Totally Digital

It’s been more than 20 years since a new full-service community hospital has opened in Omaha. And it almost seems as if the Alegent Health Lakeside Hospital, set to debut in August, is the result of two decades of pent-up health-care design energy. “We wanted this hospital to have the latest technology and an infrastructure capable of change expansion in the future,” says Randy Rees, operations director for construction and design at Alegent Health. Omaha-based LEO A DALY was responsible for the architectural and engineering design of a facility that boasts some of the most sophisticated IT networks and building automation and medical systems anywhere.

“This new facility will be a full-service, all-digital ‘smart’ hospital, designed and built from the ground up with the latest medical equipment advances, IT networks and building technologies,” explains Terry Brown, Alegent’s operations leader for IT infrastructure on the project.

Brown explains that planners decided on a strategic course and wanted to see how far they could go with it. Their goal was to provide optimal patient comfort and care through a total integration of systems at the facility—an integration that depends very much on the communications network. “We pulled together a team of biomedical, facilities and security and IT systems folks to design the communications backbone,” Brown explains.

Central to the total integration philosophy are the “patient diagnostic center” and “patient procedure center” concepts, which had a major influence on the construction design. “The old way was to have patients go to different places in a facility for different services. At Lakeside Hospital, services are brought to the patients. The diagnostic center provides single-stop service for outpatient services, such as lab and radiology testing,” says Brown. “Now it’s all in one place. Patients will be able to go through the entire organization transparently.”

What this centralized approach means for the patient is a streamlined system of medical diagnosis and treatment. By bringing all of these services together in a digitally integrated, seamless process, the facility hopes to offer its patients a much more effective level of care.

“Lakeside Hospital is not about the use of high technology for the sake of high technology,” says Charles J. Marr, CEO of Alegent Health. “What we’re building … is a place where patients will be informed and comfortable and where the medical staff can practice with the best information available at all times. It’s an exciting concept whose time has come.”

Marr, who will be retiring as Alegent CEO at the end of June, has been a major visionary in the development of the facility. “Mr. Marr had the foresight to buy the land for Lakeside when there was nothing there,” says Brown. “Steady development of the area over the years has created a strong need for the Lakeside facility.”

But the story isn’t just about the Lakeside facility. The long-term plan envisions a seamless, integrated data network that includes all of Alegent Health’s eight hospitals and 100 clinics. All patient information, medical data and diagnostics—virtually all data that is produced by patient monitoring, testing and record-keeping systems—will be part of one enterprise-wide system and can be shared throughout the network.

However, standardizing medical equipment and patient data isn’t the only goal. Planners are also looking to provide standardization of building systems across all Alegent facilities, including all lighting, building automation systems (BAS), climate control and IT systems.

Lakeside BAS

In recent years, a number of controls vendors have begun to offer total automation solutions packages to the health-care industry. In September 2002, Alegent Health and Siemens announced a 10-year strategic alliance. The alliance includes four different Siemens operating companies and covers all Alegent Health hospitals and clinics in eastern Nebraska and western Iowa. Naturally, a primary goal of the alliance is to standardize digital systems throughout Alegent Health’s facilities. Siemens Building Technologies spokesperson Mike Ruggeri reports that BAS at the Alegent Lakeside Hospital includes the following:

• Building controls, fire safety and security systems are integrated on the same IT network, rather than on individual networks. This approach provided substantial savings in capital costs. For example, integration reduced the hospital’s wiring costs for its HVAC and security panels, chillers, variable-frequency drives and generators.

• The BAS platform provides integrated control of HVAC; indoor air quality; energy usage; fire alarms; and other critical alarm systems. The platform resides on one server that—in addition to Lakeside—provides integrated control to several other Alegent Health facilities. For example, from one server, the BAS provides environmental control to five other facilities, in addition to Lakeside. Alegent only has one server to maintain, while each building within its network retains stand-alone capabilities. Building control information can be accessed from any workstation within the network, resulting in improved patient comfort and employee productivity.

