About two years ago, the Bowen Center, a provider of mental health care in northern Indiana servicing 21 counties with a staff of nearly 1,300, had gone through tremendous growth. But that growth was halting, thanks to instabilities throughout its various systems and IT infrastructure.

THE PROBLEM

The problems were extensive. The Bowen Center is a 39-location health system with a wide spread of mobile workers outside of physical locations. Network and data center instabilities were causing weekly unplanned outages in service, clinicians were accustomed to canceling patient appointments because of EHR outages, and various locations were having trouble leveraging telemedicine services because active telemedicine would take up the available bandwidth, slowing other clinical services tremendously.

“In one instance, I went to one of our primary locations and sat down with staff to understand the clinical impact of the disruptions,” said Andrew Grimm, who arrived as vice president of IT at the Bowen Center about two years ago.

“I felt like people needed to see IT care and not just hear it was being worked on,” he said. “While there, I spoke with clinicians who were in tears over their inability to deliver care to their patients, over the stress of trying to meet clinical expectations when the systems didn’t support their efforts, and one clinician in particular who expressed they were considering leaving because the situation had become too difficult to manage.”

Grimm called in a consulting group, Qubit Networks, whom he was both familiar with and trusted to assess the stability of the network because the existing tools and infrastructure left the health system blind and incapable of diagnosing the issue without falling upon assumption. That, in concert with the clinical visit, became the impetus for change.

PROPOSAL

Once the assessment came back, Grimm immediately chose Extreme Networks to replace all levels of network infrastructure because of his familiarity with its products and previous outcomes attained for a hospital system he had led prior to joining the Bowen Center.

“I knew the product was reliable, I knew it was more than competitive versus market leaders like Cisco in terms of cost, features, stability, reliability and more,” he said. “As I had just gone through a vendor assessment at my previous health system just a few years prior, I felt very comfortable choosing Extreme.”

Much needed to be accomplished in a very short window of time to earn back the trust of staff and return the system to a growth pattern. There was a bottleneck at many locations limiting bandwidth because internal and external traffic was going through the same appliance, the wireless infrastructure was unreliable, and a host of other problems within the network that needed to be addressed on all levels from the data center to the end-points.

“We stabilized multiple points in the network, changed all wireless access points, moved to Layer 3 Extreme switches, and we are in the process of wrapping up the replacement of Layer 2 switches,” said Grimm.

The Bowen Center now can see the network traffic, diagnose issues with its tools and watch for disruptions rather than wait for a location to tell staff about a disruption. IT also is earning back the trust of the organization.

MARKETPLACE

There are many networking infrastructure vendors on the market, such as Cisco, CoreOS, Cumulus Networks, HPE Networking, Juniper Networks, Nutanix, Pluribus Networks, SnapRoute, Versa Networks and VMware.

MEETING THE CHALLENGE

The first step in meeting the challenge was to eliminate the bottlenecks at affected locations. That alone did a lot for network stability. With interior and exterior traffic separated and bandwidth barriers lifted, clinicians saw an immediate impact in their ability to deliver service in a timely fashion.

“This was the beginning of us winning back the clinician’s confidence in the system,” Grimm said. “From there, we replaced all Layer 3 switches throughout the network, setting up redundant network connections at our locations and assessing whether the various connections shared last mile with any other providers and making plans to rectify that issue as we identified it.”

In healthcare, as with any industry, uptime is everything. If a health system stops delivering care at a single location due to bad planning or lack of redundancy in network availability, that can be a loss of hundreds of thousands of dollars, he added.

"Today, hotspots aren’t used in our facilities and our Wi-Fi is a trusted IT service that meets the needs of the clinicians. This was a big step toward further recovery of IT’s reputation."

Andrew Grimm, The Bowen Center

“From there we increased the stability of the wireless network, replacing all WAPs with Extreme,” Grimm explained. “The health system, prior to this effort, had taken to putting Verizon hotspots at our various locations to deliver clinical care because of a combination of poor wireless stability and local bandwidth issues.”

That meant the health system was bringing in more and more Wi-Fi signals into facilities, worsening the situation through the remediation effort, he said.

“Today, hotspots aren’t used in our facilities and our Wi-Fi is a trusted IT service that meets the needs of the clinicians,” he explained. “This was a big step toward further recovery of IT’s reputation.”

Next, IT started placement of Layer 2 switches and added the ability to use the advanced tools within Extreme to look for packet collision on the application layer and monitor for persistent connections at the center’s various locations, which allowed staff to respond to outages before the location could report it. These tools enabled staff to look within and manage every layer of the OSI model, putting meaningful tools into the hands of administrators.

“Flash forward to today, our network is a highly stable environment we rely on to do business every day,” Grimm said. “We’ve not only increased the use of telemedicine services, but we are providing telemedicine to our clients from outside of the state, something we never would have considered previously.”

RESULTS

The Bowen Center started measuring customer service scores when Grimm first started over two years ago as a means of determining if IT staff was trusted enough for people to tell them what was wrong. Since starting, those scores have increased from a 72 percent satisfaction rate in the first six months of customer evaluations to 95 percent for more than a year now.

“Stability of the network has helped to move us to the 99th percentile for total uptime of all systems,” Grimm said. “The previous number was well below that, given the high number of outages, but because it wasn’t tracked, I cannot ascertain percentage gain.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

Twitter: @SullyHIT
Email the writer: tom.sullivan@himssmedia.com

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