Audio, Installations, IT/AV, Video

The Backbone Of Healthcare: Tyler Junior College’s technology-enhanced classrooms.

In response to the critical need for nursing and other healthcare professionals in the state of Texas, Tyler Junior College (TJC) launched one of its most ambitious capital projects: construction of a new building, the Robert M. Rogers Nursing and Health Sciences Center. The new 130,000-square-foot facility on the Tyler campus triples the classroom and laboratory space of the college’s current healthcare programs, and is expected to increase the number of TJC graduates in healthcare fields by 50% in 2017.

Simulation Labs
The four-story building houses state-of-the-art simulation laboratories, as well as technology-enhanced classrooms. The fast-track $2.4 million AV installation that began in August 2014, and was commissioned in February 2015, involved the installation of presentation, lecture-capture, communications and collaboration, digital signage, room scheduling and control system technologies. In some instances, the integration of AV with medical technologies was required. The AV project encompassed more than 75 rooms and spaces, including classrooms of various sizes, skills practice labs, manikin simulation spaces and occupational therapy suites. Additionally, there is a public dental clinic requiring confidentiality and patient privacy under HIPPA.

“The combination of AV/IT, high-fidelity manikins and associated software to create real-life simulations is like nothing else in the East Texas region,” said Larry Mendez, TJC Chief Information Officer.

The Teams
Early on, the college’s leadership understood the complexity associated with a project of this magnitude. “They assembled a team of internal and outside experts in order to provide a tightly integrated yet collaborative project focus,” Mendez noted. An advisory committee of local medical specialists guided the development of new healthcare programs TJC would offer.

The lead architect was SmithGroupJJR, the construction manager-at-risk was HGR+Turner Joint Venture and the GC was Turner Construction. “Among the outside AV contractors, The Sextant Group (thesextantgroup.com) worked in collaboration with our IT department and various health sciences departments on the AV design. The AV bid for systems installation and integration was handled directly by TJC with guidance from The Sextant Group,” Mendez explained.
Ten AV system integration firms attended an open house to familiarize themselves with the vision and goals of the project. Six firms responded to the bid and Whitlock (whitlock.com) was awarded the contract.

The criteria for selection was based on several typical factors: financial stability of the company, previous work on projects of similar size, technology and timelines, industry certifications of staff assigned to the project, and adherence to bid specifications. “Staffing resources, such as project managers, system engineers/designers, programmers and crew leads were also a factor,” Mendez noted. The overall criteria for selection was “best value” weighted at 40%, “costs” for labor and supplies weighted at 50%, and recent similar projects with other clients at 10%.

Whitlock’s proposal was competitive and weighted with good references from a recent teaching hospital project. “Assurance that Whitlock could provide enough resources to complete the project in the short time frame was a key factor,” said Laurie Harrigan, CTS, Business Development Manager at Whitlock.
“It was definitely a challenge, even with our large staff, to meet the critical class opening dates. After Whitlock was contracted, we had to hit the ground running and had an installation staff and full-time project manager living in Tyler for about three months to complete the project,” Harrigan reported.

Design Considerations
There are three classroom sizes, ranging from 100 seats to 30 seats. All classrooms, regardless of seating arrangement, have a common AV system design scaled to the room size. Classroom AV systems and all teaching presentation systems contained as a subsystem in such spaces as the Musculoskeletal Lab and 10 Bed Skills Lab can support lectures and classes, as well as meetings.

“The systems had to be simple and easy to use, and had to be consistent from room to room to help the staff easily use any classroom without having to learn a new control system,” said Mary Cook, CTS, Project Consultant, The Sextant Group.
The primary display surfaces are either single or dual motorized front-projection screens, sized to accommodate 16:10 aspect ratio images and HD LCD projectors. For one of the smaller classrooms adjacent to the Radiology Lab, the projector was DIACOM compliant.

A custom lectern or integrated millwork houses the user interfaces, computer and video source devices. Lecterns have an integrated monitor and touchpanel, and all computers have integrated Blu-ray disc drives. “The lecterns are fully movable and have an umbilical connection to a wall plate because TJC prefers wall connections to floor boxes,” Cook explained.

