25 Bay Street, Antigonish, Nova Scotia, B2G 2G5 REQUEST FOR PROPOSAL. Radio Frequency (RF) Wireless Site Survey

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1 25 Bay Street, Antigonish, Nova Scotia, B2G 2G5 REQUEST FOR PROPOSAL Radio Frequency (RF) Wireless Site Survey

2 TABLE OF CONTENTS 1.0 ORGANIZATIONAL SUMMARY INSTRUCTIONS TO BIDDERS VENDOR PROPOSAL FORMAT CLOSING DATE KEY CONTACTS SPECIFICATIONS STANDARDS IF APPLICABLE ELECTROMAGNETIC INTERFERENCE (EMI) MEDICAL DEVICE REGULATIONS PATIENT PRIVACY AND INFORMATION SECURITY SITE REQUIREMENTS AND LAYOUT ACCEPTANCE TESTING (if applicable) DOCUMENTATION SERVICE NOTIFICATIONS EVALUATION REFERENCES PROPOSAL COST ENVIRONMENTAL SUSTAINABILITY EVALUATION CRITERIA PROPOSED COPIES... 9

3 1.0 ORGANIZATIONAL SUMMARY The Guysborough Antigonish Strait Health Authority (GASHA) is one of nine district health authorities established by the Nova Scotia Department of Health on January 1, 2001, following the proclamation of Bill 34, the Health Authorities Act. Replacing the Regional Health Board system, the District Health Authorities were created to bring health care decision-making closer to the community level and improve accountability for health care decisions. Guided by a volunteer Board of Directors, the Guysborough Antigonish Strait Health Authority s mandate is to govern, manage, plan, monitor, evaluate and deliver health services and programs according to the health care needs of our district. Key to GASHA s mandate is the development and implementation of annual business plans which incorporate health plans developed by our three local Community Health Boards. GASHA is responsible for delivering a wide range of health services and programs to over 47,000 residents of Antigonish Town and County, Guysborough County, Richmond County and the southern portion of Inverness County. Over 700 employees and 61 medical staff work within GASHA to deliver quality healthcare to residents in our district. Five hospitals and two programs fall within the GASHA district. The five hospitals are: St. Martha s Regional Hospital, Antigonish; Strait Richmond Hospital, Cleveland, Richmond County; Eastern Memorial Hospital, Canso, Guysborough County; Guysborough Memorial Hospital, Guysborough; and St. Mary s Memorial Hospital, Sherbrooke, Guysborough County. The two programs are: Public Health Services and Addiction Services (both shared with the Cape Breton District Health Authority). 2.0 INSTRUCTIONS TO BIDDERS These instructions to Bidders, Equipment Requirements, and Terms and Conditions are for the furnishing, installation, start-up, calibration and the testing of medical equipment for the Guysborough Antigonish Strait Health Authority, 25 Bay Street, Antigonish, Nova Scotia, B2G 2G5, hereafter referred to as BUYER or GASHA. Proposals will be evaluated on the basis of price; conformance to Equipment Requirements and Terms and Conditions; conformance to Biomedical requirements, equipment features, specifications, performance, and reliability; vendor experience; the experience of users with the equipment and vendors; delivery and installation schedule; warranty terms; service capabilities; user training and support services; operating costs and overall responsiveness to the Request for Proposal (RFP). The order in which the above selection criteria are listed is not necessarily indicative of their relative importance. It is expected that vendors submitting proposals will demonstrate extensive and substantial qualifications, capabilities, and experience in manufacturing, installing and servicing the equipment sought, including successful provision of similar goods and services to comparable institutions. The BUYER intends to select a vendor on the basis of proposals received in response to the RFP and any other information it obtains from other sources regarding the equipment and the vendor. The BUYER reserves the right to make its final decision independent of any or all of the above factors. The BUYER reserves the right to solicit service contract bids from qualified independent service organizations, in the interest of reducing its technical support costs. Any questions regarding this RFP should be directed to the appropriate key contact(s) identified later in this document. Information offered from sources, other than these contacts, is not official and may be inaccurate. All proposals must be received by the Director of Materiel Management or designate at the address specified no later than the time identified. Failure to submit a proposal, by the deadline specified, will result in the rejection of the vendor s proposal. This proposal shall be available to the following District Health Authorities should they wish to participate: - Capital District Health Authority - IWK Grace Health Center - District Health Authorities 1, 2 & 3 - District Health Authorities 4, 5 & 6 - Cape Breton District Health Authority Page 1

