Case Study - Borrego Health

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Borrego Health migrated from T1 to a Software Defined WAN architecture to add reliability and performance for their EHR, Citrix and hosted VOIP, as well as significantly reduce their operating expenditures

Industry

Health / Medical Industry

Challenge

Network downtime was affecting mission critical operations such as VOIP, EHS and Citrix

One carrier’s MPLS network didn’t cover all locations, creating the need to bond and manage two networks

Migrating to a centralized phone system required a single platform that integrates data and voice

Solution

Truffle based Broadband Bonding technology was used to connect the clinics

Benefits

Solved reliability and up-time issues in a cost effective manner

VOIP, EHS, Citrix and other cloud services gained fault-tolerance

Various ISP connections are orchestrated for best value, getting the best performance in a cost effective manner

Replaced expensive and unreliable single ISP links

Centralized management of devices enabled ease of deployment and monitoring

Borrego Health Foundation is a private, non-profit healthcare provider across Souther California. Borrego Health offers patients at satellite clinics direct access to visiting specialist in such fields as dermatology, mental health, pediatrics, podiatry, prenatal care, repoductive health and women’s health. Borrego Community Health owns 24 clinics and will reach over 30 sites in 2017. Borrego Health is supporting their interconnected clinics based on Mushroom Networks’ Software Defined Wide Area Network (SDWAN) solution, to harmonize their network performance and reliability.

Streamlining their WAN at their clinics by migrating away from T1 to add performance and reliability

Borrego Health’s clinics connect to the servers at the colo, for various centralized private cloud services. The phone systems were all independent and were not centralized. In majority of the clinics, the aging copper infrastructure of rural telcos could not support high speeds and high availability - as it was common to have ISP failures a few times a month. They had tried Cradlepoint wireless routers for failover, however, the manual switch over process was not a solution that worked. The remote locations didn’t have dedicated IT personnel, so making any changes to the network, as the ISP lines went down or came back up, meant a long trip to the location.

When Dave Baldwin, the CIO of Borrego Health, started planning the WAN upgrade, his team had various requirements and constraints: the solution needed to be cost effective, needed to provide fail-safe in real-time and have the capability to enable seamless and highly redundant connectivity between their clinics and their EHR data-center, as well as connectivity to their cloud based services, such as their hosted PBX.

Additionally, Borrego Health’s accelerated growth meant that the same small IT team now has to manage the IT of organization four times the size. This initiated a search for a solution that can address both voice and data in a single platform. Up until recently, both their carrier voice and data connectivity did not have redundancy.

Alongside the planned migration to hosted-PBX in their clinics, Borrego also heavily relies on a Citrix environment to access various application servers over the Internet, via Citrix Remote Access.

One clear motivation was the patient experience, which is tracked via a quality score by Medicare that affects the funding support. Downtime meant Borrego’s access to their Electronic Health System (EHS) was not available, and therefore the doctors couldn’t access patient records. This not only caused poorer patient experience, but since they had to revert back to paper based records, this meant increased potential mistakes that can put lives at risk - a risk that needed to be resolved.

Baldwin’s team partnered with James Munro, an experienced IT consultant to evaluate the options and design the network solution that will meet all the requirements that the project presented. Mushroom Networks SDWAN solution was picked to provide Broadband Bonding capabilities at the clinics and combine various private and broadband ISP connections from Centurylink, Skyriver and Telepacific. Truffle, the Broadband Bonding appliance from Mushroom Networks, manages the WAN connections at the locations by intelligently combining the Internet resources into a faster and more reliable connection, whereby, automated fail-over is accomplished to optimize application up-time.

The Software Defined nature of the Mushroom Networks solution also provided hosted VOIP services to be provided without being interrupted by the WAN problems, as Truffle manages to route VOIP packets around network problems without losing the session. This meant VOIP calls were uninterrupted even during times when some of the WAN links would have issues. “Mushroom’s VOIP Armor technology is a true enabler for hosted VOIP services, as it takes the problems related to cloud connectivity out of the equation”, said Munro, and added, “Being able to optimize both real-time and non-real-time applications in a simple manner was one of the key factors in us choosing Mushroom Networks solutions for our WAN upgrade project”.