Document cameras are installed in half of the classrooms, with a connection to use a portable document camera provided for spaces where a document camera is not part of the installed equipment. Some rooms have a video camera located at the teaching station to provide a close-up view of the instructor performing a skill or manipulation for the students to emulate.

Other common design features include wePresent, a wireless connection to the projection system for instructor or student BYOD. A pair of stereo loudspeakers flanking the projection screens provide program audio sound reinforcement corresponding with all source devices and computers. Reinforcement for a presenter’s speech is accomplished through use of a distributed system of ceiling-mounted loudspeakers. An outlet allows a portable RF hearing assist system when needed. In the classrooms, the control system processor interfaces with room lighting controls.

Videoconferencing and streaming video are provided via software-based functions from any room with a network connection and a computer. Currently, nine digital sign-age displays are located near entrances, and in lobbies and hallways.
Cook noted the complexity of the project, stating there are 42 different design concepts across the entire facility.

Simulation Rooms
There are eight simulation rooms and three simulation control rooms. Each simulation room is supported by an adjacent, and in most cases shared, control room. Some areas, such as the intensive care unit (ICU), medical/surgical (M/S), labor/delivery/recovery/postpartum (LDRP) and medication simulation/control rooms, have a range of medical equipment. These spaces support the demonstration and practice of nursing, and other healthcare skills pertaining to an ICU unit, LDRP unit, Emergency entry transport and Medication acquisition.

“Instructors initiate predefined and custom-built scenarios to assess student skills, all while monitoring and recording progress from the control room,” said Carl Shotts, Director, Technology Services at the start of this project and now Director, Information Security at TJC. Shotts provided details about the rooms requiring custom integration.

The ICU and M/S units employ Laerdal high-fidelity manikins, as well as standard manikins. “An IP-based KVM extension transmitter/receiver pair interfaces with the manikins to facilitate routing through the AV network to KbPort’s Simplicity, a specialized medical capture system. The KbPort system captures student activities during simulations from three different angles, as well as displaying output from manikin and medical devices,” he explained.

The LDRP unit utilizes a Gaumard advanced maternal and neonatal birthing simulator, NOELLE with Newborn HAL. This high-fidelity manikin offers multiple delivery options for student learning, including C-section delivery. Newborn HAL communicates wirelessly to the Gaumard control system and includes advanced airway, breathing and circulation features. Vital signs are captured from the patient monitor, as well as the perinatal monitor, and are routed to the KbPort system.

Shotts noted that the same system captures simulations created in the medication room, as well as the mock-ER entrance space. The medication room is equipped with a Pyxis MedStation 4000 system to provide students with a real-world experience with medication management.

Each simulation and control room has a telephone-style intercom to provide communication between the student and instructor, to further enhance the learning experience. The audio/video capture is combined with output from manikin and medical devices to create a single viewable episode that will be used for student assessments and training purposes. This area is rounded out by a full complement of simulation debrief rooms, one of which has videoconferencing capabilities.

Surgical Suites
In addition to the Simulation Rooms, the Surgical Suites involved complex integration in medical teaching spaces that required out-of-the-box thinking.
The surgical suite includes a check-in and scrub area, two operating rooms with a shared control room, a sterile prep area, a sub-sterile room and a sterile core storage area. Multiple PTZ and fixed dome cameras are installed in the scrub area, as well as in one operating room. Both operating rooms have Steris Harmony LED surgical lighting systems and EMS service columns that provide electrical service, network connectivity, suction and mock medical gases.

In OR2, a GE S/5 Aespire 7900 SmartVent with a GE B40 patient monitor attached to it is installed for anesthesia learning applications. The output signal can be sent to several large flatpanel displays around the room or routed to the KbPort medical capture system.

“Although not complex, one particular challenge in both operating rooms was the installation of dual 24-inch medical-grade monitors from Stryker,” noted Shotts.

