When leaders of Humber River Hospital set out to build a replacement hospital in Toronto, they didn’t just want to incorporate the latest technologies, such as a real-time location system (RTLS), integrated bedside terminals, or automated guided vehicles (AGVs), into the 1.8 million-square-foot facility.
They wanted those technologies—including automated building and clinical systems—to be able to work together and achieve a more sophisticated level of interoperability. “The technology existed,” says Jerry Jeter, vice president and principal at HDR (Denver); but it was more about “getting those things to talk to each other and do it in a way that the hospital wanted.”
The pathway to success entailed assessing every system that was going to be implemented in the 656-bed hospital and developing compatible software to connect everything, including an “enterprise service bus,” which Jeter describes as a big channel conduit that allows information to flow to and from any location within the building. This means that when a provider sends a sample for testing, it’s processed in a fully automated lab and then the provider receives a message on a smart phone about the test and what’s been done.
“Then all of that information is filtered into the electronic health record (EHR) at the same time, allowing the staff to more effectively and efficiently treat their patients,” he says.
Driven by the desire to improve the patient experience, create Lean operations, support population health, and meet mandates for EHRs, more healthcare systems are seeking robust technology solutions, which is driving new design discussions. Sandy Faurot, vice president at CallisonRTKL and director of the firm’s Chicago office, says that providers today are more technologically savvy and better educated on what specific systems they’d like to put to work inside their facilities.
“It used to be that clients didn’t really know what technology was going to do for them, but they knew it was going to change. So they wanted flexibility to handle whatever type of technology could come at them,” he says. “Now they’re a little more targeted; they know they want radio-frequency identification (RFID) for locating staff and equipment, they know they want a patient technology interface for wayfinding, and they know electronic medical records are going to interface with everything else.”
The opportunity for healthcare designers and architects is figuring out which pieces of the technology puzzle are appropriate for an organization’s goals while planning for future adaptations and changes. “The conversations are about how to streamline workflows, develop efficiencies in our process, measure data, and adapt our processes to increase efficiencies,” says Scott Chester, associate vice president within CallisonRTKL’s technology design studio (Baltimore, Md.). “With those things in mind, a lot of the focus is on strategies that leverage technology and the systems that are available to help foster that.”
All systems go
Humber River opened its doors in October 2015 with an array of digital features, including inpatient rooms with integrated bedside terminals that give patients control over room settings (temperature, lighting levels, and the intelligent glazing system which can adjust how much light enters the room without the use of shades); smart beds that monitor patients’ vital signs and update EHRs; an automated laboratory; and 10 AGVs that deliver supplies and equipment throughout the building.
Additionally, a chute system directly routes all waste, recycling, and dirty linens to specific truck beds, eliminating handling by staff, while a pneumatic tube system links the laboratory and pharmacy to the nurses’ stations on the inpatient floors and 50 other locations throughout the building to expedite delivery of samples and medications.
“Between the AGVs, the trash and linen chutes, and the pneumatic tube system, we were able to automate 74 percent of the deliveries in the hospital,” Jeter says—saving the hospital the need for 19 full-time employees per day.
Operational savings aren’t the only benefit healthcare facilities are reaping with technology—greater efficiencies and improved clinical outcomes are also being served. When St. Joseph Mercy Oakland embarked on the design of a new 204-bed patient tower on its campus in Pontiac, Mich., administrators asked caregivers to identify some of the pain points in the care process and then sought technologies to help address those problems.
One of the issues brought to the table was overall communications, says Robert Jones, senior director of information services at St. Joseph Mercy Oakland. In the existing system, a patient would press a call button and someone would have to route that call to the appropriate staff member. The staff member would then go into the patient room to figure out what was needed, and then leave and come back if the needed item wasn’t already available in the room.
“We wanted to deliver that nurse call alert directly to the nurse, wherever they might be,” he says.
