Powering the Future
Microgrids in Health Care Facilities

Danny Chisholm | August 28, 2023

The transformation of power infrastructure in health care facilities has become a pivotal conversation in recent years. As the energy demand grows and the need for reliable and sustainable energy solutions becomes paramount, hospitals and other health care facilities are searching for ways to ensure reliability while reducing their carbon footprint. Traditionally, health care facilities have relied on primary electrical power sources from the utility complemented by backup emergency generators to ensure continuous power during outages. However, the introduction of the 2021 edition of NFPA 99 has ushered in a new era, granting these institutions the flexibility to explore alternative power sources, with health care microgrids emerging as a viable and innovative solution. These microgrids, essentially miniaturized, tailored electrical networks, can operate independently and in conjunction with the main grid, offering a combination of renewable energy sources.

As these microgrids promise cleaner energy solutions and reduced reliance on traditional generator-based systems, they must be implemented with a robust strategy. This involves meticulously assessing each facility’s unique requirements, risks, and current infrastructure. Furthermore, once installed, a microgrid’s operation and maintenance requires a systematic approach, considering the technological nuances and potential vulnerabilities, especially in the realm of cybersecurity. As the health care sector stands at the brink of this power revolution, this article delves deep into the key considerations for microgrid deployment, ensuring optimal functionality, and the critical regulations that govern their usage.

NFPA 99, Health Care Facilities Code

To ensure patient safety, health care facilities must be equipped with both a primary electrical power source and a backup emergency power source. This backup power source is part of an essential electric system (EES) and is necessary to prevent injury or loss of life during a power failure. In compliance with NFPA 99-2012, most health care facilities opt to use a backup power source, such as an emergency generator that can handle the high electrical demands of a patient care setting.

However, the 2021 edition of NFPA 99 opened up a new option, allowing health care facilities to use alternative power sources beyond emergency generators. One such alternative is a health care microgrid, which is a small-scale electrical network tailored to an individual facility’s needs. They have intelligent controls and can operate independently or with a larger electric grid.

3.3.75 Health Care Microgrid. A group of interconnected loads and distributed energy resources within clearly defined boundaries that acts as a single controllable entity with respect to the utility.NFPA 99, Health Care Facilities Code, 2021 edition

The power sources for a microgrid can include a combination of clean energy technologies, such as fuel cells, solar panels, wind turbines, energy storage systems, and other renewable energy sources. These sources can provide primary power or supplement the existing electrical infrastructure. By embracing these innovative solutions, health care facilities have more flexibility and can reduce reliance on traditional generator-based systems.

Key considerations for hospital microgrid deployment

When hospitals consider implementing a microgrid, it is crucial to prioritize reliability, security, and cost-effectiveness. Leveraging the existing essential electrical system (EES) infrastructure, such as on-site switchgear, electrical distribution feeders, and backup generators, can significantly reduce microgrid implementation costs. However, each hospital’s unique circumstances and requirements must be carefully evaluated to develop a robust strategy and execution plan that ensures energy reliability. A thorough analysis of specific risks and needs is essential to inform decision-making.

To facilitate this process, hospitals should consider conducting a microgrid assessment or microgrid feasibility study as a crucial first step. A reliable microgrid assessment service can provide a comprehensive, tailored analysis and detailed energy action plan. The assessment entails inventorying and identifying critical assets within the hospital’s existing EES, including main switchgear and associated electrical distribution equipment. This evaluation determines whether the current assets can fully support the proposed microgrid or if modifications, such as additional switchgear capacity or alterations to existing switchgear, are necessary.

The microgrid assessment service also delves into the proposed microgrid’s critical aspects, considering load sizes, load profiles, switchgear location, and metering and control capabilities. These considerations enable a thorough evaluation of whether the existing assets can adequately support the microgrid’s requirements. By conducting this assessment, hospitals can gain valuable insights into the feasibility and suitability of their existing infrastructure for microgrid deployment.

Every hospital’s microgrid deployment is unique, requiring an individualized approach. The microgrid assessment service assists in identifying the specific risks and needs associated with each hospital’s circumstances. This understanding is a foundation for developing an effective strategy and execution plan that ensures energy reliability for critical operations. A microgrid assessment helps hospitals make informed decisions and mitigate potential risks by tailoring the approach to the hospital’s specific situation.

Ensuring effective microgrid operations and maintenance

Once a microgrid is installed in a health care facility, it is crucial to maintain its optimal functionality and performance. Key best practices are defining the responsible party for ongoing microgrid operations and maintenance (O&M) and establishing protocols for addressing issues.