4 Submission of the Proposal constitutes the vendor s acceptance of the procedures, evaluation criteria, and other administrative instructions of the RFP. It is NOT acceptable to fax the Proposal. The BUYER assumes no responsibility for delays in Canada Postal Service or any delivery or courier service the vendor may select. Time extensions will not be granted. All submissions/changes must be made only to the Director of Materiel Management or designate. Vendors will not be allowed to alter proposal documents after the deadline for proposal submission. Each vendor shall appoint an individual to act in an official capacity on behalf of the vendor/company for this acquisition. The following information shall be included in the proposal: - Name of the Vendor Representative - Representative s Title - Name of the Company - Company Address - Telephone / Fax Number - Cell Phone / Pager Number - Address GASHA reserves the right to change the acquisition schedule or issue amendments to the RFP at any time. GASHA also reserves the right to cancel and/or reissue the RFP. Vendors may withdraw a proposal which has been submitted at any time up the proposal closing date and time. To accomplish this, a written request signed by the authorized representative of the vendor must be submitted to the Director of materiel Management. After withdrawing a previously submitted proposal, the vendor may submit another proposal at any time up the proposal closing date and time. 3.0 VENDOR PROPOSAL FORMAT All proposals submitted shall follow the format as outlined below First Section The first section of the proposal shall be a line-item price quotation that separately lists all of the components of the proposed equipment/system, installation costs and any other costs associated with this acquisition. Installation costs should be included in the price. All pricing is to be installed (freight prepaid and included in price proposal), including rigging and inside delivery. Each line item, for each quotation, must have both the standard list price as well as any discounted price. This shall include service and equipment. Second Section The second section of the vendor s proposal shall include details and compliance claims as they relate to the following sections of this RFP. The vendor shall reference the same line item numbers for easy reference by the BUYER. Provide as many details and information as necessary to avoid unnecessary follow-ups with the vendor that may jeopardize the sale. Any mandatory requirement requested by the GASHA in this RFP, is an essential need that must be met by the vendor. Failure to meet a mandatory requirement (grounds for disqualification) shall be established by any of the following conditions: Vendor states that a mandatory requirement cannot be met. Vendor fails to include information necessary to substantiate that a given mandatory requirement has been met. A response of will comply is not sufficient. The vendor presents the information requested by this RFP in a matter inconsistent with the instructions stated by any portion of this RFP. Customer references, or site visits, report the vendor s inability to comply with one or more of the mandatory requirements. The vendor fails to include the customer references required. Third Section The third section of the proposal shall include a brief description of the key points/advantages of the vendor s product and why GASHA would benefit by selecting this product. Fourth Section Any brochures, references, support documentation, training schedules, medical device licenses etc. shall be included in this section. Page 2

5 4.0 CLOSING DATE Closing Date for the submission of proposals is Friday, August 6, PM AST. 5.0 KEY CONTACTS Submission Inquiries: Leonard MacEachern Director of Materiel Management Guysborough Antigonish Strait Health Authority 25 Bay Street, Antigonish, Nova Scotia B2G 2G5 Phone (902) ; Fax: (902) Technical Inquiries: Lisa Mullin Director of Information and Communication Systems Guysborough Antigonish Strait Health Authority 25 Bay Street, Antigonish, Nova Scotia B2G 2G5 Phone (902) SPECIFICATIONS This procurement document is for detailed wireless radio frequency site surveys of the various facilities in GASHA. This project will include both on-site RF surveys and use RF modeling tools to determine access point quantities and placement to provide required services. A site survey is the initial task at hand with the plan to invest in upgrading this wireless infrastructure to a more robust system, expanding the footprint where necessary. The scope of the work to be done will be determined by GASHA, thus the pricing should be broken out as follows: 6.1 The site surveys must be broken out by facility in the following way: St. Martha s Regional Hospital (SMRH) This facility is a regional hospital located in at 25 Bay St. in Antigonish, Nova Scotia that was built in This building is 200,000 ft 2. The attached building, the Martha Center, is to be priced separately. The pricing options for this facility should be: The entire building (basement, main, 3 rd and 4 th floors) The 2 floors where the majority of nursing unit are located (main and 3 rd floor) Martha Center (MC) This facility is primarily a professional building that is adjacent and accessible from St. Martha s Regional Hospital. It was built in 1961, but had major renovations over the past 3 years. This building is 92,000 ft 2. The pricing options for this facility should be: The entire building (basement, and 4 floors) Strait Richmond Hospital (SRH) This facility is a twenty-bed facility located in Evanston, Richmond County Nova Scotia that was built in This building is 52,500 ft 2. The pricing options for this facility should be: The entire building (basement and main floors) The main floor where the nursing units are located Eastern Memorial Hospital This facility is a six-bed facility located Canso, Nova Scotia. This facility is attached to the Canso Seaside Manor; however the manor is not part of this study. It was built in 1975 and is 16,372 ft 2. The pricing options for this facility should be: The entire building (one floor) Guysborough Memorial Hospital This facility is a ten-bed facility located Guysborough,, Nova Scotia. This facility is adjacent to the Milford Haven Home for Special Care; however the home is not part of this study. It was built in 1988 and is 12,200 ft 2. The pricing options for this facility should be: The entire building (Basement and main floor) The main floor where the nursing units are located. Page 3

6 6.1.6 St. Mary s Memorial Hospital This facility is a six-bed facility located Sherbrooke, Nova Scotia. It was built in 1975 and is 10,695 ft 2. The pricing options for this facility should be: The entire building (main floor, and upstairs) The main floor where the nursing units are located. 6.2 Additional Considerations Infection Control precautions The vendor must follow established infection control procedures while in GAHSA facilities Scheduling The scheduling of on-site work to be mutually agreed between GASHA and the vendor. 6.3 Current Environment The current wireless environment in the GASHA sites was implemented with the introduction of the Meditech PCS (Patient Care System) module in The wireless access points are being used for workstations on wheels in the 5 hospitals and there is limited wireless to the physician offices in the Martha Center. The only equipment other than these computers is the Spacelab monitors in the Trauma and Emergency Services Department of St. Martha s Regional Hospital Network infrastructure The network infrastructure at St. Martha s spans the main hospital complex as well as the attached Martha Center complex. An HP Procurve 5400 chassis series switching environment is currently in place throughout the site. The current wiring supports a nonconvergent, overlaid voice network running on the same switches as the data segments. There are a dozen wiring closets that are wired back to a main communications room located on the main floor of the hospital. These wiring closets are connected via a fibre backbone. The main server room is air conditioned, but the other closets are generally not. St, Martha s is also running a voip phone system for both building that is interfaces with the various paging systems and physicians offices in the Martha Center. This is a Cisco system that runs on the same HP Procurve infrastructure. The network infrastructure at the 4 rural hospitals in built on HP Procurve 2600 series chassis. Strait Richmond Hospital has 2 wiring closets, each with a switch, and the other sites Eastern Memorial, Guysborough Memorial and St. Mary s Memorial each have one small rack with. Of these, only one 6-port at SRH is POE capable Wireless Access Points The wireless architecture for the sites was primarily designed to simply cover the requirement of having workstations on wheels in the nursing areas in each facility. A secondary focus was to provide limited computer connectivity in the Martha Center. The following table lists the current access points we are using. Site Location Make/Model WiFi Level Martha Center Basement - OBGYN office area Proxim AP4000 G Martha Center Basement - OBGYN office area Proxim AP4000 G Martha Center Main Floor - ENT office Avaya AP-3 B Martha Center Main Floor - Pediatrics offices Avaya AP-3 B Martha Center Main Floor - Internist office Avaya AP-3 B Martha Center Basement - Surgeon office Avaya AP-600 B Martha Center CMGP Proxim AP4000 G St. Martha's Main Floor - OPD/Emerg Avaya AP-3 B St. Martha's Main Floor - Emerge / Observation Proxim AP4000 G Page 4

