At the 2013 Healthcare IT (HIT) Institute Conference held last month our customer, Bruce A. Rainey, Corporate Vice President, Construction and Facilities at Scripps, shared his insights into the future of wireless in healthcare. He highlighted the capability of his locations across California and the wireless challenges facing them with new and emerging healthcare technologies and the benefits of a comprehensive wireless strategy. See Bruce’s presentation below.

1. The New Wireless Utility at
Scripps Health
Bruce A Rainey
Corporate Vice President
Construction & Facilities
05-06-2013

2. Agenda
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 Who is Scripps
Health?
 Why is this
discussion
important to
you?
 What Changed
 What is Medical
Grade Wireless
Utility
 Benefits of
Medical Grade
Wireless Utility
 Opportunity

3. The Next Decade
$2.3 billion investment
 New hospital facilities
 Renovations & expansions
 Medical technology
 Emergency & Trauma
 Cardiovascular Institute
 Earthquake retrofits
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 State-of-the-art Imaging
 Cutting-edge research
 New ambulatory centers

4. Scripps Health
 Private, $2 billion,
nonprofit community
health system, San
Diego, Calif.
 Integrated delivery
system caring for
approximately 500,000
patients annually
 Two of San Diego’s six
trauma centers
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 Forefront of clinical
research and graduate
medical education
 1,368 total licensed
beds
 2,900 Physicians & 145
residents/fellows
 13,100 employees

5. Scripps Health
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6. Scripps Health
Specialized programs
include:
Diabetes Institute
Accredited Cancer
Center Network
Center for Integrative
Medicine
Robotic Surgery
Program
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Graduate Medical
Education
Genomics & Clinical
Research
Translational Science
Institute
West Wireless
Partnership

7. >1.6M Square Feet
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8. >1.1M Square Feet
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9. 9Slide Footer

10. This Discussion and You
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11. The Problem
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Study identifies top five
wireless challenges
• Physical Connectivity
• Technology Connectivity
Issues
• Meeting User Demand
• Security Considerations
• Network Management
Issues
May 20, 2009

12. The Problem
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New Technologies
 Body Area Networks
• Communications in and around the body
• Utilizes sensors, actuators, processing elements
 Mobile Clinical Devices
• Linkage to EMR
• Security
 Expanding the Chipset Venue
• Marketplace Dynamics

13. The Problem
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14. The Problem
Wireless Data Use
Exponential growth
80% within buildings
70% of staff and
physicians already
using smart devices
Handheld computing
deployment exploding
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2011 2012 2013 2014
0
1,800,000
3,600,000 4%
5%
8%
17%
66%
Source: Cisco VNI Mobile, 2010
TBperMonth
Mobile VoIP Mobile Gaming Mobile P2P
Mobile Web/Data Mobile Video
Wireless Data Growth
108% CAGR Through 2014

15. The Problem
 Wireless Infrastructure is often vendor-
specific
 More vendors creating more wireless
devices
 More devices in the built environment
creates “noise”
 Portions of the wireless spectrum not
covered with current 802.11 solutions
• Emergency operations
• Police
• Fire
• Cell
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16. Our Current Situation
WiFi (802.11a/b/g/n) Single Channel coverage
• Production network
• Visitor hot spots
WMTS for patient monitoring
• Several different solutions
Low frequency wireless headsets and phones
T-Mobile Nano Pico cell in building coverage
AT&T/Verizon broadband for remote Users
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17. Our Current Situation
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18. Our Current Situation
Over the Air Intrusion Detection System
In building spectrum management and
interference detection
Device Management and Support
In building cell carrier coverage (i.e.
AT&T, Sprint, Verizon, etc.)
Data Transmission Security
Discrete WMTS infrastructure for
telemetry
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19. What Changed…The Goals
 “Own” the architecture
 Create open architecture for future
wireless devices
 Be vendor neutral, not driven by clinical
needs
 Allow for equipment changes without
infrastructure changes
 Expand the coverage while maintaining
control
 Lower Costs
Ongoing operations
Capital expenditures over time
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20. What Changed – The Team
Cross-Functional
Leadership Team
• Information Services
• Facilities / Construction
• Biomed
• West Health Institute
(Advisor to Scripps)
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21. What Changed – The Times
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 Ubiquitous wireless is expected
and necessary
 High growth in wireless devices
and apps
 Need to embrace the future of
wireless

22. Solution
Create a Medical Grade Wireless
Utility as the platform for wireless
health going forward
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23. Medical Grade Wireless Utility
…An expected utility, much like electricity,
plumbing and HVAC
- Installed as part of the base building
…An open and vendor neutral converged wireless
infrastructure, supporting transport for any wireless
signal across 3 grades of service and 4 networks
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WWAN
WLAN
WCDN
LLAN
Consumer
Enterprise
Medical

24. Three Grades of Service
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TimeCritical
Medical
Grade
Enterprise
Grade
Consumer
Grade
HighMediumLow
Low Medium High
Acuity

