Cabling for Healthcare

Carol Everett Oliver, RCDD, ESS Marketing Analyst, Berk-Tek

BICSI Northeast Region DirectorBICSI Northeast Region Director

Matt Odell, RCDD kNetwork Project Manager

Johns Hopkins Health System

Mission Critical Network

Agenda

• Healthcare I.T. Challenges• Regulations & Requirements• TIA-1179• TIA-1179• Cabling Best Practices• Case Study: Planning a Healthcare Infrastructure

�– the NEW Johns Hopkins Hospital

Yesterday…

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…Today

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Healthcare I.T. Evolution

Healthcare I.T. Challenges

• Diverse IP Applications• Exploding Bandwidths• Unique Installation Environment (i e ICR)• Unique Installation Environment (i.e. ICR) • Government Initiatives

IP Applications

Beyond patient records• Dispensary tracking• Security• Physio monitoring• Patient tracking

N ll t• Nurse call systems• Digital signage• PagingPaging• Fire, life safety• Building automation systems

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g y

Exploding Bandwidths

MRI20 GB

Angiography

Ultrasound

1000 MB

Ultrasound500 MB

10G Impact on Efficiency

Time to Access File

@1G (1000BaseT) = 160 seconds (2 minutes & 40seconds (2 minutes & 40 seconds)

@10G (10GBaseT) = 17 seconds

MRI = 20 Gigabytes

Infection Control Requirements (ICR)

• Containment (Biosafety Levels 1 - 4)• Sealed communication cabling pathways• Use of tents, carts and vacuums for

filt tifiltration

Government Regulations

• HIPAA - Health Insurance Portability and Accountability Act enacted 1996 �– Data interchangey g

• ONCHIT - Office of the National Coordinator for Health Information Technology within Department of Health and Human Services (HHS) �– est. 2005 �– 10 year EMR goal

• ARRA American Recovery and Reinvestment Act• ARRA -- American Recovery and Reinvestment Act --2009 Stimulus package �– ended Sept. 2011

• HITECH ACT - Health Information Technology forHITECH ACT Health Information Technology for Economic and Clinical Health (HITECH) Act �– part of the 2009 ARRA �– Provides incentives for a national health information exchangehealth information exchange

Joint Commission (Organization)

• Accreditation

B d i ti d f (A b l t B h i l• Based on organization and focus (Ambulatory, Behavioral, Critical Access, Home Care, Hospital, Lab, Long Term)

• CertificationCertification

• Based on staff and responsibilities of service and safety

• Standards and Measurements• Standards and Measurements

• Operational standards and manuals

• Performance evaluations patient tracers and national• Performance evaluations �– patient tracers and national safety goals.

www.jointcommission.org

ANSI/TIA-1179

• Supports a wide range of healthcare facilities and systems to include:• Topology• Topology• Pathways and spaces• EF, ER & TR Requirements, q• Cabling Recommendations• Work area densities • Ancillary devices

Pathways

• Shared pathwaysi h l f• High Levels of EMI

• Route Diversity• Separation of services

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Entrance Facilities (EF) &Equipment Rooms (ER)q p ( )

• Route diversity - two separate pathways• Demarcation point of outside access providers

may be determined by federal or local regulations.

• Accommodation of other systems may increase y ysize (BAS, nurse call, security, CATV, biomedical systems)

• Growth factor of 100%

Telecommunications Rooms (TR) and Telecom Enclosures (TE)Telecom Enclosures (TE)

• Non-telecommunications services (i.e.Non telecommunications services (i.e. gasses, fluids) not allowed

• Larger TR than office building -- 12m2 Larger TR than office building 12m(130 ft2 ) or larger

• TE serves smaller floor area or where• TE serves smaller floor area or where TR is not allowed (be aware of exposure of magnetic fields, radiation, p g , ,chemicals, etc)

Backbone Cabling

• Future-proofingFuture proofing• Redundant pathways• High bandwidthHigh bandwidth• Ease of Installation

Backbone Cable Choices

• OM3/OM4/SM Fiber• Copper:

• 100 ohm (Cat 6 or higher)

• 6A for new installations

Cabling tips: Think about armored cable and pre-term.