• A campus-wide, centralized paging system can send all critical alarm messages to facility engineers, technicians and security personnel via pager to a centralized call center located in one Alegent facility.

• Security systems include access control and a video surveillance/intrusion-prevention system. A single card is used for both ID and security. Also, the security system is integrated into Alegent’s IT network and Peoplesoft system to simplify the HR process.

• Advanced fire detection is integrated into the BAS. But whether it’s medical equipment, building automation or patient and staff communication needs, all of this high-tech handling of data depends on a sophisticated communications backbone, which in turn is based on a system that is both wired and wireless.

Wired and wireless

While networks are primarily hard-wired, wireless operation is a key component of the IT system, with the wireless standard being 100 Mb. “As for wireless, the plan is to have the capability to use wireless devices throughout the facility,” says Steve Nudd, director of customer relations with Siemens Medical Solutions.

In fact, at Lakeside, patient records will be all electronic. X-ray and other exams will be digital diagnostic images, and nurses and physicians will make changes in treatment and charting with digital assistant devices.

“A clinician can access any info or enter data using wireless devices. They also have wired capabilities throughout including patient rooms,” says Nudd. “The idea is to accommodate either wireless or wired connections anywhere vs. being part wired and part wireless.” Nudd goes on to explain that wireless will also include general Internet access for patients, families and physicians.

In other words, high-speed wired and wireless networking will serve the patients in many ways. With respect to health care, from the time they are admitted until they are discharged, their lives will be much simpler. Patient registration will be at bedside, where patient records, charts and diagnostic testing will all be handled electronically. Administrators are confident that this system will result in greater efficiency and greater patient safety.

And with a broadband, high-speed communications backbone, the patients are offered several electronic amenities that one doesn’t typically find in hospitals. “With Internet access, TV with digital capabilities and wireless Internet for laptops, we will have an entertainment system more like a hotel than a hospital,” observes Alegent’s Terry Brown. While a stay in the hospital is not exactly a vacation, designers have worked to make the experience as pleasant as possible.

Suppliers of medical and building systems were responsible for working with Alegent Health facility planners, construction and design, IT and diagnostic personnel to create the systems. The infrastructure was designed by a cross-organizational team. “We leveraged the contract to keep costs under control and as a starting point to determine the ‘future’ standards to be used at Lakeside,” says Alegent Health’s Brown.

Armstrong explains that consulting engineers knew how to make their contribution to the distribution system design from experience on similar projects. “We pretty much understand it’s a computer-based system. We’ve designed similar types of networks for hospitals and schools, most of which are in either a star or radial pattern,” he says. “Cable trays are run in definite patterns for future access and cable management. Another goal is to get communications closets stacked vertically for cabling and fiber-optic cabling efficiency.”

But wireless is only part of the story and only one means for communicating with a very advanced network. “We’re doing things that are leading-edge in this particular industry,” says Alegent IT specialist Brown. Specifically, the hospital is employing DWDM (dense wavelength division multiplexing), which is a fiber-optic transmission technique that employs light wavelengths to transmit data parallel-by-bit or serial-by-character. This is being implemented on the Wide Area Network that connects all the Alegent facilities. “We need a very high bandwith to share radiology, cardiology and other diagnostic imagery and video back and forth,” he says.

Along with the fiber-optics, there is a wired backbone. “Everything within the hospital is standard Cat 6,” says Brown. “It might look to some as if we overwired, but even though there wasn’t an immediate requirement, we wanted to plan ahead.” Brown points out that while networking costs have gone up, their return-on-investment models showed that the communications network design would be cost-effective.

Central to the digital hospital concept is the Picture Archive and Communication System (PACS). The images (like X-rays and CT and MRI scans) that PACS displays are better and clearer than traditional film or computer monitors. With the new system, the medical staff can also turn, enlarge and change an image to get the best view possible with the click of a mouse button. Several PACS monitors, which will be able to call up any patient image, will be available at Lakeside Hospital.

