What infrastructure can support modern hospitals to solve their issues?

1. Smart Hospital Blueprint
Supporting the hospital of the
future
Stefano SOLIANI
Healthcare Solution Architect
EMEAR PSV
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 1

2. Access to care Quality and Care
Rising Care Costs Delivery
• Staffing shortages • Specialists and GPs • Patient expect higher quality
distribution
• Ecosystem interoperability • Growing patient consumerism
• Underserved areas
• Lack of proper IT support • Lack of standard tools and
• Lack of Interoperability single patient view
• Inefficient processes in the
hospital • Mobility not well supported • Missing Decision support at
point of care
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 4

3. Technology vision for the provision of care
Inefficient processes cause major waste of time in Always-on
staff daily activities. A hospital must be Collaboration
considered by definition a streamlined enables expertise
organization: whatever happens must be alerted, availability
and should trigger the related procedure. Time is anywhere
never to be wasted. Proper Workflow Management anytime, to
should be in place for system-to-system, system- complete patient-
to-human, and human-to-human communication centricity
Interoperability is the only Healthcare resources are always
way to achieve single patient scarce, and demand for storage,
view, providing the highest computing, bandwidth, tools is growing
support to caregivers. steadily. Flexible support based on
Mobile access bring support adoption of Managed Services,
to point of care Virtualization and Cloud is
recommended
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 5

4. • Reliably relaying critical and patient events to the right clinicians, or to the
right system
Hospital
communi
cation
Workflow
Engine
• Speed-up communications
• Less time fulfilling request
• Less disturbance by
reducing audio alarms
• Improved patient care
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 6

5. Records Telehealth eRx
Public
Exchange Health &
Image
Quality
Exchange
Reporting
PHR NHIN
Home
Care
Application Communications Billing Analytical
eRx
Services & Collaboration X.12 Services
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 7

6. MESSAGING
Patient to Patient BLOGGING/COMMUNITY
PLATFORM
ENTERPRISE SOCIAL SW Synch/Asynch
WEB CONFERENCING PATIENT CARE
Caregiver to
Patient to Caregiver
Caregiver
MOBILE APPLICATIONS
MESSAGING
TELE PRESENCE
IP COMMUNICATIONS TELEMEDICINE
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 8

7. Source: Frost & Sullivan - North American Radiology
PACS and RIS-PACS Markets – July 2009
Type of Study Approx. Size
X-Ray Computed Radiography 5 MB
Digital Mammography 200 MB
Ultrasound 100–500 MB
Nuclear Medicine 200–500 MB
Positron Emission Tomography (PET) Scans 200–500 MB
Magnetic Resonance Imaging 200-500 MB
Computed tomography 150–1000 MB
Angioplasty 500–1000 MB
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 9
Cardiology 5–10 GB

8. Consolidate Virtualize Automate
 Reduced complexity,  Higher resource  Dynamically
less to manage utilization allocate resources
 Lower OPEX  Lower CAPEX  Simplified policy-
based provisioning
 Regain control of  Decouples logical
IT resources from physical  Increase IT
resources productivity
The Network is the Platform
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9. Cloud Computing for HC:
•Scalability
•Cost optimization
•Reduced IT complexity
•Standardization
•OPEX vs CAPEX
HC SaaS opportunity:
•eHR
•PACS
•HIS
•RIS
•ePrescription
•TP/HealthPresence
•Web Collaboration
•Email/vmail/IP Tel
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 11

10. Providing proper network support
CLINICAL SYSTEMS STAFF EFFICIENCY
EMR Hospital Portals & Learning Systems
Patient registration Communication & Collaboration
Physician Order system Video Conference and Telephony
Patient Tracking and Monitoring Workflow Management
Emergency e-monitoring
Caregiver search
RIS
PACS
Telemedicine/ Tele Care
Robotic Surgery
Online operating room
INTELLIGENT BUILDING
Lab management system
Video Surveillance
Pharmacy Management system
Intelligent System
Excellence center
Access management
Ambulance management
IHE middleware
BACK OFFICE & HOSPITAL
BEDSIDE SERVICES EFFICIENCY
Patient portal Device Tracking.
Internet access Paying system
Digital Signage E-procurement
Contact Center
External portal
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 12

