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Smart Hospital Blueprint Sanitized
 

Smart Hospital Blueprint Sanitized

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What infrastructure can support modern hospitals to solve their issues?

What infrastructure can support modern hospitals to solve their issues?

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  • In addition to being a messaging middleware is a piece of infrastructure that coordinates all the messages to users so that we can ensure a save messaging and proper coordination just as UCM does for voice calls. That will turn UCM as a regulated medical device.
  • US100MB#/day24number of ys7tot/US (TB)5.847931Conversion of film-based imagesimage size MB500image size Mb4000nw BW Mbps100overload0.2time sec48time min0.8
  • According to the research firm Gartner, global sales of cloud services will rise 17 percent this year, to $68.3 billion from $58.6 billion in 2009. About half of what Gartner defines to be cloud services are, in fact, the computing power involved in the display and tracking of Internet ads. The rest is sales of computing services, mostly to large businesses. Global sales of cloud services are poised nearly to double by 2012, to $102.1 billion, Gartner estimates. But Europe is expected to remain a relatively modest user of cloud services, accounting for only $18 billion this year, or about 26 percent of the global total. By 2012, Gartner estimates, Europe’s proportion of global cloud sales will rise to 29 percent, even though the bloc’s economy is larger than that of the United States. Facing legal obstacles in Europe, the U.S. businesses with the greatest stake in cloud computing — primarily Microsoft, Google, H.P. and Oracle — are lobbying lawmakers to loosen restrictions on cross-border data transfers. Alternatively, some are developing new methods to make cloud computing work within Europe’s complicated legal landscape. At the H.P. Labs in Bristol, England, researchers are devising ways to encrypt data before it is sent into a cloud computing center and then decrypt it after it leaves the cloud, thus addressing the privacy concerns of many European governments.
  • Should these be characterized by their ‘profile’ on the network, so as to prepare for proper nw support?CLINICAL SYSTEMS – Hospital Information SystemsElectronic Medical RecordPatient database with entire patient history, clinical diary, radiographies, analysis, diagnosis, medicines, ..Patient registrationPaperless and mobile system to register new patient. Includes bed and room allocation.Physician Order systemPhysician can place order online any time. Total mobility and secure remote access required.Patient Tracking and MonitoringAll patients are tracked and monitored via RFID in-house or remotely (through Internet). All vital parameters are made available.Emergency e-monitoringDisplay status and facilitate patient flowCaregiver searchAutomatic system to search for caregiver on the base of proximity and skills. Integrated with telephony system.Radiology Information SystemA RIS is a computerized database used by radiology departments to store, manipulate and distribute patient radiological data and imagery. The system generally consists of patient tracking and scheduling, result reporting and image tracking capabilities. RIS complements HIS (Hospital Information Systems) and is critical to efficient workflow to radiology practices. Picture Archiving & Communication SystemStore and manage all type of medical images (x-ray, scans, …). Secure access is allowed over Internet.Telemedicine/ Tele CareCollaborating system to support remote consultancy, in a synchronous (video capability is key) or asynchronous way (ex: store and forward).Robotic SurgeryRemote robot control for surgeryOnline operating roomRemote access to operating room to attend an operation with learning purposes.Lab management systemSystem to securely place lab orders from anywhere. Secure access to lab results on Internet. Integration with EMRPharmacy Management systemSolution to remotely place orders to pharmacy from anywhere. Includes a pharmaceutical handbook. Product is delivered by robot or automated delivery and is tracked via RFID or similar. System is integrated with procurement system.Excellence centerBest practice and knowledge management. Content can be offered externally.Ambulance managementCoordinate ambulance operations in real-time. Ambulances are connected to the hospital for exchange of first emergency information.IHE middlewareMiddleware to set up interoperability between HC systems, using standards and scenarios.BEDSIDE SERVICESPatient portalPatients have online access to: 1) Hospital General