients the tools to produce better health outcomes.

Electronic Records Move at Light Speed

"The commitment that Clarian is offering its patients and caregivers to improve the quality of care is in my mind, second to none," said Johnson. "One of the ways to accomplish that is through technology." A key initiative is the electronic medical record – a single, comprehensive electronic record that can be read or updated instantly, using computers in or near patient rooms, wireless personal digital assistant (PDA) devices or other terminals. The choice is up to the caregiver who can select the technology that will be the most comfortable for the patient. Lab and test results can be incorporated in a moment, transmitted from test instruments wired into the network.

"One of the driving forces for partnering with AT&T was that we had such a need for information in multiple locations and a need to get it now," said Johnson. "AT&T helped us push or pull that data in many locations at the same time. A resilient, reliable, robust and redundant network allows me to put information in the hands of the caregiver now in multiple locations, in numerous forms that they never had access to before."

At the new Clarian North hospital in Carmel, this future focus takes the form of a new IP telephony communication system. Unlike traditional private branch exchange (PBX) systems, IP telephony sends "packets" of voice communication over the same digital circuits used for data communications. It enables new communications features, such as desktop video conferencing, that can be used to expand the Telehealth program. At Clarian North, bar code scanners track patient medications, helping staff spend less time on data entry and more on patient care. Bedside e-portal terminals actively involve patients in their treatment. A state-of-the-art wireless infrastructure enables full use of mobile data and voice communications.

Take a Walk in the Users' Shoes

In addition to his network, a secret to Johnson's success is his relentless focus on what works best for his customers: healthcare practitioners and patients. "What helps Clarian Health is not a great IT organization or gee-whiz technology, but a great physician, a great nurse, a great technician," he said. "By enabling our clinical community to use technology, we are putting the expertise in their hands, and we just become more of a conduit to get that done."

A critical element is to develop a deep understanding of the needs of Clarian's caregivers and staff. "We have to work with them and be in their shoes so that we can enable their success." That is now possible due to the new infrastructure which doesn't require all of the attention that the old network did. "It's solid," he added.

Beneath all the hard work, the state-of-the-art innovations and the national recognition lays a harsh reality that Johnson feels keenly: Lives may depend on the performance of his network. "What I have to do is provide doctors and nurses the means to facilitate their clinical activity the best way they can. If I want to call 911 I expect my phone to work. If I have decisions to make clinically and the data is electronic I must be able to get to it. It's life or death.

"I have awakened at night a lot of times, and the one thing that I don't wake up for now is my infrastructure. That is a good feeling because three or four years ago, I did. If you talk to my network team right now they are not fire fighting any more. This is a wonderful place to be."

Voice of the Customer

"The commitment that Clarian is offering its patients and caregivers to improve the quality of care is in my mind, second to none. One of the ways to accomplish that is through technology."

– Rich Johnson, Clarian Health Senior Vice President and Chief Information Officer