Special Report: Hi-Tech Hospitals

Jan. 1, 2006

Flexibility is key to accommodating advancing technologies and the evolving needs of today’s healthcare facilities.

In the rapidly changing healthcare industry, technological advances have made many new procedures and methods of diagnosis and treatment possible, and have changed both the traditional delivery of care by hospital staff and the design of healthcare facilities. Advances in information technology continue to improve patient care and worker efficiency with devices such as hand-held computers that can record notes on each patient and provide easy access to valuable reference material. Information on vital signs and orders for tests are now transferred electronically to a main database, eliminating the need for paper and reducing recordkeeping errors. The effects (and challenges) of these advances on the design of healthcare facilities will be significant.

The U.S. Department of Labor reports employment in healthcare will experience significant growth into 2014 for several reasons, and experts predict that the healthcare market will be among the fastest growing for the design and construction industry in 2006 (see page 18 for more). The number of people in older age groups—with much greater than average healthcare needs—will grow faster than the total population between 2004 and 2014; as a result, the demand for healthcare and medical facilities will increase. Employment in home healthcare and nursing and residential care should increase rapidly as life expectancies rise, and as aging children are less able to care for their parents and rely more on long-term care facilities.

For A&D firms, an understanding of how technology will shape the design of healthcare facilities is needed to ensure successful space planning that enables efficient delivery of care for staff and accommodates hospitals' evolving needs.

Perhaps the most notable challenge facing designers is the complexity of hospitals and their various functional units. Diagnostic and treatment functions, such as clinical laboratories, imaging, emergency rooms and surgery; hospitality functions, such as food services and housekeeping; and fundamental inpatient care or bed-related functions are all governed by specific regulations, codes and oversight that design and construction must adhere to, requiring a variety of specialized knowledge. According to the National Institute of Building Sciences' (NIBS) Whole Building Design Guide, "each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical and telecommunications systems, requires specialized knowledge and expertise. No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design."

Consequently, designers need to look to information technology experts, engineers, resident medical staff and other consultants to ensure that the needs of the various facilities are met accordingly.

"Healthcare facility needs are evolving rapidly, and the direction of that evolution is difficult to forecast with any certainty," notes Robert F. Carr, NIKA Technologies, Inc., a consulting firm specializing in design and management services and information technology in healthcare and other technical fields. "New equipment technologies, new treatment methodologies, changes in diseases and changes in the patient population base all impact the facilities that house them," he says. Inpatient care is steadily being reduced while outpatient services are growing, and there is increasing emphasis on special-care units and smaller satellite facilities rather than large, centralized facilities. As a result, "flexibility must be a basic feature of any new healthcare facility to keep it from rapid obsolescence in the face of changing needs and technologies," he notes.

The Whole Building Design Guide (WBDG) offers the following recommendations to ensure that designers meet the evolving needs of healthcare facilities:

  • Provide flexibility for delivering power, voice and data.
  • Provide distributed, vertical cores, satellite closets, and generous horizontal plenum spaces with relocatable, user-based services to ensure technical, spatial and environmental quality in the rapidly changing electronic office.
  • Provide systems that are controllable and adjustable by the users without burdensome reliance on outside contractors. w Incorporate sustainable design principles, which can help achieve flexible spaces.

Hand-held Technology
One of the more recent advances in the delivery of healthcare is the use of personal digital assistants (PDAs) by medical residents. An article in the International Journal of Medical Informatics found in a 2004 survey that PDAs were used by a majority of residents on a daily basis (75 percent) for a variety of uses, including contact information, calendar organization, medical guidelines and calculators, patients notes and management, and most popularly (84 percent) for medical reference applications. Staff working in emergency rooms found it easier to use pharmaceutical booklets for reference than PDAs, while residents working with easy access to computer workstations (in radiology) did not use PDAs as frequently.

Despite their high usage, many residents felt that storing patient contact information on PDAs was unnecessary as patient files were already easily accessible, the survey found. Other staff members felt less likely to lose information when using a PDA rather than paper-based information, while some respondents were concerned about data loss and PDA damage, though few actually experienced it.

One of the most significant problems with using PDAs to store sensitive patient information is that it may violate the Health Information Portability and Accountability Act (HIPAA), which addresses security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information, both paper and electronic, as well as patient accommodations. As a result, designers need to consider these regulations when making design decisions that may affect the transfer and storage of sensitive health information—particularly how hospital staff uses portable devices for delivery of care and storage of information.

The WBDG recommends designers take the following information about the use of PDAs and other technology into consideration in the planning and design of medical spaces:

  • Consider how PDA usage may affect the need for file cabinets and reference libraries. w Consider preferences within different specialties and facilities for the use of PDAs when designing healthcare environments.
  • Provide computer workstations for regular backup to PDAs to prevent data loss or restore data damage.
  • Use of hand-held computers and portable diagnostic equipment allows more mobile, decentralized patient care, and a general shift to computerized patient information of all kinds. This might require computer alcoves and data ports in corridors outside patient bedrooms.

Other Considerations
Designers should also be aware that as more interactive technologies develop, they may provide a means for patients and families to connect with healthcare providers as a supplement to or in lieu of in-person visits. Also, patients and families will have different needs for information and will utilize technology differently than medical staff. Accommodating the needs of both while protecting patients' privacy will present significant challenges. The best bet for designers is to plan for flexibility to achieve the most effective healthcare design solutions.

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