information, 2) Schedule an appointment with a Physician, 3) schedule a hospital procedure, such as Radiology or Lab work, 4) view their full Medical Record via secure Internet access; 5) Health calculator (Body Mass Index, diet calculator, life expectancy); 6) directions (end-to-end interactive map), facility navigation, and ability to pre-purchase parking; 7) Personal Health Organizer (support for the whole illness experience, including remainder for visits, medicine assumption, tracking results)Internet accessFor employees, patients, and guests.Digital SignageHospital IP based network is used to deliver TV, Education, Entertainment, generic information. STAFF EFFICIENCYHospital PortalsRole-centric portals for Physicians, Employees, Nurses, Executives. Information delivery is based on multimedia capabilities. Integrated with e-learning system. Physicians can also access their decision making support system. An online agenda is available .Communication and CollaborationBaseline tools: E-mail, vmail, IM, calendar, meeting organizer, remote presentation tool, Video Conferencing, Audio conferencing, web seminar, etcVideo Conference and TelephonyIP-based Video and audio systemsWorkflow ManagementEnables the definition of workflows and procedures in the hospital, including the automation of messages to staff when any critical events happens.BACK OFFICE & HOSPITAL EFFICIENCYDevice TrackingAll hospital devices, staff and patients are tracked via RFID.Paying systemSystem to pay for any services delivered in the hospital (not only clinical), securely accessible from anywhere.E-procurementAutomated system for hospital procurementContact CenterHospital Contact Centers, leveraging integration between all different channels (phone, e-mail, fax, web, ..)External portalCitizens (potential patients) have online access to: 1) Hospital General information, 2) Directory hospitals locations with interactive map 3) Directory of Physician profiles, 4) Interactive site with online operator and Internet call me feature 5) job posting 6) Health Campaign and Support MaterialINTELLIGENT BUILDINGVideo SurveillanceIP-based Video surveillance systems.Intelligent SystemCentrally manages all hospital systems: machinery sensors, heating/cooling systems, lighting, …Access managementManages all info from badge readers to provide access right to various hospital areas. Key to track all employees’ movements in the hospital.
  • Change title to “Smart Hospital Overall Architecture”?
  • (i.e. Legacy medical deviceand applications requirement for layer 2 adjacency)
  • Cisco EnergyWise helps helthcare organizations measure, report, and manage energy usage within the network.You can see power consumption across multiple devices-even 3rd party ones using our open SDK. So you can reduce energy costs, comply with green directives, and reduce your carbon footprint.With new Energywise integrations from Schneider Electric, you can manage both networked and non-networked devices with building controllers and building management systems.
  • As healthcare organization use new applications such as remote consultation with video and collaboration that loads the network real-time application responsiveness becomes even more important. Everyone throughout the organization – insure agents, remote labs and patients – all need secure access to the same information in real time from anywhere. Application Performance makes this possible.  Cisco’s new application performance network service, Application Velocity, introduces the fastest application performance in the industry, fully integrated into Cisco’s Borderless Networks, enabling the optimal experience of any application, at any time, and on any device. Application Velocity also allows IT to meet or exceed business Service Level Agreements and user expectations through application visibility and control, application acceleration and WAN Optimization, and real-time route application agility.  This allows increased numbers of devices and users to access more resources – whether local, remote, virtual or cloud based – from more locations. With application awareness built in to the network, IT has an effective tool for managing applications that requires little to no maintenance. As a result you can confidently deploy bandwidth intensive applications and centralize them in the data center for easier management and for a lower total cost of ownership.  Seamless and secure remote access for insurance companies and vendors via high-speed encrypted links on Cisco ISRG2 and ASR 1000 RoutersRemote consultation with video and collaboration with ready 10 Gbps access and core on Cisco Catalyst Series SwitchesIntelligent bandwidth management with industry leading quality of service, Wide Area Application Services