“It’s web-based data management system,” says Nudd. “At Lakeside, they will be able to look at patient historical data through the same browser they use for viewing other information and images. PACS manages the images, and our Sorian system manages the documents.”

Staff from the systems vendor are supplied with fictional data—such as patient information, billings and the like—in order to simulate communications infrastructure needs. “We do a lot of testing back at the lab. We do volume and scalability testing. We simulate customer volume. For example, we set up “x” number of users performing given functions in a given way,” says Nudd.

He explains that additional data is captured at bedside using a combination of PDAs, tablets and cart-based computers. Alegent staff has been exploring the bedside digital monitors that combine entertainment and data, but are not sure when they will implement that technology.

Patients will also notice their physicians and nurses using digital pads to access patient information, enter orders and check for drug interactions. It is hoped that this digital information system will reduce possible mistakes at every step. Particularly with medications, the Computerized Physician Order Entry (CPOE) system, coupled with Alegent Health’s existing robotic and medication administration systems, will vastly reduce possible drug dispensing errors.

“Unlike the hospitals of the past, which often relied on ‘islands of technology,’ the new Lakeside Hospital will be fully integrated and secured so clinical images and important patient information is available to health-care professionals when it is needed, where it is needed,” says Tom McCausland, CEO of Siemens Medical Solutions. “This improves patient care and efficiency and lowers costs at the same time.”

With the hospital’s opening scheduled for August, it remains to be seen how well all of these high-tech systems But the prognosis is good for it to be a model for health-care facilities well into the future.

Building Systems, Up and Running

New York City has more than its share of power dips and losses. Running a health-care facility in this metropolis calls for preparedness. And that’s why NewYork-Presbyterian Hospital makes it a priority. Staff need access to vital information on all building systems. They are already relying on the kinds of technology that will be deployed in the soon-to-open Alegent Lakeside Hospital in Omaha, Neb.

With two campuses comprising approximately 8 million sq. ft., administrators decided on 24-hr. monitoring and alarming of the facility’s upper Manhattan campus, which takes up six city blocks—about 5 million sq. ft. The most critical points for monitoring include power supply and the air-handling equipment in 30 operating rooms and 70 isolation rooms.

Two requirements were particularly important: diagnostic capabilities and remote monitoring. As a result, all of the hospital’s critical systems—multiple generators, mechanicals, critical operating room and isolation room equipment—are integrated into the BAS.

Moreover, the system generates daily reports that give hospital staff a schedule for routine maintenance needs. If a critical failure does occur, remote monitoring automatically informs key staff members by dialing a pager or cell phone.

The system vendor claims that since its installation, the system has cut downtime in half. Problems large and small are often invisible to patients and staff. Finally, temperatures are maintained at precise levels, and with an energy usage slow-down program for evening hours, the hospital reports significant energy savings, as well.

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Lakeside M/E Design

Alegent Lakeside Hospital, opening soon in Omaha, Neb., is cooled by two 600-ton chillers with variable-speed drives, with one chiller functioning as a redundant unit. Chilled water is circulated to the air handling units at 40

“Operating rooms are designed for extreme low temperatures, which seems to be pretty much a requirement these days,” says Clive Moore, lead mechanical engineer on the project for LEO A DALY. “The operating room staff wants the temperature to be lower and lower, and it’s possible to drop the chilled water to 38

For HVAC commissioning, the TAB contractor will do the air side, and the BAS vendor will do their own controls, says John Andrews, project manager with LEO A DALY. But he explains that there will be an initial two-month period to shake the building systems out. And LEO A DALY will monitor systems over a several-month period. “We usually take the approach that we have to go through a full year to shaking things out completely,” says Andrews.

As for the electrical, Mike Armstrong, lead electrical engineer on the project, is proud of the system redundancy for critical power. Two 13.8-kV power feeds are supplied from separate power company grids. Services are equipped with automatic throwover.

“We have one genset to carry half of everything, with capability for adding another,” says Armstrong. “And there’s a raised-floor computer room on the lower floor with UPS backup. Also, some diagnostic equipment is higher voltage and on a separate system.”

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