by Craig Park FSMPS, Assoc. AIA, Principal Consultant, The Sextant Group
Improving care while lowering costs — that is the holistic mission of hospitals across the globe.
Today, innovative technologies are changing the face of the healthcare environment. Hospital facilities everywhere are challenged to be more flexible and efficient to meet rapidly changing patient care and load demands, while facility managers and hospital administrators are charged with doing more with less. As a result, new applications of technology are both improving operations and patient care.
What makes a contemporary hospital state-of-the-art? Several technologies support the latest delivery methods and caregiving processes for patients, while improving the working environment of physicians, nurses, and administrators. The differentiating factor in planning an advanced facility is having the vision for integrated technology at the programmatic phase of the project that looks at the future of healthcare practice. An integrated technology approach for a unified communication model at the design stage can save time and expense and provide improved patient care and safety.
By approaching a new healthcare project as an evidence-based design program, technology decisions are based on the best information available from research, project experience, and from measurable data gathered from the operations of the client (and similar clients) and research into emerging systems. This research-based consultative approach develops appropriate solutions to the design challenges based on demonstrated improvements in the hospital’s productivity, patient improvement and satisfaction, community perceptions, and economic performance. As the non-profit patient advocacy organization Planetree1 has noted, technology helps deliver improved results by providing ease and access to more, timely, and relevant information. [see also “Healthcare Acoustics: Shhh!”]
The Digital Hospital
The latest technology-enhanced hospitals are envisioned with one meta-control technology managing all aspects of the facility on one backbone and one set of systems protocols. This vision can move from concept to reality as intelligent building technologies combine with information technology in new and exciting ways.
A meta-control approach links all the disparate industry-standard protocols for connectivity and communication (e.g., BACNet, SNMP, TCP/IP, Ethernet, IEEE 802.1x, HDBaseT, etc.) under a common control framework that that facilitates operational management, monitoring, signal distribution, and control all of the critical building systems and information. Approaching intelligent building technology this way also lays the groundwork for meeting sustainability and energy management goals. A state-of-the-art digital system enables information to move from that first contact as a patient arrives through all aspects of their interaction with the hospital’s staff, physicians and nurses, seamlessly and transparently.
Receiving data from a sensor embedded into their insurance card, the staff at the admissions desk is prepared with the patient’s electronic medical record (EMR) as soon as the patient enters the facility. The same sensor alerts administrative staff to their arrival, and the nursing staff is notified in the department or floor where the patient is scheduled for their procedure. The physician is advised on their smart phone that the patient is here for their visit. Finally, the patient’s “smart” room is electronically activated for those monitoring systems specific to their visit.
Designing an integrated digital backbone also simplifies the technology infrastructure design. A common fiber-optic based network can carry all of these signals and a common cable can connect to the wall outlet, allowing virtually any device can be attached at any wall outlet. Using “Power over Ethernet” (PoE) further reduces the amount of wires, adding to a more sustainable design.
The traditional approach of separate designs for each technology system — supporting such diverse needs as administrative and patient information, nurse call, television, internet, education, and security — as disparate elements, creates barriers to efficiency and communication. Using technology to help break down organizational silos is a good first step in actually creating a hospital as one fully coordinated and integrated system.
The future of planning healthcare facilities technology is based on convergence and integration. This approach doesn’t necessarily mean the lowest first cost. However, the results can be worth the time and expense. The hospital will have an improved environment for patients, for visitors, for staff, and for nurses and doctors — a subjective measure of success. As the intelligent information environment improves, the hospital can anticipate improved efficiency and reduced long-term operating costs — a much more pragmatic and measurable metric. [see also “The Future of Healthcare”]
It Starts With the Patient
A good example of integration starts with the “head wall” in a new “smart” patient room. In a technology integrated building, this wall provides connections to all the basic gases and liquids needed for the patient, but also provides connections to the network for electronic medical records, sensor monitoring, along with hospital-originated patient education programs. In this way different patients can be housed in a room that is quickly and easily reset based on their medical needs.
The screens being planned for the patient room of the future continue to get thinner and lighter while also increasing in size, using rapidly advancing organic light emitting diode (OLED) technology. They can be positioned easily on adjustable mounts for use by the physician and nursing staff, or repositioned for use by the patient. The screens can be connected to the network, allowing the patient to watch TV, play music, surf the web, play electronic games, or get email.
This same concept of ubiquity and integration can also extend to hybrid operating rooms that incorporate radiology and MRI, allowing the facility to refresh and repurpose based on immediacy and demand.
On the systems side, physicians and staff can monitor and confirm that particular education programs have been viewed, how many times they were viewed, down to the detail of knowing if any sections of the program were re-watched and how many times. This can alert staff to a patient needing more information or an additional one-on-one review.
