Three Case Studies

Case History # 1: GreenField Health System, Portland, OR                            

GreenField Health was the first complete embodiment of modern primary care clinic practice theory in Portland: no wait for visits, no waiting rooms, extensive telephone and e-mail consultations, patient-centric rather than doctor-centric care, a full team approach, etc. While these concepts had been previously applied in teaching hospitals or partially implemented in clinics, they had never been used collectively as the basis for a primary care clinic’s operations.

The consulting requirement was to (1) understand the philosophies and practical requirements underlying this approach and (2) to identify and specify the infrastructure and technologies that would be necessary to support it.  This included, for example,  custom integration of telecom and instant messaging systems with applied presence sufficient to know who was in the office,  and how and when to page medical staff and/or route calls accordingly, systems to optimize digital patient communications, etc.,  all while keeping the technology well-hidden.  

Another challenge was to use technology to provide this small firm not only with the appearance of a larger one, but to use technology to actually provide them with a competitive operating advantage.  I negotiated with Qwest for provision for up to 5,000 directory numbers while initially paying only for 100. I then negotiated elsewhere for custom software to allow for up to 5,000 numbers to be automatically recognized and correctly routed to the correct doctor/patient care representative team while strictly adhering to Hipaa requirements.  The results were so outstanding that I became an early patient myself.  

Case History # 2: Rose Villa, Inc.,  Portland Oregon

Rose Villa is a non-profit retirement community emphasizing affordable and compassionate care.  I was retained to enhance communications systems to reflect current and future competitive conditions in the face of a deteriorating infrastructure that had not been well maintained or updated for 50 years. Rose Villa also wanted or had to satisfy Hipaa-requirements, provide E911 capabilities, voice mail, Caller ID, enhanced call accounting, and wireless voice, and other communications over the entire 22 acre campus.  

The complexity of the requirements was in sharp contrast to the user population. To quote from the Teleconvergence RFP: “In general, Rose Villa’s needs are not very sophisticated.  The system’s users (both residents and staff), almost without exception, are not technically nor especially business oriented.  Instead, they are very much involved in caring about and for each other, and their systems must unobtrusively and reliably enable them to carry out their everyday tasks.”  

Finding the right balance of comprehensive system capability and apparent user simplicity was the most delicate aspect of the entire project, especially regarding handling 911 calls.  The most difficult was that all cables had been paved over 20 years earlier, no records existed, and water had seeped into the entire network.  Repairing cables would have meant the incessant noise of jackhammers next to residents in their eighties and nineties.  Instead, I identified a cost-effective solution that kept no one awake, including the Chief Financial Officer.

Case History # 3: Oregon Episcopal School  (OES), Portland, Oregon

OES is a non-profit K12 private school.  It enjoys a wide reputation as a superior academic and college preparatory institution.  Faculty members use laptops, student homework assignments and course material are available from the school’s servers over the Internet, and most buildings support wireless communications.

The project was to replace the school’s outgrown telecommunications capabilities with unified communications and similar solutions intended to last for fifteen years in the face of students’ use of cell phones, smartphones, instant messaging, etc.  I also had to anticipate solutions for emergency situations: E911, manual/automatic notification of natural disasters, lockdowns, terrorism, etc.  All while ensuring the traditional personal approach for which the school is renowned (“Only if we’re all dead will a live person not answer the phone”).

Unusual aspects of work:
1. Voice and data were managed cooperatively by different individuals in different departments with computer and telephone equipment in separate buildings that nevertheless required consolidated administration.
2. The OES administration wanted an answer to the question, “What do we do if we have a Columbine?” [This was pre-Virginia Tech.]  While it was obvious that guarding against perpetrators operating unseen on campus required full-fledged video surveillance, this solution was completely unacceptable to the administration. The real task, then, was to refine the question, provide an array of possible acceptable solutions, and then to integrate the accepted solution into the final communications system.

The ensuing difficulty was that no system on the market could provide the desired operating features with an acceptable degree of security at an affordable cost.  The ultimate solution required that I document the solution concept and the degree of operational detail necessary for the vendor to meet OES’ requirements. One vendor complied by agreeing to incorporate my specifications without change into its next software product release, an unusual solution that demonstrates the value of being a consultant with a product development background.