Horizontal Cabling

• Plan for the future �– less accessible• Separate applications �– Color codeSeparate applications Color code• Match cable to the environment

Horizontal Cable Choices

• Category 5e; Category 6 or higher is recommendedhigher is recommended

• Note: Category 6A recommended for newrecommended for new installations

• Multimode, 850 nm 50/125, 2-fiber or higher

• Single-mode, 2-fiber or higher

• Note: Bundled and hybrid cables can be used .

Horizontal Cable Recommendations

Long-term Network Ease of EMI ODgSupport Installation Resistance

Cat 6a UTP

Cat 6a F/UTPCat 6a F/UTP

Premium Cat 6 UTP

Cat 6 F/UTP

S d d C 6 UTPStandard Cat 6 UTP

Work Areas

• Based on applications and usage requirementsusage requirements

• 11 Classifications:

• Patient Services • Caregiver• Surgery/Procedure/ OR • Service/Support• Emergency • Facilities• Ambulatory Care • Operations• Women�’s Health • Critical Care• Diagnostic and Treatment

Work Area Classification Tables

• Tables within the standard list the recommended work area configurations based on the f ti t th t l tifunctions at that 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:• Waiting Room, Ambulance Bay, X-Ray, Patient Holding,

Consultation, Mechanical Rooms

• M = Medium:• Registration, Patient Prep & Recovery, Exam & Evaluation,

Nursery, Pharmacy, Administration, Food Service

• H High:• H = High:• Patient Room, Nurse Station, Intensive Care, Operating

Room, Emergency Procedure, Out-Patient Surgery, Delivery Room MRI CT Scan Lab Security OfficeRoom, MRI, CT Scan, Lab, Security Office

Cabling Considerations for Work Areas

• MUTOAsMUTOAs• Multi-media outlets

C l di• Color-coding• Stainless steel• Shutters

Note: CPs NOT allowed

Summary: Challenges & Solutions

• Broader scope of applicationsS iti i t ll ti i t• Sensitive installation environment

• High density �– cables & WAOs• High bandwidth requirements• Color coding and cabling separation• Install the highest performing

system possible for the longest possible useful life and support forpossible useful life and support for demanding mission critical applications

Planning a HealthcarePlanning a HealthcareInfrastructure:

Th NEW J hThe NEW Johns Hopkins Hospital

Matthew Odell, RCDD N t k P j t MNetwork Project Manager,

Johns Hopkins Hospital

History

• 1889 Johns Hopkins Hospital opens• U.S. News & World Report 19 years at the

toptop• Over 40,000 employees• 32 buildings on East Baltimore 22-acre

campus and growing!• ~1960 Nelson/Carnegie Buildings open

Hospital Campus

Dr George DoverDr. George DoverChairman, Dept. of Pediatrics Director of Hopkins Children�’s C tCenter

�“This small corner at Wolfe fSt. and Orleans could become the most important corner in the world forcorner in the world for pediatric medicine�”

New Hospital Design Scope

• 1.6 million sq. ft. • 2 towers, 12 stories each

• The Charlotte R. Bloomberg Children�’s Ctr.• The Sheikh Zayed Critical Care &

Cardiovascular Tower

• 560 Private patient rooms• 33 State-of-the-art operating rooms• 33 State-of-the-art operating rooms• Pediatric trauma & burn services• Modernized diagnostic imaging and radiology facilitiesModernized diagnostic imaging and radiology facilities • Indoor play areas, auditorium, food services

A few �“small�” construction details

What does it take to build a 1.6 million square foot medical facility?square foot medical facility?

• Up to 1,500 on-site construction workers 12 500 t f t t l t l• 12,500 tons of structural steel

• 44,500 cubic yards of concrete• 322 miles of conduit• Over 4,000 plumbing fixtures• 244,000 sq. ft. of glass windows • 3.5 million pounds of sheet metal ductwork for HVAC3.5 million pounds of sheet metal ductwork for HVAC• Powered by (2) JHH owned on-site power plants• And about $1.3 billion.