  • The next few slides we highlight the Vblock and its core components. Highlight the key components of the solution – application & management, VMware virtualization, Cisco Unified Computing, Cisco networking, and EMC storage
  • Cisco’s collaboration architecture not only powers our product portfolio, it is also our most important differentiator. From the ground up, it is constructed to enable boundary less collaboration – breaking down silos between content formats, between individual tools and devices, between companies, and ultimately between people working towards a common goal.At Cisco, we recognize that it requires a combination of both great software and purpose-built hardware to deliver the experiences that most effectively bring people together. Yet at the same time, we recognize that heterogeneity is a fact of life and that interoperability, openness and customer choice are paramount. These principles are actively embraced throughout our architecture.We also realize that it’s neither all about the desktop nor all about the cloud – it’s about recommending the right option to empower individuals, teams and communities to get their work done. But whether it’s an on-premise in-room solution, a hosted PC-based solution, or a combination of the two – it’s an intelligent network that’s the foundation that makes it all possible.It is the converged network that binds together today’s infrastructure domains of virtualized computing, network resources and persistent storage to enable unmatched agility, resiliency, scalability and quality of experience – and that allows an organization to securely span beyond its corporate firewall in order to collaborate with customers, partners and suppliers.With MediaNet, the network will be able to dynamically route rich media traffic along the path of least resistance to deliver the fastest and highest quality voice, video and data experiences to end users.With the Service Advertisement Framework we’re building into MediaNet, devices will automatically be able to advertise what services are available to them so that things like the configuration of dial plans can be automated… changing the experience for those working in IT behind the scenes as well.And there’s much more - so when you hear competitors talk about the network as “just plumbing”, you can respond with confidence that it’s actually an intelligent platform for rich and effective inter-company collaboration.Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. 9a. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. 9b. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.9C. On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.9D. Lastly, aforementioned layers of the collaboration architecture enable the development of industry-specific solutions, such as Cisco HealthPresence==========================================================Our collaboration architecture is our most important differentiator. From the ground up it is constructed to enable boundary less collaboration—breaking down silos between content formats, individual tools and devices, companies, and between people working towards a common goal. The bottom layer of the network binds together today’s infrastructure domains of virtualized computing, network resources, and persistent storage. It provides unmatched agility, resilience, scalability and quality of experience. It allows an organization to securely expand beyond the firewall to collaborate with partners, customers, and suppliers. On top of this foundation lies a comprehensive set of network-based services that enrich collaborative applications. These services can: Turn data into information by providing associated context Construct social graphs of who you know—and need to know—to build a product, close deals faster, or spot market opportunities. Let you know who’s available. This is presence beyond the boundaries of instant messaging. It goes across different tools and devices and individual application silos by using standards-based protocols Locate people for you, whether in the office or on the road, and can manage collaborative sessions for you. These services operate consistently and reliably, with both Cisco and non-Cisco collaboration applications and they are consistently secured and managed via network-based policy.On top of this layer are communication and collaboration applications. Applications on this layer leverage these services to help companies deliver against the top line business imperatives they are facing today—such as saving on travel costs, improving employee productivity, increasing customer intimacy, and facilitating innovation.
