Tackling Communication Technology in a Doctor's Office

It might sound simple, but it isn’t. The project is a technical challenge, far more complicated than moving a commercial business. Why? There are life safety issues to consider as well as the business side of a medical practice.

The following from the old location need to be accounted for:
• Phone system with an auto attendant (they also use a live answering service)
• Six phones and five lines plus a dedicated fax line
• Computer local area network (LAN)—switch, server, five workstations
• A broadband line from a local carrier to provide high-speed Internet access that is always on and faster than the traditional dial-up access.

The new location will require a universal cabling system for maximum flexibility. Any station jack must be able to provide any service (voice or data).

Cable selection is important on many levels
First, we determined that the new office space will employ a return-air plenum HVAC service. We must use CMP (code approved) cable. We also want to use a cable that will deliver the performance needed today and over the next decade. We shopped the market and placed our order with Commodity Cables for four boxes of Cat 6 four-pair UTP CMP cable.

We installed proper cable support hardware from the communications closet (rack and patch panels) to the jacks. We used the ever-dependable Erico Caddy electrical fixings, fasteners and supports, including J-hooks and other related hardware.

Safety is too important to ignore, so whenever we penetrated a firewall, our factory-certified fire stop technician installed the proper hardware from Unique Fire Stop Products, a manufacturer of split sleeve and smooth penetrator systems for penetrating fire barriers. Unique fire Stop Products use intumescent sealants. 

The equipment room: the rack and ladder with ups
We properly grounded the rack and extended power to the Para System MinuteMan 1500 rack-mounted UPS. The UPS protects the LAN and the telephone system from surges and power outages. The system utilizes individual UPS units at each PC workstation.

We bolted the rack (with proper grounding) to the floor and to the overhead horizontal ladder. We installed the plenum-approved CMP Cat 6 four-pair UTP station cables overhead to the telephone/datacom equipment room and terminated on the top Cat 6, 48-port patch panel A. Other services such as the LAN and Telephone stations were terminated on the CAT6 48 port patch panel B installed below. Cat 6 patchcords allow the user to choose any station location for any service. We installed adequate cable management hardware on the rack for the cables and patchcords.

We also installed shelf units on the rack to accommodate the future installation of the LAN PC server with RAID, monitor, keyboard and mouse. This will allow server administration and management without interfering with the workstation personnel.

We installed a fire-resistant painted, ¾-inch plywood backboard on the rear wall to mount the telephone system, the computer LAN switch, alarm, telco, and CATV. All crossing cables, wiring and cords to the rack are mounted across the ladder to eliminate a tripping hazards.

The electrical contractor installed stub out conduit from the outlets to the plenum space with pull cords. Planning made the job go much smoother and faster.

Wall outlets
We used Siemon Z-Max Cat 6 Jacks. They are priced reasonably, install quickly, and are highly durable, delivering Cat 6 performance after multiple insertions. www.siemon.com We also installed cable runs and jacks at locations deemed appropriate for growth and future needs.

The Cat 6a UTP Z-MAX outlet offers great performance in every critical specification, exceeding all Cat 6a performance requirements, including alien crosstalk. Its innovative features not only accelerate and simplify termination, but remove installation variability for consistently high and repeatable performance.

After the station cabling was installed and connected at both the patch panel and the jacks, we tested the cable performance with the Fluke Networks DTX cable analyzer. All cable runs passed Cat 6 with significant headroom. Then we labeled all cables at both ends in accordance with the latest TIA standards using Rhino Industrial Labeling Systems.

Other design considerations used in healthcare facilities
Protected pathways: Pathways carrying data cables may need to be separated from other services, such as gases and liquids, that may share the above-ceiling spaces; additionally, these pathways must be fire-stopped.

Higher bandwidth demands: From transmitting imaging files (MRI, images) to video consultations, networks must work at higher speeds; They need to support 10G speeds in critical areas and 40G or 100G in the core.

Data storage: New government regulations require long-term storage for 7 years up to a lifetime, which means constant additions of servers and SANs to the hospital’s network.

