Cabling for Healthcare Carol Everett Oliver, RCDD, ESS Marketing Analyst, Berk-Tek, a Nexans Company
Healthcare Digital Movement 1970 s First computer usage for administration (billing, etc.) Early 90 s Integrated computers automation of order entry, results reporting Mid 90 s Emergence of Internet 2000 Availability of large-scale databases 2006 Evolution of Gov t regulations for Electronic Medical Records (EMR) 2010 TIA-1179 Standards for 2010 TIA 1179 Standards for Telecommunications in Healthcare
Agenda Market Drivers Government Initiatives Industry Standards TIA-1179 Recommended Cabling Practices Difference between Premises Networks and Healthcare Case Studies: Boston Medical Center and Tifton Regional Medical Health
Market Drivers Government Initiatives Industry Standards TIA-1179 Application specific vs. non-application based (568) Digital media (EMR) Long distance collaboration & education in real time IP Convergence
Exploding Bandwidth Requirements MRI Ultrasound 18 MB 39 MB Angiography 15 MB
Gov t Regulations HIPAA Health Insurance Portability and Accountability Act (HIPAA), enacted 1996 Addresses the security and privacy of health data Encourages the use of electronic data interchange in the U.S. health care system Establishes regulations for the use and disclosure of Protected Health Information (PHI) and e-phi
Gov t Regulations ONCHIT Office of the National Coordinator for Health Information Technology (ONCHIT) within Department of Health and Human Services (HHS) est. 2005 Promote the development of a nationwide id interoperable healthcare information technology (HIT) harmonization process 10-year goal for total EHR
Gov t Regulations ARRA American Recovery and Reinvestment Act -- 2009 Stimulus package includes healthcare Promotes the adoption of interoperable electronic health records (EHRs) to develop a national health information network Ends September 2011 Office of the National Coordinator for Health Information Technology (ONCHIT) to continue to implement this plan
Gov t Regulations HITECH Act Health lhinformation Technology for Economic and Clinical l Health (HITECH) Act part of the 2009 ARRA Promotes exchange of health information on a national basis Provides incentives for entities that adopt Electronic Health Records (EHR) Widens the scope of privacy and security provisions of HIPAA
Joint Commission (Organization) ACCREDITATION Based on organization and df focus (Ambulatory, Behavioral, Critical Access, Home Care, Hospital, Lab, Long Term) CERTIFICATION Based on staff and responsibilities of service and safety STANDARDS Operational standards and manuals MEASUREMENTS Performance evaluations patient tracers and national safety goals. Periodic performance assessment www.jointcommission.org
Newly Ratified Standard ANSI/TIA-1179 Telecommunications infrastructure intended to support a wide range of healthcare facilities and systems to include: Topology Pathways and spaces EF, ER & TR Requirements Cabling Recommendations Work area densities Ancillary devices
Pathway Guidelines Pathways should not compromise operation of the facility Enclosed pathway systems -- in air handling spaces to meet Infection Control Requirements (ICR) Segregation of cables for different networks & applications (due to safety protocols)
Entrance Facilities (EF) & Equipment Rooms (ER) Route diversity - two separate pathways from the entrance facility to the equipment room Demarcation point of outside access providers may be determined by federal or local regulations. Accommodation of other systems may increase size (BAS, nurse call, security, CATV, biomedical systems) Growth factor of 100%
Telecommunications Rooms (TR) and Telecom Enclosures (TE) Non-telecommunications services (i.e. gasses, fluids) not allowed Larger TR than office building -- 12m 2 (130 ft 2 ) or larger TE serves smaller floor area or where TR is not allowed (be aware of exposure of magnetic fields, radiation, chemicals, etc)
Centralized Optical Fiber Cabling Growing trend of optical lfb fiber in horizontal network applications Reduce installation costs Increase network flexibility, simplifies network management Allows cable runs to 300 meters
Backbone Cabling Needs to accommodate future equipment needs Minimum of two diverse pathways and cables to each TR or TE Recommended cabling: 100 ohm (Cat 6 or higher)* 850nm, LOMF (laser optimized multimode fiber) Single-mode *Notes: Cat 6A is recommended for new installations Cat 3 should be limited to analog voice
Horizontal Cabling Plan to accommodate future equipment needs, diverse and increasing user application-specific services Less accessible than backbone cabling During the design, reduce the probability requiring changes to horizontal cabling Recommended cabling: Category 5e; Category 6 or higher is recommended Note: Category 6A recommended d for new installations ti Multimode, 850 nm 50/125, 2-fiber or higher Single-mode, 2-fiber or higher Note: Bundled and hybrid cables can be used.
