Protecting Healthcare Technology

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    Protecting Healthcare Technology - Presentation Transcript

    1. A White Paper from the Experts in Business-Critical ContinuityTM Best Practices in Protecting the Technology Systems Revolutionizing Healthcare
    2. Executive Summary Technology systems such as electronic medical records and digital imaging are revolutionizing healthcare by streamlining processes, eliminating waste, improving accuracy and, most importantly, improving patient outcomes. As these systems become seamlessly woven into the fabric of how healthcare is delivered, their continuous operation becomes increasingly critical. Yet, the explosive growth of healthcare IT applications is making it more difficult to achieve continuous operation both in the data center and throughout the hospital. While today neither electrical code nor the hospital accreditation standards of the Joint Commission require healthcare organizations to use uninterruptible power supplies (UPS), most have begun doing so to protect vital equipment and systems. Currently it is common practice for healthcare facilities to install UPS backup at the device level, such as an MRI machine or computer server. As the number of UPS units located throughout the facility grows, however, so does the complexity of managing them to keep the devices they protect continuously online. Additionally, device-level protection does not enable the ability to add loads as critical systems spread throughout the hospital, particularly in the operating rooms, patient rooms and nurses stations. This paper outlines an approach to power protection that addresses the problems that accompany the distributed approach. The centralized approach to power protection presented here enables healthcare organizations to achieve higher availability and scalability for future growth at lower cost and should be considered for all new healthcare facilities and, whenever possible, in retrofit situations. Emerson Network Power has developed three centralized UPS configurations specifically for healthcare settings, which we recommend based on the level of protection and seamlessness of operation desired. 1
    3. Introduction • Picture archiving and communications systems Information technology is being integrated Picture archiving and communications throughout healthcare operations to improve systems (PACS) provide faster access patient care, service levels and operating to diagnostic information, reduce the costs. Through the use of technologies such need for film and film storage, virtually as digital diagnostic equipment, electronic eliminate the problem of lost films, medical records and patient RFID, the and increase radiologist and physician healthcare industry is benefiting significantly satisfaction and productivity. Because of from increased accuracy and efficiency. the efficiencies and cost saving associated Consequently, these innovations have with their use, the size of the U.S. market become vital tools on which medical and for PACS should reach $8.6 billion by other staff increasingly rely to perform 2011, which represents 76 percent their roles in the healthcare system. growth over its size in 2007.2 A walk through an endovascular hybrid • Wireless communications operating room, for example, reveals a While healthcare is often behind other sophisticated control center incorporating industries in adopting new technologies, monitors, workstations and communications it has been a leader in the use of wireless equipment along with diagnostic and technology. Clinicians are ready users treatment devices. This ability to integrate of mobile devices, and hospitals have and comprehensively control equipment, moved quickly to deploy IP telephony information and environments is being and wireless LANs to save money and replicated on varying scales throughout more effectively provide connectivity healthcare facilities because doing so makes in older buildings. As a result, wireless patient care safer and more efficient, which healthcare applications have become improves outcomes. key to optimizing the benefits of EMR. Healthcare Technology Trends • Pharmaceutical barcode/RFID technology Pharmaceutical barcode/RFID technology The desire to improve patient care, as well as is designed to ensure the right patient factors such as federal government initiatives gets the right dose of the right medication and physician attraction and retention at the right time. It aids compliance with strategies, are driving the deployment of state and federal regulations requiring new technologies throughout healthcare additional product tracking to curb information systems. Among the most drug counterfeiting and improve patient important of these technologies are: safety and integrity. According to a 2008 study of RFID trends, 76 percent of larger • Electronic medical records healthcare organizations have invested Implementing electronic medical records in RFID-based solutions.3 (EMR) makes healthcare workflows more efficient, improves the quality of patient Within the new digital healthcare care and reduces costs. The use of EMRs environment, IT is the link connecting is expected to grow 14 percent annually the facility’s medical staff (whether they through 2011.1 are located in the OR or a patient’s room) 2
