Cabling an inner-city healthcare facility

The 250,000-square-foot Shapiro Center, part of the Boston Medical Center campus, posed challenges and opportunities as it was being built.

By Carol Oliver, Berk-Tek, a Nexans company

Healthcare buildings and services are expanding at an unprecedented rate. The design of a healthcare facility greatly influences patient care, staff performance and clinical outcomes. Healthcare structures are built for longevity and therefore the network and cabling infrastructure must be designed to accommodate future uses, which can be somewhat daunting with many systems and services going digital, including electronic health records (EHR).

Berk-Tek's ArmorTek was selected for the backbone because it is easier to install by eliminating conduit and only having one pull as well as providing added protection to the optical fiber cable.

Building or renovating healthcare facilities in an inner city presents additional challenges, such as finding space and then carefully coordinating construction in a busy urban environment. Boston Medical Center (BMC), the first municipal hospital established in the United States, faces constant growth and expansion and has recently built a new outpatient facility at the same site as the old Boston City Hospital. Located in the heart of the city's South End, the BMC campus includes 22 buildings–inpatient, outpatient and administration–and services nearly one million patient visits per year. Approximately 70 percent of patients are impoverished and the hospital's policy is to provide care to everyone who walks through the doors, without exception. Therefore, the budget for new construction is scrutinized because the funding is based on grants and donations as well as city subsidy.

The newly completed Shapiro Center is a 250,000-square-foot, nine-story building dedicated to outpatient services including dermatology, neurology, orthopedic care, pediatrics, pulmonary and women's health. Although mainly doctors' offices, this facility also has operating rooms for surgeries ranging from pediatric to organ transplant. So although the basic floor layouts were designed to be similar to one another, the actual applications on a given floor can vary. The design of the network infrastructure required cooperation between both the hospital's design-and-construction and information-technology (IT) departments.

Bernie Kamp (left), project manager and Eric Johnson (right), general foreman with Broadway Electrical Company, in the main crossconnect with the patching racks for data on the left wall and punchdowns for voice on the right wall.

Prep work

Because the Shapiro Center was designed as a completely new facility, the old hospital had to be torn down. The razing process took two years due to the intricate conduit and utility systems that had to be removed without disturbing the other buildings on the campus that were tied into the old hospital. "While the demolition was taking place, the IT department worked in tandem with design and construction to lay out the infrastructure," says VonFyler. "Also, this building was designed to set a new standard for sustainable design by employing environmental sensitive materials and technologies including energy-efficient and water-conserving features for mechanical, electrical and architectural systems. Designing the facility for LEED credits added a new dimension and learning curve to the design and construction team.

"One of the biggest challenges for a healthcare facility, particularly one in the middle of a busy city, is safety and fire protection," VonFyler states. In a healthcare environment, there are various ratings for different wall types. Architects will specify these ratings and outline proper fireproofing methods that must be taken when penetrating through the walls with cable.

"The traditional method is to apply fire-rated caulk where cable penetrates through walls or sleeves, which gives a tight seal for the cable pathway. But it does not allow you to add cables later on," explains Eric Johnson, general foreman with Broadway Electrical Company, the installation firm for the Shapiro Center at BMC. "We used a unique sleeve system in the walls, called Speed Sleeve from Hilti, which allows cable to be routed through an open sleeve and then with a simple twist the sleeve closes around the cable. When you want to add more cables, you can easily untwist and reopen, and then close the sleeve for maximum fire and smoke protection," he notes.

The Shapiro Center includes many labs and radiology rooms, as well as operating rooms for day surgery.

Network and infrastructure planning

This new facility implemented converged data, voice and building systems, bringing together many disparate systems on the same infrastructure. These devices included security cameras, access-control systems, paging, CATV, wireless and building-automation controls. The integration of these services included coordination between the facilities departments (mechanical and electrical) with IT. The IT department is responsible for installing all the network cabling to the device locations as well as planning for the terminations in the telecommunications rooms (TRs) while the other specialty departments would attach the end devices and complete the program setup.

All of the LANmark-2000 enhanced Category 6 horizontal cable was 100-percent patched in the TR. All moves, adds and changes are performed through virtual local area networks (VLANs).

There are two main crossconnects (MCs) within the building, on the third and eighth floors, that serve different TRs and are terminated in other buildings on the campus. With two MC rooms, there is a fully meshed network as the cabling runs in redundant, diverse paths.

