Embracing new patient technology in planning and design

The future medical office building must harness the power of technology and clinical collaboration through such innovations as mission control centers.

Image courtesy of Cannon Design

Today’s buildings are often fancier versions of the 1960s tower-on-podium model with a lot of technology crammed inside. The patient is moved around from place to place — in an environment assembled by a collection of departments or individual silos — to receive care instead of bringing the care and technology to the patient. 

During design, architects and planners focus on the patient and health outcomes but, frequently, the new built environment is not patient centric. Technology is an area where it often gets lost. Designers spend time reviewing the health benefits of daylight improving patient outcomes and handrails to prevent falls, but technology is pushed off to be addressed only by the health care organization’s information technology and biomedical departments. 

Embracing technology as a key design team element can dramatically improve building designs and patient outcomes. Architects and planners truly can save lives by changing their design view of technology. 

Thinking beyond tradition

The COVID-19 pandemic has rattled the health care design community to think beyond traditional design. In five months, the pandemic has forced the use of technology and accelerated implementations that could have taken five or more years. 

Health care leaders are applauding the field’s quick adaptations and improved processes, but it shouldn’t stop there. Designs for medical office buildings and hospitals must address the positive disrupters technology can bring, including patient safety, improved outcomes and the overall return on investment.

Virtual care, building systems integrations, infection control dashboards, predictive analytics, remote monitoring, mobile health care units, wearable technologies, predictive fall prevention systems and real-time location system (RTLS) workflow solutions often are overlooked or eliminated from design as too costly or futuristic. 

Helping organizations incorporate these into the design process improves outcomes by capturing proper clinical workflow, real infrastructure needs and space requirements that are missed. Exposing health care organizations to current trends and options helps them to think beyond how they are delivering care by providing informed decisions and comprehensive designs. 

Technology strategies 

One of the pioneers of modernist architecture, Ludwig Mies van der Rohe, espoused “form follows function.” This design philosophy is applicable to the technology that’s driving health care today. Often, health care designers are reacting to technology rather than embracing it, which is why a new approach is needed. The following areas should be considered: 

Evaluating existing technologies for additional safety opportunities. Health care facilities frequently have technologies that are already installed with capabilities that can be configured to support patient safety initiatives and safety protocols. Nurse calls, wireless phones, physiological monitoring, electronic health records and equipment tracking systems are just a few to consider. For example, nurse call integration with medical equipment alarm management to caregivers’ wireless telephone devices can provide quicker response times, avoiding adverse events.

Finding the right safety technology. Educating health care organizations on emerging trends is a great way to begin pushing them to think beyond what they are doing. Incorporating technology patient safety goals into design processes at each major milestone helps ensure they’re not missed. Technology that supports patient safety often seems expensive, but evaluating with readmission costs due to patient falls, health care-associated infections (HAIs) and other mishaps usually demonstrates a quick return on investment. For example, a “telesitting” solution can save over $120,000 by preventing four patient falls per year.

Incorporating patient safety into the master plan. A comprehensive patient safety technology strategy should be developed at the beginning of the master planning process and continued throughout the duration of the project. This approach will help explore new care delivery ideas such as creating a new “patient experience center” and a “wellness-focused campus.” 

Colocation of technology, clinical operations and patient experience functions should be explored. Developing a safe ecosystem that integrates people (e.g., patients, families and staff), environment (e.g., buildings and spaces in between, including homes) and technology (resulting in constant data flow in real time) can reinvent operations, providing better clinical outcomes and improved patient satisfaction. 

Making the building intelligent. In a not-so-distant future, patients will have an intelligent “twin,” or virtual digital patient, and the data flow will be continuous and seamless. This will allow a patient to know about a potential condition before it happens and will signal the need to perform preventive measures. To assume that today’s buildings can handle such a concept would be a mistake and begs the question: How long will the health care field wait before it lets go of today’s health facility design and reformulates its evolution? The sensors sending real-time data on a patient’s health will need an intelligent hub to monitor their well-being. It won’t matter if the patient is driving, at home or on their way to the medical office building or hospital, because data flow will be continuous and without walls.

