Technology and health facility design

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The pace of change in the planning and delivery of health care is often related to the rapid evolution and incorporation of health care technology. The impact of technology remains significant and will continue to evolve quickly. To paraphrase an often-used observation, when there is change in the delivery of health care, organizations will lead, follow or simply be inconsistent.

Not unlike the use of Lean and evidence-based practice by planners to predict health care response, urban planning that concentrates on the bigger picture is instrumental in understanding social, economic and political shifts to assist planners, designers and health care providers to respond more positively to demographic and systemic opportunities.

Factors such as population and technology influence and facilitate health care delivery and facility planning. Technology, in particular, plays a significant role because it is constantly evolving and leveraging the means and locations to deliver health care. No longer are planners simply talking about hospitals or outpatient centers. The health care technology interface in the community primary care office or living room is here.

Connected care

Health care technology generally is associated with equipment or data. Health care organizations must think about these elements from an urban planning perspective. Technology can bring about strategic and philosophical change in how facilities are planned and built, which suggests important new questions:

• Will being virtually connected impact the hospital footprint to grow or shrink in scale?

• Is there an impact to the health care program or cost from technology?

• What about health care delivered through cybercommunities?

Connectivity, which is the soul of urban planning and at the core of health care delivery, has acquired a different level of understanding in today’s digitally and technologically connected world. Connectivity today is not only about being connected physically or virtually, but it is also about having access to information. In the context of health care, it is delivery expectations and different facilities. There is immense opportunity to explore the benefits and impacts of these connections. Urban planning in health care design is about this new connection as much as it was about the traditional urban design or common planning requirements in the past.

This new connection cannot be overlooked when considering smart or focused resources. In an era when health care providers and users are glued to phones and tablets, it is almost impossible to overlook the value of virtual real estate while planning future growth. Cisco System Inc.’s (San Jose, Calif.) global mobile data traffic forecast update shows that global mobile devices and connections grew to 7 billion in 2013 — a number that is roughly equal to the number of humans on this planet.

If that number is staggering, think of the information gathered every second and the scope it provides in creating a more robust virtual connection among the health care provider, the patient and the community. Handheld devices carried 24/7 in purses and pockets present a great opportunity to better understand and serve the end user.

Yet, only about 3 percent of U.S. health care facilities offer some kind of branded mobile app to their patients, according to one recent analysis. Metro Health’s integrated system in Wyoming and Michigan, for instance, has created a mobile app called MyChart for its patients; they can receive test results and timely health reminders, communicate via email with their doctors, and store summary records of medications and allergies.

It is important to understand the relevance of this new connectivity to facility planning and design because such applications can create an opportunity to leverage brand and identity as well as rethink traditional space programming or functional programming when predicting and modeling space use. Many hospital providers are asking their design team to find new ways to find space without building it or negatively affecting patient safety and satisfaction. Perhaps this suggests a new programming model that is centered on design connectivity or goals.

According to recent reports by Reuters, both Stanford (Calif.) Health Care and Duke University, Durham, N.C., will pilot such a platform. At Stanford, the emphasis will be on tracking blood sugar levels for pediatric diabetes patients; at Duke, doctors aim to track vitals such as blood pressure and weight for patients suffering from heart disease or cancer. HealthKit, a new initiative of Apple Inc., Cupertino, Calif., makes a critical link between measuring devices, including those used at home by patients, and medical information services relied on by doctors, such as Epic Systems Corp., Verona, Wis.

Remote monitoring benefits

The practice of telemedicine relies on connection and can have significant outcomes for health care delivery. Michael R. Crowe in Healthcare Law Insights by the Husch Blackwell law firm, refers to a study in which the key outcome measure was the rate of hospitalizations per 1,000 resident days per facility. The study found that the rate of hospitalization in the two facilities where telemedicine was least used had dropped by 5.2 percent while, in the four facilities where the highest use of telemedicine was documented, the rate of hospitalization declined by 11.3 percent. The researchers found these figures to be statistically significant and estimated that annually, 15.1 hospitalizations out of a potential 180 could be eliminated.

Microsoft Corp.’s (Redmond, Wash.) new Kinect infrared camera has opened potential opportunities ranging from robotic surgeries to guided rehab in home-based environments. The application, originally built for Xbox game systems, will allow therapists to document rehab routines, monitor them and consult with patients.

Such remote monitoring can be crucial in controlling emergency visits, eventually reducing the demand on the facility. It also will affect the type of space being planned as hospitals of all sizes face a continuing increase in the volume of emergency department visits.

Mercy, St. Louis, this year officially broke ground on the first virtual care center in the United States, marking another milestone in its promise to transform health care. The four-story, 120,000-square-foot center located in Chesterfield, Mo., will open in 2015 and accommodate nearly 300 physicians, nurses, specialists, researchers and support staff.

Care will be delivered 24/7 via audio, video and data connections to locations across Mercy as well as outside of Mercy through partnerships with other health care providers and large employers. Mercy estimates the center will manage more than 3 million telehealth visits in the next five years. The center also will be a hub for advancing telemedicine through research and training.

