Navigating the integration superhighway
May 01, 2008
Appeared in Healthcare Design Magazine
Communication is the transportation of information. Just as America's roads and highways can be small and overcrowded or vast and speed-driven, so can today's hospital communications systems.
By dissolving individual wireless and stationary network systems into a single, integrated superhighway, hospitals can save in total upfront, construction and maintenance costs, while simultaneously increasing reliability and redundancy.
Wireless and stationary systems
Wireless voice/data. Wireless voice and data systems are a vital part of all progressive healthcare facilities. From laptops, cell phones, and pagers to electronic medical records (EMR) and wireless patient charting, today's medical centers want their physicians and caregivers to communicate with each other and the hospital network from any point on campus.
To generate 100%-reliable wireless voice and data communication in hard-to-reach spaces like staircases, basements, elevators, and parking structures, strategically place Wireless Access Points (APs) throughout a hospital's floors, in each elevator cab, and minimally at every third flight of stairs.
Special attention must be paid to shielded rooms (i.e., MRI and radiology suites) that block dangerous radio waves from leaving the space. This shielding also obstructs wireless signals, though, creating a “shadow” behind the room. This challenge can be met by specifying additional APs locally to offset the shaded spots.
Although wireless voice and data systems can increase flexibility and communication within a hospital, they also have their limitations. Securing wireless systems is a challenge for owners and designers, while today's wireless bandwidth, currently running at about 54MB (per 802.11 N standard), still rations the amount of transmittable information at any particular time.
Wireless radio. In large healthcare centers where multiple buildings are used to house a variety of services, patients are often shuttled back and forth between diagnostic and treatment areas, isolation spaces (such as ORs), and their own patient rooms. These expansive campus centers take the need for wireless systems to the next level, requiring 100%-reliable wireless radio distribution, as well.
While wireless voice and data system employ an internally-generated frequency, wireless radio uses an external frequency, brought into the hospital by a rooftop antenna. Through a series of fiber cables and internal antennas in the same hard-to-reach places as described above, the wireless radio signal can be enhanced throughout the healthcare facility to create 100% wireless radio coverage.
Stationary systems. While a wireless system is ideal for many hospital functions, it is not right for every application. Clinical systems like the picture archiving system (PACS), medication dispensing system, and the computer physician order entry (CPOE) system require high-powered infrastructure support, and are therefore unable to go wireless because of their large files.
Nonclinical or support systems like the nurse call, intercom, and building automation systems, on the other hand, demand significantly less power and memory than other systems, requiring a slower, stationary connection to accomplish their jobs.
Effective stationary systems design can be accomplished by right-sizing the infrastructure to provide both clinical and nonclinical systems with the amount of support they need.
A hospital's wireless radio and voice/data and stationary networks for each system are typically implemented by independent contractors who install proprietary network cabling, creating individual networks for each system. This single set of systems requires individual upfront, construction, and maintenance costs, as well.
Integrating all wireless and stationary systems into a single network, however, can accommodate all power supply and frequency demands while cutting redundant costs simultaneously. Physically, both the wireless and stationary systems use the same fiber-optic and copper cables. But, logically, traffic is separated over different networks. Those applications demanding faster speeds, like PACS, travel in one lane, while slower operations, like the nurse call system, drive on another.
Upfront costs can be reduced by eliminating duplicate system components. Sharing servers, storage devices, and the larger network, the systems convene on one set of cabling infrastructures.
Construction costs will be cut by eliminating the installation of numerous individual systems and by installing one network to be shared by a number of systems, and therefore reducing surplus first-time installation cost.
Maintenance costs and the total cost of ownership are trimmed by creating one set of network standards instead of a number of proprietary standards from a variety of service providers. As a result, only a single set of materials needs to be maintained. With all the systems under a single network, there's no need to upgrade each one independently. Instead, major network components can be upgraded, while others are added without having to take down the entire system, decreasing the total cost of ownership. After all, the maintenance of one highway is more cost-effective and less damaging to uptime than that of a number of local streets.
Achieving reliability and redundancy
Independent systems are small in both size and reliability. They can run only on their own set of cables, utilizing their small proprietary servers and single networks. When an independent system crashes, its own service provider must revive it before it can resume operation.
Systems that share the same infrastructure and network distribution, however, are naturally designed with 100% built-in reliability. On an eight-lane highway, for example, a crash in one lane still leaves seven other fully functioning paths. The total traffic will subsequently increase with fewer functioning lanes and therefore reducing driving speed, but flow of traffic and reliability will still be maintained.
Additionally, sharing common network equipment, such as storage and networking hardware (switches, servers, and routers), building systems (including support infrastructure, electrical, HVAC, and plumbing), and one cabling infrastructure naturally breeds a higher level of redundancy.
Utilizing the same generators and UPS systems makes better use of the infrastructure support space inside the data center, providing increased reliability at the power source, as well. Even doubling the physical infrastructure completely to provide a redundant cable supply to the data center in case of an outage won't equal the amount of total cable used in proprietary systems.
U.S. healthcare expenditure is among the highest in the world. With reduced costs, hospitals can integrate their wireless and stationery networks into a larger superhighway, paved with reliable and redundant patient care.