Ultimately, these strategic changes will affect the nature of the health care organization as it’s been understood. This reimagined environment will have the following characteristics:

• No longer called a medical office building or a hospital. For example, it may be a “wellness hub” with Uber mobile medical clinic docks for those who cannot come to the building.
• A place where patients go prior to becoming sick, and it is not just associated with pain and suffering. For example, a wellness and training center where patients can check in (in person or virtually) to maintain their digital twin.
• Not designed just around a doctor-first, “you come to me” model. Instead, it will be a no-department environment where subspecialty teams work together instead of in silos. It also extends with technology to interact with a patient’s care-at-home setting.
• A place where patients do not wait. Rather, technology allows them to dial into the visit to avoid wasting time.
• Constantly shifting from in-person to virtual. This includes a new virtual care module, designed so clinicians have adequate space to perform virtual visits, not just cameras and microphones added to exam rooms. For example, adding teledigital pods for one-on-one sessions and larger spaces for care teams to replicate rehabilitation or nutrition activities and equipment.
• Not solely designed around a specific functional program. More theater-like interiors that can be reconfigured as needed without destroying the building infrastructure.
• The operational approach is customized around each patient’s needs. 

Technology suggestions

Creating the best healing environment and patient experience is the ultimate goal. A multitude of patient safety technologies are available and should be explored during master planning, space programming and design. Each impacts process, operations, space programs, adjacencies and room layouts to varying degrees, but all can improve patient safety when properly implemented. 

The following patient safety technology suggestions, along with their space and infrastructure configurations, should be considered during design: 

Patient fall prevention. Telesitting solutions via fixed or mobile cameras for at-risk patients have proven to reduce falls. Ochsner Health in Louisiana reduced falls by 51% by utilizing telesitters in centralized locations to monitor cameras in a medical-surgical unit. Patient room closed circuit television analytics, such as those from Axis Communications Inc., provide in-room cameras with virtual bed and chair rails that send alerts to assigned caregivers. Space and infrastructure considerations include incorporating long-term monitoring stations on-site and off-site coordinated with overall health system visions.

Patient engagement. Digital health coaches, such as those from Pillo Health, provide in-home patient engagement devices with customized health support for medication management. Vanderbilt University in Tennessee has developed a flu diagnosis tool utilizing Amazon Alexa. Continued development of these solutions and proactive apps are anticipated to continue to support population health and hospital brand commitment. Space and infrastructure considerations include wearable technology data connectivity infrastructure and dedicated monitoring locations.

Patient active monitoring. Mercy Virtual in Missouri developed an artificial intelligence health monitoring platform with Myia Labs Inc.’s Myia Health that supports proactive remote monitoring. Implantable sensors, such as Profusa, provide real-time personal health data via smartphone, creating new health monitoring opportunities. These examples provide exciting health monitoring possibilities and impact space programming for clinical staff who will support and actively monitor patients. Space and infrastructure requirements include wearable technology data connectivity and monitoring locations.

Surgical team collaboration. 3D printing of pre-surgical planning models provides the ability to collaborate before the first incision occurs, helping to reduce errors. Although printers only need counter spaces and work areas, space and infrastructure considerations include an enhanced surgery planning suite to address pre-surgical collaboration and evaluation with monitors displaying clinical data and current patient images.

Virtual care command center. The growth of telehealth during the recent pandemic is staggering. New care delivery models continue to advance. Remote monitoring of mobile patient devices also has gained traction. This trend will require facilities to provide a virtual care center for clinicians to monitor and interact with patients remotely. Customized solutions that are adaptable for future growth will be required. Space and infrastructure considerations include new virtual care technology areas, spaces or buildings.

The constant shift from in-person to virtual care will require new virtual care modules so clinicians have adequate space to perform virtual visits.

