The New Wireless Utility atScripps Health

Bruce A RaineyCorporate Vice President Construction & Facilities

05-06-2013

Agenda

2Healthcare IT Institute

Who is Scripps Health?

Why is this discussion important to you?

What Changed

What is Medical Grade Wireless Utility

Benefits of Medical Grade Wireless Utility

Opportunity

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The Next Decade

$2.3 billion investment

New hospital facilities

Renovations &

expansions

Medical technology

Emergency & Trauma

Cardiovascular

Institute

Earthquake retrofitsHealthcare IT Institute

State-of-the-art Imaging

Cutting-edge research

New ambulatory centers

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Scripps Health

Private, $2 billion, nonprofit community health system, San Diego, Calif.

Integrated delivery system caring for approximately 500,000 patients annually

Two of San Diego’s six trauma centers

Healthcare IT Institute

Forefront of clinical research and graduate medical education

1,368 total licensed beds

2,900 Physicians & 145 residents/fellows

13,100 employees

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Scripps Health

Healthcare IT Institute

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Scripps Health

Specialized programs include:

Diabetes Institute

Accredited Cancer Center Network

Center for Integrative Medicine

Robotic Surgery Program

Healthcare IT Institute

Graduate Medical Education

Genomics & Clinical Research

Translational Science Institute

West Wireless Partnership

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>1.6M Square Feet

Healthcare IT Institute

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>1.1M Square Feet

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This Discussion and You

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The Problem

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Study identifies top five wireless challenges

• Physical Connectivity

• Technology Connectivity Issues

• Meeting User Demand

• Security Considerations

• Network Management Issues

May 20, 2009

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The Problem

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New Technologies Body Area Networks

• Communications in and around the body

• Utilizes sensors, actuators, processing elements

Mobile Clinical Devices

• Linkage to EMR

• Security

Expanding the Chipset Venue

• Marketplace Dynamics

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The Problem

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The Problem

Wireless Data UseExponential growth

80% within buildings

70% of staff and physicians already using smart devices

Handheld computing deployment exploding

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2011 2012 2013 20140

1,800,000

3,600,000 4%5%

8%

17%

66%

Source: Cisco VNI Mobile, 2010

TB

pe

r M

on

th

Mobile VoIP Mobile Gaming Mobile P2P

Mobile Web/Data Mobile Video

Wireless Data Growth108% CAGR Through 2014

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The Problem

Wireless Infrastructure is often vendor-specific

More vendors creating more wireless devices

More devices in the built environment creates “noise”

Portions of the wireless spectrum not covered with current 802.11 solutions

• Emergency operations• Police• Fire• Cell

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Our Current Situation

WiFi (802.11a/b/g/n) Single Channel coverage • Production network • Visitor hot spots

WMTS for patient monitoring• Several different solutions

Low frequency wireless headsets and phones

T-Mobile Nano Pico cell in building coverage

AT&T/Verizon broadband for remote Users

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Our Current Situation

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Our Current Situation

Over the Air Intrusion Detection SystemIn building spectrum management and

interference detectionDevice Management and SupportIn building cell carrier coverage (i.e.

AT&T, Sprint, Verizon, etc.)Data Transmission SecurityDiscrete WMTS infrastructure for

telemetry

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What Changed…The Goals

“Own” the architecture Create open architecture for future

wireless devices Be vendor neutral, not driven by clinical

needs Allow for equipment changes without

infrastructure changes Expand the coverage while maintaining

control Lower Costs

Ongoing operationsCapital expenditures over time

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What Changed – The Team

Cross-Functional Leadership Team

• Information Services • Facilities / Construction• Biomed• West Health Institute

(Advisor to Scripps)

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What Changed – The Times

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Ubiquitous wireless is expected and necessary

High growth in wireless devices and apps

Need to embrace the future of wireless

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Solution

Create a Medical Grade Wireless

Utility as the platform for wireless

health going forward

Healthcare IT Institute

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Medical Grade Wireless Utility

…An expected utility, much like electricity, plumbing and HVAC

- Installed as part of the base building

…An open and vendor neutral converged wireless infrastructure, supporting transport for any wireless signal across 3 grades of service and 4 networks

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WWANWLANWCDNLLAN

ConsumerEnterpriseMedical

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Three Grades of Service

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Tim

e C

riti

cal

MedicalGrade

EnterpriseGrade

ConsumerGrade

High

Medium

Low

Low Medium High

Acuity

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4 Networks

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…Each with a defined Assurance