  • Missing:EM release dateNew additions for healthcare, such as bar-code reader, battery life, hermetically sealed.A detaThe Cius will be orderable on April 5th. The ordering guide is posted; review for full detail:http://wwwin.cisco.com/voice/doc/Cius_Ordering_Guide.pdfVTG Announcement:http://wwwin.cisco.com/voice/news/stories/ipcbu040111.shtmlGeneral Availability is targeted for May 31st- This date could push based on demand and other factors, so I'd suggest setting expectations for GA sometime in June. Long lead times may also result if demand is high.Ordering & Pricing:60% discount for all orders placed through Cisco Commerce Workspace, starting around April 11th Plan is for the promotional discounts to be available until the end of FY12Submit standalone Cius orders (don't mix Cius with other orders) Partners must be Advanced UC specialized to sell CiusAll orders must go through the Experience Assurance Program (similar to TelePresence) UCL "Desktop Video License" ($295), CUWL STD ($325), or PRO ($500) requiredProduct Number Description List Price (US$)CIUS-7-K9Cius 7 Inch Tablet, Phantom Grey $1,575 CIUS-MS-H= Cius Media Station, Standard Handset, Phantom Grey $795 CIUS-MS-H-S= Cius Media Station, Slim Handset, Phantom Grey $795 CIUS-STD-CASE= Cius Standard Carry Case $100 Spare products: The Cius tablet ships with a battery and a Cius power cube and country specific power cord by default. The following part numbers can be ordered if customers need additional batteries, power cubes or cords. Product Number Description List Price (US$)CIUS-BATTERY= Cius Spare Battery $295 CIUS-PWR-CUBE= Cius Power Cube for Tablet $65 CIUS-PWR-CORD-(xx)= Cius Power Cord (xx=Country Code. See 2.2) $10 Experience Assurance ProgramSimilar to TelePresence, an Experience Assurance Program is being put into place Program will be in place around the end of April The Experience Assurance Program is a questionnaire, formed in partnership by IPCBU and Cisco Services, which is designed to initially assess the customer’s network readiness for innovative solutions, such as Cius.  Any orders placed prior to this  Experience Assurance Program being in place will subsequently need to complete  the questionnaire and submit it through the program tool.        More details in the ordering guide (link above). chable and serviceable 8-hour battery supports all-day communications under normal conditions.
  • http://newsroom.cisco.com/dlls/corpinfo/factsheet.html
  • http://newsroom.cisco.com/dlls/corpinfo/factsheet.html
  • High performance, scalableGE- more point-to-pointIBM- close to cisco, cobbled different software

Smart Hospital Blueprint Sanitized Smart Hospital Blueprint Sanitized Presentation Transcript

  • 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
  • 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
  • Technology vision for the provision of careInefficient processes cause major waste of time in Always-onstaff daily activities. A hospital must be Collaborationconsidered by definition a streamlined enables expertiseorganization: whatever happens must be alerted, availabilityand should trigger the related procedure. Time is anywherenever to be wasted. Proper Workflow Management anytime, toshould be in place for system-to-system, system- complete patient-to-human, and human-to-human communication centricityInteroperability is the only Healthcare resources are alwaysway to achieve single patient scarce, and demand for storage,view, providing the highest computing, bandwidth, tools is growingsupport to caregivers. steadily. Flexible support based onMobile 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
  • • 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
  • Records Telehealth eRx Public Exchange Health & Image Quality Exchange Reporting PHR NHINHomeCare Application Communications Billing Analytical eRx Services & Collaboration X.12 Services © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 7
  • MESSAGING Patient to Patient BLOGGING/COMMUNITY PLATFORMENTERPRISE SOCIAL SW Synch/Asynch WEB CONFERENCING PATIENT CARE Caregiver to Patient to Caregiver CaregiverMOBILE APPLICATIONS MESSAGING TELE PRESENCE IP COMMUNICATIONS TELEMEDICINE © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 8
  • 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
  • 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© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 10
  • 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
  • Providing proper network support CLINICAL SYSTEMS STAFF EFFICIENCYEMR Hospital Portals & Learning SystemsPatient registration Communication & CollaborationPhysician Order system Video Conference and TelephonyPatient Tracking and Monitoring Workflow ManagementEmergency e-monitoringCaregiver searchRISPACSTelemedicine/ Tele CareRobotic SurgeryOnline operating room INTELLIGENT BUILDINGLab management system Video SurveillancePharmacy Management system Intelligent SystemExcellence center Access managementAmbulance managementIHE 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
