Telecommunications systems implementations in healthcare facilities


Attention to detail makes the difference between success and failure, especially in an environment where communication can be a life-or-death necessity.

Bruce Bakaj, PMP

It's the middle of the night, you're sweating, your chest is tight and you have an overwhelming sense of impending doom. Your organization is considering a new phone system and you will be responsible for the implementation.

Whatever the impetus—your present lease is expiring, the old dinosaur is starting to be more trouble than it's worth, or you figure you're going to have to do something anyway to conform to the North American Numbering Plan (NANP) changes taking place in 1995—the pain is still the same. You're suffering the old Chinese curse: “May you live in times of constant change.”

Change is never easy, especially in a healthcare environment where providing 24-hour service is a life-or-death necessity.

Whether or not telecom is your usual bailiwick, the implementation of a new system can be a daunting task. So here's a rundown of things to watch out for, places to be proactive and ways to avoid potential roadblocks.


Start the process early. Give yourself sufficient time to:

Solicit Information From Vendors. Let a few vendors come out and do the dog-and-pony shows so that you can see what's available. They can show you the latest emerging technologies, like two-way interactive video (to provide remote diagnostic capabilities) or computer telephony integration (to link the processing power of your computers to your phones). These can easily cost-justify themselves by increased efficiencies or the ability to attract the best physicians. Realize that every one of these gizmos (unless fully integrated into the phone system) means additional floor space, power, heat generation, etc. According to Jack Campbell, a communications consultant to the healthcare industry for nearly 30 years, “Collecting as much information as you can, up-front, leads to a more complete needs assessment for your RFQ or RF.…Carefully spelling out your needs, wants and expectations ahead of time will do more to smooth the process than any other bit of advice I could give you.”

John Kammerer, director of security/communications/transportation at Christ Hospital in Jersey City, New Jersey, has recently gone through the implementation of a new phone system. In presenting their wares, he would exhort vendors to “simply put forth opinions, in generic non-technical terms, that laymen like us can understand… and we will be more receptive.” His ideas on how vendors can make you more comfortable with the implementation process:

  • Do something like a storyboard presentation of the step-by-step process.
  • Make a videotape of the process and pop it in for 30 minutes and show it to us.

Vendors that provided hands-on demos of the proposed equipment also got high marks from John.

Identify Everything. Everything that has to do with telephones or telephone lines should be identified to determine if they (1) need to be integrated into the new system, (2) merely require an interface to the new system, or (3) are completely independent of the system. Check existing voice mail systems, overhead paging systems, radio paging systems, call tracking systems, automatic call distributors, doctors’ answering services, alarm lines, remote maintenance lines, HVAC monitoring lines, fax lines, modem lines, personal CO lines, data lines,…everything. This is a good time to have the local exchange company (LEC) and/or your long-distance service provider come in and make sure all the lines you are paying for are clearly identified on a standard demarcation unit (DEMARC, e.g.: RJ21X).

Appoint One of Your People as a Project Coordinator. Make sure this person has the authority to make decisions as to set type (who gets what model phone) and restriction levels (who can call where). Demand that the vendor provide a single point of contact (such as a project manager) to be responsible for the implementation from start to finish. Depending on the scope of the installation, the vendor's implementation team can easily have up to 15 people (software designers, programmers, installation technicians, wiring crews, trainers, and so forth) working for different managers and different departments.

Have Accurate Floor Plans Available. Very important! These will be required by the system software designer to complete the end-user requirement reviews, and by the wiring crew and/or installation technicians to facilitate jack and phone installation.

Plan for Growth. What you pay for equipment under the initial contract is sometimes 30–40 percent below the post-cutover price.

Demand a Reasonable Change Control Period. The change control period is the period after initial contract signing, but before equipment is shipped to your site, during which changes can be made to contracted amounts of equipment. Depending on the size of the order, you should be allowed to make changes up to two to three weeks before the materialon job (MOJ) date.

Identify Vendor Standard Offering. Find out, in writing, what the vendor does and does not include as part of their “standard offering.” What level of support does the vendor provide in the following areas:

  • Will they conduct reviews with phone users and/or the department heads to determine the type of phone, what features should be programmed on each phone, and how calls are to be covered when unanswered?
  • Who will gather system-level data on how outgoing calls are routed, what features are to be activated in the system, adjunct programming, voice mail, automatic call distribution, interactive voice response?
  • How will all this information be documented, analyzed and transferred to the software that becomes part of the new system?
  • Phone labeling: Will the vendor custom label all phones?
  • Phone user training: Does the vendor provide personalized, on-site training and customized phone guides?