When the tower opened in March 2014, a new communication network was in place that uses iPhone-based communication devices to connect nurses with patients, staff, and physicians as well as deliver alarms and monitoring cues. Nurses can also use the handheld devices to send text messages to one another and to receive alerts about delivery times for medications and meals.
Jones says that the average nurse call response time decreased by 57 percent between fourth quarter 2014 and first quarter 2016, which correlated with a 12 percent improvement in the HCAHPS survey on the response to questions on hospital staff. “The number of unnecessary caregiver trips was reduced as a result of more effective communication among caregivers and between patients and their caregivers,” he says.
Optimizing the benefits
Location-based services, such as RTLS and RFID, are other technologies that have been gaining popularity in recent years to identify and track the location or movement of patients, staff, or assets, such as wheelchairs and stretchers, throughout a facility. At Humber River Hospital, RTLS enhances security for vulnerable patients, such as newborn babies and those with mental health conditions, who wear tracking tags that are linked to a nurse call system. A security response is initiated if the RTLS system is activated by certain activities, such as a patient making an unsanctioned leave from a department.
Humber River uses RFID as a separate but interconnected system to RTLS to improve communications between staff and family members. The technology tracks patients through a department or procedure and sends updates via text to a family member’s smartphone to inform them when a patient moves from pre-op to surgery and then into a recovery room.
Additionally, each care provider wears an RFID device and when they enter an inpatient room, their name and reason for the visit come up on an integrated bedside terminal and a monitor on the footwall, making the information visible to patients as well as family members in the room. “It’s a way to connect people using technology so they know what’s going on and they can ask the right kind of questions,” says Norman Fisher, project manager at HDR’s Toronto office.
Real-time data can also be used to take a more analytical approach to drive process improvements by measuring and evaluating certain activities, such as patient flow through specific departments (surgery, the ED, or a clinic), and making adjustments.
“There’s a huge advantage in those departments to be able to identify a patient’s flow, where they are in the process, and then to adj
ust your approach to their visit based on the information that’s available,” CallisonRTKL’s Chester says. As time goes on and more data are collected, he says design teams can also mine that information to make decisions about facility size, layout, and number of exam rooms needed in a specific department.
As healthcare organizations expand their technology initiatives, Jeff Brand, principal and national healthcare leader at Perkins Eastman (New York), says providers are allocating space on their campuses for data rooms, equipment, server racks, and more. “They want to have things fairly close to them so they can monitor it,” he says.
Tom Stanfield, technology integration coordinator for Parkland Health and Hospital System (Dallas), says the massive New Parkland Hospital, which opened in August 2015, required a robust network that could be “future-proof for 10-15 years down the road.” To support that goal, Stanfield and his team built an infrastructure that includes a redundant fiber ring around the entire campus to carry high-bandwidth data to support a range of technologies, from telemetry coverage across the campus to smartboard technologies in the footwall of the inpatient rooms to a video integration system in the operating rooms that allows surgeons to consult with other clinicians in real time.
During construction, Stanfield says, ductwork and manholes were placed in locations where they could easily accommodate expansion as additional buildings and technologies are brought onto the network. Inside the hospital, Stanfield says there are more than 70 technology closets, which hold 9-foot-tall equipment racks to maximize the vertical and horizontal spaces within each room.
“We built out the racks to 100 percent, but some of the racks are still empty,” he says. “It was easier to go in and install the racks [now] and then fill them with technology as the need accrues.”
Jones says he’s always looking for technology that he can continue to build on for St. Joseph Mercy Oakland but that one of the biggest hurdles within healthcare is funding. “You have to identify the return on investment or how you can leverage existing infrastructure to get you what you need,” he says.
CallisonRTKL’s Chester says involving the IT team early on in the planning can help figure out what’s available and cost-effective, both now and for the future. “We can look at it and do things in the planning process to provide the connectivity or infrastructure so if the budget doesn’t support it on day one, they can roll a system out when they have the funds to support it,” he says