Planning for low voltage systems

• Telephone systems

Systems to consider for Healthcare environments• Telephone systems• Data network• Wireless network • Nurse call system• Building automation system• HVAC, Med Gas Alarm• Clinical engineering network• Security systemy y• Television• GPS clocks• Distributed antenna system• Telemetry• Telemetry• Real time location service (RTLS)• Pediatric gaming

EIDF/IDF Room Designs

• External Intermediate Distribution Frame (EIDF) includes:• CES network• Security & camera system• DAS & Telemetry systems• RTLS & Nurse call systemsy• TV services• All other vendor supported systems

• Intermediate Distribution Frame (IDF) includes:includes:• JHH enterprise network• Telephone cross-connects

• MDF, IDF and EIDF systems all share power provided from (2) large redundant UPS.

Fiber Infrastructure

There�’s about 1500 strands of fiber within the building not including OSP

• Outside Plant Single Mode Fiber192 strands each to redundant core locations

within the building, not including OSP

192 strands each to redundant core locations

• Riser Fiber24-strands 50um MM & 24-strands SM to each IDF�’s24 strands 50um MM & 24 strands SM to each IDF s24-strands 62.5um MM to each EIDF (CES)We doubled the fiber counts on all the OR floors

• Horizontal FiberHorizontal FiberEach OR has 12-strands of 50um MM to redundant IDF�’sEMU and Auditorium have 12-strands 50um to local IDF

Copper connections

• 29,000 Cat 6 data drops– Each OR has 42 dropsp– Patient rooms have 8 drops– Every TV, Phys. Mon. have drops

• 6,000 Cat 5e telephone drops• 3500 Cat 5e RTLS sensor drops• 705 WAP Cat 6 locations

– 4 drops to every WAP

Color Coordinated

• Data Cat 6 BlueCables and Jacks are colored according to system

• Data Cat 6 - Blue• Telephone Cat 5e - White• Physiological Monitoring Cat 6 - Yellow• Real time Location System Cat 5e �– Orange• Nurse Call System �– Lime Green

T l i i D k G• Television �– Dark Green• BAS �– Brown• Medical Gas Alarm - Greyy• Fire Alarm �– Red• DAS & Telemetry Coax - White

Special cabling areas

• EMU - EpilepsySpecific JHH healthcare cabling situations:• EMU - Epilepsy

Monitoring Unit (copper mesh lined)M ti R• Magnetic Resonance Imaging (MRI OR�’s)

• Lead lined X-Ray roomsy• Auditorium, War room

areas• Elevator connectivity• Media filming areas

P di t i ti tCopper lined MRI OR Suite

• Pediatric patient room gaming

Pathway considerations

• HVAC Ducts VAV boxesSome of the stuff that goes above the ceiling:

HVAC Ducts, VAV boxes• Plumbing for cold water, steam system, sprinklers, &

waste• Pneumatic Tube SystemPneumatic Tube System• Electrical conduit for house elect, emergency elect. &

dedicated circuits• MI Cablingg• Lighting• Security conduit• Fire alarm cables• Medical Gases• Cable tray

Systems Commissioning

Low voltage cable inspections check list:Are BICSI best practices and recommendationsAre BICSI best practices and recommendations used during installation?Certified RCDD�’s on the inspection team.Do you know the manufacture o you o e a u ac u erecommendations?Are pathway�’s clear and large enough? 40/60 rule.Should we use J-Hooks? Caddies? Snake tray?What is MI (mineral Insulated) cable anyway?Are the racks put together correctly?Cables punched down correctly? Complete cable test resultsJHH Cabling Standards Document

Connecting the network!

• 40 Gb redundant links from dual routers to JHH core network.

• 20 Gb connections to every closet (redundant 10 Gb)( )

• Connectivity to (2) offsite data centers• Medical records storage for 21 yrs.• 1 Gb Physiological unity network• Fetal monitoring network• Ability to connect high-bandwidthAbility to connect high bandwidth

Radiology machines at 10 Gb for image uploads.

Some obstacles to overcome!

• Rollercoaster pathway�’s lead toRollercoaster pathway s lead to longer than normal cable lengths

• OR ceiling access for future gupgrades

• Cabling within a medical boom

• Choose the correct cabling to support ever advancing network gear 5 years before go livegear, 5 years before go live.

Questions

Contacts:Contacts:

Carol Everett Oliver RCDD ESSCarol Everett Oliver, RCDD, ESScarol.oliver@nexans.com

Matt Odell, RCDDmodell@jhmi.edu