BIoT Canada

Health Care Connections

A new cabling standard now in development will go a long way to changing the current landscape in this country's health care sector. With upwards of 30 new hospitals being built in Canada over the next five to eight years, at a cost of $20...

May 1, 2010  

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A new cabling standard now in development will go a long way to changing the current landscape in this country’s health care sector. With upwards of 30 new hospitals being built in Canada over the next five to eight years, at a cost of $20 billion, the timing is critical.

In 2007, the 479-bed Brampton Civic Hospital, a $790 million high-tech project, opened its doors, hailed as a centre of innovation. Months later, three top executives resigned after several patient deaths were blamed on long wait times, short staffing and poor communication, leading to a march of 1,500 protestors through the streets of downtown Brampton.

The problem was blamed on the magnitude of the project, which included a hospital with new systems, protocols and technology, as well as a number of newly graduated hires. The emergency room, for example, was set up differently than other hospitals, in “pods,” and this system still had some kinks in it. But in a hospital environment, technology “kinks” cost lives.

There is no doubt, however, that technology has huge potential for transforming health care, which is why the development of a new cabling standard to address both current and future needs is now underway.

With upwards of 30 new hospitals being built in Canada over the next five to eight years, at a cost of $20 billion, the timing is critical.

The ANSI/TIA1179 draft standard specifies requirements for telecommunications infrastructure in health care facilities including cabling types, topologies and distance requirements, outlet requirements as well as cabling design and installation requirements.

It is intended to support a range of applications, including nurse call, patient tracking, pharmaceutical inventory and clinical systems. The standard could be approved as early as June or later this year.

“Every piece of diagnostic imaging ranging from ultrasounds to CAT scans are based on understanding particle wave theory,” says Brantz Myers, director of healthcare business development with Cisco Canada. “Meanwhile we have this other great product of quantum physics – computing – which in the past has been haphazardly applied to the problems around health care. While computers have traditionally been embedded into diagnostic imagers, ultimately those imagers would kick out yet another piece of film. So they would get back to being bound by pulverized cellulose and vegetable dye.”

A lot of the problems surrounding e-health and electronic medical records have had to do with getting out of a paper-based world. Historically, computing solutions were created by computer people and thrown over the fence to clinical people. They were not included in the design process, and proponents of those solutions also did not consider the role change management plays in applying new tools and technologies.

“There has been a huge gap or barrier to the successful implementation of what is now called health informatics,” says Myers. “While the tools have been around for a long time, they have not been applied well, and there are a myriad of challenges beyond the technology – around uptake, adoption and change management. Now we are seeing consultants who do nothing but change management, since it is so vitally important to deployment.”

That is even true of devices. If you bring in a new infusion pump, where the old one was manual and the new one has an LCD display on it, nurses will reject it unless you build in a win for them and train them properly, he adds: “The moving parts are there – the problem comes down to politics and people and money. And while there needs to be a simple, easy “wrapper” for the users of the system, underneath all of this is a powerful medical-grade network that ties together everything from clinical information systems to heating, cooling and lighting systems and conforms to the appropriate privacy and security standards.

“We can now deliver some intelligence to the network through biomedical MAC access control, which allows the network to query what is being plugged into it and apply the right policy to that device,” says Myers.

“That actually takes the wiring requirement down a little bit, but at the same time you are applying more wiring into the ceilings of the hospitals to put in access points for location services and wireless information access. That means the skills of the structured cabling industry need to be enhanced with wireless to understand office automation and control systems, because these networks are now touching heating, cooling and lighting.”

While the new health care standard is awaiting approval, new hospitals are already taking into account the “spirit” of the standard, says Henry Franc, senior account manager for capital projects with Belden and chair of the TIA TR 42.1 engineering subcommittee. It will help them ensure they have enough space and flexibility in their design to accommodate future changes.

“Often when you are in the planning stages of a hospital that will not go live until 2015, you are doing a basis of design for technologies that may not even have been conceived of yet,” says Franc. “And even after they have designed it, they do not necessarily know what the clinical networking requirements are because as much as telecommunications technology is changing at an ever-increasing pace, so is clinical care equipment.”

Structured cabling standards evolved from commercial requirements in the 1980s and early 1990s, when everyone was using proprietary systems that required proprietary cabling. When generic cabling came into effect, the TIA 568 series provided a foundation for cabling, but in application the standard was very much a prescriptive document for commercial premises.

Telecommunications was the central focus of the document, since it assumed telecommunications was the primary focus of the facility. “But when you get into a premise standard like health care, what we have to acknowledge is the primary function of the facility is not to deliver telecommunications, but to deliver clinical services,” says Franc.

This led to a broad-based open study about the role of telecommunications and health care standards.

Standards are a good thing, but (the results) highlighted the fact we need more work on this, says Franc.

“This health care document is really the first premise-based telecommunications standard where the first priority was respecting the unique nature of that facility and its functions. In a commercial premise, the authority having jurisdiction is typically the building inspector. In hospitals, however, they are not the highest authority having jurisdiction – it is those in infectious control. You are going to build it to code, and the building inspector has to sign off on it, but whoever is in charge of infectious control and clinical operations will have the final say.

In the old commercial document, diversity and resiliency were optional.

In a hospital there are a myriad of other factors that affect patient safety. In a commercial building, for example, the doors swing out to maximize the space in the room. In hospitals, opening up into a common hallway could result in a gurney being hit. As a result, doors have to swing in, which takes up an extra three feet of space. “There are so many more telecommunications IP-based services in a hospital than a commercial building it’s not even funny,” says Franc.

If you start at the infrastructure level, it becomes an enabler at other levels, meaning data flow is faster and there is better redundancy, fewer patches and fewer points of failure, he points out. Historically each dedicated system was managed by a different department and often a different third-party partner outside the hospital.

“You have got different people going into ceiling tiles at different times and moving or managing other people’s systems,” says Rod Sampson, vertical marketing manager with Belden. “If you follow the standard, you do not invest in dead-end proprietary protocols. You are not investing in something that’s going to
become obsolete.”

Because hospitals do not renovate – they build a new wing. They cannot just shut down that wing for six months, which is why it is important to put cabling in the walls that will future-proof their investment. Even if systems and applications are designed to be supported over the local-area network, the needs of that LAN are going to change. “Clinici ans do not care about infrastructure, they just want it to work – but infrastructure is a critical component of making it work, and that is where you get a disconnect,” says Sampson. CNS