Case Study
Customer Name
• Skaraborg Sjukhus (SkaS), Sweden
Industry
• Healthcare
Business Challenges
• Dispense high-quality, accessible medical care as efficiently as possible
• Increase collaboration with other hospital groups and health centres in the region
• Streamline the hospital's processes so that care and administration operate more efficiently
• Facilitate change
Network Solution
• A Cisco Medical-Grade Network connects the hospital's four sites and over 40 primary care units across the region
• Cisco Unified Communications are delivering advanced IP telephony and call management facilities across the entire network
Business Results
• Cisco IP telephony will save the hospital
€ 3.2 million over the next five years in support and equipment alone, and the rollout of new services could increase the cost benefit even further
• The hospital and its primary care units are better able to share information and resources, with a greater focus on patients
• A common infrastructure is enabling the development of new services and ways of working, including making better use of scarce specialist skills
Sweden's Skaraborg Hospital is building a converged digital infrastructure to support its administrative and clinical systems, and increase collaboration with other hospital groups and health centres in the region. The hospital has already identified major savings by moving all its communication to a single, robust and secure Cisco Medical-Grade Network. More importantly, it has created the foundation on which to achieve its vision of Connected Health with resources and information easily accessible wherever and whenever they are needed to improve patient care.
Like healthcare providers the world over, the Västra Götaland region of Sweden is wrestling with the problems of how to provide better, but increasingly expensive care to a population that is living longer.
Created in 1999 in response to the need to achieve economies of scale through better sharing of resources and a more consolidated approach to service management, the administration is responsible for healthcare and regional development. In bringing four previously separate local administrations together, the new region became one of the country's largest healthcare providers, employing around 44,500 people.
One of the most important hospitals in the region is the 900-bed Skaraborg Sjukhus
(SkaS), which treats around 38,300 registered patients each year. One of four hospital groups, SkaS resides in the region's west, and is made up from sites at Falköping,
Mariestad, Skövde, and the independently managed Lidköping Hospital.
The group contains over 30 medical specialisms, the majority of which are concentrated at the main group hospital in Skövde. Together, the four hospital sites employ 4,700 staff, and serve approximately 265,000 inhabitants.
But while Sweden's lakes and the mountains make for breath-taking scenery, they pose particular challenges to healthcare providers. People are spread out around the region and, as a result, over 40 primary care units – health centres – look to the hospital for a full range of medical services.
Anders Karlsson
IT Strategist
Skaraborg hospitals

Communications across the new administrative region was also enhanced in 1999 with the creation of a Cisco wide area network, to which the hospital and health centres were connected. Several years later, however, it was becoming obvious to the hospital's IT team and managers that technology could do much more to support the healthcare community.
“IT is becoming increasingly important as a way of improving efficiency and rationalising medical care. Technology is becoming an integral part of treatment and in the administration that is required to get a care chain to function smoothly for its patients,” says Anders Karlsson, IT Strategist at SkaS.
Jan Sunnergren, IT Operations Manager, believes the role of technology is even broader. “Technology also represents a tool to make our employees' work simpler, so that as much time as possible can be spent on direct patient-related work,” he says.
Berndt Fahlgren
Telephony Systems Manager
Skaraborg hospitals
While the hospital already benefited from a Cisco data network, the need to support a wide range of bespoke medical systems had led to a patchwork of networks. In 2004 the need to set up a helpdesk for its newly merged IT and Telephony teams provided the opportunity for Berndt Fahlgren and his colleagues to better explore how the latest generation of communications technologies could be harnessed.
After considering a range of options, the team selected a solution based on Cisco Unified Contact Center Express, from
Cisco's Unified Communications family of products, to create a virtual helpdesk providing access to people located around the hospital's sites using IP telephony running over the existing data network.
The solution was so successful, easy to deploy and manage, that when the hospital's ageing telephony system was considered for replacement the following year, the team had no hesitation in seizing the opportunity to not only switch to IP telephony, but also to evolve the infrastructure to a Cisco
Medical-Grade Network capable of better supporting not just the hospitals but also the health centres.
A Medical-Grade Network draws on Cisco's best practice to create a proven foundation for connecting people, processes, information and devices within a hospital environment and beyond to create a 'connected health' community. It can be applied to a Greenfield site or to a specific networking project as the first step in a route map towards a fully converged, resilient and secure network that intelligently maximises application and device performance which supporting communications between various technologies and devices.
The hospital was able build on its previous investments in
Cisco technology by installing new switches to provide Power over Ethernet to Cisco IP Phones and introducing Quality of
Service (QoS) to ensure prioritisation of voice traffic and critical applications over the network. Bandwidth within the core networks was increased to 1Gbps, with ability to easily upgrade to 10Gbps as demand requires.
The first hospital site switched over to the new solution in June
2005, with the hospital's IT team carrying out stringent testing and training staff without disrupting the hospital's existing telephone system. The three other sites followed, one each month. “This was a major advantage compared with the upgrades to our old solutions that we had implemented over the years. The transition was unbelievably painless. We had been expecting teething troubles,” recalls Berndt Fahlgren,
Telephony Systems Manager at SKaS.

