Operating on medical and hospital projects: automation and controls

Engineers tasked with working on hospital and medical campuses find themselves tackling unique challenges: evolving technology, increased specialization, and maintaining operations while under construction. Here, professionals with experience on such facilities share advice on how to finish projects that report a clean bill of health regarding automation and controls.

By Consulting-Specifying Engineer November 21, 2016



Larry Anderson, PE, RCDD, CDT, Principal, TEECOM, Oakland, Calif.

Jeremy Jones, PE, LEED AP, EDAC , Healthcare Market Leader, Affiliated Engineers Inc., Chapel Hill, N.C.

Daniel S. Noto, PE, LEED AP BD+C, Healthcare Studio Leader-Southeast Region, exp, Atlanta

Eric Reuther, PE, LEED AP BD+C, Principal, McClure Engineering Associates Inc., St. Louis

Jonathan B. Slagel, PE, LEED AP, HFDP, Principal/Vice President York Office & Healthcare, Barton Associates Inc., York, Pa.

Bill Talbert, PE, BEMP, LEED AP, Senior Mechanical Engineer, MEP Associates LLC, Verona, Wis.

CSE: When working on monitoring and control systems in hospital or medical campus buildings, what factors do you consider?

Reuther: Reliability and simplicity are very important when designing controls systems in hospitals. Because HVAC systems can be very critical in hospital spaces, the facility cannot afford for certain failures. Control systems need to be designed with a backup plan in case a certain piece of equipment fails or is out of service in order to provide uninterrupted conditions in the space. While it is sometimes tempting for an engineer to write a very complicated sequence in order to provide the best energy performance, the designer needs to realize that if it’s an emergency situation and something fails, the operator still needs to be able to understand how the system works. The best controls system typically combines keeping it simple with a blend of straightforward energy-savings tactics that the operator can understand. The reality is that an overly complicated sequence that has a bunch of operator-installed overrides due to lack of understanding the system does not perform better than a simple one. Many of our clients have told us that one of the biggest problems hospital managers face is finding qualified maintenance and operations personnel. This must be considered when designing a controls system.

Talbert: Hospital systems are often very complex, and there is a need to balance the available facility resources with the amount of control and monitoring available. The key is to provide facility staff with the information necessary to measure performance effectively and identify and solve problems efficiently. Hospital staff may be dealing with thousands of potential monitoring points, resulting in hundreds of alarms. Controls systems need to effectively organize and manage this information in a manner that fits the hospital’s resources; otherwise, staff will become overloaded and will seek quick fixes that may sacrifice system performance.

Slagel: Whenever our work involves monitoring and control systems in a health care environment, we ensure that the facility owner and engineering team is part of the design discussion. It is imperative that the equipment and control points and alarming specified with project equipment be coordinated with the owner’s operational practices and needs. Monitoring additional points on a piece of mechanical equipment that an owner/operator does not look at simply adds cost to the project without any associated value. Similarly, if control points that are critical to allowing a facility engineer to efficiently troubleshoot system problems are omitted from the project scope, the owner may experience delays and increased system downtime if/when a system problem occurs. Noto: Using a system that is compatible with the existing controls system is very important. Most facilities don’t want multiple building automation systems (BAS).

Jones: Factors that are considered are accountability and simplicity. It is an unfortunate truth that most hospitals’ maintenance departments are understaffed; they are being asked (perhaps "asked" is the wrong word) to do more with less. They do not have the time or personnel to maintain and fully troubleshoot BAS complexity. They need simplicity. If a design engineer can squeeze out an additional 0.5% in energy efficiency by adding 20 steps to the logic of a control system, we might not have done them any favors down the road. Also, another unfortunate truth is that when a facility engineer is confronted with a problem in the field that has generated a patient or physician complaint, they need to fix it immediately. The result is that the best intentions of control systems can be manually overridden. Sometimes the easiest way to deal with a hot call is to manually close a hot-water valve. Without a means to track what has been changed and by whom, a perfectly functioning control system can become unrecognizable and impossible to troubleshoot within a very short time.

CSE: What types of system integration and/or interoperability issues have you overcome in such projects, and how did you do so?

Slagel: The single, greatest factor that will determine success or failure in system integration is communication. The best results occur when all vested parties (designers, owners, technology vendors, etc.) communicate early and often throughout the project. System integration can offer great benefits to the owner, such as lighting controls, room temperature, window blinds, and television (for entertainment and education) in patient rooms, as well as asset tracking throughout the facility to improve operational efficiencies. Successful integration requires a high level of communication and coordination early in the design process to ensure that all parties understand the goals and parameters of the project and the owner.

Jones: For a long time, many building owners sought-and many controls manufacturers claimed to provide-true open-protocol BAS. By open protocol, I mean nonproprietary in the sense that a BAS manufacturer could (A) install the system and (B) immediately maintain and service it without being encumbered by proprietary elements. I’m not sure such a system actually exists. The root problem is that the service over the life of a BAS the building owner receives varies over time and region. Building owners typically want to purchase a BAS that doesn’t lock them into a 50-year relationship with a manufacturer whose ongoing service might decline. A portion of the solution has arrived in the way of gateways that combine multiple BAS into a consolidated front end. However, I still believe that proprietary gremlins are scattered throughout the offerings from most BAS manufacturers. I am in no way implying that this is malicious, just that it appears to be the current state.

CSE: What unique tools are the owners of such projects including in their automation and controls systems?

Reuther: Some owners have starting using building analytics software to help identify problems with their systems. The program uses algorithms to analyze the building automation system (BAS) data and look for common problems like simultaneous heating and cooling, leaking control valves, etc.

Jones: We have seen a drastic increase in the desire for monitoring, metering, and data trending. Hospitals are second only to restaurants in energy use intensity (EUI), and operating margins for health care are historically very low. Improvement in energy efficiency is key. Building owners are realizing that you can’t improve what you can’t measure and identify. There is a big difference between suspecting that your facility’s EUI is higher than your competitors’ versus being able to pinpoint exactly where your energy dollars are being spent, how they trend over time, and where outliers might be. The latter is easier to improve upon.

CSE: How have you worked with the building owner or facility manager to tackle the Internet of Things (IoT)? Have you helped catalog every device in a hospital, such as lights, fire alarms, electrical outlets, and more?

Reuther: We’ve done various things to help owners catalog their facilities. One owner had us do a survey of each of their hospitals and identify all of the MEP systems including the age of equipment, how it operates, etc., and compile it all into a single volume for reference. We’ve also assisted owners with keeping up-to-date CAD drawings of their facility including HVAC floor plans, electrical one-line diagrams, and system flow diagrams. In some cases, we’ve even helped the owner put together a master plan for a facility identifying future projects to plan for based on facility needs.

Anderson: Our firm’s sole focus is technology engineering. We are in a unique position to tackle the IoT since it is our wired network, wireless network, and network cabling that backhauls all of the data. To design the telecommunications infrastructure for a facility, we consult with the owner on their current use of technology and discuss the trends in technology we see. Although we see a convergence of technologies, where devices are using standard wired and wireless protocols, they will integrate into the building infrastructure at different levels. For example, a hospital may require that the patient data be separated from the public wireless network for security reasons.