How to Leverage Existing Coax to Deliver Patient Internet Access. A SONIFI Health White Paper June 2015

Transcription

1 How to Leverage Existing Coax to Deliver Patient Internet Access A SONIFI Health White Paper June 2015

2 EXECUTIVE SUMMARY As the Internet bandwidth needs of hospital patients continue to increase, hospital and IT administrators are caught in a dilemma. Ensuring a working Internet alone may not be sufficient as patients and visitors expect to be able to stream content at high speeds, often on multiple devices. One might expect that meeting these demands requires a major facility upgrade as well as considerable time and expense. Hospitals cannot afford to upgrade again every few years. Hospitals have options. Upgrading an entire facility with CAT6 or pulling fiber to every patient room is an expensive proposition. One approach to solving the bandwidth problem is to leverage the coaxial cable (coax) infrastructure already in place in hospitals. Believe it or not, coax can deliver quite a bit of data and it is expandable. DOCSIS technology, used by cable companies to deliver substantial bandwidth to residential customers, lets hospitals provide patients with significant bandwidth, cost-effectively and in short order, without tearing up walls. A DOCSIS implementation could easily provide a ten-year plan for Internet services, keeping patients and their visitors happy..

3 BACKGROUND Increasing demands on hospital IP networks show no signs of easing up. Patients and visitors are using multiple devices, and they expect their content to stream and their applications to work flawlessly. The use of smaller devices, such as tablets and watches with weaker radios, coupled with heightened security needs of over-the-top (OTT) content akin to Netflix and Hulu, are increasingly compelling hospitals and their providers to add a wireless access point in every patient room. Even though those access points are called wireless networks, they still require wires. DOCSIS is used by cable companies to deliver amazing bandwidth to the wired and wireless devices in subscribers homes. Cable service providers such as Comcast and Time Warner Cable are using DOCSIS in more than 75 million subscriber homes in the United States. Most U.S. home broadband users have Internet access through their cable providers. Like hospitals, cable providers need to increase capacity at the rate of innovation of the Internet while making prudent incremental investments, scaling as subscribers bandwidth demands increase. Most cable Internet subscribers received a new modem when their provider upgraded from DOCSIS 2.0 to DOCSIS 3.0, and the cable in their walls was untouched. The downtime to service providers and their home subscribers for this upgrade was minutes. In addition, investments in cloud technologies and centralized components have enabled subsequent bandwidth increases without requiring new in-home components. DOCSIS technology lets hospitals leverage the existing coax infrastructure already in place and provide for a better patient experience without tearing apart walls or taking rooms out of service. For hospital and IT administrators, it s worth taking a closer look at how they might benefit from the multi-billion dollar investment that cable companies have made. Hospitals can take advantage of the economies of scale, in terms of both price and functionality, made possible by cable operators and their suppliers. DOCSIS, however, is not without its complexities. DOCSIS today coexists on the same infrastructure that is deliveringtelevision channels and interactive television (itv) functionality. The technology must be properly engineered to make use of spare RF spectrum. Each deployment can present a myriad of challenges based on environmental factors, as well as the quality of the cabling, and the quality of the FTG and itv installation. It s wise to seek out a service provider with experienced RF, coax, and television deployment expertise, in addition to excellence in Wi- Fi and IP networking, to further enhance the return on investment in a DOCSIS system.

4 DOCSIS 3.0 AND BEYOND MORE ABOUT THE TECHNOLOGY Developed and released in 1996 by CableLabs, the DOCSIS 1.0 specification uses 6 MHz channels over the coax plant to send data modulated using quadrature amplitude modulation (QAM). In DOCSIS 3.0, higher speeds are enabled by bonding multiple RF channels together while being backward compatible with older versions of the standard. Residential suppliers today are routinely bonding up to sixteen (16) channels to obtain theoretical download speeds of 608 Mbit/s. Such large degrees of bonding are also what make it possible for local cable providers to offer cost-effective high bandwidth circuits to the commercial enterprises. The rollout of an increasingly performant DOCSIS network will enable the inevitable migration and conversion of the end applications and services to all-digital and all-ip over the next 8 to10 years. Figure 1: A look at evolving use of spectrum toward greater IP traffic. Source: Bright House Networks, March 2013 For hospitals, there are three factors that make an existing coax/docsis environment easier to deploy than residential cable: 1. Shorter cable runs (hundreds of feet vs. miles) 2. Fewer channels ( vs. 300+) 3. Less hardware: fewer customer premises equipment (CPE) units (hundreds vs. thousands) Hospitals can leverage the economies of scale that the multi-billion dollar cable TV industry has created. The cable industry will continue to invest in backward-compatible DOCSIS standards, creating an opportunity the healthcare industry can capitalize on by for those properties not wired with optical fiber or CAT6, thus permanently avoiding these upgrade costs.