Mercy officials say that services improving certain types of care will be especially valuable, such as telemedicine solutions to speed sepsis recognition and treatment, which could cut mortality by 50 percent or more and lower costs per case by more than $8,000.

Finally, in the age of Twitter, social media provides a strong and almost instantaneous voice. Satisfaction or dissatisfaction can become public instantly. Statistics show that approximately 58 percent of the population use some form of social media, but only 25 percent of hospitals do so.

Institutions of all sizes and locations have realized the profound impact social media can have in health care delivery and the promotion of health and wellness.

The Rochester, Minn.-based Mayo Clinic Center for Social Media (MCCSM) provides training and resources to help accelerate effective adoption of social media in health care. Through its Social Media Health Network, MCCSM provides an opportunity for health-related organizations to learn together and share best practices.

Planning ramifications

What does this mean for health facility planning and design? If the hospital brand is about wellness, being external and engaging, it puts an expectation on facilities to reflect and represent the same spirit. This will change how health centers are planned.

Urban planning concepts can help to revive facilities so that they will be inviting to the community and connected to the context. It puts pressure on the experience and quality of space as much as on providing good care. It also calls for a planning focus on ease of use, clarity of information and speed of access — similar to what users expect in the mobile virtual world.

Another technology, geomapping, a frequently used tool by urban and city planners to map enormous amounts of data, process it, analyze it and visually represent it to draw inferences, has become very important in the strategic planning process. Retailers have used this tool extensively to predict future needs and optimize locations of new facilities. Health care providers can use a combination of public health and demographic data to predict patient needs today and in the future.

Health care planners overlay demographic models with current facilities, service lines or even competitive facilities to better understand resource allocation and technology implications of current or proposed facilities. This tool is effectively used in other industries to predict changes in population, age group and ethnicity.

One challenge has been the availability of data. A few years back, the demographic data available were largely based on census data. New changes with data compiled in 2010 are available publicly on American FactFinder (http://factfinder2.census.gov), which can be extremely useful.

When combined with robust data from electronic health records and accountable care organizations, geomapping for health care planning is a reality. Managing this data — while keeping personal identity confidential — provides an opportunity to cluster data to understand health patterns with logical technology implications.

In the wake of cost-cutting, mergers and acquisitions of health care partners are common. Mapping and analyzing locations among merging partners is an effective tool for technology integration. Consider the opportunity to place an outpatient radiology center, for instance, based on data-driven design information versus real estate availability.

Facilities managers also can use geomapping to be better prepared to respond to emergencies. Knowing patient movement within the hospital and campus will help to manage technology use and impacts when tracking disease outbreaks, understanding congested traffic routes and sharing information about capacity. The regional network of health care centers can react better in situations such as hurricanes, earthquakes and other disasters.

Opportunity to reinvent

Over the past decade, the retail, hospital–ity and entertainment industries had to reinvent themselves to adjust to changes in technology that offer a new way for people to shop, relax and be entertained. For instance, retail has switched from a mall concept to a neighborhood scale. Urban planning and connectivity have played vital roles in leading this transformation.

Similarly, the ability to work from virtually anywhere in the world has impacted how office facilities are planned. The focus has shifted from individual office space to more flexible cluster environments. Urban planning and workspace planning have helped facility planners to understand these changes and suggest patterns that help to foster collaboration and connections.

Health care data are sensitive and it is not easy to integrate technology in health care delivery because of HIPAA privacy rules. However, as people become more comfortable using technology, those concerns likely will diminish.

With technological advances enabling us to maintain our health and a high-quality lifestyle, it is time to challenge the way health care facilities and campuses are planned. Technology will affect how facilities will perform and be organized, but the opportunity to reinvent them philosophically and strategically becomes apparent when viewed through an urban design filter. 

Morris A. Stein, FAIA, FACHA, is principal and senior vice president and Yogesh Patil, AIIA, LEED AP, is practice leader for health care urbanism at HKS Inc. They can be contacted at mstein@hksinc.com and ypatil@hksinc.com, respectively.

Need more information? Go to the sources

Need more information on how technology and urban planning concepts are being combined to create health care organizations of the future? These sources were referenced by the authors in the preparation of this article:

• “HKS Plans Transformational Campus for Cleveland’s People’s Hospital”: www.hksinc.com/insight/hks-plans-transformational-campus-for-clevelands-peoples-hospital

• “How GIS and Analytics Can Improve the U.S. Health Care System”: http://data-informed.com/gis-analytics-can-improve-u-s-health-care-system

• “Medicine increasingly turning to video games to speed recovery”: www.tucsonsentinel.com/local/report/050613_video_medicine/medicine-increasingly-turning-video-games-speed-recovery

• “Use GIS to Deliver the Promised Value of Mergers and Acquisitions”: http://data-informed.com/use-gis-deliver-promised-value-merger-acquisitions