Penn State Milton Hershey Medical Center's Cancer Institute Building deploys air-blown fiber, which is critical to simplified MACs and infectious-disease control.
The land upon which Penn State Milton S. Hershey Medical Center (www.pennstatehershey.org) now resides was once a 318-acre cornfield, given to The Pennsylvania State University by the famous chocolate manufacturer Milton S. Hershey. Offering a $50 million endowment from his foundation, Milton Hershey asked Penn State to establish a medical school and teaching hospital at the heart of Hershey, PA. With the Hershey grant and another from the United State Public Health Service, the medical center accepted its first patients in 1970.
The 550-acre campus of the Penn State Milton S. Hershey Medical Center requires a far-reaching and high-bandwidth optical infrastructure.
Since then, the medical campus has grown from 318 to 550 acres and often serves patients from areas near Baltimore, Pittsburgh, and Philadelphia who are willing to drive several hours to receive help from the center's award-winning medical services. Those services have received honors that include Best Children's Hospital from U.S. News & World Report, Highmark Blue Distinction for Complex and Rare Cancers, and CVI Top 100 Hospitals for operating at low cost and reinvesting dollars back into the provision of care at the medical center.
Although its origin and setting are unique, the medical center can serve as a solutions model for the unprece-
dented information technology (IT) network challenges
and pressures that all hospital and healthcare facilities face today. New demands are being placed on the network and IT departments to respond quickly to the implementation of new high-bandwidth imaging equipment and services; wireless technologies; the convergence of clinical, Voice over Internet Protocol, and IT systems; and the interoperability of nurse call, physiological monitoring, and electronic medical records in order to improve patient care and satisfaction.
Pushing the envelope
These mission-critical systems are pushing the limits of data transmission and available capacity on the hospital LAN. For this reason, the fiber-optic backbone system must be able to quickly adjust to physical changes as rapidly as they occur, while simultaneously continuing to support all the systems being transported over it.
Along with the pressures of uncertain network capacity, congested conduit, and growth, hospital IT network and facilities managers are also facing new legislations in patient safety, increasing demands to do more with fewer budget dollars, and new environmental protocols to create sustainability. Essentially, today's hospital/healthcare IT network and facilities managers are required to build a network infrastructure
responsive in real-time to the growing needs of the various departments, clinical areas, and patients. At the same time, the network must contribute to patient safety and
infection control, achieve green initiatives, cut costs, and deliver measurable return on investment.
Like many of today's leading hospitals, Penn State Hershey Medical Center (PSHMC) is in a constant state of growth and change, simultaneously renovating legacy networks in older buildings and expanding its campus with new, state-of-the-art centers, such as the Penn State Hershey Cancer Institute building scheduled to open in July.
For PSHMC, the fiber-optic infrastructure solution that resolves the myriad IT network challenges for both its legacy networks and the Penn State Hershey Cancer Institute building is Sumitomo's FutureFlex Air-blown Fiber System (www.futureflex.com). FutureFlex has been mandated as a standard for all legacy network renovations and new builds throughout the vast medical center, and it is the only structured cabling system used throughout the Cancer Institute building.
“Ready for anything”
FutureFlex air-blown fiber is the only fiber-optic infrastructure that supports our ‘just-in-time' mentality at Penn State Hershey Medical Center so that we can better serve the clinical community and patients with speed of delivery for critical needs, comments Sherry Mettley, director of IT infrastructure for the medical center. We often need to respond quickly to new high-bandwidth technologies or network changes requested by our departments, and with air-blown fiber, we know we have the capacity to make moves, adds, and changes [MACs] rapidly, efficiently, and cost-effectively for emerging technology, growth, and change. So, we're ready for anything.
Mettley explains that IT network project turnaround time used to take days or weeks with a conventional infrastructure where fiber-optic cables are pulled: Now with FutureFlex, we can turn around our IT network projects and MACs in hours by blowing in optical fiber quickly and easily only when and where we need it, between and within buildings making up our campus infrastructure. We, of course, wanted to extend our ‘just-in-time' philosophy to the new Cancer Institute building as well.
Other benefits cited by Mettley include air-blown fiber's non-obtrusive attributes that ensure infection control and patient safety, significant savings of budget dollars, and a clean technology that helps meet the Cancer Institute's green initiatives.
Though this photograph was taken before dawn, there are no dark fibers at the Penn State Milton S. Hershey Medical Center, because the blown-fiber system allows fibers to be installed when and where they are needed.
From bench to bedside, is how Michelle Ebersole, IT project manager working for Mettley, describes the Cancer Institute. The new facility integrates leading-edge clinical outpatient cancer care and treatment with research to promote collaboration, exchange of intelligence, and discoveries to cure cancer. Patients have a one-stop facility, equipped with a healing garden retreat and a light-filled atrium lobby.
