Accelerating and Optimizing the Transfer of Patient-Critical Medical Imaging


National Surgical Healthcare (NSH) is an innovative healthcare company that provides a full range of capital, development, and management services for physician and company-owned surgical hospitals throughout the United States. The company currently supports over 20 community-based facilities from coast-to-coast and takes on the responsibility to ensure that each one remains true to its goal of providing “efficient, friendly, and cost-effective care” to all its constituents including physicians, the patients, payors, and the community-at-large.


By providing comprehensive facility and management services, NSH frees surgeons and clinicians to focus on providing the highest quality healthcare and patient services. One important component of the service is providing a secure, fast, and reliable IT network connecting each facility to the NSH headquarters in downtown Chicago. The NSH has an all Cisco network. According to Senior Network Systems Engineer Chris Paalman, each
location uses a Cisco 2900 ISR router connected to a third-party MPLS service as its primary link to the Chicago office. Each location also uses a VPN connection over the Internet as a backup link.

For some time, nearly all of the network traffic went in one direction from the central office to the remote locations. Today this is changing. The member hospitals are now sending medical imaging files and print files to the main office, as well as enormous amounts of archive files created by scanning years of paper-based medical records.

“We knew we had to be preemptive in handling document imaging if we were to prevent our core applications from getting stepped on,” Paalman said. “We started getting some calls from users saying there was contention during peak times such as when people were logging in. Most of the time the circuits were not overtaxed, but there were definitely bursty moments. Document imaging has become a big concern and we’ve had to evaluate our controls on the WAN, which had been mostly wide open until now,” Paalman said. “The old adage of just throwing more bandwidth
to the problem no longer works. We knew we had to deploy Quality of Service (QoS) to prioritize our traffic, but the configuration that went along with it was a little overwhelming.”

Although he has 20 years of experience with routing and Cisco’s command-line interface, Paalman had only limited experience with QoS and was not sure if his initial implementations were actually making a difference. “We began looking at different tools that could explain how this additional traffic was impacting our network.”