7 St. Martha's Main Floor - St. Martha's Emerge Proxim AP4000 G St. Martha's Main Floor - St. Martha's Emerge Proxim AP4000 G St. Martha's I Main Floor - CU Avaya AP-3 B St. Martha's Main Floor - PCU Avaya AP-3 B St. Martha's Main Floor OBS Case Rooms Avaya AP-3 B St. Martha's Main Floor - W/C Health Unit Avaya AP-3 B St. Martha's 3rd Floor - GARU Avaya AP-3 B St. Martha's 3rd Floor - GARU Avaya AP-3 B St. Martha's 3rd Floor - Psych Avaya AP-3 B St. Martha's 4th Floor - HITH/Pal Care Avaya AP-600 B St. Martha's 4th Floor - Dialysis Proxim AP4000 G St. Martha's 4th Floor - Dialysis Proxim AP4000 G St. Martha's 4th Floor - ALC Unit Proxim AP4000 G St. Martha's St. Martha's Amb. Care Unit Proxim AP4000 G St. Martha's St. Martha's Amb. Care Unit Proxim AP4000 G Strait Regional Main floor - Nursing Area Avaya AP-3 B Strait Regional Main Floor - Physio Avaya AP-3 B Strait Regional Main Floor - OPD/Emerg Avaya AP-3 B Strait Richmond Main Floor - Addictions Services Detox Proxim AP4000 G Strait Richmond Main Floor - DEC Proxim AP4000 G Guysborough Memorial Main Floor - Nursing Area Avaya AP-3 B Eastern Memorial Main Floor - Nursing Area Avaya AP-3 B St. Mary's Memorial Main Floor - Nursing Area Avaya AP-3 B 6.4 Future Plans The wireless applications possibilities in a hospital environment are continually changing. This site survey should map the appropriate access point locations based on the following future implementations Other types of wireless medical devices, such as infusion pumps, etc Infrastructure to support state of the art paging solutions The extension of the SMRH voip system to wireless phones The integration of Wi-Fi devices, such as hands-free wearable badges, etc Wireless access for staff computers throughout the facility including offices, conference rooms, lounges and cafeterias Limited wireless capability outside the facilities, but on the groups for paging security, etc Location-based services, such as RFID Possibility of an interface with public cellular network Please see the attached reports on Wired/Wireless Integration Strategy Project - Current Situation Assessment and Future State Definition. 6.5 Deliverable This deliverable for this project is a detailed inventory of number and location of the all access points in the areas studied. This work would include a review of the current locations of access points and the overall wireless infrastructure with any recommendations. This inventory should include the floor plans provided with all recommended access points indicated. 6.6 Value-added Components GASHA will consider the value-added components of a proposal. To be scored, these value-added components will be fully disclosed at the time of the proposal and included in of the submission pricing. While the format of the proposal will be based on the District s Request for Proposal, it is Page 5

8 the obligation of the bidder to clearly outline all such value-added components of the submission. All value-added components will be listed separately with their values shown. 7.0 STANDARDS IF APPLICABLE 7.1 The equipment shall be CSA approved to applicable CSA standards. 7.2 The vendor shall indicate the standard(s) that your system is in compliance with. 7.3 They system and all its components MUST be labeled as CSA approved. 7.4 Any system/equipment proposed, that is not CSA and not properly labeled as such, will not be accepted until such time that this is performed and reviewed to the satisfaction of the Biomedical Engineering department. 7.5 Any system/equipment that requires special acceptance testing to be certified to CSA standards, must have been carried out, prior to shipment to the identified Facility, by an agency that has been accredited with the Standards Council of Canada. Copies of any inspection reports, for this special inspection, MUST be submitted if requested. 7.6 The vendor must provide proof of certification to the above standards if requested. 8.0 ELECTROMAGNETIC INTERFERENCE (EMI) 8.1 This equipment/system shall be in compliance with CSA Standard, CAN/CSA C22.2 No Medical Electrical Equipment, Part 2: Collateral Standard: Electromagnetic Compatibility Requirements and Tests. The vendor MUST provide Biomedical, a copy of documented proof of testing and its results, if requested. 9.0 MEDICAL DEVICE REGULATIONS Any system/equipment sold in Canada, must now meet the Medical Device Regulations, as set forth by the Health Protection Branch at Health Canada. 9.1 The vendor must include a copy of the current year Establishment License with this RFP proposal. - ALSO, in addition to the Establishment License If the equipment/system is classified as Class I, as defined by these regulations, then the system does not require a device license; a copy of the Establishment License will be sufficient. - HOWEVER If the equipment being proposed is classified as Class II, III, or IV, as defined by these regulations, then a medical device license is required for the device(s) and the vendor must include a copy of the current year Device License(s), for each piece of equipment indicated in this system. 9.4 Any copies of the Establishment and/or Device Licenses must be for the current year. 9.5 Any vendors that DO NOT meet these requirements and submit the necessary copies requested may not be entertained in this project and will jeopardize their submission PATIENT PRIVACY AND INFORMATION SECURITY It is essential that GASHA ensures that the privacy aspects and protection of information have been properly addressed as it relates to the following ACTS. The vendor shall indicate compliance to the following: 10.1 Freedom of Information and Protection of Privacy Act (FOIPOP) an act respecting the right of access to documents of public bodies in Nova Scotia and a right of privacy with respect to personal information held by public bodies in Nova Scotia Personal Information Protection and Electronic Documents Act (PIPEDA) An act to support and promote electronic commerce by protecting personal information that is collected, used or disclosed in certain circumstances, by providing for the use of electronic means to communicate or record information or transactions and by amending the Canada Evidence Act, the Statutory Instruments Act and the Statute Revision Act Manufacturer Disclosure Statement for Medical Device Security (MDS2) (if applicable) The vendor MUST (if applicable) provide with this proposal, a Patient Information Impact Assessment for possible privacy-related consequences of equipment and/or systems that use or disclose personal patient information or data including electronic Protected Health Page 6

