There are some unique fundamentals that come into play when the healthcare sector engages in network planning. Conversations around future proofing, security and redundancy all have a special meaning in a sector that increasingly relies on network performance while at the same time, is ultra-vigilant about privacy.
Connectivity isn’t just about dedicated communications between hospital departments and practitioners. Today the tech discussions are tackling smart carts and beds, Wi-Fi and cloud, nurse paging systems and VoIP, electronic patient record sharing and province-wide (and even nationwide) connectivity.
Greenfield projects — defined by Wikipedia as a project which lacks any constraints imposed by prior networks — are pulling out all the stops to move digital to a new level. Brownfield sites for their part are continuously challenged to strike a delicate balance between bringing networking infrastructures up to speed in a 24/7 working environment without disrupting services and the number one priority: the patient.
Telemedicine and unified communications are an integral part of the discussion as healthcare facilities try to extend their reach to remote communities, while saving costs. At the same time, network strategists are going the route of collapsing everything from security cameras and access control systems to patient data and voice services onto one network.
As Shanti Gidwani, healthcare industry director, for Cisco Canada in Vancouver, explains, "healthcare transformation is like a spinal cord. There are more connections, links to more members, and a clear focus on security and privacy. The more information that’s passed to different branches, the more efficient you can be in building out medical applications."
All-in-One: Gidwani confirms that right now, it is all about the converged backbone. "Hospitals are now doing so much more with unified communications, collaboration and clinical workflow solutions to create a more efficient healthcare system. Telemedicine and telehealth are taking the field by storm. Cloud and collaboration soluTtions are also becoming key pieces of the conversation."
Stephen Foster, director of ICT for EllisDon Corp. is in the throes of a brand new billion dollar hospital job in Oakville, Ont. What has struck him from a cabling network perspective is the conversion of edge devices (security cameras, building automation, card access systems, metering, etc.) from traditional dedicated networks to the enterprise network infrastructure. "We all come from a model where buildings had six or seven disparate networks," he says. "Now they’re getting that down to one enterprise network. The basic cabling rules have not changed. But the sheer volume has increased dramatically." He adds that consolidation was not always feasible, because networks simply couldn’t handle the job safely and securely. "There has been a tenfold increase in reliability of enterprise networks. In moving devices to the enterprise network everything, from cameras and card systems, to computers and telephones to imaging equipment, is being treated the same."
Make Room for Data Sharing: One of the biggest challenges within healthcare is the massive quantities of data that needs to be shared or protected or both, says Henry Franc, premise specialist with Belden in Toronto and a member of the CNS editorial advisory board. "The data demands are huge. Wireless, cloud type services, information on demand … all these mean everyone wants lots of information very quickly. The key for healthcare is prioritization and security, because you’re dealing with clinical and non-clinical data that may or may not be in the cloud. That takes on a whole new level of complexity versus the old voice/data conflict resolution."
This is not such a burden from a greenfield perspective, when everything is new and obstacles if any are limited. Brownfield projects are another matter. In those cases, the question is, what do you do with a building that is 30 years old that was built not knowing what technology would be available today?
When planning things out, it is essential to know if and when areas will be renovated. If you want to future proof and allow room for more services, you must make sure pathways are big enough based on how fast and how much volume you need. "Those kinds of things can be trickier in brownfield applications because you have to work with existing conditions," Franc notes. "Greenfield for the most part is much easier because you can make sure pathways and spaces are big enough."
Network lifespan is also a much longer-term proposition than within other sectors. Typically, a network design is based on the lifespan of a facility, which tends to be in terms of a 10 to 15 year lease in a commercial setting. When building a hospital, planners talk in terms of a 50 year or more lifespan, which means factoring in the flexibility to adapt to changes over time. "The business decisions around future proofing represent a completely different dynamic. And all through that you have to balance what you are investing in now with delivery of clinical services," Franc says.
Cabling Conundrums: Cabling choice is far from an either/or situation. With the complexity of healthcare facilities, it’s rarely a single Cat X or Y or copper/fibre/air answer. Every single one of those media has a purpose. The key to planning is determining their suitability over the short, medium and long term, and sort out needs in terms of volume, velocity and portability.