Microgrid O&M typically falls into three main categories:

  • Do-it-yourself (DIY): Utilizing on-site personnel for microgrid O&M is a cost-effective option since facility staff is readily available on-site. However, each microgrid is unique, lacking a standardized “owner’s manual” for reference during troubleshooting. Extensive training is necessary to equip staff with the knowledge and skills to address potential issues. Factors such as employee turnover rates and access to training materials should be considered when assessing the feasibility of this approach. As industry experts recommend, integrating a microgrid simulator can serve as a valuable training tool to minimize disruptions to the actual microgrid.
  • Third-party contractor: Another option is to engage specialized companies that offer microgrid O&M services. These contractors often have extensive experience and expertise in microgrid operations, and a competitive request for proposal process can help ensure cost-effectiveness. However, third-party contractors may require a learning curve when assessing new projects,
  • Microgrid integrator: This option leverages the team that was responsible for integrating the facility’s microgrid to handle ongoing O&M tasks. The integrator is deeply familiar with the organization’s microgrid and can help ensure problems are resolved accurately and efficiently. Moreover, many system maintenance issues can be handled remotely, enabling real-time response to faults, even without an on-site presence.

If health care organizations opt for ongoing O&M services from the microgrid integrator, it is essential to establish clear contractual agreements ahead of time. This includes defining the scope of work and accounting for associated costs. Because only one microgrid integrator is typically involved in each project, facilities that choose this route rely heavily on their integrator’s knowledge and availability. Therefore, documenting clear expectations in writing is a vital best practice. The agreement should also outline specific examples of microgrid O&M tasks falling within and outside the scope of the contract to avoid misunderstandings.

Cybersecurity measures and O&M considerations

Maintaining the reliability of power delivery within a microgrid is of utmost importance, and protecting against cyberattacks is crucial. Recent years have seen a significant rise in disruptive cyberattacks, highlighting the vulnerability of critical infrastructure. Hospitals and other organizations have fallen victim to cyber threats, emphasizing the need for strict cybersecurity measures, especially for microgrid components such as switchgear and controllers.

One common practice to enhance microgrid cybersecurity is the isolation of digital equipment, including microgrid controllers, switchgear and distributed energy resources (DERs), from the internet. This is typically achieved by firewalls or establishing a separate intranet exclusively for microgrid hardware. Switchgear with embedded firmware should reside on a firewalled or separate network, isolated from external access.

Periodic updates to software components incorporated into the microgrid controller and occasional updates to switchgear firmware are required. While many of these processes can be automated, they still demand additional resources to maintain the quality and reliability of the always-on energy resources within the microgrid.

Despite the need for enhanced cybersecurity, an effective modern microgrid will outweigh these costs in the long run as the microgrid framework allows health care facilities to anticipate future mandates on power delivery and reduce overall energy costs.

Microgrid commissioning requirements

Commissioning a microgrid involves following a detailed plan that outlines the necessary steps and methods to verify that the equipment, controls, and safety systems function as intended. This written plan includes an overview of the commissioning process, defining roles and responsibilities, outlining plans and specifications, documenting activities, checklists, testing forms, training requirements, and identifying qualified personnel. This plan helps ensure that the microgrid is thoroughly tested and validated.

A crucial component is a comprehensive commissioning report prepared by the commissioning agent. This report summarizes the entire commissioning process, including the system features, final commissioning plan, commissioning results, as-built plans and specifications, and any identified issues and corrective actions taken. The report is a valuable reference document, providing an overview of the system’s performance and will help guide future maintenance and enhancement activities.

To maintain optimal performance, health care microgrids must undergo recommissioning every five years or sooner if there are significant changes to the system configuration. Recommissioning ensures that any modifications or updates to the system are thoroughly tested and validated, preserving the system’s integrity and performance.

CMS waiver requirements

Health care providers and suppliers opting to utilize the categorical waiver must formally declare and document their decision. At the start of an accreditation survey, facilities that have chosen the categorical waiver must provide the survey team with their documented decision and evidence of compliance with the relevant requirements stated in NFPA 99-2021, NFPA 70-2023, and other associated references

The survey team will review the documented decision and ensure that the facility complies with the applicable requirements, confirming the necessary level of protection for the health and safety of patients and residents. Facilities that have elected to use the categorical waiver for a health care microgrid and follow all applicable codes and references will not be issued a citation for non-compliance with the 2012 edition of NFPA 99.


Offering sustainability, reliability, and a shift towards green energy, microgrids represent the future of the health care power infrastructure. However, their successful implementation requires rigorous planning, continuous assessment, and stringent cybersecurity measures. As we navigate these transformative times, it’s crucial that health care facilities remain proactive, harnessing the benefits of microgrids while ensuring patient safety and operational efficiency remain paramount.

Danny Chisholm

Danny Chisholm

President, MGI Systems

Since 2003, Dan has been an emergency power consultant, performing risk assessments, commissioning, decommissioning, and training for hospitals, data centers, and universities. He is a member of the Technical Committee responsible for NFPA 99, Health Care Facilities Code, Electrical Section, NFPA 110, Standard for Emergency and Standby Power Systems, NFPA 111, Standard for Stored Electrical Energy and Standby Power Systems, and an instructor for the Certified Healthcare Emergency Power Professional (CHEPP) program.

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