Managed network, VoIP makes innovation a SWARH thing
With 147 sites spread across 50,000 square kilometres, there was never anything normal about the challenges facing SWARH (South West Alliance of Rural Hospitals) when it began planning to network them together. Nearly a decade later, however, a commitment to managed services has turned the organisation's network -- and, more recently, its Voice over IP (VoIP) -- into a paradigm of co-operative service delivery.
Established in 1999, SWARH grew out of the recognition that Victoria's centrally funded but distributed management approach to healthcare was antithetical to the principles of sound network management. Based out of the coastal city of Warrnambool, SWARH became a centre of gravity for technological investment in the region, which bridges disparate healthcare services spanning the whole of south-western Victoria.
From its early days, the jointly funded SWARH called on networking expert Dimension Data to help install and configure a far-reaching Cisco Systems based wide area network (WAN) that would provide reliable connections between the sites. This task brought together a broad range of equipment, ranging from fibre-optic backbones to massive network switches and microwave trunks, that coalesced into a highly available, mission critical network over which Dimension Data maintains constant vigilance.
Ongoing management of such a large network obviously involves both considerable amounts of travel and the application of very smart network management technologies. This last fact, and the sheer size of the network SWARH is running, have long given it a certain priority in accessing new Cisco Systems technologies; CIO Garry Druitt still recalls how an early e-mail from Cisco head John Chambers -gave me confidence that our interests were in fact Cisco's interests".
More than firefighting
By 2003, however, Druitt had become concerned that the service, while effective, was focused more on day-to-day management than strategic, long-term improvement. This wasn't a shortcoming on Dimension Data's part, but rather a result of the results-focused agreement that was in place. Druitt soon began a period of negotiation that was to completely reinvent the notion of managed services.
-We had gotten to a situation where we would ring up [for support] and would be told the issue was outside of the agreement, and that they needed an order number before they could help," he recalls. -We needed an agreement where they would understand that if SWARH rings with an issue, they would solve the issue and not worry about payment. We had to say 'we don't care what the network looks like; we just want it end to end'."
The process of revisiting and renegotiating the arrangement with Dimension Data was a slow but steady one: it took 18 months of give and take before the organisations worked out an agreement that satisfied them both.
While the new arrangement is slightly more expensive than the old one, Druitt says it was still cheaper than the alternative. His calculations showed that SWARH would have faced a bill of up to 50 percent more -- including manning a three-shift roster, technical training, benefits and so on -- just to match the service levels provided under the managed service arrangement.
-We believe in selective outsourcing where it makes business sense, and in this case it makes sense," he explains.
A different voice
Revisiting the managed services arrangement was particularly important when it came to SWARH's VoIP environment, which from its early days was built around Cisco Systems VoIP technologies. In the early years, those technologies were completely proprietary to Cisco, but evolving standards and improved call management have gradually opened up the environment to facilitate addition of new types of end points.
In SWARH's configuration, VoIP is managed through a single cluster of Cisco CallManager servers, which service each remote site via existing WAN connections. More than 3000 VoIP handsets and 200 videoconference units are spread across the sites, which range in size from GP clinics to large regional hospitals.
Because reliable phone communication is absolutely critical in the healthcare environment, the collaborative problem solving philosophy behind the new managed services deal -- rather than trouble-ticket driven firefighting -- was particularly appropriate for the managed VoIP environment.
-It's a complex environment here, but if we can have a vendor manage that, it's quite effective," says Druitt. -Moving from a traditional support base to the new environment is a significant process, and was a significant improvement for Dimension Data too. [With voice] everything is a critical issue and has to be managed quite carefully, has to be service oriented, and has to be quite auditable."
To this end, a core team of Dimension Data staff keep a running watch on the status of SWARH's voice services by using SNMP to check the status of each networked device every three minutes. This doesn't just mean making sure everything is up and running, however: the managed service team also checks on call quality and service availability to ensure that the VoIP environment is performing from a service as well as a technical perspective.
Towards the future
Dividing strategy and execution is often held up as a major benefit of managed services, but without proper controls it can be easy for in-house staff to also get involved in day-to-day operations. To avoid this, SWARH has physically prevented its technical staff from being able to access any device on any part of the network.
-Nobody within SWARH who even pretends to have knowledge of networks can access the network devices," Druitt laughs. -We do that internally to manage stability: once you have internal staff starting to fix things, they will be fixing things all the time. Their role is not to fix the box, but to get it fixed."
This approach may be unconventional, but it has helped reinforce the point that the in-house technical staff are there not to keep the network running, but to make sure Dimension Data are quickly made aware of things that need to be fixed. It has also helped the technical team focus more on strategy, with several recent initiatives pointing the way forward for SWARH and its constituent organisations.
A recent disaster recovery upgrade, for example, has increased reliability and provided redundant links to increase service uptime. Making this happen has been considerably easier than it might have been, because the SWARH model has long been built around a centralised and clustered computing approach that requires only one target for the DR configuration. Improving reliability to satellite locations thus becomes an issue of maintaining communications links, not trying to mirror many clusters of servers scattered around the countryside.
The SWARH network has also recently been supporting a videoconferencing based telemedicine trial, which has linked healthcare providers in 29 remote towns so they can access specialists in Victoria's larger cities without having to travel to them.
With the flexible managed services agreement in place, Druitt has the confidence to pursue these and other business plans without worrying about whether SWARH's extensive and complex network infrastructure is up to the task.
-It's a long change management process to get people away from the technology into focusing on productivity using technology," he admits, -but our real role in organisations is to improve the service product within health. That's our real role and where we're targeting. And in the end, if I've got the confidence to go on holiday, that says something."