5 As depicted in Figure 2, the components of a DOCSIS deployment are relatively straightforward: Figure 2: DOCSIS system components. Cable Modem Termination System (CMTS): A small communications server centrally located in the hospital near the coax cable distribution point. This is often referred to as the headend or main distribution frame (MDF). Until recently, the cost of the CMTS component has been the prohibitive factor in deploying DOCSIS based solutions in hospitals. Today, a CMTS suitable for a hospital-size distribution network costs a fraction of what the large systems used by cable providers. Cable Distribution (coax): Coaxial wiring runs to patient rooms via one of several architectures, such as a home run or drop-tap deployment. DOCSIS supports both of these deployments. Cable Modem: A modem that is deployed into the patient room. There are two main options for in-room deployment today: One is an integrated cable modem/access point and the second is a standalone version of each component. The traditional advantage for standalone has been central control of the modem or wireless access point (e.g, components from Ruckus or Cisco Systems). However, new advances in integrated solutions that significantly reduce cost and allow for one device to function as both the DOCSIS modem and a centrally controlled wireless access point are now available.

6 Cloud Management Solution: Back end software (for use by hospital and IT administrators) that handles network monitoring, simple support requests, revenue reporting and authentication tracking. By deploying a DOCSIS system today, hospitals can quickly and inexpensively achieve speeds from Mbit/s per room with both a managed wireless system and hardwired ports in each room. (Note that the ultimate aggregate bandwidth of Internet access is also capped by the speed of the carrier circuit that has been provisioned into the hospital.) For DOCSIS 3.0, a logical capacity for hospitals to target is 152 Mbit/s downstream to the room and 76 Mbit/s upstream from the room, comprising 4 bonded downstream (DS) channels and 4 bonded upstream (US) channels. This capacity is shared among several modems. A typical hospital in 2015 would be well-served by a system configured with 8 DS and 8 US channels, resulting in 304 Mbit/s to the rooms and 152 Mbit/s from the rooms. To more efficiently manage bandwidth, different modems can be restricted to a subset of the bonded groups. In addition, individual modems can be assigned QoS (Quality of Service) limits corresponding to different Wi- Fi tiers. The wireless network can be configured as an individual network, mapped specifically to a room and its patient, enabling secure activities such as television streaming and sharing of data between devices in the room. The in-room equipment typically provides hardwired ports in addition to Wi-Fi. Hospitals can also use hardwired ports to deliver entertainment content, patient education and hospital system integrations such as meal ordering to the television settop box or to the TV directly. Additional secure ports can be used for in-room controls/automation, future IPTV needs, voice and perhaps, one day, two-way video. As Internet of Things (IoT) devices and networks grow, having a secure hardwired port in each room creates endless possibilities to build upon. Number of downstream channels Channel configuration Number of upstream channels Downstream throughput DOCSIS Upstream throughput DOCSIS (152) Mbit/s (108) Mbit/s (304) Mbit/s (108) Mbit/s (608) Mbit/s (108) Mbit/s (912) Mbit/s (216) Mbit/s Table 1: Increased upstream and downstream bandwidth using bonded channels in a DOCSIS environment. The figures in parentheses (e.g., 152 Mbit/s) indicate throughput without accompanying network overhead. Source: last visited July 22, 2015.

7 EXPANDING COAX CAPACITY AGAIN AS NEEDED When it s time to make the next increase in per-room capacity in the hospital, the first and most costeffective option is to license additional bonded channel groups and to assign pools of modems to subpartitions of the capacity. This software-enabled capacity expansion can easily be used to increase the shared capacity to 608 Mbit/s or even 1.2 Gbit/s without the need to replace the CMTS, distribution network, or in-room equipment. The next step in capacity expansion will be to configure multiple (2 or more) bonding group(s) to be carried on the same RF frequencies. However each group is only distributed on a select number of the coax distribution channels. For example, in a multi-drop architecture, bonding group A can be sent to half the rooms in the hospital and bonding group B can be sent to the remainder. This effectively doubles the capacity per room by halving the number of rooms sharing the resource. This upgrade may require expansion of the CMTS by adding server blades, but it does not entail any in-room remediation with its associated direct costs or revenue lost from taking a room out of service. Figure 3: DOCSIS channel bonding and scaling. Figure 3 illustrates the expansion of IP bandwidth in a hospital in two steps, moving from 152Mbit/s shared amongst all rooms in successive doubling. In the first scenario, software licensing expansion enables growth from 4 bonded DS channels to 8 bonded DS channels. The CMTS and cable modems are managed via cloud services to double the bandwidth to 304 Mbit/s. Note that this license expansion is used multiple times to achieve linear growth in capacity until such time as the MHz channels in a typical hospital are fully utilized between FTG (analog and digital service), itv services, channels avoided due to interference and other impairments, and DOCSIS services. A second scenario is a subsequent expansion wherein a server blade is added to the CMTS and the patient rooms are divided into two groups. Connecting the two CMTS outputs to the cable TV and itv signals (using simple signal combiners as shown in the block diagram) and distributing the signal to the two equal-sized room groups, the bandwidth to the room is once again doubled. (This option may not need to be exercised until significantly greater bandwidth is required however they are presented here for illustrative purposes.)