Request System Specs. Request environmental, floor space, HVAC and electrical specifications of the proposed system ASAP. Obviously, a new empty telephone equipment room is preferred, if at all possible. When reusing an existing equipment room, keep in mind the combined footprint of the old and new system, combined wall space requirements, combined electrical requirements until after the cutover when the old system can be removed. If you are planning to use an existing uninterruptible power system (UPS), make sure it is sized appropriately for the new phone system. Surprisingly, the latest systems require more power than most older ones because of the higher-density circuit cards used in the newer systems.

Establish Acceptance Parameters. Establish clear parameters for acceptance of the new system. What constitutes the completed job? Will you require an acceptance period?


Concentrate the most time and effort working with the vendor's system software design people, making sure all calls will be covered, voice mail is tightly integrated and any high-volume applications (outpatient service, patient accounts, visiting nurse service, doctors’ answering service) are well thought out in advance, including scripts for all broadcast messages, on-hold messages, in-queue messages and automated attendant menus (will you want professional voice-over?).

A reasonable freeze date must be established after which changes to the old system cannot be incorporated into the new system software before cutover. A freeze file will have to be created to document those changes so that they can be re-input after the cutover.

Plan adequate time, well before the cutover, preferably before the vendor does the interviews with the phone users, to accomplish any system administration training, if provided.

Plan a comprehensive and workable phone and voice mail user training schedule, taking into consideration three shifts and weekend/part-time help. A good rule of thumb is one and one-half hours per class to train users on phone and voice mail functions and one hour per class for phone only. Keep it to no more than 15 to a class. Make sure the vendor includes setup and programming of the training phones.

Make sure you have a secure area/ room for storage of equipment from delivery through implementation. Try to have the storage areas as close to the telephone equipment room as possible; this will speed up the work considerably. The technicians will also need space to do final assembly of the phones. Think about trash removal; this is usually not included in the scope of work for the new system.

Vendors will assume that all system administration terminals will be in or near the telephone equipment room; let them know if you want them elsewhere because then you get into distance limitations or additional interface hardware issues. With some vendors’ equipment you do dial-in administration from any PC equipped with a modem and communications software capable of terminal emulation (e.g., Terranova, Crosstalk).

Will you be re-using existing wiring? Are the new phones compatible with the existing station wiring scheme? (This means that the jacks use the same number of wires laid out in the same configuration.) If any jack rewiring has to be done at the time of cutover, the actual cutover to the new phones will take significantly longer. (Depending on the number of phones involved, it could be days before all the phones are back on line.) This is becoming less of a problem as more vendors are offering two-wire digital phones.

If ordering direct inward dialing (DID) number blocks, order extras. They are inexpensive and it is much more convenient to have concurrent numbers; it also makes administration of the system easier. Put your modems and faxes on DID lines through the system, this lets them take advantage of the least-cost-routing capabilities of the phone system.

Let the vendor act as your agent in dealing with the local operating companies and long-distance vendors, it is one less headache for you, and they already have the contacts and know the terminology. One possible benefit is that the vendor might find some lines billed in error. One large northeastern hospital had been billed by the local phone company for lines that were never installed, and the billing went back to 1982!

Give the vendor a priority phone list. Which phones do you want working first after cutover to the new system (special code phones, ER, OR, ICU, CCU, nurses stations, security)? Sterile area(s) phone replacement—when can it be accomplished?

Place network orders as early as possible, especially if additional circuits are in the plan, since it could mean that additional service must be run to the building. This type of work usually requires a long lead time.

Plan for emergency communications during cutover. Have extra security on hand, extra radios, notify local police, fire and ambulance services, and alert them to the possibility of false alarms during the cutover.

The vendor should provide a comprehensive security review checklist of the newly installed system. This will assure that all possible steps have been taken to minimize the risk of someone hacking their way into your system.

Set up a formal progress reporting schedule: once a week during the month before the cutover, once a day during the week of the cutover.

In this type of endeavor it is attention to detail that makes the difference between success and failure. You must be proactive. There are complex interactions on many levels in a modern telecommunications system. A breakdown in communications during the implementation can mean long delays or cause costs to mount. But if you take a heads-up approach and follow these suggestions, it can be almost painless. ■

Bruce Bakaj, PMP, is senior technical rep/project manager in AT&T's Global Business Communications Systems Division. He has been responsible for implementing telecommunications and computer systems at numerous Fortune 500 and healthcare facilities.


PM Network • December 1995



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