Work area outlet: Each of the hospital’s networks should be easily identifiable within the outlet using color-coded modules or icons; additionally, outlets may need to be located in non-traditional locations, such as on a ceiling or on an overhead boom in an operating room. Stainless steel wallplates are available for critical care areas to make cleaning and sterilization easier.

Outlet densities: As more equipment is network-enabled, outlet density is dependent upon the number of applications the end-user needs to access at that workstation; more outlet connections correlate to additional bandwidth.

MUTUOAs: for retrofit applications, multiple user telecommunication outlet assemblies permanently mounted on a wall or in an architectural column are an option for areas where frequent rearrangements are required.

No office is complete without TV
We also installed coaxial cable to support CATV to screens in the waiting rooms and an office for future telemedicine broadcasts. All the RG6 coax cables were CMP and run to the DEMARC area in the communications equipment room.

Technology and privacy issues
We conducted several system reviews of the medical office after the move and uncovered an area of concern. The insulation in the walls (particularly the exam rooms) provided insufficient sound suppression. They could rebuild the walls for a small fortune or use technology to correct the problem area. The management had requested a quotation for a background sound system with music. After some research, we found an affordable sound masking system with music that would mask leaking sound and provide comforting music.

Technology plays an important role in HIPAA privacy for doctors and medical professionals
You know that HIPAA requires medical professionals to safeguard medical records by all reasonable means. You would never put patients’ paperwork on display, but you might not fully realize what is transmitted verbally. Whether it’s in the open waiting room, through the walls, or via a telephone conversation, the human voice travels. And what has become ordinary and routine to medical staff is very private and personal to patients. They expect professionalism, which includes safeguarding their medical histories in every way possible.

Sound masking and how it works
Perception is everything, and the patients need to feel valued and important enough that you took the proper steps to safeguard both their records and their conversations. Those steps include sound masking. Rather than re-design your entire office or hospital, you can install a simple but effective sound masking system.

Similar to the concept of “white noise,” sound masking systems employ compact speakers in areas where speech is heard to add low-level background sound to an environment. This low level noise fills in the spectrum of sound around building occupants to create an almost undeterminable low background signal, thus drowning out undesired speech or distracting sounds. Contrary to what you may think, sound masking systems use as low a level of sound as is necessary for covering and ultimately are not any louder than the gentle sounds typical of an air conditioning system.

Why is sound masking the best solution?
While adding absorption techniques, such as carpet and fabric interiors, can help ease sound leaks, they also require extensive cleaning and maintenance to remove airborne contaminant, not to mention deviate from desired aesthetics. Sound masking systems do not give off volatile organic compounds or contribute in the collection of dust mites or allergens. Rather than tearing out, replacing, or redesigning your office or building, sound masking systems can offer a nearly invisible solution. In addition, modern systems require almost no maintenance cost. The VoiceArrest system requires no tuning and uses a paltry 6 watts of electricity.

As in any business, the customer experience cannot be underestimated. Thriving practices grow because their patients have a great experience and high levels of satisfaction. While most physicians and office managers know this, sadly, office acoustics are often overlooked. The effects can be significant: a good “beside manner” can be undone by an overheard conversation from the exam room next door. You can increase your patients’ satisfaction level and, therefore, grow your practice by making simple and relatively inexpensive improvements to the acoustics in your office or building.

We also addressed other considerations:
• We moved and reinstalled network printers and scanners
• We moved and reinstalled fax machine and printer
• A specialty licensed contractor installed emergency lighting (installed by
• A specialty licensed contractor installed a fire alarm system
• A specialty licensed contractor installed a burglar alarm system

In summary, technology plays an increasingly major role in the practice and administration of our healthcare, from the large hospitals to the individual doctor's office. Even in tough economic times, the medical sector continues to grow and upgrade with new technology to improve the healthcare delivery systems.

BISBEE is with Communication Planning Corp., a telecom and datacom design/build firm. He provides a free monthly summary of industry news on www.wireville.com.

About the Author

Frank Bisbee

Freelance Writer
Frank Bisbee is with Communication Planning Corp., a telecom and datacom design/build firm. He provides a free monthly summary of industry news on www.wireville.com .

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