11. Event What happens Benefits Tech Infrastructure
Patient is Availability of bed is checked, bed reserved, All workflows are set to automate RFID tag
admitted into bedside services set, location tag installed on procedures, to optimize care. MSE
hospital patient, staff alerted to start procedures. WiFi
HL7
CUCM
IP Phones
Patient is Assistant is notified for patient transportation, Automated and Optimized process Workflow Mgmt
transported to looks for wheel chair using speech recognition for transporting patients eliminates WiFi
room interface to location tracking, elevator waits for waiting times and accelerate healing MSE
assistant to go to predefined floor. Patient cycles. Patient tracking guarantees RFID Tag
journey is automatically tracked. safety. CUCM
WiFi IP Phone
SpeechConnect
LDAP
Smart Building
Patient Medical record is checked (allergies, available Single patient view is created pulling Tiani-Spirit (IHE middleware)
receives lab results, scans, previous medical issues, …) medical info from all systems in the VPN
consultations hospital community (local, regional, ISR G2
national) UCS [Express]
Scan is Doctor authenticate into RIS from tablet, scanner System integration enables WiFi
reserved availability is checked, reservation is made, automation of workflow and real- AAA
specialist is alerted, RIS record is created. time notifications, accelerating the CUCM
scan cycle. CIUS
Patient is Same as before
transported to
modality
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 13

12. Event What happens Benefits Tech Infrastructure
Scan is Patient scan is created and made available for Image is created, securely and DC
performed diagnostic. Specialists is alerted. Modality is quickly transported into storage, Load Balancer
immediately available for next scan. accessible by having rights. WAAS
Workflow involves alerts to involved DICOM routing
staff. Gigabit switching
QoS
CUCM
Workflow Mgmt
Lab analysis Doctor enters requests for analysis using tablet, Reduce errors and optimize analysis WiFi
are requested lab is notified to start procedures. Doctors is cycle. CIUS
notified when lab result is ready. CUCM
IP Phone
Workflow Mgmt
Diagnostic is A team is dynamically created to collaborate Experts are grouped into a team in Presence
elaborated around the image, and deliver a diagnostic. the most flexible ways, and given CUCM
Team is created according to presence immediately the possibility to fully Webex
information, specialties, or other hospital logic. collaborate to produce the highest TP
Collaboration is remote with full audio/video/ quality of diagnostic. CUVA
image sharing capabilities. PACS
Surgery is Availability of operating room is checked, room is Workflow automation for Surgery AAA
requested reserved together with available surgeon and procedure enhance care process CUCM
staff, team is alerted. quality and minimize errors. HL7middleware
Workflow Mgmt
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 14

13. Event What happens Benefits Tech Infrastructure
Patient is Assistant is notified for patient transportation, Patient journey is always under Workflow Mgmt
transported to looks for mobile bed using speech recognition control, every event triggers specific WiFi
operating interface to location tracking, elevator waits for actions to guarantee highest quality MSE
assistant to go to predefined floor. Entrance of of care. Complete patient RFID Tag
room patient into room is detected, Medical Record is information display eliminates errors. CUCM
automatically fetched and important info shown WiFi IP Phone
on LCD screen (reason for surgery, scan image, SpeechConnect
operation histories, allergies, …) Smart Building
DMS
MDES
Patients starts Patient conditions are monitored by connected Automation of Biomedical device BioMed NAC
surgery biomedical devices, fixed or mobile. ICU staff is connectivity simplifies IT operations WiFi
recovery prevented if vitals signs goes off boundaries. and guarantees for optimal working QoS
Patient can trigger intervention of nurse if conditions, ICU staff are supported CUCM
phase required. Patient uses bedside services to by automated alerts to optimize Nurse Connect
connect with family, use entertainment system, productivity and quality of recovery. Bedside monitor
select food, access Internet, control HVAC or Smart Building
lights, etc. Firewall
Drugs are Doctor input requests for specific drugs. Reduce errors and optimize WiFi
ordered Pharmacy receives order. EMR is checked for pharmacy cycle. CIUS
counter indications and updated. Staff is alerted CUCM
when drugs are available. IP Phone
Workflow Mgmt
Patient is Patient can go home, cleaning ladies are alerted Increases average availability of CUCM
dismissed to set up the bed/room for new patient, status is beds, and therefore number of Workflow Mgmt
updated. patients treated.
Patient status Patient is scheduled for a visit using Minimize travel time for doctors, or CHP
is checked TeleMedicine. The closest patient pod is associated risks for patients.
reserved, together with a doctor pod and
specialists in the hospital. Vitals are checked
during the visit, and doctor can monitor patient
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 15
evolution.

