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Best Practice in Protecting The Technology Systems
Best Practice in Protecting The Technology Systems
in Business-Critical ContinuityTM
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
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
2
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
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
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
Utility
Source Nurse Station
O/R
Patient Rooms
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
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.
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
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.
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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
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.
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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
SS
R
ATS I
UPS
ES
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.
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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
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
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
Table 1. The UPS with automatic bypass to STS maintains the load in the unlikely event of a total
UPS failure.
10
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
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Conclusion References
1. Kalamora Information, 2007.
Hospitals and other healthcare facilities are U.S. Market for EMR Technologies.
turning into data centers, with increasing 2. Datamonitor, 2007. Digital Imaging:
reliance on digital technologies to help Reducing Medical Error and Improving
improve patient care, increase efficiency and Diagnostics.
lower costs. To ensure continuous availability 3. Spyglass Consulting Group, 2008.
of life-critical information and equipment, Trends in RFID 2008.
hospitals can turn to proven power protection 4. The Joint Commission, 2009.
strategies used in 24/7 data centers delivering Hospital Accreditation Program.
high 9s availability. When compared to the 5. Institute of Electrical and Electronics
device level approach, deploying a centralized Engineers. IEEE Std 1100-2005. IEEE
UPS system allows hospital IT management to Recommended Practice for Powering
maximize power protection at the best cost, and Grounding Electronic Equipment
while enabling future growth. (Emerald Book).
6. Institute of Electrical and Electronics
Note: Materials sold hereunder cannot be used in Engineers. IEEE Std 602-2007. IEEE
the patient vicinity (e.g., use where UL, cUL or IEC Recommended Practice for Electric Systems
60601-1 is required). Medical Applications such in Health Care Facilities (White Book).
as invasive procedures and electrical life support
equipment are subject to additional terms and
conditions.
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