In 2006, Ministry Health Care and Marshfield Clinic joined forces to build the $92.5 million Weston Regional Medical Center in Weston, Wis. The 56-acre campus includes an 85,000-sq-ft medical office building, the 90,000-sq-ft Marshfield Clinic, and the 475,000-sq-ft, 104-bed St. Clare's Hospital. This article will discuss the cabling infrastructure and network integration that made St. Clare's one of the first fully digital and integrated hospitals in the United States and earned Ministry Health Care and HGA Architects and Engineers a Networked Controls Leadership Award from HPAC Engineering in 2007.1
A key objective was to create a state-of-the-art, all-digital environment that would establish Ministry Health Care and St. Clare's Hospital as leaders among health-care providers. This would increase visibility to the area, attracting and retaining high-quality medical professionals and ensuring high-quality health-care services.
To achieve this goal, Ministry Health Care required that all of its systems reside on a single cabling and communications backbone and be able to share information. This integrated system had to provide a higher level of service than stand-alone systems and be created with minimal effect on the budget and absolutely no effect on the schedule. The budget issue was addressed by employing a single cabling contractor and reducing cabling-cost duplication. It is estimated that these actions saved more than enough to cover additional system-integration costs. The schedule was kept on target with the hiring of a single integration contractor to handle the cabling, controls, and integration.
To create a single incorporated system, the Ministry Health Care facilities staff challenged the engineering team to develop an integrated building-management-system (BMS) solution. The design had to meet several basic goals, including:
Integrate the building systems so fire, security, and other systems can communicate directly with the building-automation system (BAS) without black-box technology.
Utilize the network backbone to run the building systems.
Have a single cabling contractor wire the entire building, including all of the building systems. This would simplify the installation and save money on the project.
Consolidate the building systems so money would not be spent buying redundant equipment. For example, a lighting-control system might have a microprocessor-based time-control system to turn lights on and off. Because the BMS already had these features built in, there was no need to purchase this equipment.
Integrate other components into the BMS, including vertical-transportation, nurse-call, power-monitoring, pneumatic-tube, and select medical equipment. The idea was to gather information in one location and make that data accessible to facilities staff via the hospital network or Web portal. Therefore, management and maintenance work would go through the information-technology (IT) department.
The IT and facilities departments of Ministry Health Care's corporate offices were highly involved in the process. This provided opportunities and challenges for the design team. As the project was nearing completion, the operations-and-maintenance staff was hired while the design and installation team worked with the owner to educate and explain the systems and integration. Because the new staff observed the commissioning, the systems were easier to understand. Recommissioning occurred one year after the owner took occupancy of the facility. This opportunity was used to address operational concerns and retrain the staff in the design intent and continued operation of the facility.
Because of the network integration, data is accessed through the main firewall. Utilizing a Web interface, Web access was set to one location, and access control was set with specific parameters (i.e., certain people were granted access to admitting, billing, security, etc.). The result: Anyone with the correct login and security clearance can get to the information — now all on one network — through the same single connection.
Today, Weston Regional Medical Center is a “chartless” multispecialty clinic and hospital, one of the few medical facilities in the world to have paperless medical records. Physicians and nurses have instant access to patient records through a wireless computer tablet linked to state-of-the-art integrated electronic medical records created by Marshfield Clinic. Details of a patient's visit are available immediately to providers on campus, as well as throughout the Ministry Health Care and Marshfield Clinic systems.
More than 50 systems were integrated on the same backbone, although not all of them needed to talk to each other. The BMS hardware, installation, wiring, terminations, software, programming, commissioning systems, and project management were included within the scope of the bid documents, which were produced by the design team. The contract was bid directly to the general contractor.
The design team also took measures to ensure the proper design and successful implementation of the BMS, which meant providing a clear understanding of the final integrated solution. An integration spreadsheet that listed equipment, how the equipment would be integrated, and what points would be monitored via the BMS was created. The spreadsheet was used to verify that the solution met the owner's expectations.
The following were interfaced with the BMS: electric dumbwaiters; electric-traction passenger elevators; hydraulic elevators; a pneumatic-tube system; medical-gas piping; firetube boilers; centrifugal water chillers; open-circuit mechanical-draft cooling towers; air-handling units (AHUs); domestic-water heating; pumps; valves, dampers, and other end devices; lighting-control devices; packaged engine generators; a rotary uninterruptible power supply; modular metal-enclosed switchgear; generator-paralleling switchgear; transfer switches; switchboards; nurse-call system; lighting controls; variable-speed drives; a card-access/security-management system; an infant-protection system; a patient-wandering system; the fire-alarm system; closed-circuit-television (CCTV) equipment; an automatic control system; an operable-window contact; a bulk oxygen-tank level; utility systems; water meter; a natural-gas meter; an electric meter; various medical equipment; and clinic-building utility submetering — heating hot water, cooling, domestic hot water, cooling water, and steam.
The BAS addresses interoperability and integration of multiple systems, such as fire/smoke, submeters, irrigation, security, and lighting, by integrating them on a single backbone with an open protocol sharing information. For example, the fire-protection system was interfaced with the smoke-control systems for the atrium and inpatient unit. Smoke detectors in these areas activate the smoke-control sequence for the area that impacts AHUs, smoke dampers, exhaust fans, fire notification, elevator positions, smoke doors, and variable-air-volume boxes.