The five-story, 175,000-square-foot institute includes Radiation Oncology on the ground floor, which boasts the latest in advanced technology, such as radiation vaults, high-bandwidth CT scanners, and linear accelerators that target radiation only to the affected cancer area. The first and second floors also are dedicated to patient care, comprising 38 infusion bays, exam rooms, and other areas where patients recently discharged will receive care similar to their inpatient stay but in an outpatient setting. The first floor also includes an outpatient pharmacy and a café, while the second floor additionally accommodates the clinical-trial office and a state-of-the-art conference and media room equipped with the latest videoconferencing technologies.
The third and fourth floors consist primarily of cancer research labs. The facility has integrated crucial automated control systems, such as staff/patient tracking, access control, audio-visual systems, physiological monitoring, wireless telephones incorporated with nurse-call systems, and wireless data transfer throughout the institute—all of which are supported by the FutureFlex air-blown fiber LAN infrastructure.
The structured cabling team, under Mettley's leadership, includes: myself, Bill Toothaker, RCDD, of Edwin L. Heim Company (www.elheim.com), who is chief installations engineer for the medical center; and the dedicated in-house IT facility staff, including Ebersole and others. PSHMC has been using the FutureFlex system for approximately four years.
The design of the FutureFlex Air-blown Fiber System differs from that of conventional or traditional fiber-optic cable in that the optical fiber, bundled in polyethylene extruded foam (PEF) jacket, is a separate component from the various indoor/outdoor, riser, and plenum-rated tubes.
The tube cables contain 2, 4, 7, or 19 small individual tubes within a tough outer jacket with strength properties that can negate the need for inner-duct. The tubes remain empty until the fiber bundles are ready to be blown, and are installed throughout the hospital or health care facility's LAN between and within buildings for a point-to-point, splice-free fiber run. This eliminates points of failure in the network. The tube cables can be considered as dedicated pathways in the same sense innerduct is used to support conventional fiber-optic cable, except that the air-blown fiber tube cables provide far more capacity. A 4-inch conduit will support two tube cables each with 19 smaller tubes, providing a total of 38 pathways. In that same conduit space, conventional fiber-optic cable provides four pathways.
From a fiber termination unit (FTU) usually located in a main crossconnect (MC), data hub, or telecom room, the empty tube cable leads to various tube distribution units (TDUs) within the building or campus that ultimately lead to and terminate at multiple communication centers. The TDU acts as a traffic intersection or router, where tubes can be interconnected using push-fit connectors for changes in direction. This provides a modular solution that can quickly adapt to changes and reconfigurations. Through the empty tube cable infrastructure, any type of and amount of fiber can be quickly and easily blown in and out—using nitrogen or compressed air—at speeds as high as 150 feet per minute throughout the network on an as-needed basis.
For the Cancer Institute, 19-tube cable radiates in two directions from the main equipment room located on the ground floor. In one direction, it extends 750 feet to the institute's main telecommunications room where servers, switches, and primary data-communications equipment reside. The tube cable extends 1,000 feet in the opposite direction from the third floor of the institute to the third floor main telecommunications room (which communicates to the medical center's offsite data center across the street) to create a redundant and physically diverse fiber-optic pathway providing excellent network survivability.
A LAN with accuracy
The second 19-tube cable extends from the main equipment room and runs vertically through the stacked telecommunications rooms located on the first through fourth floors. The telecommunications rooms each have one wall-
mounted distribution unit to provide access to the 19-tube cable. Typically, two tubes extend from the TDU to the rack-mounted FTU in each telecom room. This provides a direct path from the FTU located in the main equipment room to each of the four telecommunications rooms and ultimately to each FTU.
A 24-count singlemode fiber bundle is then blown in from the ground floor main equipment room to each of the main telecom rooms, and the four telecom rooms servicing each floor. By blowing only the required amount of fiber currently needed, we have engineered a LAN with accuracy, having neither overbuilt nor overengineered the infrastructure by adding unnecessary cost for dark fiber, which is often a regular part of traditional fiber-optic cabling projects. The air-blown fiber design not only includes crucial redundancy, but allows the institute to double capacity from 24 to 48 fiber strands to every closet, and up to as many as 432 into many of the remaining empty smaller tubes within the 19-tube cables, without having to add any tube cabling above the ceilings—a crucial consideration for infection control and patient safety.
The Centers for Disease Control and Prevention estimates that more than 90,000 people die each year from hospital-acquired infections that are transported through ventilation systems. Potentially toxic mold spores and airborne pathogens may lie dormant above ceiling tiles or in walls until disturbed, posing a direct threat to immune-deficient patients and to highly sanitized areas. Financial costs associated with hospital-acquired infections have risen to $27.5 billion in additional healthcare expenses annually, according to the article Costly Infections, published November 1, 2007 at www.healthcare-informatics.com.
The FutureFlex Air-blown Fiber System from Sumitomo has been mandated as a standard for all legacy network renovations and new builds throughout the vast medical center.
Moreover, CMS Mandate: Section 5001(c) of the Deficit Reduction Act cites that Medicare will no longer pay for hospital-acquired infections. Major hospitals enforce Infection Control Risk Assessment (ICRA) standards in construction work, and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)requires documentation of ICRA.