    4. with patient data stored on servers in the data When implementing a UPS system it’s center. This link can be broken when problems important to understand future requirements in the data center, such as brownouts, shut and ensure a growth plan is in place to cost- down the system; or when the power supply effectively meet those requirements. Providing inside the hospital is disrupted because of just the capacity required today – with no weather disturbances, voltage surges or growth plan – can constrain future growth other abnormalities. and increase the cost and disruption of future technology. As availability requirements The tremendous growth in the use of rise, power system redundancy is often technology is having an impact both in the implemented to reduce single points of failure, data center, where technology systems have enable future growth and increase operating traditionally been housed, and in the facility flexibility. itself, which now must support a complex, interrelated network of technology systems that For more information on high-availability extend from the data center to the bedside. data center power protection, refer to the Emerson Network Power white paper, Power Supporting IT Growth in the Data Center Management Strategies for High-Density IT Systems and Facilities, available at Reliance on IT to diagnose and treat patients www.liebert.com. and improve organizational efficiency brings a new set of concerns for healthcare IT Cooling management in meeting rising expectations Proper environmental control – temperature, from surgeons, doctors, nurses and patients. humidity and air quality – plays a key role The required increase in computing capacity, in overall continuity. As more servers and file storage and performance creates a storage systems are added to the data center, corresponding need to have greater control the existing cooling system may be unable to over the IT infrastructure in order to assure the keep temperatures in safe operating range. continuous operation of technology systems. When sensitive electronics operate at higher than normal temperatures, their short-term In the data center this means transitioning to reliability is compromised and long-term an infrastructure that can support “always on” viability is significantly decreased. operations while scaling to support continued growth in server and storage capacity as well as Cooling system scalability can be changing with new technologies and methods. accomplished via supplemental refrigerant The key areas of the IT infrastructure that or chilled water cooling systems, such as the hospital IT executives must consider as they Liebert XD™ system, that bring cooling closer retrofit existing data centers or plan for new to the source of heat. This allows cooling to data centers are: be focused where it is needed most and can be added to, rather than displace, the existing Power cooling system. The data center needs disturbance-free, uninterrupted power to do its job. An online For more information on data center cooling, double conversion uninterruptible power refer to the Emerson Network Power white supply (UPS) is the only such system that paper, Blade Servers and Beyond: Adaptive protects against the full range of power Cooling for the Next Generation of IT Systems, disturbances and is the best practice available at www.liebert.com. for mission-critical applications. 3
    5. Monitoring The Joint Commission 2009 chapter on The third line of defense in keeping a data Emergency Management establishes center up and running is effective monitoring standards to ensure that healthcare and automated data analysis. A centralized organizations have documented response approach to monitoring power and cooling procedures to be without utility power for systems can increase visibility into system 96 hours. The chapter on Environment of performance, enable more effective preventive Care includes several standards impacting maintenance and speed response to power continuity, including: equipment problems. • EC 02.05.01: The [organization] manages For more information on data center all risks associated with its utility systems. monitoring, refer to the Emerson Network Elements of Performance include Power white paper, Managing Critical Systems mapping the power distribution systems, for Higher Availability and Reliability, available documenting procedures for responding at www.liebert.com. to outages and documenting procedures to perform clinical interventions Supporting IT Growth in the Hospital during disruptions. While the changes that are occurring in the • EC 02.05.03: The [organization] has a data center are evolutionary, the changes reliable emergency power source. This occurring on the facility side are revolutionary standard recommends the essential and may dictate a completely new approach electrical distribution system complies to healthcare power protection. With the with National Fire Protection Association increased dependence on technology, (NFPA) 99. a power disruption inside the hospital or healthcare facility can lead to: • EC 02.05.07: The [organization] inspects, tests and maintains emergency power • Lost patient data systems. The testing procedure must • Corrupted diagnostic images conform with NFPA 110. • Patients and staff waiting for IT reboot – Test the generator 12 times a year • Comprised patient safety for 30 minutes at 30 percent of load • Hospital staff dissatisfaction and – Test all automatic transfer switches reluctance to use IT 12 time a year • Damage to expensive equipment – Test the generator once every 36 • Lost revenue because equipment is months for 4 hours on 30 percent load unavailable (e.g., during MRI recharge) Depending on transfer equipment design, Article 517 of NFPA 70, National Electrical complying with the monthly testing standards Code, requires hospitals to have a power could cause hospitals to have outages 24 times transfer switch and a quick-start backup a year (once when switching to generator and generator that will be available to carry load in once when switching back to utility for each 10 seconds. Recognizing the risks to patient generator test). While the tests are conducted safety posed by power outages within the at the least critical times, every outage at environment of care and under emergency minimum causes unprotected IT systems to management situations, the Joint Commission reboot and electronic equipment throughout has established standards for power continuity the hospital will need to be reset. that augment what is required by code.4 4
    6. While the Institute of Electrical and Electronics small servers is a management nightmare Engineers is not an accrediting agency, it and reduces power system reliability and does recommend as a best practice the use of scalability (each new device requires an transient voltage surge suppressor products additional UPS). As a result, virtually all data (TVSS)5 and uninterruptible power supply centers now employ a centralized UPS system, systems in healthcare facilities.6 Typical because that is the only way to achieve the applications recommended for backup support high availability required. include sensitive laboratory and diagnostic equipment, life-support equipment in intensive Hospitals have been deploying UPS units care units, data processing systems, and for to protect individual diagnostic devices for illumination in life-support areas. years. A typical deployment of UPS systems on the critical branch is shown in Figure 1. While the IEEE recognizes using UPS The telephony system and the MRI machine backup in healthcare facilities as a best each is protected by its own UPS (likely practice, there also are best practices in purchased with the equipment the UPS is how to deploy a UPS system. protecting), but the nurses stations and operating rooms are left unprotected and The Move to Centralized susceptible to power surges, voltage sags Power Protection and interruptions. With the proliferation of technology that is occurring today, this The changes in healthcare IT are mirroring approach has become less practical, less changes that occurred in the data center 10 economical and more risky. to 15 years ago. When servers were first being deployed in data centers it was common for Instead of providing protection at the device each server or server rack to be configured level, hospitals will find they can achieve with its own UPS. As servers continued much higher power availability and simpler to proliferate, that approach became less management by moving power protection practical. Besides the growing cost of adding upstream. For smaller facilities this may multiple UPS systems, maintaining multiple mean providing a single, large UPS directly UPS1 Data Closet Genset ATS Distribution UPS2 MRI Utility Source Nurse Station O/R Patient Rooms ATS = Automatic Transfer Switch UPS1 = Small Uninterruptible Power Supply UPS2 = Midsize Uninterruptible Power Supply Figure 1. A typical critical branch with a distributed UPS configuration that provides UPS backup for devices such as the MRI and the wireless telephony system, but leaves the nurses stations and operating rooms unprotected. 5
    7. downstream of the Automatic Transfer standards regarding backup power. These Switch to the facility; larger facilities may configurations are presented for reference require multiple critical branches with a single purposes only and a professional engineer large UPS on each branch. In either case, a should always be involved when configuring centralized UPS which resides upstream of power protection for any life-critical application power distribution can provide protection for which our equipment is installed. for multiple devices in the facility, creating a power protection system that is more reliable, Each configuration is based on an online more scalable and more manageable than the double-conversion, three-phase UPS, distributed approach. such as the Liebert NX™ or Liebert NXL™ product families. Online double conversion As illustrated in Figure 2, the centralized UPS systems provide the highest degree of approach provides UPS backup to all loads protection of any UPS system. By converting inside the hospital and supports the ability to incoming power to DC and then creating a add loads for future operating rooms and other clean AC