Streaming health care

By Jason Meserve
Network World Fusion, 06/01/99

ALBUQUERQUE, N.M. -- Sun Healthcare Group is moving its intranet into the video age, with an aggressive streaming-media service that features video-enabled training applications and healthy doses of audio feeds.

The company, which operates nursing homes and assisted-living facilities, now has 40 hours of original video and audio programming, which can be picked up on any of the 5,000 workstations connected to its global intranet, says Bruce Stabile, vice president and CIO. Top company officials also use the network to broadcast live addresses to the company's 83,000 employees.

"We are trying to increase learning retention rates," Stabile says of his company's online training effort. "We are combining all the structures out there so our employees can increase their performance and abilities."

At the heart of the video effort is four RealNetworks G2 servers, split between two HP NetServers running Windows NT. Each box has four Pentium 200 processors and 2G bytes of RAM. They run Microsoft Internet Information Server and load-balancing services.

Users select what they want to watch via a standard Web browser, then view their selection using RealNetwork's RealPlayer.

Roughly 600 remote offices are connected to headquarters by a 56K bit/sec WAN run by AT&T. Sun Healthcare also has a large mobile workforce dialing in to the intranet via 28.8K bit/sec modems.

Because of the relatively narrow pipe, most of the videos are sent out at the lowest-possible quality - which preserves the audio, but makes the video appear more jerky. Users connected via the headquarters LAN can select slightly higher quality video, Stabile says.

"We have found that the high-quality picture that RealPlayer is capable of delivering is overkill in most cases," Stabile says. "We look for the most efficient environment we can provide and still get the most bang for our buck."

Live audio broadcasts are streamed using IP Multicast technology to save bandwidth. Unlike the RealVideo servers, which require users to connect to a single server - which could swamp the machine - IP Multicast sends out a single stream of IP packets that can be picked up by anybody with an intranet connection. All of the company's Bay routers are multicast-enabled.

"That's the only way we could pull it off," says Stabile, adding that one recent live Webcast peaked at 1,000 viewers. Live broadcasts are also recorded for later viewing.

The company has its own production facility for creating and digitizing the video and audio programs. "We do all our own encoding and streaming," he says.

But Sun Healthcare's intranet is more than a glorified video-on-demand system. "We call our internal customers 'viewers,' not users," Stabile says. "You not only watch a video, you interact with the system."

Supervisors can set up a training schedule and "career path" for employees via the intranet. After an employee watches a training video, he is tested on the material. If he fails the first time, an e-mail is automatically sent to the supervisor advising them of the employee's score and where he may need additional training. Further action can be taken if an employee fails a second time, but that has not happened yet, Stabile says.

Employees are guided through the system by an animated cartoon character that uses scripting and artificial intelligence to interact with them.

All training and testing records are stored in a SQL 7.0 database and can be used to comply with state and federal regulations governing the nursing home and health care industries. The training and education database is connected to the Oracle-based payroll system to ensure that everyone working for the company receives the proper training and no one falls through the cracks.

Information is kept moving on the network with load-balancing software on the Web servers and clustering on the back-end databases. Stabile says his staff of four constantly monitors the network for congestion and other problems but have yet to run into any such problems.

At the moment, the team is not implementing any type of caching in remote offices. As the system expands, the company is planning to add a second cluster of fully replicated servers in the U.K. to handle Sun Healthcare's European subsidiaries.

The entire system was developed over a 10-month period in conjunction with a local consultancy, Protess. Stabile says approximately 11 people work on the project at any given time.

In addition to audio and video training, the intranet contains external news content from CNN, Bloomberg and others. "We've got 20,000 pages of [text-based] content stored on the Intranet," Stabile says. "Everything from how to take care of an Alzheimer's patient to the proper formula for prescribing Zantac."

Employees can also access e-mail and send faxes using the intranet. "We look at the intranet as a productivity tool," Stabile says.

As a reward for the company's efforts, Sun Healthcare received the Streamers Award in the Enterprise category during the recent RealNetworks Conference and Expo in San Francisco.