“Power and video cable from the Stryker monitors needed to be installed through a Steris boom arm system. This scope of work and cabling had been completely missed by the medical equipment companies. Additionally, neither vendor was excited about handling the other’s equipment. However, the college was able to rely on Whitlock to install the power cable and fashion a custom mounting bracket for the power adapter that was neatly installed inside the ceiling shroud,” Shotts explained. Whitlock had already installed video cabling in OR2 and customized the monitors to accept input from multiple sources. For OR1, the college opted to purchase an HD wireless transmitter for delivery of video signals.

The Stryker endoscopy system, which sits on a Steris service column, includes an SDC3 HD Information Management System, Crossflow Integrated Arthroscopy Pump, L9000 LED Light Source and a 1488 HD camera control unit. Output is captured from the SDC3 unit and routed through the Crestron system to any or all of the wall-mounted displays, Stryker medical grade monitors and KbPort medical capture system. A Crestron touchpanel with custom interface programmed by Whitlock is used to select source and destination.

“We used Crestron software but implemented a custom GUI design and processor code,” reported Brandon Ware, CTS, Whitlock’s programmer. The goal was to keep the number of unique code files to a minimum. The classroom systems integrate with the Lutron lighting system. Ware looked for common functions and equipment for each room type and built code that encompasses the needs of similar room types.

“Each room still required a few unique functions or settings, so we made these adjustable, via the touchpanel, inside a service menu,” Ware explained. “Another challenge, yet fun to do, was creating touch control for camera pan-tilt-zoom functions allowing very dynamic speed and direction control. Although there were still many unique code files for the entire project, we were able to reduce the number of code files by at least 20%,” he noted.

Testing Rooms
Nursing students taking course exams, as well as practice tests in preparation for state licensure exams, primarily use the testing areas. There are two testing rooms (80-seat and 40-seat labs), both using LG 23-inch zero-client devices connecting to virtual desktops in the data center instead of traditional desktop computers.

The college started using server virtualization almost 10 years ago. “Three years ago, the college launched a VDI (virtual desktop infrastructure) proof of concept followed by a successful one-year pilot and, in spring 2014, purchased a VCE Vblock system for deployment of VDI across campus,” reported Shotts.

VCE is a joint partnership between VMware, Cisco Systems and EMC Storage. Because it was the first Vblock in the country shipped with EMC’s XtremIO storage option, the IT staff at TJC has nicknamed the system Xblock. “Building VDI images for nursing was fairly uneventful, with the exception of a few legacy applications that were required. However, with some ingenuity on the part of IT and the flexibility of the platform, these challenges were quickly overcome,” Shotts noted.

Dental Studies
One of the benefits of the state-of-the-art dental facility is the ability to offer new programs. The college has had a very successful Dental Hygiene program for over 40 years. The new facility allows for doubling the capacity of that program and also provides the necessary foundation for a new Dental Assisting program that currently is in the initial accreditation phase. The new space is comprised of 32 semi-private Operatories (five with live gas), one private Operatory, a pre-clinic lab/dental materials lab, a sterilization room, debrief area, student resource lounge and three panoramic X-ray suites.

The Operatories serve as a public Dental Hygiene clinic, as well as a teaching space. Five of the semi-private Operatories were designated as “fully AV outfitted,” with the remaining spaces completed with infrastructure only.

The fully outfitted spaces use the KbPort skills capture system, which allows the instructor to record and assess the student’s work with live patients. A privacy switch is used to allow the patient to opt out of participating as a teaching subject. Each bay has a desktop computer running Patterson Technology’s EagleSoft practice management software. Students use a variety of tools, including Acteon Sopro inter-oral cameras and Gendex/Schick digital intraoral X-ray sensors.

Output Routing
Output from the desktop computer, as well as a ceiling-mounted PTZ camera and a ThirdEye light-mounted dental camera, is captured and routed to the KbPort system. Flatpanel displays are located in the bays to allow the instructor to push content into each station, and for students to see their own work. All of the stations are controlled from one of two instructor stations. The bays can operate independently or as an integrated unit. A full-room paging system allows instructors to provide direction to the entire clinic.