waveform from the DC power, online critical spaces and equipment. This ability to double conversion systems remove every type add/grow loads enables hospitals to implement of power disturbance, effectively isolating redundant operating rooms where surgery downstream equipment from the incoming suites are being powered by different critical power source and are less dependent on the branches of the hospital’s power system. alternate AC power source (typically a diesel genset) for power conditioning. Recommended UPS Configurations Three-phase UPS systems provide greater Emerson Network Power has defined three flexibility in distributing power downstream levels of UPS configuration suitable in life- and generally support higher capacities, deliver critical applications for healthcare facilities greater reliability and enable more advanced that are in compliance with Joint Commission monitoring than single-phase systems. Genset Genset Nurse Station Large Data ATS Distribution Closet UPS O/R Large Distribution MRI ATS UPS Suites Future Future CT O/R ATS Large Distribution UPS Utility Patient Source Rooms ATS = Automatic Transfer Switch Large UPS = Large Uninterruptible Power Supply with a maintenance bypass Figure 2. The centralized approach to UPS installation utilizes a large UPS system at each critical branch to provide protection for all loads inside the hospital. 6
    8. In each case, UPS backup power can be special disposal requirements because they delivered by either a battery system, as is do not contain hazardous materials. typically used in data center applications, or a flywheel system. The flywheel system provides Lastly, regularly scheduled preventive energy efficient, short-term backup power and maintenance is required for all UPS systems is ideal for use in applications with fast-start operating in healthcare facilities. The generators. According to the Electric Power recommended schedule is every three Research Institute (EPRI), 98 percent of all months for systems with batteries, once outages last less than 10 seconds. Flywheel a year without batteries. units can provide instant ride-through power and voltage stabilization for up to 13 seconds Basic Configuration for a Hospital’s (or other combinations of power and time) — Centralized UPS more than enough time to switch to generator. Flywheel units are parallelable for additional The minimal configuration for centralized capacity and/or redundancy. power protection in a life-critical healthcare environment is shown in Figure 3. The UPS Compared to batteries, flywheels have a low is connected downstream from the Automatic installation cost, take up minimal floor space Transfer Switch that transfers utility power and have a design life of 20+ years. Flywheels between the utility and generator. As noted also have a smaller environmental footprint previously, this switchover has traditionally than batteries. They do not need special created a 10-second interruption in power ventilation or air conditioning, and have no availability as the generator starts up; Basic Safety Utility Interlock MBB ATS MIB MBS Generator SS R ATS I UPS ES ATS = Automatic Transfer Switch ES = Energy Storage UPS = Uninterruptible Power Supply MBS = Maintenance Bypass Switchboard R = Rectifier MBB = Maintenance Bypass Breaker I = Inverter MIB = Maintenance Isolation Breaker SS = Static Switch Figure 3. With the basic centralized configuration, the UPS is connected downstream from the Automatic Transfer Switch that transfers utility power between the utility and generator, and maintains power availability during this process. Diagram is for reference purposes only; not all inputs, breakers and TVSS products are shown. 7
    9. however, the UPS allows power availability event of a UPS failure. Should that occur, to be maintained continuously during the the length of the outage will depend on transition from utility to generator power and how quickly someone can get to the MBS from generator back to utility. By deploying a and transfer power. However, without a UPS, power availability can be elevated from redundant UPS, the UPS still represents a the 98.8 percent provided by the utility to single point of failure. approximately 99.999 percent for the total power system. Intermediate Configuration for a Hospital’s Centralized UPS The UPS does represent a single point of failure between the utility/generator The intermediate configuration, shown in and downstream equipment. Therefore, Figure 4, replaces the manual bypass with a it is imperative to have at least a manual combined automatic open transfer function bypass, provided by the maintenance and manual bypass, separate from the bypass switchboard (MBS) – including a upstream automatic transfer switch (ATS). safety interlock to prevent both breakers This MBS can also detect an interruption in being manually closed at the wrong time – UPS output power and automatically switch connected to the UPS to route utility power to utility (or genset) power through ATS. around the UPS during UPS maintenance. Unlike the high-speed Static Transfer Switch A maintenance bypass also provides a used in the High Availability Configuration basic level of protection in the unlikely discussed next, this MBS switchover takes Auto-open Transfer Switch to MBB with UPS failure Utility MBB ATS MIB MBS Generator SS R ATS I UPS ES ATS = Automatic Transfer Switch ES = Energy Storage UPS = Uninterruptible Power Supply MBS = Maintenance Bypass Switchboard R = Rectifier MBB = Maintenance Bypass Breaker I = Inverter MIB = Maintenance Isolation Breaker SS = Static Switch Figure 4. The intermediate configuration delivers the same projected availability as the basic configuration, but substantially reduces the risk that a catastrophic UPS failure could cause an outage of greater than 10 seconds. Diagram is for reference purposes only; not all inputs, breakers and TVSS products are shown. 8