Wireless technology enables accurate up-to-date information that is both personalized and pervasive, and can be accessed anywhere and anytime, allows for more timely treatment, and warnings before a serious incident via implanted sensors and data input devices. Real-time data allows healthcare facilities to innovate and integrate, reducing costs and improving patient outcomes in the continuum of care. Using technology can allow the building to be proactive to changing conditions, and help the staff react and respond more quickly.
The use of inexpensive LED projectors can provide an augmented reality experience that displays wayfinding in hospitals as a projected map on the floor. Combined with facial recognition software, this imaging solution could be used to guide individual patients to their rooms. The same technology could be used to create a video wall that allows visitors to see what’s new in a medical building or to create immersive environments in patient rooms — at the push of a button, a patient could be transported to a beach or a child could decorate the walls of their room without creating any real mess.2
A Body of Knowledge
Today, physicians and nurses go to places to get information. In the future, the information will come to the places where the doctors and the nurses are. Wireless tablets and other portable information appliances are replacing the traditional “clip board” of patient data. This will have a significant change in the layout of patient floors, patient rooms and centralized nurse station. Instead of pulling records at a central location, the patient’s information will come to physicians and nurses at the bedside.
As we move forward, it is clear that ubiquitous patient information will be a key factor in the design of healthcare facilities. With the advent and acceptance of tablet computers, information access is instantly more portable. There will still be places in every building where wired connections are required because of the high concentration of connections and bandwidth to support high definition signals, but there will be many more areas where information can follow the user (doctor, nurse or patient) and be accessed as needed.
While wireless technology is indeed becoming more prevalent, the bandwidth requirements of some medical files and HIPAA requirements may affect that wireless usage. Of those two issues, the performance of the wireless network is increasing and improving continually.
There is also a fast growing trend toward devices that combine functions. Like smart phones that provide video and web-browsing, the health practitioner’s information appliance of the future will combine many of the healthcare provider’s day-to-day applications, access to electronic medical records, and communicate with both the patient and other consulting professionals. And much of the same information will be available to the patient on their iPad or home computer.
Advances in flat-screen and touch-screen technologies are making sharing and demonstrating medical information easier and more engaging. Using an electronic touchscreen table technology, anatomy classes may reduce the use of actual bodies and body parts, and switch to a virtual dissection table developed to help students learn about anatomy without the need to practice on a corpse. Using hand and finger gestures as a scalpel — familiar to anyone with a smartphone or tablet PC — the medical student can work on a body, experiencing virtual surgery techniques. The same display technology can also show an X-ray view.3
In the near future, that same electronic touchscreen table will replace the traditional coffee table during the patient/doctor chats. Gone will be the days of images drawn on napkins or dry erase boards to explain procedures. Instead, patients will see their knee replacement or other procedure in 3-D.
New remote medical “pod” systems will provide connectivity to health care for those patients living in remote rural areas. Doctors will be able to communicate from their offices or hospital with patients from remote locations thousands of miles away. These self-contained units can be located in general practice surgeries, community hospitals, shopping malls, schools, senior centers, or employer sites. The pods can be equipped with digital signage indicating availability, types of services offered or other relevant information. The only local staffing would typically be an attendant to greet patients, help with registration (if needed), assist with the medical devices, and, of course, make sure the pods are clean and ready for use.4
It’s not just patients who will be communicating with doctors. With advances in teleconferencing systems, surgeons will be able to communicate easily via life-size video from one operating room to another operating room across the country. This allows a very senior physician to consult and support those less experienced at other locations.
A Vision for the Future
The push for advanced technology is consistent with many hospital systems’ goals for creating a healing environment, while communicating to the local community that they care deeply about the individual. Traditionally, and based on personal experience, most patients have the perception that their hospital of choice is caring, but really low-tech.
Designing a robust technology infrastructure (i.e., cable paths, power, grounding, connectivity to other systems, mechanical cooling, plus architectural and structural considerations) can anticipate new technologies and minimize long-term facilities renovation costs. However, because of the rapid rate of change, we recommend delaying final systems decisions until the “last responsible moment” (usually about 6-9 months before occupancy), to ensure that investments in the more costly systems reflect the latest technology.
With a design based on a vision for an integrated technology infrastructure, the patients and the community can see the hospital remains friendly and caring, but also invested in a technology future. And the doctors, nurses and staff are more efficient and effective, thus lowering costs.
How far ahead can you look when planning for technology? While many of the technologies described above are already here, few have yet to be adopted for the specific needs of the hospital. The benefits for planning a new healthcare facility with an overarching vision for technology in healing hands ensures patients, staff, physicians and nurses will be working in a building that provides the best environment for care available, and sets the standard for information access and applications in healthcare facilities for many years to come.
About the Author
Craig Park FSMPS, Assoc. AIA, is a principal with The Sextant Group, and is based in Omaha, Nebraska. Trained as an architect, Craig is an award-winning thought leader in the design of technology-enabled collaborative and communication environments. He has practiced as an audiovisual consultant for more than 35 years on more than 400 projects for clients in healthcare, education, corporate and government.