Work Areas Based on applications and usage requirements High density drops 11 Classifications: Patient Services Surgery/Procedure/ Operating Rm Emergency Ambulatory Care Women s Health Diagnostic and Treatment Caregiver Service/Support Facilities Operations Critical Care
Work Area Classification Tables Tables within the standard list the recommended work area configurations based on the functions at that t location: L = Low: 2-6 outlets per area M = Medium: 6-12 outlets per area H = High: >14 outlets in each area
Work Area Density Tables L = Low: 45% of 75 listed including: Waiting Room, Ambulance Bay, X-Ray, Patient Holding, Consultation, Mechanical Rooms M = Medium: 25% of 75 listed including: Registration, Patient Prep & Recovery, Exam & Evaluation, Nursery, Pharmacy, Administration, Food Service H = High: 30% of 75 listed including: Patient Room, Nurse Station, Intensive Care, Operating Room, Emergency Procedure, Out-Patient Surgery, Delivery Room, MRI, CT Scan, Lab, Security Office
Cabling Considerations for Work Areas MUTOAs: Recommended for renovations of existing facilities, not new construction Provides flexible layouts for spaces that are frequently rearranged Locate in open area, fully accessible Limit to serving a maximum of 24 outlets Multiple faceplates Color-coding Plan for PoE Note: CPs NOT allowed
Unique Cabling Installation Best Practice Recommendations High termination work area density recommended to use multi-fiber, preferably pre-term High-levels of EMI, high temperature and chemicals may be present Cabling products with unique attributes to comply with atmospheric conditions Use of colored cables, jacks and keyed connectivity i to maintain i segregation of the networks Become familiar with unique codes and regulations
Healthcare vs. Premises Broader scope of applicationspecific IP devices Sensitive installation environment Larger pathways Larger Telecom Rooms Work area classifications and densities
Unique Solutions for Healthcare FTP shielded cable (in radiation sensitive areas) High-density fiber (pre-term) High-density fiber cassettes TE vs. TR PoE (copper or fiber) --access points, security cameras, WAP MUTOA Color-coded cable and jacks to match TR and WAO Multi-media outlets with protective shutters Properly sized basket tray with cable separation Stainless steel outlets Floor boxes, poke thrus
Case Study: Boston Medical Center, Shapiro Building Boston, MA
Case Study: BMC Shapiro Building Stats Boston o Medical Center e -- 26 building campus New Building: Shapiro Building Ambulatory Care outpatient services (orthopedics, neurology, dermatology, cosmotology, general day surgery, etc) 9 stories, 250,000 sq. ft. Five years construction: two years to relocate and raise previous bldg.
Case Study: Shapiro (BMC) Unique Challenges Old School/New School Diverse and high-bandwidth applications High-density applications Need to allow for future expansion and IP Convergence
Case Study: Shapiro (BMC) Pathways Backbone redundancy Self-closing sleeves into the TRs (firestopping) Horizontal: Cable in tray around perimeter J-hooks for horizontal Conduit to the WAO (not in plenum spaces)
Case Study: Shapiro (BMC) Backbone cabling Armored Cable: SM (APC Connectors) mainly for video MM: 24 strands of 62.5 (mainly for voice) 24 strands of 50µ (data and IP)
Case Study: Shapiro (BMC) Telecom Room Two MDFs (10x13) Two TRs per floor (located in the middle of the floor) 800 horizontal cables per floor 100% patching to limit client services traffic into TR: VLAN for MACs
Case Study: Shapiro (BMC) Horizontal Infrastructure No horizontal redundancy Enhanced Category 6 for data, voice, cameras and other IP applications 110 blocks for phone, but looped for future migration to patching Color-coded cable: White voice Blue data Security Green Patching Yellow
Case Study: Shapiro (BMC) Work Areas 800 cable runs per floor 6-port stainless steel faceplates with blue/white color-coding Sealed/fire-rated outlets for firestopping and sound PoE to all wireless APs and security cameras
Case Study: Shapiro (BMC) Lessons Learned Pre-planning for sizing of the sleeves No plenum (no mixing with HVAC) Armored cable saves time and cost, but needs grounding Higher grade Category 6 for new facilities Cable category inconsistency - Old with New: (MACs) older facilities using older cable (Cat 5e vs. 6) Total patching environment ease of MAC
Case Study: Tift Regional Data Center Tifton, Georgia
Case Study: Tift Reg. Data Center Stats Built in 1965 as a community hospital Today regional hospital for 6 counties Region of 250,000 people 151,000 square feet 26 buildings Situated in Tornado Alley
Case Study: Tift Reg. Data Center Old Cable Plant Networking Challenge One 24-strand fiber cable backbone under city streets MDF located in old doctor s offices Frequent power outages No redundancy No centralized data center
Case Study: Tift Reg. Data Center Data Center Stats $10 million Tier 2 (N+1) Redundant fiber ring Redundant networks 15,000 square feet Plans to double size in 5 years 10 CRAC units, 2 generators CPOE (Computerized Physician Order Entry) working towards total EMR
Case Study: Tift Reg. Data Center Pathways Multi-tier cable baskets Segregation of copper/fiber Total redundancy Segregation of A and B cabling 5 rows 53 server cabinets
Case Study: Tift Reg. Data Center OSP: Backbone Diverse fiber ring Two 72-strand SM in ductbanks Hospital Armored 72-strand SM cable within the hospital (10G to each building) Data Center: 24-strand SM to SAN area Total redundancy 15 10G on each switch (200 10G ports)
Case Study: Tift Reg. Data Center Horizontal Infrastructure OM3 LOMF from switches to server rows -10 Gig Redundant 24 strands from switch to each server cabinet 5,088 anaerobic field terminations Category 6 Copper connections to each server cabinets (total 1,060) Color-coded cable: Patch cables Green for A side, Blue for B side Purple CCTV/Security and BAS
Case Study: Tift Reg. Data Center Lessons Learned Pre-planning with BOD support Total redundancy OSP, backbone and horizontal Allow excess power and cooling units Plan for the future storage capacities Bandwidth intensive environment storage capacity to 30 years Commissioning is critical for environmentally challenged areas
Questions Contact: Carol Everett Oliver, RCDD, ESS Carol.oliver@nexans.com Thank you, Brian Thank you, Mel