9 Information (ephi). The Manufacturer Disclosure Statement for Medical Device Security (MDS2) provides manufacturer s model-specific description of: The equipment/system s ability to maintain/transmit ephi. Security features and safeguards associated with the equipment/system If applicable, the vendor shall submit a fully completed MDS2 form for the equipment/system being proposed ( SITE REQUIREMENTS AND LAYOUT 11.1 Vendor must provide a complete and detailed description of the requirements for the proposed equipment/system that may include, but not be limited to: Shielding Electrical; Any special utility and electrical power system needs Mechanical (HVAC); Provide a complete description of environmental conditions required Structural and access requirements Ceiling, wall, and floor loading Environmental controls including air conditioning 12.0 ACCEPTANCE TESTING (if applicable) 12.1 The system shall be subject to and must pass acceptance testing, performed by GASHA s Biomedical Engineering Department As bound by the provincial guidelines for Nova Scotia and Health Canada: The system will be inspected for compliance with applicable CSA standards Devices will be checked that they meet the device license and/or establishment license requirements as defined and set forth in the Medial Devices regulations stated earlier Any equipment that does not meet the requirements of these new Medical Devices Regulations or CSA medical standards, will not be expected DOCUMENTATION The system purchase must include allowances for the following documentation: Manuals DO NOT have to be included in this RFP submission, but must be included if you are awarded contract One (1) service manual for each type of equipment in this system and all major components. Each manual must contain but not limited to: Mechanical and electronic schematics Electronic component layouts Mechanical component breakdown Complete electronic, electrical and mechanical parts list Circuit descriptions Calibration procedures Troubleshooting procedures Equipment specifications Installation requirements/manuals System wiring diagrams Error code listing, with descriptions/problems and how to access these 13.2 Two (2) Operators Manuals; one (1) for the department and one (1) for Biomedical/IT 14.0 SERVICE 14.1 The vendor shall provide a description of local and regional factory-based service capabilities, including the following: The number and qualifications of service engineers Their training Their base locations The locations of backup service engineers The location of primary and backup spare parts locations. Page 7

10 The time for delivery of parts after notification The vendor shall indicate where support is from How many service reps available The vendor shall indicate: Time to respond to a problem call Time to be available on-site Are remote diagnostics available? hours a day? What are the requirements to set this up? 15.0 NOTIFICATIONS 15.1 The following will be provided for the life of the system: Immediate notification of any alerts affecting any part of the system Notification of manufacturer s technical service bulletins Immediate notification of any software or hardware threats (viruses, worms etc.) or any other threats to any computer-based equipment/software that may be used The manufacturer shall arrange for free access to the manufacturer s website for the downloading of any applicable updates, software patches, corrections, etc. that are required in maintaining a reliable, effective and safe working system These notifications shall be provided at no additional cost to GASHA EVALUATION 16.1 The vendor must provide a demonstration on-site of the proposed system A system specialist shall present or be available during the on-site demonstration If an on-site evaluation/demo of the system is not an option, the vendor shall include arrangements for site visits by three (3) GASHA representatives. The cost of the site visit shall be covered by the vendor The vendor will indicate the reference sites that will be included in these site visits REFERENCES 17.1 Include a list of references from similar Canadian institutions that are presently using this system. Please supply the names and telephone numbers for these contacts PROPOSAL COST 18.1 Proposals are to be F.O.B Hospital 18.2 Pricing quoted are to be in Canadian funds ENVIRONMENTAL SUSTAINABILITY The Guysborough Antigonish Strait Health Authority is committed to reducing its environmental foot print. A mission statement with strategic goals has been established to assist in this effort. As an early adopter with the Antigonish Sustainability Project, the Guysborough Antigonish Strait Health Authority is looking to build relationships with partners that share the same social and environmental values. To that end, can you please provide GASHA with: Your environmental sustainability mission statement and values along with key initiatives your enterprise is engaged in. The sustainability features of your product EVALUATION CRITERIA The proposals will be evaluated on the following criteria: Price 40% Meets Specification 25% References and Vendor Profile 25% Page 8

11 Future Expandability 10% 21.0 PROPOSED COPIES 21.1 Please include three (3) complete copies of the proposal. Purchasing Department (Master) 2 copies Electronic Copy as well Page 9

12 CURRENT SITUATION ASSESSMENT WIRED/WIRELESS INTEGRATION STRATEGY PROJECT Prepared By: Concertia Technologies Inc Date Released: April 17, 2009 Version: 1.0