Cisco Unified Call Manager provides advanced call-handling features, which are being extended as each of the health centres are transferred over to IP telephony with a router and switch upgrade at each centre. In a separate initiative, the WAN network was upgraded to a Cisco multiprotocol label switching
(MPLS) network, ideally suited to providing secure and converged multi-site connectivity.
Within the hospital, WiFi hotspots have been created to extend access to information and resources to clinicians and nurses moving within the hospital. However, thanks to the flexibility and open standards of the Cisco Medical-Grade Network,
Skaraborg was able to integrate existing IP-DECT phones into the solution, thereby making use of its previous investment while enabling the old phones to take advantage of the new features provided by Cisco CallManager.
“Cisco has always been our trusted advisor in all WAN and
LAN issues. We found most of what we needed in Cisco's IP telephony portfolio, and the product's open interface guaranteed that connection to third party products would be straight forward,” explains Berndt Fahlgren.
The new converged infrastructure is having a major impact on both costs and furthering the hospital's primary objective to improve patient care.
By consolidating voice and data on to the same network support and maintenance costs have been significantly reduced and the hospital expects to save 3.2 million over the coming five years. Network complexity is being further reduced as every opportunity is being taken to migrate legacy networks supporting bespoke systems to the new network.
Another advantage has been that the costs of adds, moves and changes has virtually disappeared – a major benefit in a fast changing environment such as healthcare – while toll byepass promises to reduce communication costs between hospital sites and health centres still further.
“We can quickly adjust the IP telephony system to reflect changes in incoming phone traffic. That saves us time and money, as well as providing better service to the public,” says
Berndt Fahlgren
Centralised call management is also benefiting the public. In the past callers found it virtually impossible to contact their local health centre in the morning due to demand. Now they are able to leave a message and are called back by health centre staff
The new Cisco Unified IP phones have proved very popular with hospital staff who have found a novel way of using the phone's speaker facility. When treating patients who do not speak Swedish an interpreter is needed. The interpreter is usually reached by phone. Previously the nurse or the doctor had to find a room with a speakerphone in these situations.
Now any phone at the hospital can be used.
But the major benefits on patient care are coming from the ability to securely transmit voice, video or data around the network.

The hospital's Picture Archiving and Communication System
(PACS) database of patients' records, and images such as Xrays and scans, sits centrally in the Skövde campus computer centre and now runs over the new network. Clinical staff are able to retrieve an image from PACS and see it on their own PC or laptop screen within seconds, wherever they are in the hospital. Importantly, health centres will have access to the system, enabling a patient's local doctor to be better informed.
Improved communications between the hospital and health centres will have other important benefits. In the past specialists spent about half their working day travelling from centre to centre. This time is now being minimised with greater use of telemedicine facilities, including videoconferencing. And when they do need to visit health centres, they can log into any
IP Phone just as if it were there own phone, complete with their normal extension number.
The Medical-Grade Network is also helping the hospital to realise its vision of 'One Patient, One Record'. Information is the enemy of ill health, and key to ensuring the correct treatment is given at the right time, and that unnecessary costs such as repeated lab tests, are avoided.
Not only will it be possible to extend access to hospital's
Health Information System to health centres, a Digitised
Journal is being developed to complement the system. Doctors currently record their notes on various devices and pass them to audio typists who enter them into the system. Soon, doctors will be able to dictate via the IP phones straight into the system with voice recognition software converting the sound to text.
Quoting the patient's social security number will ensure that the information is inserted into the right patient record. The solution will initially be able to recognise Swedish, German,
Polish and Danish.
“Limiting the number of gadgets for doctors for example, who currently operate separate equipment for dictation, alarms, paging and telephony, is of course also something we are striving for,” comments Berndt Fahlgren.
The Medical-Grade Network is also supporting other important applications, such as a security access control system.
The centralised solution has enabled various security contracts to be consolidated onto the one centralised system which is simplifying administration, reducing cost and enabling sites to be added as required. It is now possible to open, close and lock the doors at every location and manage access authorisation in real time from a single PC, as well as monitoring fire alarms. Hands-free access is being introduced along with personal security alarms linked over the network to a local paging system, a feature that is increasingly important in the emergency wards.

Jan Sunnergren
IT Operations Manager
Skaraborg hospitals
The core of SkaS' network comprises Cisco Catalyst 6509
Series switches, providing a secure backbone running at
1Gbps with the ability to scale to multiple gigabit speeds as traffic grows. The network is being designed to provide a resilient and responsive infrastructure. Cisco Catalyst 3560
Series switches sit at the network edge, with Power over
Ethernet (PoE). Wireless hotspots have been created using
Aironet 1200 Series access points.
The Cisco Medical-Grade Network is also supporting the hospital's storage network which is built up with directors and switches from Cisco's MDS 9000 multilayer storage networking family of technologies.
The four hospitals in the SkaS group communicate with each other over redundant Cisco 7206 Series routers, which encrypt all traffic. Cisco VPN 3000 Series concentrators are also used for secure remote access together with Cisco PIX
Security Appliance firewall solutions.
Eight Cisco Unified CallManager 4.0 units support IP telephony, with Cisco Unified Contact Center Express, and a
Netwise call handling system which provides specialised features tailored to Swedish users. Cisco Unified IP 7940
Phones are installed at Falköping (560), Mariestad (256);
Skövde (2,450), and Lidköping (875).
Within the health centres, VPN access, security and voice are delivered via a Cisco 2800 Series Integrated Services Router, with PoE and LAN connectivity provided by a Cisco Catalyst
3560 Series switch.
Future plans include the use of video call functions, increasing the use of XML integration with other applications and the installation of Cisco Unified MeetingPlace, a voice, video, and
Web conferencing solution. Security in the network will be further enhanced with NAC (Network Access Control) and
Intrusion Detection Services.
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