Today's healthcare delivery system involves a complex array of medical computerized information databases and instrumentation. These microprocessor-based computers are extremely sensitive to power anomalies such as brownouts, blackouts, spikes and line noises. While electrical companies make every effort to maintain reliability, there is no guarantee of power quality and availability.

Provider healthcare organizations (HCOs) must consider national regulations and standards regarding electricity, as well as those from various accreditation bodies. Fundamental considerations in addressing adverse power events include NFPA's National Electrical Code for healthcare facilities, IEEE's recommended practices for electric systems in healthcare facilities and for emergency and standby power systems for industrial and commercial applications, JCAHO's standards for management of the environment of care, HIPAA's Security and Electronics Signature Standards, and local fire codes.

These considerations must be analyzed and interpreted according to an individual HCO's environment, services and products, too. For example, JCAHO has different accreditation standards for hospitals, long-term care, home health care and sub-acute care. Also, since HIPAA's physical safeguards section addresses the protection of all physical equipment housing patient data from natural and environmental hazards, an HCO must consider where patient data is sent and stored outside the primary institution, be it managed care organizations, outpatient care centers, laboratories or physician offices.

Interpretation, liability considerations, implementation and documentation of activities are all vital in meeting minimum standards of care, assurance of patient safety, accreditations and quality outcomes.

Primary Issues

Utility power companies are not required to provide computer-grade power. The American National Standards Institute, which coordinates and administers U.S. standards and conforms the assessment system, defines acceptable voltage variation for power to be typically in the range of plus 5.7 percent to minus 8.3 percent from absolute specification. This range frequently exceeds the data storage, medical imaging and diagnostic equipment specifications within the healthcare environment.

With the regulatory pressures of HIPAA and rapidly increasing conversions to filmless or paperless information systems, the requirements for data protection and disaster recovery planning (DRP) at both the enterprise and department level have significantly increased. This places greater responsibility on decision-makers involved with picture archive communication systems, bar coding implementation, computerized physician order entry and other IT solutions to take DRP into consideration.

In a disaster situation, HCOs must focus primary contingency plans on patient safety and life support, possible evacuation from the site, appropriate ambulatory drug delivery and equipment support, and a data communications and information trail that will follow and guide the patients' caregivers. This involves data from a variety of sources within the institution, including patient records, physician instructions, pharmacy drug-delivery instructions, and diagnostic and imaging information. This information can continue to be delivered both electronically and through secured telecommunications, if effective measures are taken.

The Healthcare Power Train

HCOs also have other power and regulatory requirements. JCAHO requires organizations to demonstrate the reliability of their emergency power systems by testing generators and automatic transfer switches 12 times per year, with testing intervals between 20 and 40 days under a dynamic load of at least 30 percent of the nameplate rating. Dependence on power availability and quality solely from backup generators does not address the total impact on the maintenance of data integrity.

A hospital's power protection solution generally starts with a hard-wired transient voltage surge suppressor (TVSS) connected to electrical distribution gear in single-, two- and three-pole power systems. A TVSS protects transient over voltages, spikes and surges that come from lightning, utilities and internal operations such as large control motors starting and stopping. A typical medium-sized hospital will have paired breaker panels: one is for standard power, which supports noncritical loads such as laundry areas, televisions, non-emergency lighting and office equipment; the other is the emergency breaker panel, which is on the emergency distribution system. In a typical facility, the emergency distribution system supports approximately 50 to 60 percent of all power used.

The fact that an institution has a generator does not ensure complete data integrity in adverse events. An emergency power master plan should prioritize generator loads the following way:

* Priority 1: life safety branch loads such as alarms and emergency safeguards;

* Priority 2: critical branch loads that support patient functions;