13 CURRENT SITUATION ASSESSMENT DOCUMENT CONTROL Prepared By Concertia Technologies Inc Upper Water Street First Floor, Collins Court Halifax, Nova Scotia B3J 1S9 Contact Person: Ross MacDougall Phone: Fax: REVISION HISTORY Revision Description Authors Issue Date 0.1 First draft Johanna Voerman Khisa, David Bruce, March 24, 2009 Kevin Burgess 0.2 Final draft. Incorporated comments from Project April 7, 2009 Working Group. 1.0 Final version. Incorporated comments from Project Working Group and Project Sponsor. April 17, 2009 ACKNOWLEDGEMENTS Concertia would like to thank the following people who constituted the Project Working Group at various points: Phil Langford SSDHA Herb Stiene SWNDHA Cathy Cruz SSDHA Allan Zasitko SSDHA Rick Crowell SWNDHA Dan Goodwin SWNDHA Tom Hillier SWNDHA Bill Fraser AVDHA David McCurdy DoH Jeremy Dann NSAHO Philip Bradfield NSAHO Leigh Whalen HITS-NS Ken Young HITS-NS Leigh Whalen HITS-NS Michael Barton CDHA Ken George IWK Glenn Dove CBDHA As well, representatives from every District in the areas of IT, Engineering, Clinical Engineering, and others were very helpful, both in allowing us to access information, and to discuss current and future applications. APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: I

14 CURRENT SITUATION ASSESSMENT TABLE OF CONTENTS DOCUMENT CONTROL... I REVISION HISTORY... I ACKNOWLEDGEMENTS... I TABLE OF CONTENTS... II TABLE OF TABLES... IV TABLE OF FIGURES... V INTRODUCTION... 1 PURPOSE OF THIS PROJECT... 1 SCOPE AND OBJECTIVES... 1 METHODOLOGY... 1 DOCUMENT ORGANIZATION... 2 CURRENT TECHNOLOGY INFRASTRUCTURE... 3 THE DHA NETWORKS... 3 Wireless LAN at the DHAs... 4 Application Drivers for Wireless LAN Adoption... 5 CLINICAL WIRELESS TECHNOLOGIES... 7 OTHER WIRELESS TECHNOLOGIES... 9 Cellular Systems... 9 RFID Paging systems Trunk Mobile Radio Emergency Health Services Network CORE SWITCHING INFRASTRUCTURE SECURITY ARCHITECTURE VOICE SERVICES SYSTEMS MANAGEMENT EVALUATION OF INFORMATION TECHNOLOGY ORGANIZATION GOVERNANCE CLINICAL ENGINEERING HITS-NS PACS MEDITECH PCS APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: II

15 CURRENT SITUATION ASSESSMENT Exchange Telehealth Other central applications RECOMMENDATIONS FUTURE INFLUENCES PATIENT CARE INFLUENCES TECHNOLOGICAL INFLUENCES Wireless LAN Technology Digital Television (HDTV) and WMTS Life Critical Networks APPENDIX A DHA CURRENT SITUATION TECHNOLOGY MATRIX APPENDIX B - HITS-NS WIRELESS POLICY & STANDARDS APPENDIX C - CDHA WIRELESS SERVICES MODEL APPENDIX D - DRAFT SPECTRUM MANAGEMENT PROGRAM, DHA 1/2/ APPENDIX E - SANTA CABRINI WHITE PAPER APPENDIX F - COMPLETED TEMPLATES OF 9+IWK DHAS APPENDIX G - PROVINCIAL DHAS APPENDIX H - SPECTRUM MANAGEMENT COMMITTEE TERMS OF REFERENCE APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: III

16 CURRENT SITUATION ASSESSMENT TABLE OF TABLES Table 1 Wireless Equipment at the DHAs... 4 Table 2 Application Drivers for WLAN Adoption at the DHAs... 5 Table 3 - MEDITECH PCS Implementation Planning... 6 Table 4 - Clinical Engineering Applications... 8 Table 5 - Cellular Carriers Table 6 Core LAN Switches Table 7 Antivirus Software Table 8 Voice and VOIP Table 9 Network Management Systems Table 10 Service APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: IV

17 CURRENT SITUATION ASSESSMENT TABLE OF FIGURES Figure 1 Network Overview... 3 Figure 2 Current Governance Model Figure 3 - Provincial District Health Authorities APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: V

18 CURRENT SITUATION ASSESSMENT INTRODUCTION PURPOSE OF THIS PROJECT The South Shore District Health Authority (SSDHA) is undertaking a project on behalf of the provincial District Health Authorities (DHAs) to identify a set of standards, protocols and architecture for a secure integrated wired/wireless infrastructure capable of supporting healthcare applications for the provincial health authorities. The purpose of this project is to develop a strategy to integrate wired / wireless infrastructures in provincial health care facilities. SCOPE AND OBJECTIVES The Current Situation Assessment provides an overview of the existing wireless systems, supporting technologies, and support infrastructure in place at the provincial District Health Authorities (DHAs) and, where appropriate, documents their strengths and weaknesses. The focus of this deliverable is to communicate to the Wired/Wireless Integration Strategy team members the essence of the current situation and to confirm our understanding with the District Health Authorities. As well, we have included several recommendations based on our METHODOLOGY A Concertia project team has been working with various technical subject matter experts, clinical subject matter experts and a variety of other stakeholders from the District Health Authorities. A Project Working Group was formulated for the kickoff workshop with Information Technology (IT) representatives from Districts 1, 2, and 3, Department of Health (DoH), and Health Information Technology Services Nova Scotia (HITS-NS). The kickoff workshop identified a number of current state applications. The workshop also generated discussion on the scope of a wireless network in relation to biomedical equipment and clinical functionality, versus wireless LAN (local area network). Initially, Concertia was provided with a list of the DHA IT Directors and made contact with them directly to collect information for this Current Situation Assessment. Concertia prepared a template of applications for each DHA, which was based upon information categories submitted by Clinical Engineering representatives from the Nova Scotia Association of Health Organizations (NSAHO). This template was completed in person or via conference calls. In some cases, Concertia spoke with the IT Director; in others, we were referred to alternate contacts within the DHA IT, Engineering, Clinical Engineering, and other departmental teams. The completed templates of information collected from each DHA are included in this document as appendices. APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 1