Had the Cancer Institute been cabled with a conventional infrastructure, any new network upgrades or expansions would require the removal of ceiling tiles, potentially compromising the health and safety of patients and the sanitized lab areas. Although conventional infrastructure network MACs use HEPA filter units and plastic enclosures called NAPEs to help decrease the chances of infection, they cause other disruptions at the facility, such as moving patients, crowding hallways, consuming time of infectious-disease-control officers, and interrupting the work of lab researchers. Also, the time-consuming and costly infectious-disease-control procedures can often add 20 to 40% to the total project cost.
With the non-obtrusive FutureFlex Air-blown Fiber System, all network MACs are completed behind the scenes through the TDUs in telecom rooms, negating the need to remove ceiling tiles or re-enter conduit, and making the MACs immediately ICRA-compliant. There is no intrusion to the daily activities of lab researchers, clinicians, and patients.
The cancer patient is immunosuppressed, explains Ebersole. The infection-control attributes of air-blown fiber alone warrant its use in any hospital/healthcare facility.
Currently, no communication- and information-industry certification standards exist for Leadership in Energy
and Environmental Design (LEED). But both the Telecommunications Industry Association (TIA) and BICSI are working closely with the United States Green Building Council (USGBC) to establish such standards. Meanwhile, hospital and healthcare facilities create their own internal objectives for sustainability. In a network upgrade, for example, FutureFlex bundles can be blown out undamaged, so they are immediately recyclable and reusable in another part of the network at the medical center, preserving the initial fiber investment.
By blowing the exact amount and type of fiber in and out of the network as current bandwidth requirements
dictate, the Cancer Institute has created a continuously renewable and
sustainable network infrastructure with no end to its lifecycle. There is no hazardous abandoned cable or wasted dark fiber, and because there is no construction work for network MACs, there is no waste or debris. Moreover, the air-blown fiber infrastructure takes up less building space and provides virtually unlimited network capacity, thereby allowing heating/ventilation/air-conditioning (HVAC) and other energy systems to operate with unobstructed airflow.
Had a conventional cabling infrastructure been designed, it would have necessitated 96-strand-count plenum-rated singlemode fiber-optic cable from the main crossconnect to the two main telecommunications rooms, as well as 48-strand-count to each of the four telecom rooms. In this traditional cabling scenario, dark fiber would be added merely as insurance for uncertain bandwidth requirements and MACs. At an average labor rate of $63 per hour, the installation would have cost $134,650.
The air-blown fiber total installation cost, at the same labor rate, was $103,000. And the Cancer Institute can double capacity with another add of 24-fiber singlemode, should it need it, for $26,000 and still incur less cost than with the conventional cabling infrastructure.
One's first inclination is to say that the Cancer Institute, under the conventional infrastructure scenario, would never require any additional fiber; that it would last a lifetime, comments Toothaker. But I remember saying that with each 50- and 62.5-µm multimode upgrade, and look where we are today. Also, optical-fiber manufacturers are continuing to innovate better fiber types; replacing one for the other with FutureFlex would cost the same $26,000 whereas the conventional infrastructure would cost another $134,000, assuming the old fiber type is left in.
Although both the conventional and the air-blown fiber scenarios are equipped to handle 40-Gigabit Ethernet, the Institute of Electrical and Electronics Engineers (IEEE) is already announcing 100-Gigabit Ethernet specifications coming in 2012. What this will do to fiber count, we just don't know; however, with the FutureFlex system, the Cancer Institute is ready for a fast, easy, non-obtrusive, and cost-effective transition.
The National Electrical Contractors Association (NECA) Labor Manual says it takes seven hours to pull 1,000 feet of conventional fiber-optic cable in an innerduct under normal conditions with four installers. According to Toothaker, it takes only 10 minutes with two installers to blow 1,000 feet with FutureFlex.
Rather than dealing with time-consuming and expensive recurring costs associated with conventional cabling, we're saving over 70% of the time and cost with each network MAC, providing the medical center with continuous savings and ROI, says Toothaker. Most importantly, by using the FutureFlex system, the IT and facilities departments can respond in real time to the needs of clinicians and patients, whether installing a new mission-critical piece of medical equipment faster and easier, or whatever the need might be, without even lifting a single ceiling tile.
Remember the 19-tube cable providing 38 pathways? Some of those pathways and extra capacity within the Cancer Institute will be used to support a new Children's Hospital building, currently in planning stages.
Along with the Mayo Clinic and other adopters of Sumitomo's FutureFlex Air-blown Fiber System, I'd like to think that Penn State Hershey Medical Center is a pioneer in hospital/healthcare infrastructure design, proving how the physical layer can save budget dollars and improve infection control, while escalating the speed and delivery of new healthcare technologies and the critical needs of our patients, clinicians, and the communities that we serve, Mettley concludes.
CHRISTOPHER ARCHER, RCDD, is senior design engineer with Brinjac Engineering (www.brinjac.com).