It’s hard to think of a more politically charged situation than having to deal with the amalgamation of four hospitals — and their respective network environments — as a result of the Ontario government’s province-wide healthcare restructuring plan.

That’s exactly the situation facing Peter Lambert, CIO of Quinte Healthcare Corp., the recently formed merger of four hospitals located in Prince Edward County and Hastings County in Eastern Ontario.

But according to Lambert and officials from Unis Lumin, the consulting firm for the project, political infighting has been kept to a minimum as teams from each of the hospitals have worked together on how to amalgamate the hospitals’ existing telephone and data networks.

“We certainly believe in a pretty open process, which includes all the stakeholders. We try to do it that way right from square one, and it does seem to avoid a lot of problems,” Lambert said.

Starting from early on in the merger process, Quinte Healthcare has held regular meetings with key managers, IT staff and end users to keep them abreast of how network amalgamation is proceeding.

Unis Lumin president John Breakey said keeping key players informed is one of the most important “checklist” items when putting together a strategy for merging two or more companies’ operations.

“The Quinte group did a good job of managing the process, managing the people. They very early on got these different teams working together and, from our perspective, there was a hell of a lot of cooperation that happened between the various sites,” Breakey said.

Quinte Healthcare’s Lambert and his staff, located at Belleville General Hospital in Belleville, Ont., were chosen as project leaders, with senior management from North Hastings Hospital in Bancroft, Ont., Trenton Memorial Hospital in Trenton, Ont., and Prince Edward County Memorial Hospital in Picton, Ont., brought in for monthly update meetings.

Breakey said Unis Lumin has acted as IT consultant in a number of merger situations and, in his experience, amalgamation projects are usually chaotic and rife with bickering and political jockeying as each organization tries to impose its technology plans on the newly merged company.

“The problem you have, of course, is that two different organizations have different infrastructures, they’ve grown differently and they have different biases…The first thing you have to establish is some sort of decision on who’s going to take the leadership role,” Breakey said.

“Sometimes it’s great when both (organizations’) systems are really obsolete or aged-out, and they both need to be replaced anyway. Oftentimes, somebody has made an investment in the last year or two, and that tends to be the dominant [technology] going forward, unless there’s some technical reason why the two can’t work together.”

In the case of Quinte Healthcare, a long-term investment in Nortel Meridian voice communications equipment at each of the hospitals made it a relatively easy decision to keep the existing gear, upgrading where necessary. The Belleville site uses the Meridian 1 61C model, while Trenton has a 51C model installed. The hospitals in Picton and Bancroft will each use a smaller PBX within the same Nortel product line.

“On the voice side, you’re really obligated to go homogeneously with one vendor. Otherwise, you get into trying to integrate different voice-mail systems, and it’s almost impossible,” Breakey said. “It can be done, but you lose a lot of functionality in the process.”

When the four hospitals officially merged in November 1998, it became necessary to quickly set up WAN connections among the different sites, even before the various voice equipment was unified into one interoperable system and a comprehensive WAN plan could be put into place, Breakey said.

“To get connectivity between all of these sites, we actually had to bring up separate T-1 lines into each of these sites. Once we get the systems normalized, we’ll actually drop down and converge the WAN links.

“Then [Quinte will] be saving a lot of money, because right now they’re oversubscribing. They have to provision a certain amount of bandwidth for the data and a certain amount for the voice, but collectively we could tear that down by 25 (per cent) to 30 per cent,” Breakey said.

One of the challenges of linking the rural hospitals together was finding an appropriate connection method that was also cost effective, he said. Apart from the traditional T-1 lines, Quinte Healthcare also evaluated the suitability of using a microwave network or cable company services to connect the four hospitals, which are up to 150 kilometres apart in some cases.

“In Quinte’s particular case, geographically the microwave wouldn’t really work. They’d have to create intermediate hops and it got a little bit too complicated. They themselves would have to get into the carrier business, you know, so we opted not to do that,” Breakey said.

As for cable service, the regional cablecos didn’t have networks running among the different hospital sites, so that was out of the question. Unlike larger centres such as nearby Kingston, Ont., private fibre networks were not an option in the Bay of Quinte region, Breakey said.

“In some ways, we were a little bit at mercy, paying whatever list price for a lot of these T-1s.”

On the LAN side, Quinte Healthcare has decided to evolve the existing shared Ethernet environment predominant at the four hospitals to a mixed fast Ethernet and gigabit Ethernet infrastructure.

The viability of using ATM was considered but, in the end, an easier upgrade path along with more than ample bandwidth for Quinte’s current needs tipped the balance in favour of high-speed Ethernet, Breakey said.

To further streamline its network operations, Quinte is choosing to standardize on “a vanilla Microsoft NT platform, using Exchange e-mail and a standard set of hospital applications that we would apply across all the sites,” Quinte’s Lambert said.

The idea is to establish a uniform environment — or virtual hospital — which offers location-independent connectivity for physicians, nurses and hospital executives, who often need to travel among the various hospitals in the region, Lambert explained. Voice-mail or dictation systems will function the same in all locations; users will be able to plug PC notebooks into any docking station to use any networked application they have been given permission to access.

In the long term, Quinte would like to eventually converge the hospitals’ separate voice and data networks into one infrastructure, but according to Unis Lumin’s Breakey, that process will probably take “years and years and years.”

For now, Quinte is hopeful its short-term network consolidation will allow it to deliver “new and innovative services, which possibly will be at the forefront of patient care in the long run,” Lambert said.