19 CURRENT SITUATION ASSESSMENT During the course of the Current Situation Assessment phase of the project, the decision was made to revise the makeup of the Project Working Group to accommodate a larger voice from Clinical Engineering. This resulted in fewer members from the IT community. The Project Working Group consists of the following members: Herb Stiene SWNDHA (DHA2 1 ) Jeremy Dann, Clinical Engineering, NHAHO (DHA 1/2/3) Al Ilsley, Clinical Engineering, NSAHO (DHA 4/5/6/7) Glenn Dove, Clinical Engineering (DHA 8) Michael Barton, Clinical Engineering, (DHA 9) Ken George, Clinical Engineering, (IWK) Allan Zasitko Information Technology, SSDHA (DHA1) Rick Crowell Information Technology, SWNDHA (DHA2) Dan Goodwin Information Technology, SWNDHA (DHA2) Tom Hillier Information Technology, SWNDHA (DHA2) Bill Fraser Telecommunication Services, AVDHA (DHA3) David McCurdy DoH Leigh Whalen HITS-NS DOCUMENT ORGANIZATION The remainder of this document describes the Current Situation in the following areas: Section 2 Section 3 Section 4 Section 4 Current Technology Infrastructure Information Technology Organization Recommendations Future Influences 1 Please refer to Appendix G - Provincial DHAs for a complete list of District Health Authorities. APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 2

20 CURRENT SITUATION ASSESSMENT CURRENT TECHNOLOGY INFRASTRUCTURE THE DHA NETWORKS Each District Health Authority maintains its own IT infrastructure at each facility, comprising network switches, servers, PCs, printers, cell phones, pagers, and other technology equipment. The District IT Department is free to deploy the type of local area network (LAN) and wireless LAN (WLAN) that best suits their needs and/or budget, resulting in many different types of equipment in the Districts. Clinical engineering equipment, which also uses wireless technologies, is under the management of clinical engineering. Though clinical engineering and IT equipment may be similar, at present each functional department deploys their own equipment, independently of the other. In some cases, wireless access points for biomedical equipment are deployed Access to the NS Health wide area network (WAN) and to the internet is provided and managed by HITS-NS, the technology operations arm of the Department of Health. HITS-NS has provided an edge router at each facility to connect to the NS Health WAN. Core network switches are managed by the DHA. The following diagram depicts the general network design and the relationship between the DHA and HITS: Figure 1 Network Overview APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 3

21 CURRENT SITUATION ASSESSMENT WIRELESS LAN AT THE DHAS The wireless local area networks installed at the DHAs include a diverse mix of technologies. Equipment at the DHAs ranges from individual autonomous access points to significant centralized wireless LAN installations. Only District 3 reports no wireless access points at all. In Districts 2, 4, 5, 6, 7, and 8, autonomous APs are currently in use, including Cisco, 3Com, Linksys Avaya, Proxim, and possibly other brands. District 1 has installed a Cisco Wireless LAN Solution Engine with 52 autonomous access points beginning in 2006 to support a hybrid VOIP system for SpectraLink wireless phone handsets. This solution provides central management of autonomous access points each access point must have an individual configuration file, though it can be pushed out centrally. [An upgrade to the newer wireless LAN controller solution, including a conversion from autonomous to light weight access points, is possible.] DHA 8 is now starting their upgrade to a Cisco based wireless controller system at Cape Breton Regional. The equipment was purchased some months ago, and cabling for the WLAN is underway. Cape Breton is their both wired and wireless) to the main hospital IT network. Plan is to implement in the spring controller (WLC) platform with light-weight access points and managed by the Wireless Control System (WCS). The IWK design includes dual SSIDs to provide segregated access for both corporate users and patients. Table 1 Wireless Equipment at the DHAs DHA DHA WLAN Wireless Equipment Guest WLAN Adoption 1 SSDHA Medium Cisco WLSE with 1231 APs No 2 SWNDHA Low Few Linksys autonomous APs No 3 AVDHA Low None No 4 CEHHA Low 3Com autonomous APs No 5 CHA Low 3Com autonomous APs No 6 PCHA Low 3Com autonomous APs No 7 GASHA Low Autonomous Avaya/Proxim access No points. 8 CBDHA Medium Currently have autonomous No access points. WLC 4400 platform with A/B/G/N, starting Feb09, other sites without WLC. 9 CDHA High Currently rolling out WLCs. No APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 4

