Healthcare applications demanding robust infrastructure

With an industry standard in place and another in the works, the drivers of healthcare IT systems continue to move forward.

From the August, 2012 Issue of Cabling Installation & Maintenance Magazine

With an industry standard in place and another in the works, the drivers of healthcare IT systems continue to move forward.

by Patrick McLaughlin

Approximately two years ago the Telecommunications Industry Association (TIA; (www.tiaonline.org) published the TIA-1179 Healthcare Facility Telecommunications Infrastructure Standard, which includes requirements for healthcare facilities like hospitals as well as medical offices and clinics. When it published the standard, the TIA explained, “TIA-1179 specifies cabling, cabling topologies, and cabling distances. Additionally, pathways and spaces, e.g. sizing and location, and ancillary requirements are addressed.

“In addition to telecommunication systems, the telecommunications cabling specified is intended to support a wide range of clinical and non-clinical systems, particularly those that utilize or can utilize IP-based infrastructure.”

In a question-and-answer format document titled “How does the TIA-1179 cabling standard affect my healthcare facility?” CommScope (www.commscope.com) boils down several of the standard’s essential elements. Within that document, it explains, “Arguably the most important aspect of the TIA-1179 standard is the definition of work areas. The authors of the standard understood the unique needs of different work areas in a healthcare facility. The cabling requirements for a waiting room are very different than the patient room or the nurses’ station, for example.”

Work area redefined

The standard includes 11 classifications of work areas, as CommScope explains: 1) patient services, 2) surgery/procedure/operating rooms, 3) emergency, 4) ambulatory care, 5) women’s health, 6) diagnostic and treatment, 7) caregiver, 8) service/support, 9) facilities, 10) operations, 11) critical care. “Each of these categories contains specific subgroup work areas, bringing the total number of work areas defined to 75,” the document says.

Importantly, the standard identifies a recommended density of outlets for each work area. An area identified as low-density has between 2 and 6 outlets; a medium-density area has between 6 and 14 outlets; and a high-density area has more than 14 outlets.

The need for such levels of connectivity in patient rooms and other areas of healthcare facilities has multiple drivers. Within these environments, extremely large files, such as those created by diagnostic tests like CT, MRI and PET scans, are transmitted over a facility’s data network from the location at which they are taken to the location at which they are examined.

EHR’s major role

Another aspect of today’s healthcare industry that also drives the need for well-equipped networks is the migration from paper-based patient record keeping to electronic health records (EHR). This migration, for which healthcare facilities are incentivized by the United States government, is creating the need for massive information-storage capacity.

Earlier this year Compass Intelligence (www.compassintelligence.com) announced results of its annual sizing of the healthcare information-technology (IT) market. “This year alone, the healthcare IT market will reach $78 billion,” the firm said, “which includes expenditures on telecom services/equipment, IT personnel, applications/mobile applications, computer hardware, network hardware, and third-party services and outsourcing. The market is expected to maintain about a five-percent compound annual growth rate over the next five years to reach $92 billion by 2016.”

Stephanie Atkinson, managing partner at Compass Intelligence, commented, “One primary area of investment by the medical community includes mobile solutions centered around remote monitoring and patient tracking. Implementation of the various stages of electronic health records will drive infrastructure and integration needs to support the access, storage and transfer of data across CRM [customer relationship management], HIS [hospital information system], ERP [enterprise resource planning], clinical and other healthcare enterprise systems.”

Compass added that the adoption of more advanced medical software and solutions is also expected to drive the need to securely back up, store and maintain patient and medical data, adding that the firm “believes this need will give rise to cloud-based solutions specifically developed for and offered to the healthcare industry.”

Compass Intelligence also pointed to mobile solutions as a driver of the healthcare IT market. “The growth in mobile health and wellness applications is expected to drive the growth and adoption of mobile medical applications used for patient care, tracking and monitoring,” the company said. “The growing acceptance and adoption of mobile healthcare solutions are driving the vendor community to launch exciting new products and services, which in turn is also driving adoption around solutions to improve patient care.”

In February 2012, United States Health and Human Services Secretary Kathleen Sebelius announced “Stage 2” for healthcare providers using EHR technology and, for doing so, receiving incentive payments from Medicare and Medicaid. HHS developed proposed rules to govern the second stage of this incentive program. As the HHS described it, the first stage (which began in 2011) included the transfer of data to EHRs and the ability to share information, including electronic copies and visit summaries for patients. The second stage (proposed to be implemented in 2014) will include new standards such as online access for patients to their health information, as well as electronic health information exchange between providers. The third stage of EHR implementation (anticipated implementation in 2016) will be to demonstrate that the quality of health care has been improved.

An administrator within the Centers for Medicaid and Medicare Services, Marilyn Tavenner, commented in February that more than 43,000 providers had received more than $3 billion to help them transition to EHR. HHS stated that between 2009 and 2011, the percentage of hospitals using EHR more than doubled, from 16 to 35 percent. Additionally, 85 percent of hospitals reported that they intended to take advantage of government incentive payments in order to make the transition by 2015.

Establishing best practices

As these macro-level drivers shift the way information is collected, transported and stored in healthcare environments, guidelines like TIA-1179 spell out the required supporting physical-layer infrastructure. In addition to the TIA’s two-year-old standard, an in-development standard from BICSI (www.bicsi.org) will also provide guidance for cabling these facility types. BICSI-004 Information Technology Systems Design and Implementation Best Practices for Healthcare Institutions and Facilities is expected to enter the balloting stage this year.

The standard will address a number of healthcare-specific systems, such as nurse call, wireless medical telemetry, telemedicine and others. It also will cover IT systems including wireless networking, paging and intercom systems, and private branch exchanges. Additionally, the standard will discuss the integration of healthcare systems.

The healthcare field holds the promise of both challenge and reward for information systems of all types, including structured cabling. Indicators say a lot of business will be carried out over the next several years (reward), and the complexity of those projects (challenge) very likely will stretch far beyond that of the systems designed for cube-farm-style commercial office buildings. Along the way, standards and best practices will be available to guide the professionals who design, install and manage communications systems in healthcare facilities of all types. ::

Patrick McLaughlin is our chief editor.

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