WWANFacilities

WLANIS/IT

WCDNBioMed

LLANIS/IT

CoverageDriver = WWAN Medical

95% or better100% in Clinical Areas

Driver = 802.11 Medical95% or better

100% in Clinical AreasDriver = WMTS Medical100% in Clinical Areas

Signal Quality

Driver = WWAN Medical+ XX dBM above noise

Driver = 802.11 Medical- XX dBM & -XX dBM

Driver = WMTS Medical + XX dBM

CapacityDriver = WWAN Medical

Per Zone (~150k ft2)RF Carriers/Zone/Service

Driver = 802.11 Medical Per Segment (4K ft2)

# Channels / Segment

Driver = WMTS Medical Channel(s) per area

# users per area

Security Base Station HotelZone IDF Physical security Physical security

Certainty SharedEngineered

SharedEngineered

GuaranteedDedicated

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…Creates the Medical Grade Wireless Utility

Healthcare IT Institute

Location LocalArea Network

Wireless LocalArea Network

Wireless WideArea Network

Wireless ClinicalData Network

Room Area NetworkPersonal Area NetworkBody Area Network

802.11Bluetooth

ANT Zigbee

UWBFuture

PCS/CellularPaging

Fire Life Safety2 Way Radio

Future

802.11Zigbee

IRUltrasound

UWBRFID

Future

AssetsPeople

Infrastructure IndependenceUbiquitous coverage inside & outside

Democratize Healthcare DataPervasive, open, low cost monitoring

Break the proprietary hold on healthcare

Clinically Relevant InformationPervasive, low cost medical sensors

Turn data into wisdom

The Killer AppsVoice, Data, Video, Location

Medical Grade Wireless Utility

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MGWU Benefits

Lower Implementation Costs• One antenna system instead of one per technology

Lower Operating Cost• Fewer FTEs to manage ecosystem• Fewer calls to help desk• No retro-fitting for unknown dead-zones

Healthcare IT Institute

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MGWU Benefits

Lower future cost •Known capacity•Add devices without touching the infrastructure

•New technology doesn’t require closing rooms for replacement of legacy systems

Healthcare IT Institute

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MGWU Benefits

Safer use of wireless in medical settings•No interference problems associated with wireless in high acuity settings

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MGWU Benefits…Technical View

Healthcare IT Institute

DISCRETE

LAYERED

n: PACS, Video

a/n: Data

a: Voice

b/g/n: GuestNet

b/g: IV Pumps Carts

g: Voice

n: PACS, Video

a/n: Data

a: Voice

b/g/n: GuestNet

b/g: IV Pumps Carts

g: Voice

Frequency-based WLANs 2

Standard practices coverage ●Traffic separation by frequency ●No Greenfield 802.11n performance due to legacy devices

●

Frequency-based WLANs 2

Standard practices coverage ●Traffic separation by frequency ●No Greenfield 802.11n performance due to legacy devices

●

Independent WLANs 6

Guaranteed coverage ●Traffic optimization by application/device to maximize capacity

●Greenfield 802.11n performance in legacy deployments ●

Independent WLANs 6

Guaranteed coverage ●Traffic optimization by application/device to maximize capacity

●Greenfield 802.11n performance in legacy deployments ●

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MGWU Benefits…My View

Healthcare IT Institute

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Discrete

Layered

1

1

1

2

2

2

3

3

Wi-Fi client sees one channel - Traffic shares a single channel AP “highway” and must compete based on application type, priority, protocol, etc.

1

1

12

2

3

3

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Wi-Fi client sees layers of channels - Traffic can now be assigned to specific layers to dramatically increase throughput and efficiency not possible using discretely deployed APs

Start/Stop

Start/Stop

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Flip the Paradigm

Enable the hospital to make device decisions

based on infrastructure

and NOT infrastructure decisions based on the device

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Implementation – First Step

Demonstration Project• Small, non-acute facility• Go live Sept 2012• System performed as expected

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Implementation – New Construction

Acute Care Projects• 2 New hospital additions• 383,000 168-bed addition at La Jolla• 83,000 36 bed with ED addition at

Encinitas

Specialty Care Project• 175,000 specialty center attached to

acute care facility• Cardiovascular services

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Implementation – Existing Facilities

Expansion of Project• Barcoding Meaningful Use (WiFi)• IS developed plan to extend existing

discrete AP network across 1M SF• Plan redeveloped after successful

testing of MGWU to implement new system

• Project funding did not change• Project implementation just starting• Full implementation set for 2Q 2014

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Implementation – Next Steps

Negotiating with 3rd Party on wireless service provider side of system• 3rd Party better suited to

negotiations with carriers• Limit capital costs to Owner• Focuses resources on other

Meaningful Use issues

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QUESTIONS?

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