Case Study   AUSL Nuoro (Italy)   AUSL NUORO TAKES TELEMEDICINE TO THE SARDINIAN MOUNTAINS WITH 3COM® END-TO-END VOICE AND DATA NETWORK Organisation AUSL Nuoro (Azienda Unità Sanitaria Locale) Location The Commune di Nuoro covers an area of 24,000 sq km in central Sardinia. Nuoro is also the name of the provincial capital city. Employees 900 (across seven hospitals) Population 272,000 AUSL Nuoro (Azienda Unità Sanitaria Locale) is the regional authority responsible for overseeing healthcare provision in the Commune di Nuoro (Nuoro Municipality), Sardinia. AUSL Nuoro manages seven hospitals across the province, three of which are in Nuoro city. The Challenge AUSL Nuoro was dissatisfied with the voice network shared by the hospitals it was responsible for. Voice services at that time were provided by five meshed PABX's (Private Automatic Branch Exchange) located at different sites. In 2002, AUSL Nuoro gauged the approximate annual cost of using leased lines at a prohibitive $340,000 (US). Another issue was that the Nuoro province has some of the highest peaks in Sardinia and Southern Italy, which can only be traversed by an intricate web of rough, country roads. Travelling to the nearest hospital can take a couple of hours at least. AUSL Nuoro was aware that for very sick patients and others — such as women in labour showing signs of a problematic birth — a quick diagnosis is a critical factor in securing a positive outcome. AUSL Nuoro wanted the region's expert medical staff — such as consultants and surgeons — to be called upon to provide assistance anywhere in Nuoro province. In such cases where the patient is in need of urgent treatment, time is of the essence. Although technologies such as streaming video, video conferencing and web cams presented an obvious solution to many of AUSL Nuoro's problems, the limited network technology that existed across the region's hospitals was unable to support such sophisticated applications. There were only two hub-based LANs, located in the two of the hospitals in the provincial capital. Where a hospital was using PCs, the majority had no network connection. In 2002, AUSL Nuoro began the search for a complete communications solution that would allow it to cut the costs associated with its voice communications and run a number of specific applications such as telediagnostics, video conferencing, web cam and web surveillance as well as Internet access. The Solution After consulting Gigadata VSP Italia, AUSL Nuoro chose an end-to-end 3Com® voice and data solution based on the following products: 3Com SuperStack® 3 NBX® Networked Telephony Solution provides AUSL Nuoro with a fully-integrated voice network offering fully featured, high-quality voices services including all the voice messaging and call processing functionality expected of the most advanced telephone systems. AUSL Nuoro has installed a total of seven SuperStack 3 NBX Networked Telephony Solutions across the region's hospitals, which will support 900+ NBX phones. The solution is capable of supporting up to 1500 devices (lines/stations), so there is plenty of capacity for future growth. 3Com 11 Mbps Wireless LAN Building-to-Building Bridge allows AUSL Nuoro to create wireless bridges between the hospital networks thereby eliminating the need to pay for expensive leased lines. With the wireless Building-to-Building Bridge, AUSL Nuoro can link its hospitals over distance of up to 16 kilometres (10 miles) with minimal complexity. The bridge also allows AUSL Nuoro to take advantage of powerful features including security and network management enhancements. 3Com SuperStack® 3 Switch 4400 provides optimal-performance, feature-rich Ethernet LAN switching with high port density. The 3Com SuperStack 3 Switch 4400 provides Layer 2 switching together with advanced Quality of Service/Class of Service (Qos/CoS) and traffic management features to add some Layer 4 capabilities to the network infrastructure. AUSL Nuoro has installed units across its hospital network, connected to the Gigabit backbone by plug-in 1000Base-SX modules. The Benefits AUSL Nuoro and its hospitals now have a cost-effective and comprehensive voice and data communications infrastructure capable of supporting cutting-edge multimedia applications. All seven hospitals in the Nuoro region now have access to a robust 3Com voice and data solution which minimizes costs — through the use of NBX solutions and wireless building links — at the same time as enabling medical staff and patients to benefit from a comprehensive range of telemedicine and other relevant applications. The new telediagnostic service allows patients to be 'seen' and diagnosed by highly qualified specialists without delay. Using telediagnostics means that patients no longer have to suffer long and often painful journeys to get the expert attention they need. With a high-quality web camera located in hospital operating theatres, surgeons can call on remote assistance from more specialist sources, including the regional Surgeon in Chief, while an operation is actually underway. Having expert input via the webcam can make the difference between life and death. The webcam is also a potentially invaluable teaching aid, as it allows students a virtual presence in a greater number and variety of operations. Medical personnel can also secure the support and advice of colleagues by using the video conferencing service located at 25 points across the region's seven hospitals. All doctors can make use of dedicated 8Mb Internet bandwidth in support of their clinical activities. From a management perspective, the 3Com solution allows for tighter control over security. The 3Com solution allows use of web surveillance. By replacing costly leased lines with 3Com Wireless LAN Building-to-Building Bridges, AUSL Nuoro has a powerful and far more cost-effective way of connecting the hospitals. As the Building-to-Building Bridge is being used with the SuperStack 3 Switch 4400 switches, AUSL Nuoro's network administrators have "trunked" the bridges together to give a higher bandwidth link between buildings. The traffic prioritization capabilities of the Switch 4400 ensure a high quality voice service for users. By implementing the NBX solution over the new network infrastructure, costs associated with the traditional PABXs have been eliminated. "By implementing a 3Com solution we have been able to realise all AUSL Nuoro's goals. We have dramatically cut leased-line costs by using the 3Com Wireless LAN Building-to-Building Bridge. The 3Com solution will also allow the Surgeon in Chief to monitor selected operations taking place at hospitals across the region. The 3Com NBX solution allows us to make best use of wireless and our existing HDSL (High bit-rate Digital Subscriber Line) technology for voice as well as data traffic." said Gianni Gianoglio, AUSL Nuoro's marketing manager.