14. Acute Care Campus Environment
North Access 1
Clinical Core
Workstation
802.11
n AP NAM
Network
Analysis NAC
Module Server
South Access 1
Distribution
Nx 10G
Si
CT / MR
Si Si
Si
Patient Access
Monitor
South Access 2
Si
Si
CoW
Si Si
North Access 2
802.11
n AP
Wireless Intrusion
LAN Prevention
Controller(s) System
Access Distribution Core Data Center
An Optimized
Network
Architecture for
Tunnel
VPN
Public Private
the Smart WAN WAN
Hospital
Remote Clinician WAN Edge Remote Ambulatory Care
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 16

15. Network Services
Reliable Efficient
Connectivity
User Services Policy
Mobility, Video, Dynamically Linking
Workplace Experience Users, Devices, and
on a Common Fabric Applications
Integration Experience
Virtualized Devices and
Consolidated Data, Video, Resources, Anytime,
Energy, Automation Anywhere
Enhancing the Healthcare Experience
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 17

16. Access
• Hierarchal designs
TelePresence
• No single points
of failure Smart Infusion
Pump
Portable
Ultrasound
Distribution
• Utilize in box
North Access 1
Clinical
Workstation
redundancy NAM
802.11n AP
Network
Analysis Module
NAC Server
Core
• Optimize convergence
7925G
South Access 1
Nx 10G
Si
• Best practices must Point of
Sale Device Si
Si Si
adapt to unique healthcare South Access 2
requirements CT / MR
Si
CoW
Si
Si Si
North Access 2
802.11n AP
Intrusion Prevention
Wireless LAN
System
Controller(s)
Medication RFID
Administration Cart TAG
Patient
Monitor
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 18

17. Access
VSS
Layer 3 Access
stackable switches
Distribution Si Si Si Si VSS
Distribution
Core VSS/Hybrid Core
Si Si
Distribution Si Si
Access
Data Center 10Gbps Nexus
WAN WAN
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 19

18. Untrusted Access Distribution Core
Endpoints
• Summary of trust,
marking, policing and
queuing boundaries
• Correct Trust and
Markings at Access
Trusted
Endpoints
• Interswitch links in
Campus will trust
DSCP markings
• Perform Policing and Untrusted Endpoint Port Conditionally-Trusted Endpoint
Queuing where QoS: Port QoS:
 No Trust  Conditional-Trust with Trust-DSCP
appropriate Conditionally
 [Optional Ingress Marking/  [Optional Ingress Marking/ Policing]
Trusted Policing]  1P3QyT Queuing
Endpoints  1P3QyT Queuing Switch-to-Switch/Router Port QoS:
Trusted Endpoint Port QoS:  Trust DSCP
 Trust-DSCP  1P3QyT or 1P7QyT Queuing
 [Optional Ingress Marking/
Policing]
 1P3QyT Queuing
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 20

19. For the Patient…
For
Caregiver…
For
Administration
…
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 21

20. Collaboration Services Automation Services
High-Speed Internet Lighting
Buildings are today responsible for:
Wireless  62.5% of total electricity consumption Elevators
 30% of total Greenhouse Gas
produced
Mobility –
RFID – Tracking
Remote Access
Unified Communications HVAC – Sensors
Audio and Video Conferencing Fire
Telepresence Benefits of “Intelligent” approach Video Surveillance
 Electric consumption reduction
 Decrease of energy needs
Interactive Media Access
 GHG reduction
Digital Signage BAS – Energy
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 22

21. Energy Management
Building Management
HOSPITAL APPLICATIONS Facility Management
Middleware Server Security Management
Translation of Maintenance Management
disparate protocols IT Network Management
to Common format
IP Camera IP Telephony
Wireless Telepresence
Energy and BMS Lighting UPS CCTV Access
Power Control Monitoring Control
Metering
DVR
VAV Boilers
FCU AHU Door
Controllers
Heat General Intruder
Chillers Channel
Pump Lighting Panels
Controllers
Chilled
Beam Smoke Break
Sensor Glass Occupancy
Fire Alarm
Detectors
System Reader
DSI/DALI Technology
Interface
Sounder
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 23