  • Event What happens Benefits Tech InfrastructurePatient is Availability of bed is checked, bed reserved, All workflows are set to automate RFID tagadmitted into bedside services set, location tag installed on procedures, to optimize care. MSEhospital patient, staff alerted to start procedures. WiFi HL7 CUCM IP PhonesPatient is Assistant is notified for patient transportation, Automated and Optimized process Workflow Mgmttransported to looks for wheel chair using speech recognition for transporting patients eliminates WiFiroom 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 BuildingPatient 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 VPNconsultations hospital community (local, regional, ISR G2 national) UCS [Express]Scan is Doctor authenticate into RIS from tablet, scanner System integration enables WiFireserved 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. CIUSPatient is Same as beforetransported tomodality© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 13
  • Event What happens Benefits Tech InfrastructureScan is Patient scan is created and made available for Image is created, securely and DCperformed 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 MgmtLab analysis Doctor enters requests for analysis using tablet, Reduce errors and optimize analysis WiFiare requested lab is notified to start procedures. Doctors is cycle. CIUS notified when lab result is ready. CUCM IP Phone Workflow MgmtDiagnostic is A team is dynamically created to collaborate Experts are grouped into a team in Presenceelaborated 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. PACSSurgery is Availability of operating room is checked, room is Workflow automation for Surgery AAArequested 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
  • Event What happens Benefits Tech InfrastructurePatient is Assistant is notified for patient transportation, Patient journey is always under Workflow Mgmttransported to looks for mobile bed using speech recognition control, every event triggers specific WiFioperating 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 Tagroom 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 MDESPatients starts Patient conditions are monitored by connected Automation of Biomedical device BioMed NACsurgery biomedical devices, fixed or mobile. ICU staff is connectivity simplifies IT operations WiFirecovery 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 CUCMphase 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. FirewallDrugs are Doctor input requests for specific drugs. Reduce errors and optimize WiFiordered 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 MgmtPatient is Patient can go home, cleaning ladies are alerted Increases average availability of CUCMdismissed 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 CHPis 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.
  • 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
  • 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 andConsolidated Data, Video, Resources, Anytime, Energy, Automation Anywhere Enhancing the Healthcare Experience© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 17
  • 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
  • Access VSS Layer 3 Access stackable switchesDistribution Si Si Si Si VSS Distribution Core VSS/Hybrid Core Si SiDistribution Si Si Access Data Center 10Gbps Nexus WAN WAN © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 19
  • 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
  • For the Patient… For Caregiver… For Administration …© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 21
  • 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
  • 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 TelepresenceEnergy and BMS Lighting UPS CCTV AccessPower Control Monitoring ControlMetering DVR VAV Boilers FCU AHU Door Controllers Heat General Intruder Chillers Channel Pump Lighting Panels Controllers Chilled Beam Smoke Break Sensor Glass OccupancyFire Alarm DetectorsSystem Reader DSI/DALI Technology Interface Sounder © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 23
  • Cisco Video Surveillance Manager Data Center Network Operation CenterStorage 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
  • 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
  • Third Party PowerEnergyWise ManagementManagement MSE LMS ApplicationsApplication LocationEnergyWiseManagement SNMP TCP ManagementCommunications API(SSL for Network-wide) Wireless ControllerDomain – logical EnergyWisegrouping of entities Domain AP(Child/ Neighbor) Building Field ControllerEntity (unique ID)under one domain EnergyWise(Parent/Child) EntitiesMIB (power usage, Wireless Clientpolicy, alarm) © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 26
  • 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 PlayerDistribute Content Distribution WAE Appliance ISR-NM Manager (CDM)© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 28
  • 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
  •  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
  • 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