Conversation around "intelligent cabling" can also muddy the waters in the healthcare world. "That’s only one small piece of the pie," Franc explains. "Yes, you have to care about many more things: space, power, pathways, conduits, fire stopping, air handling, etc. But people are so focused on those things that they ignore the rest of the basics. An intelligent patch system may tell you port A is connected to B but that cable might run through an infectious control area. If you unplug it you have to destroy it. Intelligent cabling doesn’t eliminate the need for human control. Otherwise it becomes shelfware."
One area where healthcare seems to have a considerable leg up is 10 GBaseT deployment. In fact the sector has been relatively early adopters in order to accommodate higher speed/bandwidth applications.
The Data Centre Within: In fact you could think of every hospital environment as a large data centre, Franc contends. "You’ve got all the same issues, but you have more challenges in a hospital that is geographically larger versus a secure isolated facility. In addition, the data is just as critical if not more so. If you can’t give an investor an account balance one day, that doesn’t matter, but if you lose a medical record, that’s another story."
Then there are the privacy issues inside what is largely a public domain. Ultimately, hospitals are designed for the public. At the same time, they require equally stringent privacy controls and accuracy. Given the core business of the hospital, it’s a tricky balance between specialization and generalization.
The application explosion is becoming equally problematic, notes Matt Roberts, director of healthcare solutions for Brocade in San Jose, Calif. "You have got a sector where there is rapid adoption of electronic medical/health records. You have patient monitors, nurse call systems, VoIP, smart badges, security systems, video surveillance, and multimedia bedside service. Whether wired over IP or a wireless LAN hospitals are relying on their IP infrastructures to handle a growing number of solutions."
There is one caveat in all this, he adds. Hospitals are not ahead of the planning curve. "One of the interesting things we have seen is that 80% of infrastructure upgrades are implemented after the application. In addition, over 30% of hospitals are deploying four or more applications over the next 18 months. This is a potential problem from a planning perspective."
In With the Old: Renewing an aging infrastructure brings very specific challenges most network managers don’t have to face in other sectors, Franc adds. "The biggest thing to worry about is clinical care. You do not want infectious control issues associated with particulates, dirt and sound. Pathways and spaces are at a premium. You have to fight for every square foot."
You have to really take a look at the way you go about refreshing your network, confirms Roberts. "Rarely can you do a full refresh because there is so much patient activity. You have to pick and choose the network elements you want to work on whether at the edge, the core, or elsewhere. If you can eliminate the complexity within by using a fabric approach to flatten the network layers, you can do a lot to facilitate operational benefits."
The Cisco Medical-Grade Network is built on a foundation of common routing and switching technologies to enable operations to build upon base layer networks to support deployment of collaborative tools, unified communications, cloud and wireless, among others, Gidwani notes.
A key feature is the ability to interoperate with a majority of existing systems in place. "Healthcare has a lot of legacy systems that were built at different times, depending on the region and/or trends at the time," Gidwani explains. "The interoperability piece is key all the way up the stack from switches and routers to medical and software applications to unified communications."
Who’s On First: The network debates these days are turning to another question that was an all too familiar one in the days of network and voice convergence: who’s in charge. "What do you do now with this data and all these edge devices?" Foster asks. "Who manages and maintains them? There’s a real coming together of the real estate guys and IT.
"When VoIP became an application, the network guys were fighting it out with the voice engineers," he continues. "The network guys won at the end of the day. It’s no different here. The whole challenge is bringing these two groups together to get the long-term benefits of this evolution."
While cable performance is the focal point of any network strategy, and the battle for ownership wages on, the ultimate driver behind any decision is people, Franc notes. "The number one thing for hospitals is that they are taking care of patient services. An airport’s job is to move people. A data centre is focused on computing power. But the reason a hospital is there is to deliver services to patients. You always have to keep it in mind that technology is there to enhance clinical care."
Denise Deveau is a Toronto-based freelance writer.
She can be reached at firstname.lastname@example.org.