The Truffle devices at the clinics create a Broadband Bonding tunnel that creates an overlay tunnel to the Truffle at the colo. This enables high performance connectivity and sustained application level performance. Broadband Bonding also meant the secondary and tertiary ISP links were not kept idle, but can be utilized for the added bandwidth they provided. This also lowered the bandwidth cost for the clinics. The design also was engineered to avoid single points of ISP failure.

“Electronic Health Records is a fundamental cloud application for our clinics. Our EHR services can’t go down. It literally can be a matter of life and death. That is one of the primary reasons that attracted us to Mushroom Networks”, said Baldwin.

Truffle devices create bonded tunnels between the devices, either in a mesh or hub-and-spoke star topology to create tunnels with various paths between locations. The various WAN resources can be utilized for Internet access and cloud applications to optimize application performance - which can translate as higher throughput, lower latency, lower jitter and/or avoiding packet loss, depending on the application going through the bonded tunnel.

Using Truffle, the Software Defined WAN Orchestration devices capable of Broadband Bonding to aggregate 2 or more broadband lines provided Borrego Community Health with the following:

Boost in WAN Performance:

Truffle appliances were used to bond two or three WAN circuits per site from carriers such as Centurylink, Skyriver and Telepacific simultaneously. Borrego increased capacity 400%. The overall WAN metrics improved both for mission critical applications such as Citrix, hosted VOIP, EHS, and Telehealth as well as best effort traffic. As an example, the VPN connecting branch office to the HQ office now has the full bonded speed of the broadband lines, as opposed to an individual broadband line speed. Bonded circuits per site range from 23 Mbps to 400 Mbps of aggregate bandwidth.

Boost in WAN Reliability:

Truffle provided self-healing WAN and dynamic fail-over capabilities for Borrego’s network. As a result, on-going Internet sessions are now shielded from any WAN outages or performance fluctuations, as long as at least one of the WAN connections stay up.

Reduced WAN Cost:

Compared to a single MPLS based WAN network, the cost savings achieved by Borrego were very significant, reaching up to 70% cost savings, due to combining MPLS, Internet and Ethernet networks into one network seamlessly, reducing circuit and downtime costs and greatly simplifying management.

Reduced Emergency Calls & Related Cost:

Implementing Truffle significantly reduced emergency calls for IT problem tickets as most WAN related outages and emergencies are now shielded from the users and can now be addressed afer hours in scheduled maintenance windows.

Specialized SDN tunnels:

Truffle’s SD-WAN Orchestration meant specialized tunnels could be fitted to Borrego’s specific application requirements. One example was the use of Mushroom’s VOIP Armor. Borrego has a Cloud PBX at its 1 Wilshire data center in LA serving 1000 users. The WAN connects the PBX to all users at all the clinics. VOIP Armor tunnels shield the VOIP/SIP sessions between users and the PBX against any network fluctuations or outages, delivering high MOS scores and toll quality calls.

Borrego Health is a private, non-profit healthcare provider operating in Southern California. Borrego Health offers patients at satellite clinics direct access to visiting specialist in such fields as dermatology, mental health, pediatrics, podiatry, prenatal care, repoductive health and women’s health. Borrego Health owns 24 clinics and will reach over 30 clinics in 2017. Borrego Health decided to support their interconnected clinics based on Mushroom Networks’ Software Defined WAN (SD-WAN) solution, to boost their network performance and reliability. Borrego Health searched for alternative solutions as they migrated from single carrier network. Mushroom Networks’ Truffle appliances in their clinics, translated into network performance and reliability, providing network up-time and performance needed to support their services and applications such as VOIP, EHS, Citrix and others. All this was accomplished with up to 70% cost savings over legacy MPLS.

“We had some of our T1 connections go down several times a month, bringing our EHS down with it. This was not acceptable for us and more importantly for our patients.”,

Dave Baldwin, CIO, Borrego Health

“Being able to optimize both real-time and non-real-time applications in a simple manner was one of the key factors in us choosing Mushroom Networks solutions for our WAN upgrade project”

James Munro, Project Manager

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