Image courtesy of Cannon Design

Infection control. The reduction of HAIs with technology should be considered by all facilities. The return on investment for these solutions are usually quick when considering readmission costs. For instance, hand-hygiene compliance systems support infection control protocols and are proven to reduce HAIs dramatically. Additionally, surgical instrument tracking solutions support proper maintenance and track instruments utilized on patients when biological indicators are found post-procedure. Space and infrastructure considerations include RTLS infrastructure throughout patient care areas or strategically placed personal computers with bar code readers within sterile processing areas and the operating room suite.

Medication adherence. The Food and Drug Administration approved the first digital ingestion tracking system, Proteus, in 2017. These advances help improve compliance with high-risk patients, improving outcomes. Space and infrastructure considerations include technology data connectivity and monitoring locations.

Medication management. A study by Cedars Sinai in California reveals a reduction in pain scores by utilizing virtual reality (VR) to help patients cope with pain. Space and infrastructure considerations include charging stations for portable VR systems.

Virtual clinics. The future of virtual clinics is a collision of artificial intelligence, block chain data solutions and telehealth apps to self-diagnosis and treat standard ailments without physicians. Space and infrastructure considerations include new virtual care infrastructure and clinical evaluation or support team spaces.

Safety protocols. As noted previously, many existing technologies already provide safety processes and protocols. For example, nurse call systems’ workflow and integration solutions are among the most underutilized technologies in health care that can improve patient safety. Many systems can easily be configured for rounding reminders or integrations to assigned caregivers for improved communications. Space and infrastructure considerations include wall-mounted touchscreen staff workflow terminals for inpatient areas and interfaces to wireless clinical devices.

Access to equipment and resources. RTLSs provide quick access to needed equipment. Inventory management systems, such as those from PAR Excellence, help ensure clinical supplies are always available when needed. Space and infrastructure considerations include extensive RTLS cabling and space for an interactive wall in supply areas.

Training and education. Various VR solutions, such as those from SimX Inc., FundamentalVR and Osso VR, provide training and continuing education through interactive clinical sessions. Space and infrastructure considerations include fixed VR sensors in multipurpose training rooms.

Patient treatment engagement. A Mercy Hospital survey indicated that bedside access to treatment plans via tablet by Epic Systems Corp.’s MyChart improved patient understanding of treatments and medications. Space and infrastructure considerations include arm-mounted patient room tablets and robust wireless infrastructure. 

Artificial intelligence (AI) “heads up” displays. Various AI solutions with medical equipment integrations are developing across the health care field. For example, Decisio Health is providing an AI/real-time automated bedside sepsis monitoring dashboard that has provided positive outcomes reducing intensive care unit length of stay from 16 to six days. Space and infrastructure considerations include AI monitor displays and associated infrastructure on patient headwalls.

Effective communications. Clinical communication is rapidly advancing, integrating voice, video and short message service communications. These support mobile video consultations, clinical integrations and medical equipment interoperability. Each of these must be properly configured to avoid alarm fatigue. Space and infrastructure considerations include AI monitor displays and associated infrastructure on patient headwalls.

Patient-centric rooms. Electronic white board integrations with electronic medical records provide vital information to patients and clinical staff (e.g., assigned caregivers, fall risk and NPO). Space and infrastructure considerations include patient footwall monitors and digital displays outside patient room doors.

Each of these technologies support patient safety, but not all are appropriate for every facility. Technology should not be purchased for technology’s sake. Careful evaluation of what’s appropriate for each facility requires detailed assessments based on operational requirements and overall return on investment. 

New facility model 

Health facilities design professionals must recognize that an old facility model nicely decorated as a high-end hotel is no longer revolutionary or forward thinking.

They should ensure technology is always in the background and delivers added value to enhance the patient experience and consider that patient safety opportunities are present in every component of a health care facility. 

About this article 

This feature is one of a series of articles published by Health Facilities Management in partnership with the American College of Healthcare Architects.

Carlos Amato, AIA, ACHA, is a principal at CannonDesign, and Ted Hood is an associate and senior project manager for technology at TLC Engineering Solutions. They can be reached at camato@cannondesign.com and ted.hood@tlc-eng.com.