THE MARY McClellan HOSPITAL and Skilled Nursing Facility (MMH), the only hospital in Upstate New York's Washington County, serves approximately 70,000 people from neighboring communities. Like many hospitals in rural, remote areas, MMH needed to find economical solutions to fundamental issues involving patient care and staff training.

MMH approached the Adirondack Area Network (AAN) and NEC BNS with specific goals: to improve MMH's ability to recruit, retain, and train specialty physicians, and provide its family health centers with better access to medical expertise so that patients could be treated closer to home.

"Our vision is to transport patient information, not the patient," says Suzanne LeRoy, director of information systems at MMH. "This vision also includes a desire for all the remote sites to appear and feel like they are one campus. Physicians want to be part of a larger network, and the connectivity between our off-site locations and the main hospital will help MMH's physician recruitment and retention," says LeRoy.

NEC BNS and the AAN responded with a converged voice, video, and data solution to introduce telemedicine, videoconferencing, and distance learning between MMH and its family health centers. Using technologies from NEC, Cisco Systems, RadVision, and the AAN permanent virtual circuits (PVCs) were installed through AAN's frame relay cloud that allows MMH to eliminate the point-to-point connections to the family health centers and other AAN members. Significant ongoing cost savings are realized using these technologies.

To prove the concept design, MMH and AAN called for a stress test involving eight simultaneous voice conversations, data transmissions, and a video conference call across the AAN frame relay connections. During the test, one of the evaluators asked Dave Gauthier, senior system engineer with NEC BNS, when he would begin the voice compression. He replied, "The compression has been in effect since the phone call was initiated."

This verified that MMH's NEC 1000 IVS and the Cisco 3810 voice gateway delivers high-quality, transparent voice services from the hospital to a remote site using AAN's T1 frame relay (VoFR). It also verified the proper operation of the Common Channel Interoffice Signaling (CCIS) protocol with the Cisco 3810 to deliver full PBX feature transparency. CCIS is the internodal network architecture that NEC uses to provide feature transparency, centralized voice messaging, centralized call accounting, centralized administration, and standalone survivability. Features successfully tested include three-and four-digit dialing, call transfer, call forward, three-way calling, number display, name display, message-waiting lamp, voice calling, SMDR, and centralized voice mail.

MMH is now adding AAN connections to three of its family centers to offer more training for its medical staff, increase the hospital's efficiency and competitiveness, and heighten the hospital's visibility in the community. HeaIthcare Communicator will revisit MMH to provide an in-depth look at the network when it's fully operational. The article will explore the challenges of implementing MMH's vision of a single-campus feeling in a rural setting.