    10. about 0.5 seconds to automatically transfer sensitive downstream equipment to continue power, so downstream equipment will operating without interruption in the event experience a momentary interruption of UPS failure. in power that will cause electronic systems to shut down and restart. This configuration This configuration delivers the high delivers the same projected availability as the availability power protection offered in the basic configuration, but eliminates the risk basic and intermediate configurations while that a catastrophic UPS failure could cause an protecting against the possibility that UPS outage of greater than 10 seconds. Return to failure will cause an outage. For that reason, UPS output power is by a manual switchover this configuration is recommended for most of the MIB and MBB breakers. healthcare facilities employing technology- based diagnostic or patient-care systems. If High Availability Configuration for a Hospital’s the STS is located close to the UPS, because Centralized UPS it has the needed circuit breakers built in, it can also serve as the maintenance bypass. If The high availability configuration (Figure 5) the STS is physically separated from the UPS, uses a Static Transfer Switch (STS) in place a separate maintenance bypass (MBS) should of the MBS automatic function used in be configured with the UPS. the intermediate configuration. The STS switches power seamlessly between the Table 1 summarizes, in the unlikely event of a UPS and utility to enable even the most total UPS failure, whether the load would be Utility STS ATS Generator SS R ATS I UPS ES ATS = Automatic Transfer Switch SS = Static Switch UPS = Uninterruptible Power Supply ES = Energy Storage R = Rectifier STS = Static Transfer Switch I = Inverter Figure 5. The high availability configuration uses a Static Transfer Switch to switch power seamlessly between the UPS and utility, enabling all downstream equipment to continue operating without interruption in the event of a total UPS failure. Diagram is for reference purposes only; not all inputs, breakers and TVSS products are shown. 9
    11. dropped or maintained depending on which 2. Does a maintenance plan with clear lines power protection configuration is deployed. of responsibility exist to keep multiple UPS units spread throughout the facility Benefits of Centralizing Healthcare in good working order through Power Protection monitoring and battery maintenance? The benefits of a centralized UPS are significant 3. Will equipment and systems that require and make it an easy choice for new facilities. UPS protection continue to be added, Existing facilities that are already well down rendering a device level approach more the distributed UPS path face a tougher costly than a distributed strategy without decision, as their current approach may remain creating benefits such as the ability to feasible for the short term. However, these protect all loads inside the hospital? organizations should look for opportunities to push power protection upstream. Anytime In summary, the advantages of a centralized new technology initiatives are being deployed, power protection strategy compared to the or facility upgrades or expansions are being distributed approach include: planned, is a good time to evaluate the power (and cooling) infrastructure. Higher Availability • All loads inside the hospital are on Following are some questions to help uninterruptible power, so critical medical determine whether an existing facility equipment and information systems do has reached the limits of the protection a not go down for 10 seconds when the distributed approach can provide and may power goes out. Loads are protected be putting patient care at risk: from transients as well as outages. • Depending on the chosen centralized 1. Can the facility, especially critical-life configuration, availability ranges from areas such as operating rooms and 99.99964 percent to 99.99979 percent – catheterization labs, be without power for throughout the hospital. 10 seconds while waiting for the generator to power up during a utility outage? What Scalability is the impact of the 10-second outage • New technology is protected simply by on patient safety and confidence, and plugging it into the protected outlet. surgeon satisfaction? • With today’s large, scalable UPS systems, loads can be added without having to add Catastrophic UPS Failure? Configuration Manual Automatic Load Load Bypassing Bypassing Dropped Maintained No UPS (ATS only) Yes No Yes No UPS + MBS Yes No Yes Manual xfer with break UPS + MBS xfer Yes Yes Yes Auto xfer (0.5 seconds only) with break UPS + STS Yes Yes No Yes Table 1. The UPS with automatic bypass to STS maintains the load in the unlikely event of a total UPS failure. 10