22 CURRENT SITUATION ASSESSMENT DHA DHA WLAN Adoption Wireless Equipment IWK High Cisco WLC platform with dual SSIDs for patient/corporate users. Guest WLAN Yes, currently being rolled out WLSE platform). However, there is currently no standardized wireless platform across the Districts. Recommendation: A wireless strategy that would include a standardized general design, technology platform, and equipment vendor is recommended. This would allow any DHA to access the strategy, order equipment from a standing offer, and implement a wireless network that is already proven to meet their requirements. APPLICATION DRIVERS FOR WIRELESS LAN ADOPTION To date, wireless LAN adoption at the DHAs has been driven by applications, clinical engineering, clinician, staff and patient access. Wireless LAN access is widely viewed as being a key enabler to enhancing clinician satisfaction while improving patient care. Table 2 Application Drivers for WLAN Adoption at the DHAs DHA DHA Primary Application Driver Comments 1 SSDHA MEDITECH PCS, PHIM 2 SWN PHIM 3 AV PHIM, Other Clinical Information System, Clinical Engineering Valley Regional ER Revitalization; ACHC SpaceLabs acquisition 4 CEHHA MEDITECH PCS planned in 1½ year range new hospital 5 CHA 1½ year range 6 PCHA 1½ year range 7 GASHA MEDITECH PCS 8 CBDHA MEDITECH PCS 9 CDHA Clinician access Using McKesson IWK Patient Access through Microsoft CLICK Using MEDITECH MAGIC MEDITECH PCS The primary driver for (PCS). This is an electronic documentation system offering mobile plans of care for a patientfocused care delivery system. Automated work lists allow nurses and clinicians to document care using a point-of-care device. The PCS application is typically accessed at the bedside and APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 5

23 CURRENT SITUATION ASSESSMENT other locations as needed using Computers on Wheels (CoWs). The mobility and accessibility of this application necessitates a wireless LAN. The provincial DHAs are at varying stages of their implementation plans for MEDITECH PCS. Table 3 - MEDITECH PCS Implementation Planning with respect to their PCS implementation. Table 3 - MEDITECH PCS Implementation Planning DHA DHA Current Implementation Status 1 SSDHA Considering implementation proposal. 2 SWN No plan to implement in immediate future. 3 AV No plan to implement in immediate future. 4 CEHHA MEDITECH PCS planned in 1½ year range new hospital Comments RFP issued March 25, 2009 for ITC Systems Integration Services for Regional Hospital Replacement Project. Its implementation is planned for the new regional hospital facility in Truro planned to open in the fall of CHA 1½ year range 6 PCHA 1½ year range 7 GASHA MEDITECH PCS has been rolled out. 8 CBDHA MEDITECH PCS has been rolled out. 9 CDHA N/A Using McKesson IWK N/A Using MEDITECH MAGIC MEDITECH PCS is not a driver at the IWK or CDHA. The IWK Health Centre currently utilizes MEDITECH Magic. PCS implementation is not part of the current plan. Capital Health utilizes a best of breed approach using components from McKesson and Cerner. PRIMARY CARE Through its Primary Health Care Information Management (PHIM) program, the Department of Health has been working with the District Health Authorities to implement the first provincewide Electronic Medical Record (EMR) system to improve the quality of care and access to treatment Nova Scotians receive. Several Primary Care/Family Medicine Clinics are collocated within the Acute Care and Community Health facilities throughout the provincial DHAs. The principal application within APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 6

24 CURRENT SITUATION ASSESSMENT these Primary Care clinics is the Electronic Medical Record (EMR). The Department of Health has two approved EMRs: Nightingale (ASP model EMR hosted at HITS-NS); and Dymaxion`s Practimax (Client Server based EMR typically installed at clinic location). One of the key demands amongst Primary Care Physicians is having the ability to access the EMR application wirelessly within clinic. Early attempts on the part of these clinics to implement wireless access to the EMR have been thwarted by a lack of standards and support model. As a result, many of the early wireless implementations have been abandoned in favour of a wired connection. However, wireless access to the PHIM EMRs continues to be a driving force for wireless access. PATIENT ACCESS There are alternative drivers for implementation of wireless networking at Capital Health and the IWK: namely, patient and staff access. At the IWK Health Centre, wireless LAN infrastructure is being deployed primarily for patient access, as well as general administrative access. The IWK recently launched the Child Life Miracle Network, which provides wireless Internet access for children to communicate with their family, friends, and classrooms. This CLICK initiative prompted the rollout of the wireless network to cover the rest of the facility, which is currently ongoing. Patient Access is not a high priority at the other DHAs. CLINICIAN ACCESS At CDHA, wireless is being rolled out as departments request access. The new Emergency Department plan calls for wireless phone handsets. SpectraLink wireless handsets will be deployed over the wireless LAN infrastructure, using the existing Nortel PBX with hybrid voice over IP (VOIP) capabilities. As well, patients will be registered at the bedside, which will also require the WLAN infrastructure. In other areas of the Capital District, the Infrastructure team has deployed wireless LAN controllers at the building. Departments wishing to have wireless capability are instructed to purchase appropriate light-weight Access Points within their departmental budget. The infrastructure is then managed in- Control System. CLINICAL WIRELESS TECHNOLOGIES Several Clinical Engineering applications utilize wireless technologies. Biomedical applications such as patient physiological monitoring and telemetry employ a variety of wireless services to provide mobility for both patients and clinicians. Many of these applications have a wireless component such as between a device and its associated monitor at the bedside or nursing station. APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 7

