“ Healthcare institutions need networks that are different from ordinary business networks on almost every level.”
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Examples Abound Radiology imaging services are now exclusively digital.
Medical images of all modalities are being transferred over both LANs and WANs. Remember the proverbial joke about a physician’s handwriting only a pharmacist could interpret? Physicians no longer exclusively handwrite prescriptions. Special network prescription electronic services are the norm and the preferred method of pharmacies for filling orders because they ensure that the prescription is correct. And the services provide audit trails to legally protect both the physician and the pharmacy.
Convergence Is
Prompting Change Nothing is more emblematic of the technology
convergence in healthcare than seeing what has occurred within biomedical engineering departments. Four years ago, the biomedical engineering department at the health center where I work reported to the clinical services division. Last year, senior management decided that biomedical engineering would now be part of Information Services. The decision was driven by convergence. Almost all the pieces of equipment managed and serviced by biomedical engineering departments have computers and network components within their core. Prior to 2000, most biomedical devices were standalone devices with no internal storage, management, or communication capabilities. That has all changed. All of these devices save lives. All of these devices need a network, and if that network fails people can die. The challenge for a healthcare CIO, as opposed to
a typical business support CIO, is providing a 24/7, high-availability network that can support the clinical requirements of the devices listed above. A high- availability business network always has maintenance windows of downtime. That would be a luxury for a high-availability healthcare network. So where does one start in designing a high-availability healthcare network? You begin at the very basic infrastructure foundation and then build up. This starts with electrical power and then the core design.
Electrical Needs
Specific to Healthcare Many CIOs never review or factor electrical power into
their network design. There are three electrical sources in a healthcare environment: street or raw power, emergency power, and life-critical (LC) power. Street power is no different than what a typical home has for a source of electrical power. The power is raw (not conditioned) and has spikes and drops (low voltage). This is fine for things like lights, TVs, and radios but definitely not for computers or networks. A computer room will have UPS systems that condition the power and can maintain power on batteries for a
short period of time (minutes) until emergency power kicks in. Emergency power is usually a standby generator source, and it takes a few minutes to be brought up to peak requirements. LC is a maximum redundant electrical source. It uses multiple raw power inputs, including multiple-source electrical substations. Both continuous running generators and raw power from the area’s electrical power grid in turn source the substations. Only a few years ago, healthcare networks were electrically powered by simple emergency power. When the conditioned grid power failed, then the UPS batteries held until emergency generators fired up. Although this sounds like a good redundant power plan, it’s riddled with single points of failure. Now with more and more clinical devices requiring computers and networks, the healthcare network needs LC power.
Network Changes In the past, not many IT people paid a lot of attention
to network core design. Most viewed the network core as the main pipe into which everything was plugged. The core became a single path of network cable that ran centrally through the institution. Well, that has changed dramatically. The core network now requires parallel and redundant devices. The core should be fiber-based. Copper network cores
are long gone. The minimum bandwidth of the core network should be 10GB. Interestingly, the core network doesn’t need to be significant in length. It doesn’t need to run the whole length of a building, from one end to the other. What is important is it provides redundant access and has dual paths and an electrical power source that’s always available. Its location should be secure. The core network closets should not be closets, and definitely not be the janitor’s closets. In the past, network closets were never planned in the design of a building. Now there are specific standards for data communication rooms or telecommunications rooms (DCR/TRs). A DCR/TR should meet the minimum requirements of the ANSI/TIA/EIA- 568-B standard. There are many designs for parallel and redundant
cores. A minimum design should be three DCRs with dual-core, redundant 10GB switches. Each closet should be powered by non-associated, separate LC emergency power. In the event of one room having any type of failure, the other two rooms can manage the network load. Performing maintenance on a healthcare network is equivalent to changing the oil on your car and rotating the tires while the car is speeding down the highway at 65 miles an hour. But this type of basic core design allows maintenance to be performed on the network equipment without taking out the entire network.
ABOUT THE AUTHOR: Al Gallant is the director of technical services at Dartmouth-Hitchcock Medical Center in Lebanon, NH.
Important Core
CONNECTION
VOLUME 1 • ISSUE 2
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