  • Integration to Hospital Applications: ORIS, CMMS, Security, Nurse Call, EHR, etc. Visibility AeroScout MobileView Software Track-Alert-Manage-IntegrateInfrastructure 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
  • 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
  •  Improving image transport, routing and storage WAAS Optimized WAN  Faster Store/Transfer OperationsHospital 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 ACUORadiologist Accelerated DICOM Grid, Virtualizes DICOM Application ServersViewers Network Layer and Processes Transactions Faster Internet WANLocal 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
  • 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
  • CLINICAL SYSTEMSEMRPatient registrationPhysician OrdersystemPatient Tracking andMonitoringEmergency e-monitoringCaregiver searchRISPACSTelemedicine/ TeleCareRobotic SurgeryOnline operatingroom BACK OFFICE &Lab management HOSPITALsystem EFFICIENCYPharmacyDevice Tracking.Management systemPaying systemExcellence centerE-procurementAmbulanceContact CentermanagementExternal portalIHE middleware INTELLIGENT BUILDINGVideo SurveillanceIntelligent SystemAccess management BEDSIDE SERVICESPatient portalInternet accessDigital Signage STAFF EFFICIENCYHospital PortalsCommunication &CollaborationVideo Conferenceand TelephonyWorkflowManagement© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 36
  • •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
  • 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
  • Solutions Conferencing Customer CareCommunication& Collaboration Enterprise Social Software IP CommunicationsApplications Messaging Mobile Applications TelePresence Presence Session Mgmt Content MgmtCollaborationServices Location Client Frameworks Tagging Policy and Security ManagementInfrastructure Virtual Machines Network Storage ON-PREMISE HYBRID CLOUD © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 39
  • 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
  • Applications Corporate Scheduling Email / Messaging / Recording Calendaring Presence StreamingTelePresence 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 InfrastructureHospital Campus © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 41
  • 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
  • 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
  • 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
  • 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
  • Cisco SecurityHospital 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/ProfilerData 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
  • Data Center NAC ProfilerServices Block Philips Patient Information Center NAC Manager (PIC) & DB NAC NAC Server/Collector Collector DHCP Server Si BioMed Device Profile CreationCore Si Philips Patient InformationDistribution Center (PIC) & DB NAC Collector NAC Server/Collector Si OOBAccess IDF-1 IDF-2 Wired Wireless Patient Monitors (Bedside) Infusion Pump© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 47
  • 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
  • Dynamic load sharing andsecurity provided by ACE. Adaptive Security Appliance (ASA)Implements access policy provides high availability stateful Security reporting andand load sharing, security access control and deep packet trend analysisand reporting. SSL inspection (IDS/IPS) with the provided by CSMARSencryption services provide Security Services Module (SSM)for end-to-end encryption of ApplicationePHI 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 PreventionHighly available virtualized hostswith the ability to dynamicallymove workload, createadditional host machines forincreased demand. Security Access Layer—Web, Visual Basic,patching of OS and clinicalsystems improves security and Thick Client Backend, Thin Client, VDI, Etc. Compute Services EHR Clinical Workflow Engines 7availability 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
  • Only supported VDI hosts permitted Cisco NAC Policy only allows access to Virtualized authorized hosts and protocols. Internet or Security Deep packet Private WANRadiology 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 VPNLAB 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
  • Virtualized Data Center CLOUD VirtualizedCollaboration 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
  • Hospitals Clinics Patients Rural at home Retail Areas Pharmacies WiMAX/3G/VSATUrgent 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 PrivatePrivate or Hybrid Community Cloud© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 52 Cloud Cloud
  • Corporate Ranking Technology Awards Healthcare Endorsements Global Market Leadership Partner Landscapehttp://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
  • Partial list of Corporate Rankings and Awards• VMworld 2009 awards Ciscos Unified Computing System the gold award in Hardware for Virtualization• Cisco Ranks No. 5 on AMR Researchs Worlds 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
