National Surgical Hospitals: Increase in Medical Imaging Drives Move to QoS

Mon, 10/15/2012 - 2:53pm -- admin

Case Study—An Increase in Medical Imaging Drives Move to QoS

National Surgical Hospitals

About the Company
National Surgical Hospital facilities are focused on providing inpatient and outpatient surgical services primarily for orthopedic, spine, and pain management for physicians and their patients in an ambulatory surgical center-like setting. Each facility is dedicated to providing a pleasant and friendly environment with the customer service and operating efficiency of an outpatient surgery center.

National Surgical Hospitals is an innovative healthcare company that provides a full range of capital, development, and management services for physician- and company-owned surgical hospitals throughout the United States. The company currently supports over 20 community-based facilities from coast-to-coast and takes on the responsibility to ensure that each one remains true to its goal of providing “efficient, friendly, and cost- effective care” to all its constituents including physicians, the patients, payors, and the community-at-large.
By providing comprehensive facility and management services, National Surgical Hospitals (NSH) frees surgeons and clinicians to focus on providing the highest quality health care and patient services.
One important component of the service is providing a secure, fast, and reliable IT network connecting each facility to the NSH headquarters in downtown Chicago. The NSH has an all-Cisco network. According to Senior Network Systems Engineer Chris Paalman, each location uses a Cisco 2900 ISR router connected to a third-party MPLS service as its primary link to the Chicago office. Each location also uses a VPN connection over the Internet as a backup link.

Responding to Changes in Traffic Direction

For some time, nearly all of the network traffic went in one direction from the central office to the remote locations. Today this is changing. The member hospitals are now sending medical imaging files and print files to the main office as well as enormous amounts of archive files created by scanning years of paper-based medical records.
“We knew we had to be preemptive in handling document imaging if we were to prevent our core applications from getting stepped on,” Paalman said. “We started getting some calls from users saying there was contention during peak times such as when people were logging in. Most of the time the circuits were not overtaxed, but there were definitely bursty moments.
“Document imaging has become a big concern and we’ve had to evaluate our controls on the WAN which had been mostly wide open up to now,” Paalman said. “The old adage of just throwing more bandwidth to the problem no longer works. We knew we had to deploy QoS (quality of service) to prioritize our traffic, but the configuration that went along with it was a little overwhelming.”
Although he has 20 years of experience with routing and Cisco’s command line interface, Paalman had only limited experience with QoS and was not sure if his initial implementations were actually making a difference. “We began looking at different tools that could explain how this additional traffic was impacting our network.”

LiveAction Software

Paalman saw an article in Network World about LiveAction QoS software and proceeded to download and install a trial version of the software. He quickly realized that for the first time he could easily see and measure the before and after effects of QoS. After trying LiveAction’s graphical QoS policy editing and deployment features, he began pushing for the purchase of the software for his network.
Today, Paalman and Systems Engineer Brandon Craig continue to use LiveAction software to monitor and optimize performance on their network. However one of the biggest benefits of LiveAction is the time it saves them to do other things.

Both are responsible for providing network access, services, and support for approximately 1,800 users—most of them at remote locations. “Security is of high importance here,” Paalman said. Having a tool that can simplify our QoS and WAN operations frees us to devote our time to this and other critical issues such as HIPAA compliance.”
In addition to the QoS functions, Paalman uses the LiveAction NetFlow function to watch and learn what’s going on in his network. He relies heavily on its flow visualizations to help him decide what changes he needs to make to his QoS policies.

In a separate project, he used the LiveAction policy based routing (PBR) feature to route bandwidth-hungry disk backup operations over the mostly idle backup links. This freed up large amounts of MPLS capacity, enhancing performance without incurring any extra costs. In the future, Paalman wants to use LiveAction’s IP SLA capabilities to help him prepare new services over the WAN links. In the meantime he appreciates the software’s graphical user interface which helps ensure there are no typos when he configures a network router.

QoS From Start to Finish

How long did the NSH QoS project take? According to Paalman, it took only a couple of days to implement everything he wanted to do. That said, he gave the project 2-3 more weeks to evaluate the results so he could make fine adjustments slowly and precisely while using LiveAction to measure the changes.
Interestingly, in the process he did find some old devices talking to each other that he thought had been stopped years ago. That extra chatter is now turned off. “We hardly ever have to look at our results now,” he added. “Phone call complaints just don’t happen anymore.”

Find Out More About National Surgical Hospitals

For more information on National Surgical Hospitals, visit their web site at