The backbone cabling from the MC to the TRs includes a hybrid Berk-Tek Adventum multimode fiber-optic cable–24 strands of 62.5-µm for phones and 24 strands of 50-µm for data. In addition, there is a six-strand singlemode cable for CATV video. "BMC installed Berk-Tek's ArmorTek cable because it is easier to install by eliminating conduit and only having one pull, while at the same time adding a layer of cable protection," states Bernie Kamp, project manager with Broadway Electrical Company. "One thing to be aware of with armored cable is to make sure that it is grounded, which is something a lot of people don't think about because the cable itself is fiber," he advises.

Enhanced cabling prognosis

During the installation of the active equipment, the switches were 100-percent patched with Ortronics Clarity6 patch cables to the Ortronics Clarity6 patch panels in the TR for the horizontal cabling. "Complete horizontal patching for each port might be more expensive in the initial installation, but it eliminates the need for any client services to go into the data closets since all moves, adds and changes are handled through VLANs," says VonFyler. "Also, with a QoS system in place, a user cannot just plug in any device until it is authenticated through network software," he adds. "In the long term, this saves a lot of money and saves on headaches, while keeping the cabling organized in the TR." Currently voice and data are separate in the TR, but the cable was consistent–a better-performing Category 6 for future migration to Voice over IP. Additional cable was looped above the 110 blocks on the side walls so the cables can easily be routed into the patch panels when the changeover happens.

Ray VonFyler, ITS project manager and structured wiring with Boston Medical Center, checks out the patching in the telecommunications room.

Berk-Tek's LANmark-2000 Category 6 cable was selected as the horizontal cable. "Although the new standard, TIA-1179, recommends Category 6A for new healthcare builds, the augmented Category 6 cable wasn't a standard when we were designing this facility," states VonFyler. "Selecting an above-the-standards Category 6 cable gives us headroom for any new future technology and IP applications that come along," he adds. Going forward, the IT team will specify the highest grade of cable for new facilities, but when making renovations, they will stay with the cable that is currently installed in that floor or building so there is no "mix-and-match" scenario.

There were approximately 800 LANmark-2000 cables per floor for data, voice and other IP services. "The new TIA standard recommends color-coding the cables for separate applications, but does not suggest particular color schemes," explains VonFyler. "So we have our own–blue for data, white for voice, green for security and yellow for patching in the TRs."

The newly completed Shapiro Center is a 250,000-square-foot, nine-story building located on the previous footprint of Boston City Hospital. This building provides outpatient services and is part of the Boston Medical Center campus.

The horizontal pathways from the TRs to the outlets include Cablofil cable tray around the perimeter of the floor. From the cable tray, the cable is routed through J-hooks into conduit and terminated into Ortronics Clarity6 six-port wall outlets or Wiremold floor boxes. Each port is color-coded–three blue for data, one white for phone and two white for future use.

"We installed six-port steel faceplates, which are more durable and suitable in a healthcare environment," states Kamp. "In addition, every workstation outlet box is acoustically sealed with caulk between the mouth of the conduit and box. This limits the sound transmission and also protects against smoke or fire penetration."

The cabling infrastructure, which includes the latest technology at the time of the design stage, is also backed by a 25-year warranty–NetClear GT3 (enhanced Category 6) for the horizontal and NetClear MM1 (fiber) for the backbone from the manufacturers, Berk-Tek and Legrand|Ortronics.

Emphasis on accreditation

The design of the healthcare environment greatly influences patient satisfaction, employee performance, clinical outcomes and operational efficiency. Healthcare facilities acquire their accreditation from the Joint Commission Organization (JCO), which bases its ratings on safety, quality and best-value healthcare across a number of settings. With the advent of so many applications being added to the data network as well as government initiatives to promote total EHR, JCO has started looking at the infrastructure in addition to the other customary requisites that contribute to a positive accreditation.

Speed Sleeve from Hilti allows easy access to cable between the walls.

"Technology is exploding and hospital networks are tasked to do more than just handle data and voice," says VonFyler. "With IP, everything is considered 'data' and applications such as EHR, streaming MRIs and diagnostic visuals, email programs, and other hospital applications are complicated pieces of software that need maintenance and tweaking. The quality of the infrastructure becomes integral to the operation as all procedures and operations are being video streamed locally and nationally."

The biggest hurdle with EHR capabilities is trying to secure the information, especially staying in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations on patient privacy. In addition, there is no standardized software, so the ability to link to other hospitals can be cumbersome. However, Boston Medical Center has its own standards that will integrate with mobile devices such as notepads and PDAs.

"Because everything is going IP, it is imperative that we have a strong network and a reliable infrastructure in place," notes VonFyler. "We feel confident with the cabling system that we have installed at Shapiro and will be using this location as a model for future projects."

Carol Oliver, RCDD, ESS is market analyst with Berk-Tek, a Nexans company (www.berktek.com).