Shaping Traffic Instead of Dropping Packets: How Switching to SD-WAN Is Helping Us Weather the COVID Crisis

Healthcare and IT are increasingly intertwined. Over the last ten years, mobile devices, medical apps, and cloud-based EMRs and EHRs have changed the way we deliver medicine. Paper has become the exception rather than the rule. Doctors and other healthcare professionals enter digital case notes on tablets instead of transcribing them. Radiologists send and receive high-definition images over hospital networks and across the country, requiring high bandwidth and high speeds. We even have high-resolution cameras that provide enough detail to let remote practitioners see whether a patient's pupils are dilated.

Most patient care is still delivered in person, and a hospital will continue to function in the event of a network failure, but at a significantly reduced capacity. The digital component of medicine is deeply embedded in our workflows. Tablets, terminals, and network endpoints are now as common as stethoscopes.

Pivoting to Remote Work in a Time of Crisis

Building a robust on-prem network is one thing, but extending connectivity offsite and interconnecting medical professionals who work at hundreds of locations is another. We operate many hospitals and nearly 1,000 clinics, offices, and other facilities, including hospices and cancer care centers. 

At the beginning of 2020, we had about 600 to 700 of our employees working remotely. These were mostly transcriptionists and medical coders. Their jobs are vital for maintaining medical records and for keeping up with billing, but they don't have to work onsite or in real time. Some of our specialists were also working remotely, but again, they were the exception and not the rule. 

COVID-19 changed all that. Like most other organizations, we adapted to the pandemic by sending some of our workers home. Many of our frontline people remain onsite, but thousands of others have switched to telecommuting, and staff whom we never would have considered for remote positions are now working offsite. 

The network infrastructure team, which I am a part of, was integral in getting those new remote workers set up for their new work from home reality. We handle routing, switching, and Wi-Fi, and we do a lot of troubleshooting. When people call us, they're not just having trouble with their PC, but their entire office or building is offline. If people know who we are, it's because something went wrong. My hope was that they didn’t know our names after their remote work setup. 

The Limitations of VPNs and Leased Lines

In the past, we went one of two ways to set up remote connectivity. In the first way, we leased a line from one of three ISPs and connected workers directly to our network. We set them up with an imaged PC, a desk phone, and sometimes a printer and put them to work. But this solution was costly and difficult to deploy. We were at the whim of our providers because they had to set up the connection, which often took weeks or months to arrange. We were also paying a premium for monthly contracts. We had no way of knowing how long someone would stay at the job or decide to move, and so we couldn't sign annual or longer-term leases.

Our other option was using a VPN connection, which is a fine solution for part-time workers or those who are mobile and need to connect to our network from different locations. But it’s not perfect now that we have thousands of additional people working from home due to COVID-19. 

There are several issues with VPNs, primarily stability and speed. VPNs prioritize security over everything and will disconnect if they can't maintain a constant connection. They can't shape traffic and often suffer from packet loss because they have to resend dropped packets over a congested network rather than holding them back until bandwidth becomes available.

As a result, VPN can be a poor choice for transmitting large files, like medical images, or real-time data like voice and video streams. VPNs also tend to time out. For security reasons, IT administrators limit VPN connection time, and this can be a problem for somebody connecting to a VDI for eight hours a day, or who needs full-time access to our network because they are on-call 24/7. 

Adapting Our SD-WAN Plans to the Pandemic

We had started to look at remote connectivity options before the pandemic hit. Last fall, we embarked on a proof of concept using Cisco SD-WAN technology. We decided to limit ourselves to one vendor for SD-WAN because we wanted to stay with a single platform to manage both our on-prem and offsite users. 

There are two key benefits to SD-WAN technology. The first is that it works over any public internet connection. We don't have to lease special lines or sign SLAs with ISPs to ensure a stable and secure connection. The SD-WAN router shapes traffic and creates a secure tunnel that connects users to our network 24/7. 

The second benefit is the cloud-based configuration and activation. Our remote access support team can set up a Cisco SD-WAN router here and activate it after an employee brings it home. It's plug and play for end users and administrators, and a lot easier to manage than setting up individual VPN accounts and login credentials. 

Our initial plan was a pilot to replace some of our existing teleworker—and some small occupational clinics—setups with internet circuits and SD-WAN routers. But when COVID-19 hit—and we had to send thousands of employees home—we repurposed the dozens of routers we had already bought for our IT staff to work remotely. 

At one point in March, we were handing them out like candy, as we swiftly moved to set up people for teleworking. Many of our workers are still connecting via VPN and dedicated lines, but for those who are sending large files or need that always-on connection, SD-WAN offers many benefits. 

Cisco SD-WAN Technology in Action

Our call center employees are now working from home because they cannot maintain social distancing at our facilities. As a primary point of contact with the healthcare network, they are frontline workers despite working remotely. We cannot risk compromising their call quality or access to our electronic health records and our booking systems by connecting them to our network via a lossy VPN connection.

We are also providing SD-WAN connectivity to cardiologists, radiologist, and other specialists who need to download high-resolution image files like CT scans, MRIs, and X-rays. These documents are gigabytes in size and require the fastest and most stable connection we can provide to ensure their reliable transmission, and an SD-WAN link is the next best thing to a dedicated line.

I have an SD-WAN connection in my house, and it feels like I'm back at the office. I have access to our shared drives, monitoring systems, and data centers, 24/7. I can walk into my home office, wake up my computer, and I'm on the corporate network in seconds. It's seamless. 

One of my voice team members is on the West Coast and connects to our network from his home in California. There are roughly 80 milliseconds of lag between his router and our data center, but you can't tell when you're talking to him. He's got a couple of phones on his desk but sounds like he's in the next room, and not 2,500 miles away. We couldn't have pulled this off with a VPN connection. The call clarity is astounding. 

As I mentioned earlier, VPN technology is an affordable and effective solution for road warriors connecting to the corporate network. It is also perfect for people who need light or occasional network access to check email or consult their booking and work schedules. But that doesn’t mean it’s right for everyone, and SD-WAN has been a powerful ally in this transition. 

Looking Beyond COVID-19

Cisco SD-WAN technology has given us the plug-and-play connectivity we need to keep our people working from home during the COVID-19 pandemic. It works with our existing Cisco infrastructure, and we didn't have to learn a new platform or interface to get going. Everything works on the cloud, and I don't require a team of network engineers to set up routers for our remote workers. It's not quite the way we intended to use it, but SD-WAN proved to be the right technology to keep our operations going amid the pandemic. 

This crisis could have been worse for the organization, but we were lucky to have a ready solution in hand when COVID-19 hit. You can't plan for every contingency, but using robust technology makes it easier to adapt. I also think that some of the changes born of necessity may become permanent.

Many of us who are working from home may end up doing so permanently, which makes perfect sense. It costs far less to supply a worker with a router, PC, and VoIP telephone than to rent and furnish an office. Also, employees have more time to spend with their families and on other activities if they no longer have to commute. A better work-life balance and more free time lead to increased personal satisfaction and improved productivity. I know that's true in my case. 

I don't have a crystal ball, so I can't tell you what the future holds. Working from home is today's hottest trend, but who knows what tomorrow will bring. We have only begun to explore the possibilities of Cisco SD-WAN technology, and it has tremendous potential to further transform the way we deliver quality healthcare after the pandemic ends.