    12. more UPS modules, thereby protecting Simpler Management and Maintenance the initial investment in power protection. • With far fewer, larger UPS modules, • And, when significant additional power there is less to monitor and maintain. is needed, modern UPS systems can be • While a large UPS creates a bigger configured to be easily expanded with footprint, it is in an out-of-the way minimal or no interruption to UPS power. electrical room instead of in prime real estate, as is often the case with device Greater Reliability level UPS protection. • Reliability is increased when UPS • If flywheel technology is used instead monitoring, testing and battery of batteries, maintenance needs are replacement are centralized. dramatically reduced. Flywheels also • With everything inside the hospital take up less floor space. protected by UPS systems, the monthly generator test can be conducted at Improved Efficiency 100 percent load instead of only • Large UPS systems such as the Liebert 30 percent load and will not NXL, can be up to 94 percent efficient, cause outages. while smaller UPS units may have efficiencies under 90 percent. Initial Purchase and Five-year TCO • If the centralized system uses (4) 100kvA UPS (1) 400kvA UPS flywheels, they are significantly more energy efficient than batteries, and have a much better overall environmental profile. Lower Cost • The initial cost of deploying a large UPS is lower than deploying a few small Cost UPS units; and as small UPS deployments grow, the total cost of ownership will be significantly higher than a large UPS system, as illustrated in the example in Figure 6. • Higher costs are incurred for monitoring, testing and replacing Year 1 Five-year TCO batteries for multiple small UPS units. • Increased local heating where small Figure 6. The initial cost of four 100kVA UPS UPS units are deployed requires units is twelve percent more than the cost of one investment in more comfort cooling. 400kVA UPS. The five-year TCO on the 400kVA module is 26 percent less than the TCO for the • If flywheel technology is used, it pays four smaller units. (Unit price, battery, battery for itself soon after the first battery cabinet, shipping, start-up, unit maintenance replacement and provides savings and battery maintenance are included in the over batteries for the rest of the cost calculation. Costs related to cooling, real UPS systems life. estate and battery replacement are not included; however, each of these would increase the five- year TCO for the four 100kVA UPS installation.) 11
    13. Conclusion References Hospitals and other healthcare facilities are 1. Kalamora Information, 2007. turning into data centers, with increasing U.S. Market for EMR Technologies. reliance on digital technologies to help 2. Datamonitor, 2007. Digital Imaging: improve patient care, increase efficiency and Reducing Medical Error and Improving lower costs. To ensure continuous availability Diagnostics. of life-critical information and equipment, 3. Spyglass Consulting Group, 2008. hospitals can turn to proven power protection Trends in RFID 2008. strategies used in 24/7 data centers delivering 4. The Joint Commission, 2009. high 9s availability. When compared to the Hospital Accreditation Program. device level approach, deploying a centralized 5. Institute of Electrical and Electronics UPS system allows hospital IT management to Engineers. IEEE Std 1100-2005. IEEE maximize power protection at the best cost, Recommended Practice for Powering while enabling future growth. and Grounding Electronic Equipment (Emerald Book). 6. Institute of Electrical and Electronics Engineers. IEEE Std 602-2007. IEEE Recommended Practice for Electric Systems in Health Care Facilities (White Book). 12
    14. Emerson Network Power 1050 Dearborn Drive P.O. Box 29186 Columbus, Ohio 43229 800.877.9222 (U.S. & Canada Only) 614.888.0246 (Outside U.S.) Fax: 614.841.6022 EmersonNetworkPower.com Liebert.com While every precaution has been taken to ensure accuracy and completeness in this literature, Liebert Corporation assumes no responsibility, and disclaims all liability for damages resulting from use of this information or for any errors or omissions. Specifications subject to change without notice. ©2009 Liebert Corporation. All rights reserved throughout the world. Trademarks or registered trademarks are property of their respective owners. ®Liebert and the Liebert logo are registered trademarks of the Liebert Corporation. Business-Critical Continuity, Emerson Network Power and the Emerson Network Power logo are trademarks and service marks of Emerson Electric Co. ©2009 Emerson Electric Co. WP167-39 SL-24637 Emerson Network Power. The global leader in enabling Business-Critical Continuity™. EmersonNetworkPower.com AC Power Embedded Computing Outside Plant Racks & Integrated Cabinets Connectivity Embedded Power Power Switching & Controls Services DC Power Monitoring Precision Cooling Surge Protection
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