8 Figure 4: Diagram depicting patient room groups serviced by DOCSIS distribution (simplified). Content and services will continue to migrate to the cloud. In turn, this migration will place demands on your internal network. DOCSIS will scale with those future requirements and validate the investment you make today. With today s scalable solutions, there are immediate and long-term options. In the near term, many CMTS chasses can be scaled via software licenses and capacity added via hardware upgrades. In this manner, hospital administrators can plan to increase available bandwidth per patient room many times before reaching the ultimate capacity of the CMTS and modems available today. Figure 5: Comparative bandwidth speeds for fiber, DOCSIS and CAT6/CAT5 Once those options no longer scale to handle the needed bandwidth, there is still no need to pull expensive copper cable to the room. The MATV investment made during the prior digital upgrade pays off again thanks to the robust 850 MHz cable plant implemented earlier. By upgrading the modem and CMTS in the headend to take advantage of multiple bonded channels, and using standard cable signal combining techniques to send a different set of signals to different parts of the hospital (again, just like residential cable providers do to get those new fast speeds at home), it is possible to speed the delivery

9 of IP traffic well into gigabit speeds, fast enough for the biggest ultra-high definition videos yet to be defined. CONCLUSION Adopting a DOCSIS roadmap for patient Internet needs is no longer a stopgap measure; it is now a strategic advantage. Leveraging existing coax looks like a smart path to improving Internet speeds. Hospital and IT administrators can add bandwidth to meet patient requirements with a modest investment and a few simple steps while avoiding the need to tear holes in the walls of each patient room. Technology exists today to install a smart access point in every patient room, capable of delivering the bandwidth required for today s applications. In addition, the system can stay in place as it grows to deliver full IPTV and advanced cloud content services over the next ten years. In the short term, speeds can be increased via software and/or minor additions at the hospital headend. Dramatic speed increases can be made later with in-room upgrades and faster line cards. Costs are much lower than re-cabling with expensive copper or fiber optics. Lastly, the technologies are very similar to those that deliver interactive or digital television services today, making the coax infrastructure an ideal system to be serviced by qualified television service providers who understand QAM. PARTNER WITH THE EXPERTS To reliably install DOCSIS in a hospital environment, a provider needs to have the tools and experience to understand coax distribution and the possible interferences it may encounter. As an experienced systems integrator, SONIFI Health will work with property hospital IT administrators to upgrade headend and patient room gear to please even the most bandwidthdemanding patients, without tearing apart walls and taking rooms out of service. Look to SONIFI Health for this expertise, and take advantage of the company s cloud-based monitoring and service to bring industry-leading uptime and bandwidth to each patient. ABOUT SONIFI Health SONIFI Health provides interactive patient technology that inspires active patient participation along their care continuum for positive behavior change and improved outcomes. The system is delivered across multiple technology platforms including mobile devices, computers and televisions at the bedside and in the home to improve patient and family experience while increasing hospital operational efficiencies. The system allows the patient to view assigned educational content, complete questionnaires, order meals, view care team information, access their schedule, enjoy in room entertainment and relaxation therapy, adjust temperature controls, and interact with their care team. Nurses use the dashboards and reports for centralized visibility of the patients care participation and needs. Nurses are also saving hours each day through automating non-clinical tasks in SONIFI Health s communication tools such as patient education, meal ordering, surveys, discharge instructions and more. For more information about SONIFI Health for hospitals or to learn more about leveraging existing coax infrastructure to expand Internet capacity, please contact: sales@sonifihealth.com

10 GLOSSARY Channel bonding: First enabled with DOCSIS 3.0, channel bonding combines the bandwidth of multiple upstream or downstream channels to provide greater bandwidth to a user. DOCSIS: The Data Over Cable Service Interface Specification is an international telecommunications standard that permits the addition of high-bandwidth data transfer to an existing CATV system. DOCSIS refers to the cable modem interface itself. Drop tap: Also known as descending drop tap, in which coax wires are run as main trunks in hallways or vertically in walls. Patient rooms are tapped from the main trunk. Each drop tap supports a single outlet, the signal strength drops as the wiring propagates further from the MDF or IDF. Illustration: Descending 4-way Drop Tap Architecture Home run wiring scheme: Also known as set-run, in which coax or CAT5 wires run from a central control box or junction directly to each patient room. Each wire (or set of wires) supports a single outlet. All outlets have equal signal strength. Illustration: Homerun Installation SONIFI MDF to each room

11 OR Illustration: Homerun Installation SONIFI MDF to IDFs to Room IoT (Internet of things): Connecting any device with an on and off switch to the Internet (and/or to another device). Devices may include cell phones, coffee makers, washing machines, refrigerators, headphones, lamps, and wearable devices. IoT also applies to machine components, e.g., a jet engine of an airplane or an oil rig drill. MATV: Also known as Master Antenna Television. It is the means by which many apartment buildings, hotels, schools and other multi-unit buildings distribute TV and FM signals to a number of receivers.