25. 4 Networks
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26. …Each with a defined Assurance
WWAN
Facilities
WLAN
IS/IT
WCDN
BioMed
LLAN
IS/IT
Coverage
Driver = WWAN Medical
95% or better
100% in Clinical Areas
Driver = 802.11 Medical
95% or better
100% in Clinical Areas
Driver = WMTS Medical
100% in Clinical Areas
Signal
Quality
Driver = WWAN Medical
+ XX dBM above noise
Driver = 802.11 Medical
- XX dBM & -XX dBM
Driver = WMTS Medical
+ XX dBM
Capacity
Driver = WWAN Medical
Per Zone (~150k ft2)
RF Carriers/Zone/Service
Driver = 802.11 Medical Per
Segment (4K ft2)
# Channels / Segment
Driver = WMTS Medical
Channel(s) per area
# users per area
Security
Base Station Hotel
Zone IDF
Physical security Physical security
Certainty
Shared
Engineered
Shared
Engineered
Guaranteed
Dedicated
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27. …Creates the Medical Grade Wireless Utility
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Location Local
Area Network
Wireless Local
Area Network
Wireless Wide
Area Network
Wireless Clinical
Data Network
Room Area Network
Personal Area Network
Body Area Network
802.11
Bluetooth
ANT
Zigbee
UWB
Future
PCS/Cellular
Paging
Fire Life Safety
2 Way Radio
Future
802.11
Zigbee
IR
Ultrasound
UWB
RFID
Future
Assets
People
Infrastructure Independence
Ubiquitous coverage inside & outside
Democratize Healthcare Data
Pervasive, open, low cost monitoring
Break the proprietary hold on healthcare
Clinically Relevant Information
Pervasive, low cost medical sensors
Turn data into wisdom
The Killer Apps
Voice, Data, Video, Location
Medical Grade
Wireless Utility

28. MGWU Benefits
Lower Implementation Costs
•One antenna system instead of one per
technology
Lower Operating Cost
•Fewer FTEs to manage ecosystem
•Fewer calls to help desk
•No retro-fitting for unknown dead-
zones
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29. MGWU Benefits
Lower future cost
•Known capacity
•Add devices without touching the
infrastructure
•New technology doesn’t require
closing rooms for replacement of
legacy systems
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30. MGWU Benefits
Safer use of wireless in medical
settings
•No interference problems
associated with wireless in high
acuity settings
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31. MGWU Benefits…Technical View
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DISCRETELAYERED
n: PACS, Video
a/n: Data
a: Voice
b/g/n: GuestNet
b/g: IV Pumps
Carts
g: Voice
n: PACS, Video
a/n: Data
a: Voice
b/g/n: GuestNet
b/g: IV Pumps
Carts
g: Voice
Frequency-based WLANs 2
Standard practices coverage ●
Traffic separation by frequency ●
No Greenfield 802.11n
performance due to legacy
devices
●
Frequency-based WLANs 2
Standard practices coverage ●
Traffic separation by frequency ●
No Greenfield 802.11n
performance due to legacy
devices
●
Independent WLANs 6
Guaranteed coverage ●
Traffic optimization by
application/device
to maximize capacity
●
Greenfield 802.11n performance
in legacy deployments ●
Independent WLANs 6
Guaranteed coverage ●
Traffic optimization by
application/device
to maximize capacity
●
Greenfield 802.11n performance
in legacy deployments ●
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
a/n
b/g/n
PACS,Data,
Voice,Video
IVPumps,
Carts,Voice,
GuestNet
a/n
b/g/n

32. MGWU Benefits…My View
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Discrete
Layered
1
Wi-Fi client sees one channel - Traffic shares a single channel AP
“highway” and must compete based on application type, priority,
protocol, etc.
Wi-Fi client sees layers of channels - Traffic can now be assigned to
specific layers to dramatically increase throughput and efficiency not
possible using discretely deployed APs
Start/Stop
Start/Stop

33. Flip the Paradigm
Enable the
hospital to make
device decisions
based on
infrastructure
and NOT
infrastructure
decisions based
on the device
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34. Implementation – First Step
Demonstration Project
• Small, non-acute facility
• Go live Sept 2012
• System performed as expected
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35. Implementation – New Construction
Acute Care Projects
• 2 New hospital additions
• 383,000 168-bed addition at La Jolla
• 83,000 36 bed with ED addition at
Encinitas
Specialty Care Project
• 175,000 specialty center attached to
acute care facility
• Cardiovascular services
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36. Implementation – Existing Facilities
Expansion of Project
• Barcoding Meaningful Use (WiFi)
• IS developed plan to extend existing
discrete AP network across 1M SF
• Plan redeveloped after successful
testing of MGWU to implement new
system
• Project funding did not change
• Project implementation just starting
• Full implementation set for 2Q 2014
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37. Implementation – Next Steps
Negotiating with 3rd Party on
wireless service provider side of
system
• 3rd Party better suited to
negotiations with carriers
• Limit capital costs to Owner
• Focuses resources on other
Meaningful Use issues
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38. QUESTIONS?
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