25 CURRENT SITUATION ASSESSMENT The technology employed is often proprietary to the manufacturer and utilizes the wireless spectrum in the 400 MHz and 600 MHz ranges, as well as frequencies in the 2.4 and 5.8GHz ranges. Many applications are based on the WMTS (wireless medical technology services) or ISM (industrial, scientific and medical) protocols, as opposed to computer network IP (internet protocol). Table 4 - Clinical Engineering Applications provides a representative list of selected biomedical applications and indicates whether they use wireless technologies. A fully detailed application inventory was not in scope for this project and we gratefully acknowledge the assistance of Clinical Engineering for their assistance in providing this summary list. Table 4 - Clinical Engineering Applications DHA Equipment Description Wireless Technology 1/2/3 Patient monitors: Philips Medical, Draeger Medical, GE, Spacelabs Medical 2.4 GHZ wifi and Non-Wifi Patient Telemetry: Philips Medical, Draeger Medical, GE, Spacelabs Medical 400 MHz, 600Mhz, 2.4Ghz ECG Carts (GE) Wifi Patient remote monitor alarm notification: Philips Medical, Draeger Medical, GE, Spacelabs Medical PDA Wifi/Cell/Blackberry Vital Signs monitors (SPO2/NIBP/Temp): Welch Allyn, GE Wifi Abbott (Mednet software) General IV pumps Wifi Abbott, Baxter Patient Controlled Analgesia (PCA) pumps Wifi Roche, other Glucometers Wifi 4 HP Fetal Monitor 600 MHz HP Telemetry Monitor 400 MHz Welch Allyn Monitor System 2.4 GHz 5 Spacelab Telemetry 600 MHz HP Wireless Fetal Monitors 600 MHz 6 Philips Medical Telemetry 600 MHz Philips Medical Wireless Emerg 2.4 GHz 7 Spacelab Emerg 2.4 GHz Philips Medical Telemetry 600 MHz Corometrics Fetal Monitor MHz GE Telemetry 600 MHz 8 GE Corometrics Fetal Monitors Wireless (2.4Ghz) GE MUSE System Hardwired GE Patient Monitors Hardwired & Wireless (2.4Ghz) GE Stress Test System Hardwired GE Telemetry MHz Philips Medical Cardiac Echo Hardwired Sensor Medics Pulmonary Functions Hardwired Siemens Patient Monitors Hardwired & Wireless (2.4Ghz) Siemens Telemetry MHz Spacelabs Medical Telemetry 400 MHz range APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 8

26 CURRENT SITUATION ASSESSMENT DHA Equipment Description Wireless Technology Spacelabs Medical Patient Monitors Hardwired Welch Allyn Telemetry Wireless (2.4Ghz) 9 GE 400 MHz, 600 MHz, 2.4Ghz, 5.8GHz Philips Medical Spacelabs Medical Draeger Medical Hospira IV Pumps MedNet PCA Other IWK GE Patient Telemetry 608.xxx MHz Fetal Monitors non-wifi ECG Carts Telephone Alaris IV Pumps No wireless at present Alaris, Grasely, Medtronic, other analgesia pumps No wireless at present Simplex Grinnell, Zettler Sentinel 500 Nurse call and clinical alarms Glucometers No wireless at present Vital Signs monitors (SPO2/NIBP/Temp) No wireless at present One noteworthy observation about clinical equipment: the typical life span of a clinical device is in the order of 8 years. These devices have built in communication (e.g. WMTS) and operating system (e.g. OS/2) modalities that are difficult to change. Conversion to WLAN or alternate spectrum use will occur more slowly than with standardized computing platforms. Recommendation: A spectrum analysis, run over the course of 1-2 weeks, is recommended at each facility to fully depict the wireless spectrum in use. A detailed inventory of clinical engineering equipment and applications could then complement the resulting spectrum analyses. As part of that inventory process, an investigation into alternative wireless communications options such as WLAN should be considered. OTHER WIRELESS TECHNOLOGIES CELLULAR SYSTEMS All of the districts utilize cellular phone services, with some facilities housing internal signal boosters to reduce areas with low or no signal. An in-depth analysis of cell phone usage was not conducted as part of this exercise. However the following observations were made: A variety of carriers and technologies are employed for these cellular systems. A variety of devices are being employed for clinical and operations needs, ranging from basic cell phones (i.e. voice only) to Personal Digital Assistant (PDA) devices (i.e. voice and data services). The choice of the device is left largely to the person using the device. There is no standard device. APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 9

27 CURRENT SITUATION ASSESSMENT Coverage (i.e. signal strength) within hospital locations varies widely within the facility and from location to location. Table 5 - Cellular Carriers Carrier Voice Data Services Frequencies Utilized Services Aliant CDMA 1XRTT, EVDO 800MHZ, 1900MHz Rogers GSM GPRS, UMTS MHZ, MHz Telus CDMA 1XRTT, EVDO 800MHZ, 1900MHz There is a desire among clinicians within the provincial facilities to move more capability (e.g. basic clinical information system access) to PDA devices such as the Blackberry. If this is to be pursued, then standardization to the device and carrier level is recommended. Recommendation: Concertia recommends that a needs assessment be conducted to better understand the clinical and operational needs for cellular communications. The needs assessment should lead to the development of a standard for cellular usage within provincial healthcare facilities. RFID Radio-frequency identification (RFID) is the use of an object (typically referred to as an RFID tag) applied to or incorporated into a trackable object for the purpose of identification and tracking using radio waves. Some tags can be read from several meters away and beyond the line of sight of the reader. Examples of trackable objects are: A consumable products (e.g. a lot of perishable items such as a pharmaceutical); An asset (e.g. a wheelchair); or A person (e.g. staff member or patient). Most RFID tags contain at least two parts. One is an integrated circuit for storing and processing information, modulating and demodulating a radio-frequency (RF) signal, and other specialized functions. The second is an antenna for receiving and transmitting the signal. There are generally two types of RFID tags: active RFID tags, which contain a battery and thus can transmit its signal autonomously, and passive RFID tags, which have no battery and require an external source (an exciter) to initiate signal transmission. Some RFID technologies can be converged with wireless LAN access points; this is a factor to consider for WLAN design requirements. Today, RFID is used extensively in enterprise supply chain management to improve the efficiency of inventory tracking and management. In today's healthcare facilities, RFID is used in many different applications, such as asset tracking, inventory control, pharmaceutical APRIL 17, 2009 SOUTH SHORE DISTRICT HEALTH AUTHORITY PAGE: 10

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