22. Cisco Video Surveillance Manager
Data Center Network Operation Center
Storage
Cisco Physical Security Operation
Mgr
Cisco IP Cameras
Cisco Video Analytics
•Embedded software on video endpoints
enables innovative video analysis
•Classify objects, detect tampering, trigger
alerts, and count people and vehicles
•Analyze surveillance video in real time
and improve incident response
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 24

23. Optimize Energy Usage of hospital, Clinics, Devices
ON
IT Admin OFF
All devices set to automatically
turn off after business hours
Solution Description Features/Benefits Product/Technology
 Visibility and Control for  Low Energy Cost  Integration Schneider
PoE and PC Devices Electric
 Increased sustainability
 Open SDK/API to Third  Cisco Catalyst switches
Party Devices  Comply with regulatory
and Cisco ISR G2
 Network Building Controller
directives
and Building Management  Reduce GhG emissions
Systems
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 25

24. Third Party Power
EnergyWise
Management
Management MSE LMS Applications
Application Location
EnergyWise
Management SNMP TCP Management
Communications API
(SSL for Network-
wide)
Wireless
Controller
Domain – logical EnergyWise
grouping of entities Domain
AP
(Child/ Neighbor)
Building
Field
Controller
Entity (unique ID)
under one domain EnergyWise
(Parent/Child) Entities
MIB (power usage, Wireless Client
policy, alarm)
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 26

25. Create Manage Access
Desktop
Digital Media Encoder Video
1100 Displays
Media Experience Engine
Digital Media Encoder
2100
Enterprise TV
SA Encoder Digital Media Manager Digital Media Player
Distribute
Content
Distribution
WAE Appliance ISR-NM
Manager (CDM)
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 28

26. Third-Party
Integration to RTLS Wireless
(Nurse Call, BioMed, Management
EMR) PC—Browser
Based
Cisco Catalyst®
3750G Integrated NAC MSE ACS WCS
Wireless LAN
Controller
Wireless LAN
Controller (WLC)
MGN 2.0
Cisco Catalyst
6500 Wireless
Campus
Services Module
(WiSM)
Cisco ISR
Wireless LAN
Controller Module
Voice and QoS
Enabled L3 Access
Switches
SSC
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 29

27.  Create an AP Perimeter which facilitates greater accuracy
Increased
 Use of chokepoints provides electronic ―gates‖ to track assets
Accuracy  Time Differential of Arrival (TDoA) based systems increases
accuracy
 Improved Location Algorithms available on the Cisco MSE 3300
 Wireless Networks supporting RTLS require specifically placed
Design 802.11 APs to optimize location tracking
Network for  Parallel Infrastructures require additional hardware (chokepoints,
RTLS TDoA sensors, 110VAC based sensors, Infrared sensors)
 RF Fingerprinting based systems improves accuracy for RSSI
(Receive Signal Strength Indicator) based systems
Optimized
Convex
Hull/AP
Perimeter
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 30

28. Asset Temperature Patient & Patient Infection
Management & Humidity Staff Safety Flow Control
Monitoring
Existing Wi-Fi Network
LOCATION, CONDITION and STATUS of assets, patients and staff
In use
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 31

29. Integration to Hospital Applications:
ORIS, CMMS, Security, Nurse Call, EHR, etc.
Visibility AeroScout MobileView
Software Track-Alert-Manage-Integrate
Infrastructure Exciters
Wi-Fi Infrastructure and (Optional)
Location Engine
Tags Wi-Fi +
Wi-Fi Tags Ultrasound Passive
and Clients Wi-Fi + Sensors Wi-Fi + GPS Tags
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 32

30. Enhance Video and Data Application Performance
Application Velocity
Remote Physician Radiologist
Solution Description Features/Benefits Product/Technology
 Seamless and secure  Application performance  WAAS on Catalyst 6500
remote access consistency for Doctors/ and SRE
 Consultation with video Nurses  UCS Express on
and collaboration  Enhanced efficiency VMware/Windows
 Intelligent bandwidth  Performance Routing on
 Scales to meet video growth
management ISR G2 and ASR1000
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 33