A dual-purpose instructional space for pre-clinic labs and dental materials labs was included in the design. Twelve A-DEC patient simulator/heads are used for pre-clinic coursework. The dental area also includes three panoramic X-ray rooms, two of which are equipped with Sirona Orthophos XG5 panorex units. These units are configured to deliver x-ray images directly to the patient’s records, which are stored in the EagleSoft system.

Distribution Backbone
The networking infrastructure for the Rogers Nursing & Health Sciences Center building is pretty straightforward. The building links to the college data center via fiberoptics. Fiber and copper backbone cabling were installed between each of the IDF wiring closets in the building to the MDF wiring closet. More than 2400 Cat6 network drops support connectivity of desktops, zero-clients, VoIP phones, surveillance cameras, wireless access points, digital signage and a host of specialized medical devices.

A pair of Cisco Catalyst 4500X Layer-3 switches provides a redundant, 10Gb connection to the data center core switch. Cisco Catalyst 2960X series switches are used for local network connectivity and provide a 10Gb redundant connection from each IDF closet to the MDF closet. About 60 Ruckus R700 dual-band 802.11abgn/ac wireless access points were deployed throughout the building.
A number of Cisco high-definition surveillance cameras were installed throughout the building interior and exterior. Just prior to installation, IT staff migrated from an aging hardware-based Cisco Video Surveillance Manager (VSM) platform to a virtual environment. An EMC Isilon X410 series storage array was deployed to maintain video surveillance archives. With the addition of a new resident hall this summer, the college will have 450 surveillance cameras deployed campus-wide.

Nine DS Locations
There are nine digital signage locations at the new building, each with a slim, 48-inch Samsung direct-lit-LED LCD flatpanel and a Cisco digital media player. In addition, more than a dozen locations have the necessary infrastructure in place to support digital signage in the future. With a construction schedule that was highly compressed, the IT department opted to stay with the Cisco Digital Media Manager that was currently in operation on campus.

The college took this opportunity to implement a new campus ID card system from CBORD called CS Gold. This new platform not only provides the IP-based door access control system for the 40-plus iCLASS card readers installed in the new facility, but also provides integration points with the college’s student information system and growth potential into other beneficial services for students.

The scale of the project, including the sheer number of rooms and equipment to be purchased and installed, compounded by the schedule, would be a challenge for most systems integration firms. To illustrate the complexity of the project, Peter Hensley, Lead Project Manager, Technical Operations at Whitlock, offered these numbers: 550 communicating devices throughout the building network infrastructure, 173 Crestron endpoints, 61 touch control surfaces and user interfaces, 26 equipment racks, plus the items on the accompanying equipment list.

“Working with more than 50 vendors and coordinating timely deliveries to have everything in the right place at the right time was quite difficult,” Hensley said. “When Whitlock was awarded the contract, the Dallas branch was already at capacity (i.e., allocated to other projects). To accommodate TJC’s tight schedule, we had to react quickly to supplement the installation crew to support the critical deadline for completion,” he explained.

Whitlock’s onsite Project Manager, David Hardy, said, “The scheduled delivery date within four months of award would have been impossible, had we not developed a very creative schedule and implementation plan.” He noted that both the home office and field teams were pushed to their capacity. “Several times, we were within one day of running out of equipment to install, adding to the challenge of keeping the project on track. We used local employment companies to fill in the gaps and were fortunate enough to get good talent. We provided them with adequate training and were able to meet the rough-in schedule within two months,” said Hardy.

Despite the many challenges, all the teams agreed that the project was fun to work on, especially because TJC was breaking ground from a technology standpoint in a socially significant application.

Tyler Junior College joined the “Achieving the Dream: Community Colleges Count” initiative in 2010 to confirm the school’s commitment to student success through institutional improvement. With the successful completion of the new state-of-the-art Robert M. Rogers Nursing and Health Sciences Center, TJC and its partners have taken a giant step toward realizing the aspirations of thousands of students and the entire East Texas community.

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