By Carol Everett Oliver, RCDD/ESS, Berk-Tek
Planning an infrastructure for healthcare facilities, whether it is for a single doctor’s office or a health campus, creates similar challenges for network system designers: How to integrate many disparate systems together over a common network. The information technology systems (ITS) professionals need to understand that the rapid changes in medical technology combined with Internet Protocol (IP) convergence and demands of government initiatives, such as meaningful use and total electronic medical records (EMR), will become critical considerations in the design and implementation of an efficient network. Whereas many of the applications and systems can be attached to the network, the architecture and bandwidth requirements can vary greatly.
To aid in the design and implementation of ITS systems used within healthcare environments, BICSI, through American National Standards Institute, recently released a new standard, ANSI/BICSI 004-2012 Information Technology Systems Design and Implementation Best Practices for Healthcare Institutions and Facilities. Written by healthcare end users and system designers, this standard focuses on today’s technology infrastructure that needs to support a variety of applications, such as medical procedures (e.g. imaging), clinical processes, business and enterprise operations (e.g. patient records, wireless and wired communications), building and facilities requirements (e.g. security and alarm management) and even patient entertainment systems (e.g. interactive television system). This standard provides requirements and recommendations for the design and implementation of these systems. “Today, most of these systems are capable of being connected to an Ethernet network in some fashion. While they may share a common backbone, the horizontal cabling and configuration may vary depending on the device type and operating system. In fact, most of these systems still operate as silos with their own proprietary cabling system and this standard recognizes these differences,” states Todd Taylor, RCDD/NTS/OSP, director of low voltage/IT design with Enfinity Engineering, LLC and chair of BICSI’s Standards Committee and Healthcare Subcommittee.
Two years ago a focused TIA standards group produced the TIA-1179 Healthcare Facility Telecommunications Standard to provide base guidelines for the planning and installation of a structured cabling system for healthcare and buildings. The 1179 standard establishes performance and technical criteria for various cabling system configurations by providing guidelines for planning the cabling pathways, spaces, media and outlets. “The new BICSI-004 standard uses the foundation of the TIA-1179, but goes beyond generic cabling to address specialized requirements of all the other unique systems,” explains Jeff Silveira, RITP, AStd, director of standards for BICSI.
Taylor adds, “This standard gets very specific with the unique systems’ requirements, from providing bandwidth, network storage and transmission properties needed using different protocols for the clinical processes, as well as providing wiring architecture diagrams for applications such as call systems and DAS.”
Although this standard does include one section on the telecommunications infrastructure, covering areas such as topology, pathways (including outside plant) and telecom outlets, it provides more details and schematics, including layouts of a telecom room (TR) and patient room that needs to accommodate all the healthcare systems, beyond data, voice and video. Some of the recognized systems, exclusive to healthcare facilities, which may require special design considerations, include nurse call, medical imaging, patient monitoring (telemetry—both wired and wireless), patient television, clock systems and radio frequency identification (RFID) for patient tracking.
Due to the nature of these different applications, which can be integrated, additional requirements need to be carefully evaluated. A section titled “Integration of Systems” focuses on device requirements for operating rooms and procedure rooms to provide information on design considerations. There are many standalone systems in these spaces that require network integration to provide access to hospital professionals (doctors, nurses and medical students) to aid in patient treatment. These include, but are not limited to, a PACS (picture archiving and communication system), physiology monitors, video feeds, A/V equipment, control panels, video cameras and monitors, to name a few.
Much attention has been given to the complications and physical challenges of installing cabling in a healthcare environment. Professional, accreditation and oversight agencies, such as the Joint Commission and Center for Disease Control (CDC), have provided guidance for new construction and major renovations in healthcare facilities for the deployment of infectious control methods. This standard provides informative information on infection-control risk assessment, training, products and policies, which is vital to maintenance and contract personnel doing work in that space.
Other useful information in this standard addresses the commissioning process, definitions, listing of regulatory bodies and other referenced standards, codes and documents to aid in the understanding of designing an infrastructure in this unique market.