31.  Improving image transport, routing and storage
WAAS Optimized WAN
 Faster Store/Transfer Operations
Hospital or Imaging Center Modalities
 Reduced Wait Times
Remote Data Center ACUO
WAE DICOM Grid Radiology PACs
 Reduced Bandwidth Utilization WAE
across WAN
ISR Cisco Catalyst
6500/ACE CSS
Archival
Wide Area 6500/ACE Load Balancing
Integrated with ACUO
Radiologist Accelerated DICOM Grid, Virtualizes DICOM
Application Servers
Viewers Network Layer and Processes
Transactions Faster
Internet
WAN
Local Data Center Referring Physician
(Remote)
Presence Webex Application Unity IP
Server Servers Voicemail Phone
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 34

32. PACS 2
PACS 1
PACS 3
Cisco UCSE/SRE Cisco ISR
Network Module Router
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 35

33. CLINICAL SYSTEMS
EMR
Patient registration
Physician Order
system
Patient Tracking and
Monitoring
Emergency e-
monitoring
Caregiver search
RIS
PACS
Telemedicine/ Tele
Care
Robotic Surgery
Online operating
room
BACK OFFICE &
Lab management
HOSPITAL
system
EFFICIENCY
Pharmacy
Device Tracking.
Management system
Paying system
Excellence center
E-procurement
Ambulance
Contact Center
management
External portal
IHE middleware
INTELLIGENT
BUILDING
Video Surveillance
Intelligent System
Access management
BEDSIDE SERVICES
Patient portal
Internet access
Digital Signage
STAFF EFFICIENCY
Hospital Portals
Communication &
Collaboration
Video Conference
and Telephony
Workflow
Management
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 36

34. •Host clinical and
administrative systems on
single platform
•Virtualization helps on
scalability, cost-effectiveness,
complexity, energy reduction
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 37

35. Presentation (user access)
Application
& App Middleware servers
Management
Management & DB servers
Virtualization
Unified Computing
Network
Storage
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 38

36. Solutions
Conferencing Customer Care
Communication
& Collaboration Enterprise Social Software IP Communications
Applications
Messaging Mobile Applications TelePresence
Presence Session Mgmt Content Mgmt
Collaboration
Services Location Client Frameworks Tagging
Policy and Security Management
Infrastructure Virtual Machines Network Storage
ON-PREMISE HYBRID CLOUD
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 39

37. SIP
Cisco Unified CM
SIP Call Control SIP
Telepresence Application Servers
H.323 Gatekeeper Advanced
H.323-to-SIP GW Firewall
Conferencing
SIP Grooming Traversal
Services
3rd party SIP and H.323 Distributed Conferencing B2B and Remote Workers
video devices Services
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 40

38. Applications
Corporate
Scheduling Email / Messaging / Recording
Calendaring Presence Streaming
TelePresence Multipoint
Meeting
Call Control Session TelePresence Infrastructure
and Video Border
Endpoints Servers Controller
Session TP / Video
Border Endpoints
Controller
Internet
Global B2B
Inter-Network
Si
Enterprise
WAN
Si Branch Access
WAN Firewall
Switch
Campus Campus Firewall Campus WAN
Access Distribution Aggregation
Clinic
Network Infrastructure
Hospital Campus
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 41

39. Cisco IP Phone
M
M M Cisco
Access Points
Responder IV-V M M
CUAE Cisco 7921G 7925G
System
CUCM Cluster Wireless IP Phone
Cisco
WLAN Controller
Rauland Cisco components: CUAE, CUCM, WLAN
Borg Nurse Controllers, Access Points and Wireless
Call System IP Phones
Nurse Connect
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 42

40. Nurse Call Vendors
SIP
Cisco
TAP Plug In CallManager
Access
Point
CUAE
Medical Device SMS
Vendors
HL 7 Presence
DMS & Video
Context-Aware Services
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 43

41. Parallel Paths Through The Network
Remote Location Data Center
CUCM
CTMS
CHP-Client
API
JTAPI
API cHPAS
DA
API
TelePresence
CHP-Portal
Video Audio Ultra
Scopes Scopes Sounds CHPAS—Client
CHP—Portal Client
Vitals Telemetry Others
Ethernet
 Cisco TelePresence SIP/RTP UDP 5060,5061,16384-16389
Ports  Cisco HealthPresence—HTTPS 8080,80,443, UDP 244x
 JTAPI CUCM 2748
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 44