The BMS measures energy use and produces reports that provide the owner with information on current energy usage. The BMS, via energy meters, measures the use of electricity, chilled water, steam, domestic water, and domestic hot water. This provides access to instantaneous or historical energy-use information. Operators use this to detect energy waste, conservation opportunities, and system problems and to determine tenant energy use for cost accounting. Plant-energy trendlogs track energy use for the entire building, not just pieces of equipment.
Additionally, tenant billing is handled using integrated monitoring, and a regular report can be generated. Submetered data directly populates a billing spreadsheet, showing energy use and costs, including domestic cool water, domestic hot water, heating hot water, chilled water, and chemical use.
The BMS is pulled together via a user-friendly system that uses a combination of graphics and spreadsheets for user interfacing. These spreadsheets were designed to allow for ease of navigation and to simplify building operation.
Since the hospital's opening, various benefits have become evident, including:
Less maintenance. The IT department is responsible for the maintenance of the cabling infrastructure. Also, the hospital has electronic medical records — paper records are not utilized. Rather than employ eight people to sort papers, three IT staff members manage the digital process. This creates a single point of responsibility and control, which eliminates conflicting and redundant maintenance costs. This sharing of infrastructure means clinicians, facilities, and IT-staff members talk and work together. This approach fostered a collaborative partnership on campus. The teams found themselves focused on making the patient experience as convenient and easy as possible and were less concerned about territories, finger-pointing, and individual budgets.
Training. HGA and the controls vendor provided training for the owner on the integrated BMS. The vendor completed the system's maintenance plan, which included the treatment of sensors, controller software, and operating stations, and provided hands-on training for the BMS. These sessions were videotaped for future training of facilities personnel and as a reference resource for current personnel. In addition, facilities personnel were in attendance for the commissioning of the BMS, which was performed by HGA and the controls vendor. This provided valuable information to facilities personnel on how the design engineer intended the system to operate.
Better patient experience. Patients have access to important medical information and entertainment on a networked video system. Television, movies, patient information, etc., are fed over the Ethernet, so no additional cabling is needed.
Accurate charting. The medical staff is able to maintain more-accurate charting. Total records access is available from the clinic to the hospital. For example, if a patient is seen in the emergency department and then goes to his clinic doctor, his medical information is online and instantly available.
Shared network. There is a benefit in having fire alarms, BAS, and security share the same network. Key decision-makers in these departments can coordinate efforts when needed because they all are able to see the same information at the same time. For example, individuals or a team can log on to the network via a laptop computer and review, analyze, and control all of the campus' functions. This might include closing outside-air dampers, monitoring the building perimeter via CCTV, or adjusting the lighting. If a community emergency occurs, information can be transmitted easily from security to the BMS.
Cost management. Another benefit is the ability to manage costs. The BMS allows for collecting, analyzing, and tracking utility bills. This integrated system calculates usage and can send out bills to various departments. The information from the network is disseminated in real time, so departments can see what they are using and when it is being used.
Cautions. Hospitals are regulated for system redundancy and safety precautions. For this type of network integration, a reliable electrical-power system, backup generators, and power quality are essential. At the Weston Regional Medical Center, there are multiple backup generators and a rotary uninterruptible power system that provides clean power to the critical systems. In addition, these systems are checked regularly with real-time, in-use tests while the proper staff stands by to handle any emergency. Beyond that, the system has extensive security measures that the hospital does not make public.
Besides a Networked Controls Leadership Award, St. Clare's Hospital has received several honors since opening in 2005. In 2006, it was recognized with a Healthcare Informatics IT Innovator Award and the IT Executives' Choice Award for Best Case Study at the Gartner Healthcare Summit. In 2007, the hospital was recognized by Health Imaging & IT as one of the “Top 25 Innovators in Healthcare,” was awarded First Honors in the Hospital IT Strategy Challenge category at the Toward an Electronic Patient Record Conference, and was named by Hospitals and Health Networks as one of the “Top 100 Most Wired Hospitals” in 2006 and 2007.
This design solution will allow St. Clare's Hospital to grow in a smooth and efficient manner over the next 20 to 30 years, ensuring it will not lose services or disrupt patient care along the way.
Best practices in BAS/controls. (2007, May). HPAC Engineering, pp. 40-44, 46-47.
ABOUT THE AUTHORS
Roger Lautz, PE, HFDP, is the director of mechanical engineering for HGA Architects and Engineers' Milwaukee office. He directed the commissioning phase of St. Clare's Hospital and has designed HVAC systems for hospitals, clinics, laboratories, and other large-scale facilities. Jim Koehler is the director of specialized services for HGA. He directed the design of St. Clare's fully integrated data backbone, including the clinical integration. He specializes in integrated-IT, telecommunications, and security systems. Rick Hombsch, PE, is a principal and electrical engineer in HGA's Milwaukee office. He directed all of the phases of St. Clare's integrated electrical systems. His electrical-engineering expertise includes lighting, power, power distribution, telecommunications, and low-voltage systems, among other technical areas for large-scale health-care projects.