  • 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 Magazines Readers Choice Award for Network Routers Sept 2006• Cisco Catalyst 3000 series received the Gold Award for stackable switches from SearchNetworking.com• Ciscos 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
  • ―Cisco CleanAir, a spectrum analysisfeature set comprising recent-generationAironet 3500 series access points andVersion 7.x Unified Wireless Networksoftware on the APs and Wireless LANControllers, delivers outstanding RF(radio frequency) reporting, tracking andassessment capabilities to help wirelessadministrators build robust wirelessnetworks to host mission-criticalapplications and dense endpointdeployments.‖―In 2010 Cisco turned on yet another new feature in the Nexus 7000 platform thatbasically eliminates the ancient and universally deployed spanning tree protocol fromnetwork designs, thus enabling much larger Layer 2 networking domains within thedata center. The FabricPath Switching System is the foundation of a push by Cisco tocombine NX-OS software features with the hardware capabilities of the Nexus 7000F1 series module to build the next generation of high-performance network systems.‖ © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 56
  • 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
  • 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
  • • The Report  Internal Wireless Voice Communications Systems: Improving Patient Care & Satisfaction by Staying Connected  KLAS seeks to improve healthcare technology delivery by honestly, accurately, and impartially measuring vendor performance for their healthcare provider partners.• Key Findings:  Cisco is ranked #1 vendor (highest score of 87.1)  Cisco is #1 in all four categories: o Clinician Satisfaction, Device & Application Integration, Device Durability, Device Battery Life  Cisco is #1 in % usage within all the key buying constituents o Nursing, Physician Care, IT, Environmental Services  82% of providers identified Cisco as their wireless voice network vendor  Cisco is #1 in most of the applications cited in the report (ex: Nurse call, infusion pumps, EMR, etc.)• What does this mean for Cisco?  Recognition and validation by a well-known independent 3rd party research firm  Increased clinical relevance  Potential positive impact on sales opportunities© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 59
  • • HITRUST - www.hitrustalliance.org/csf• An industry alliance to develop security framework for the healthcare industry— Cisco on board• Common Security Framework to be released February 2009—draft in review currently• Based upon PCI, ISO/IEC 27001, ISO/IEC 27002, ISO/IEC 27799, NIST SP 800 series, COBIT 4.1, 21 CFR Part 11, HIPAA• HIMSS Community for Connected Health• The HIMSS-Cisco user group shares best practices for using information to provide better healthcare.• Health Management Academy• Cisco is proud to be a member of the Health Management Academy (The Academy), which provides an open environment for the senior executives of the countrys largest health systems and corporations to exchange best practices and benchmarking data, focused on increasing the quality, appropriateness and efficiency of care.© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 60
  • • Cisco has created specific healthcare solutions (Comply with Regulations HIPAA, PCI, EC80001 and Proposed FDA MDDS Standards for Medical-Device Data) • Cisco interacts with largest medical device providers to guarantee full compatibility (Cisco Validated Design & Certification) • Cisco goes beyond data transport, providing a healthcare-specific service level (BioMed NAC, DICOM, …) • Cisco provides a End-to-End portfolio of communications and collaboration solution, fully integrated.© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 61
  • •Wireless Infrastructure certified by european and US regulations for Healthcare • Medical device producer provide certifications for Cisco Access Point. • Access Point certificati dalla Wi-Fi alliance • Global CCX Program for maximum wireless device compatibility.© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 62
  • The list is not exhaustive© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 63
  • Security Digital Video: IPTV Switching: Modular/Fixed100% 100% 100% 80% 80% Cisco/SA 61% 80% Cisco/SA 73% 60% 35% 60% 60% 40% Cisco 40% 40% 20% 20% 20% 0% 0% 0% Voice Wireless: LAN Storage: Area Networks100% 100% 100% 80% 80% Cisco 58% 80% 60% 60% 60% 34% 40% Cisco 40% 40% 29% 20% 20% 20% Cisco 0% 0% 0% Routing: Edge/Core/Access Web Conferencing100% 100% 80% 80% Cisco 49% 60% 59% 60% 40% 40% 20% 20% Cisco/WebEx 0% 0%© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 64
  • 10+ years of Customer history—formally Central part of satisfaction tied tracking customer Cisco’s culture to the bonus plan satisfaction4.5 4.44 4.45 4.43 4.41 4.37 4.37 4.36 4.33 4.33 4.33 4.30 4.22 4.15 4.064.0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Cisco annual survey; measured on a scale of 1 to 5 in fiscal years© 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 65
  • www.cisco.com/go/healthcareStefano SOLIANIHealthcare Solution Architectssoliani@cisco.com © 2010 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 66