42. Applications Capabilities
• 802.11a/b/g/n Wi-Fi, 3G/4G data and Bluetooth help teams stay connected on and off-campus
• HD video with Cisco TelePresence interoperability for simple, lifelike video communication
• Android operating system, with access Android marketplace applications
• Collaboration applications including Cisco Quad, Cisco Show and Share, WebEx, Presence & IM
Tablet Highlights
• 7‖ diagonal, high-resolution color screen with touch interface delivers an intuitive experience
• HD media station supports Bluetooth and USB peripherals
• Highly secure remote connections
• HD audio
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 45

43. Cisco Security
Hospital WAN Edge Intelligence Remote Clinician
Wireless LAN Operations
Controller Web Security
Host Intrusion
Appliance
Prevention
6500 with
Wireless WISM
Devices
3750G MGN 2.0 Internet Physician PC with
ISR w/FW-VPN ISR w/FW-VPN Desktop UC Client
Campus
Remote Clinic
Wired
Devices 3560 WAN
Email ASA/IPS
Host Intrusion
Security
Prevention
Appliance
Host Intrusion Prevention Cisco NAC
Server
ISR w/FW-VPN
Cisco NAC
Mgr/Profiler
Data Center Partner
PACS Cisco ISR w/FW-VPN
CS-MARS
Clinical
App/EMR MGN 2.0 Cisco Partner/Payer
Data Center
ACS
DNS
Cisco Security
Manager
Email and
Web Servers
ACE/XML GW
Web App FW
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 46

44. Data Center NAC Profiler
Services Block
Philips Patient Information Center
NAC Manager (PIC) & DB
NAC
NAC Server/Collector Collector DHCP Server
Si
BioMed Device Profile Creation
Core
Si
Philips Patient Information
Distribution Center (PIC) & DB NAC
Collector NAC Server/Collector
Si
OOB
Access
IDF-1 IDF-2
Wired Wireless
Patient Monitors (Bedside) Infusion Pump
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 47

45. With wireless and BioMed NAC on
is possible to:
 Get vitals, locally an remotely, in a
safe way
 Centralize monitoring (ex: ICU)
 Move monitors from patient to
patient, room to room, and always
make sure that network recognize
the monitor when connected, wired
or wireless
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 48

46. Dynamic load sharing and
security provided by ACE. Adaptive Security Appliance (ASA)
Implements access policy provides high availability stateful Security reporting and
and load sharing, security access control and deep packet trend analysis
and reporting. SSL inspection (IDS/IPS) with the provided by CSMARS
encryption services provide Security Services Module (SSM)
for end-to-end encryption of Application
ePHI data Control Engine CS-MARS 5
1 (ACE) 3
Netflow and
Clinical User Policy
Feature Card
Community (PFC)
provide
trending and
alerting to
CSMARS
Adaptive Security Adaptive Security 6
Appliance (ASA) Appliance (ASA)
Out-of-Band
Management
Host Intrusion Host Intrusion
Prevention Prevention Host Intrusion
Prevention
Highly available virtualized hosts
with the ability to dynamically
move workload, create
additional host machines for
increased demand. Security Access Layer—Web, Visual Basic,
patching of OS and clinical
systems improves security and
Thick Client Backend, Thin Client,
VDI, Etc.
Compute Services
EHR Clinical Workflow Engines
7
availability Highly available SAN with
Virtualized Computer Services—Cisco UCS Database Server(s)
2 4 media encryption services
provide by mds-9000—
Host protection and continuous posture Storage Media Encryption
assessment provided by Cisco TrustSec services (SME) provides security for
49
© 2010 Cisco and/or its affiliates. All rights reserved.
ePHI at Cisco Confidential
rest

47. Only
supported
VDI hosts
permitted
Cisco NAC
Policy only
allows access to
Virtualized authorized hosts
and protocols. Internet or
Security
Deep packet Private WAN
Radiology Vendor Zone Contexts AAA Access
inspection using
SSM module Authentication
in ASA Server Vendor VPN
Medical Grade Access Headend
Network
RIS/PACS
Only IPSec
and/or SSL
Pharmacy System allowed to
IDS/IPS inside VPN
LAB Security Zone termination
ASA 5500 device
Trusted
with SSM
Medical Grade Inside
Network Interface(s)
Cisco UCS
EHR/Lab
Cisco NAC System VDI
Server(s)
Vendor Support
Secure Remote
Call Center
Access via
Access to Dedicated or Client
SSL/AES VPN
unauthorized based VPN Access
hosts is
Protocol break Only supported VDI protocols
prevented Session
between vendor and access methods. Deep
and clinical Logging & packet inspection if not
network Recording encrypted
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 50

48. Virtualized Data Center
CLOUD
Virtualized
Collaboration Workplace
CUPC MS Office Video
Virtualization Aware Network
Cisco Clients Microsoft OS
Branch Data Center Desktop Virtualization Software
Network
Zero Client Thin Clients VDS/CDN
ACNS/
and IP Phone
WAAS Hypervisor
Cisco Nexus Broker
WAN
Cius Business Tandberg Virtual Virtual
Tablets Endpoints QUAD CUCM
ISR
Thin Client Ecosystem
WAAS ACE
FC FC PACS
Wyse, Devon IT, iGEL eHR Server
Server
End-to-End Security, Management and Automation
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 51

49. Hospitals Clinics Patients Rural
at home Retail Areas
Pharmacies WiMAX/3G/VSAT
Urgent Universities Cable DSL Dial
Care
Reference labs
Long Term
Care
Connected
Health Core
Employers
Outpatient
Centers HC SaaS opty:
National
UNIVERSIT Y
Health •eHR/HIS/RIS
Health Insurers PBMs State / Fed Agencies Cloud •PACS
•ePrescription
•TP/CHP
•Collaboration
•VXI
Private, Virtual Public or Private
Private or Hybrid Community Cloud
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 52
Cloud Cloud

50. Corporate Ranking
Technology Awards
Healthcare Endorsements
Global Market Leadership
Partner Landscape
http://www.cisco.com/web/strategy/docs/healthcare/09CS2281_Why_Cisco_for_H
ealthcare_AAG.pdf
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 53

51. Partial list of Corporate Rankings and Awards
• VMworld 2009 awards Cisco's Unified Computing System the gold award in
Hardware for Virtualization
• Cisco Ranks No. 5 on AMR Research's World's Top 25 Supply Chains
• EPA awards Cisco with the Green Power Partner of the Year Award.
• The 2008 CIO 100 Winners: Creating Business Value With Technology
Innovation
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 54

52. Partial list of Technology Awards
• International CES Innovations 2007 Design and Engineering Awards Honoree
MPEG-4 HDTV Advanced Compression Encoder (Model D9054TM)
• Linksys Wins PC Magazine's Readers' Choice Award for Network Routers Sept
2006
• Cisco Catalyst 3000 series received the Gold Award for stackable switches from
SearchNetworking.com
• Cisco's Network Admission Control (NAC) was honored with a Gold Award for
endpoint security by SearchNetworking.com
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 55

53. ―Cisco CleanAir, a spectrum analysis
feature set comprising recent-generation
Aironet 3500 series access points and
Version 7.x Unified Wireless Network
software on the APs and Wireless LAN
Controllers, delivers outstanding RF
(radio frequency) reporting, tracking and
assessment capabilities to help wireless
administrators build robust wireless
networks to host mission-critical
applications and dense endpoint
deployments.‖
―In 2010 Cisco turned on yet another new feature in the Nexus 7000 platform that
basically eliminates the ancient and universally deployed spanning tree protocol from
network designs, thus enabling much larger Layer 2 networking domains within the
data center. The FabricPath Switching System is the foundation of a push by Cisco to
combine NX-OS software features with the hardware capabilities of the Nexus 7000
F1 series module to build the next generation of high-performance network systems.‖
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 56

54. IHE “Connect-a-thon” Results, 2009
“Framwework” Connections
(Possible 120)
• Integrating the Healthcare Enterprise (IHE): industry group developing HIT interop
―frameworks‖
• IHE’s ―Connect-a-thon‖: Industry’s key interoperability testing event.
• ―IHE, more than any other single organization, has paved the way for practical
healthcare interoperability.‖ –Gartner
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 57
Source: IHE, Gartner

55. Cisco is the only wireless LAN infrastructure endorsed by the AHA.
http://www.aha-solutions.org/aha-solutions_app/ControllerServlet?action=displayComponent&componentID=997001452&categoryID=32493076&platformID=9684994
© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 58