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Building for the Future

September 1, 2008
by Daphne Lawrence
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Embracing best practices can go a long way for CIOs involved in new facility construction

Rodney Dykehouse

Though the building boom in the United States has grinded to a halt, one segment continues to grow. “Healthcare continues to be very, very strong,” says Jim Koehler, director of specialized services for Minneapolis-based HGA Architects and Engineers. “Right now, not a lot of companies are building new headquarters. But healthcare does not go away.”

The need for new facilities comes from a convergence of factors, says Koehler. “A lot of the community hospital activity involves the replacement of an existing hospital built in the ’40s or ’50s that can't run efficiently anymore for numerous reasons.” He says that rapidly expanding communities have created new geographical opportunities as well – and added to the mix is patient-centric care that demands hotel-like amenities, and the increasing competition to woo voluntary doctors with physician-friendly technology.

John McDaniel, the new CIO of St. Vincent Catholic Medical Centers (St. Vincent's) in New York City, saw the need for new building as soon as he arrived. “I think a lot of CIOs miss this point. But when I first got here I did an assessment,” he says. “One of the quick conclusions I came to is that if we don't redo our technology infrastructure, we would never be successful.” For McDaniel, facing strong competition in hospital-heavy New York meant a new, state-of-the art facility.

This hospital boom — and the costs it brings with it — isn't ending any time soon. With an aging population in need of more care in updated facilities, and the increasing costs of construction today, hospitals can easily see their capital budgets swallowed up by building costs. And even the slightest delay or snafu can cost a hospital big bucks. So how can these be avoided, or at least, lessened?

For most CIOs, the biggest challenge is predicting the future. With IT so deeply entwined in both financial and clinical operations, it appears CIOs can't leave it to the architects to make predictions.

The UCLA Medical Center in Los Angeles opened its new Ronald Reagan Pavilion designed by architect I.M. Pei this July, after a 10-year building process. According to CIO Rodney Dykehouse, he learned a few valuable lessons prior to the ribbon-cutting ceremony.

“I think it's a general problem between construction and architectural firms that their guidelines for scoping out technology requirements is historically based,” he says. “From an IT standpoint, the IT people must get in front of the architects and the construction people and project forward.”

He echoes other CIOs who say today's architects don't seem to get it when it comes to network closets and data center requirements for power and cooling. Most CIOs understand that even though computers are getting smaller, that fact is counteracted by the demand for more technology and applications. The truth is that even as computers get smaller, they still have the same or comparable power and cooling requirements. “Anybody going down this path has to be able to figure that out in advance, because once the facility is built, you're stuck,” says Dykehouse.

Koehler says the disconnect between designers and CIOs is real. “I see it all the time,” he says. “Architects and engineers have been in the business for a long time, and it's hard for these folks to recognize how much of a change there is from a technology perspective, and how that changes a building and how it operates.”

Lindsey jarrell

Lindsey Jarrell

Often, these changes can be substantial. At St. Vincent's, for example, drop-down computers will allow patients to access the Internet, send e-mails, watch TV or movies, raise and lower the blinds and lighting, and call the nurse — all from a single device. In addition, nurses will use the same computer for documentation. St. Vincent's is also in the process of getting its first EMR installed in the new building (as of publication, the vendor has not been finalized).

To generate enterprise support for IT in the new hospital, McDaniel has built a demonstration suite in the old facility that's entirely digital and paperless. “We really designed it to allow people to envision what it would be like to work in that kind of setting,” he says. “The users are starting, in their minds, to change their process and to think about how patient flow would be in a digital facility.”

At North Memorial, a two-hospital system in Robbinsdale, Minn., CIO Pat Taffe also built a demonstration unit for his new 90-bed Maple Grove Hospital — in a warehouse.

“A lot of it had to do with the placement of the devices,” he says. Over the course of a few months, staff from almost every department in the hospital, including physicians, clinical staff, maintenance, and environmental services came through the demonstration unit, and Taffe made tweaks based on their feedback.

“We raised the workstations by two inches one week, then lowered them for the next, trying to get the optimal height.” He also trialed bedside and computer monitors on both sides of the bed. “There was a lot of work that went into trying to make sure that the technology we put there would not only do the job, but that it was positioned so doctors, nurses, and staff could do their jobs too.”




I appreciated your story very much and it does point out the need for early and sustained involvement of the IT department in defining the specifications for technology in any new hospital or clinic construction. As a former healthcare CIO now working for the technology design division of an engineering firm (hospital construction is a prime focus of the firm's work), I am now aware of how much I did not know about the phases of design work performed by architects, engineers, and the hospitals planners or facility managers.

While it is pretty clear that a hospital needs professional engineering around heating, cooling, electrical distribution and piping, there is sometimes some dithering about whether technology design can be kept internal or handled by an amalgam of infrastructure staff and a trusted wiring contractor. In the meantime, the architects need to keep the entire project moving ahead on schedule and moving toward construction documents. The cost to the facility of delaying construction even by one day can be quite heavy - as much as $1Million per day on very large hospital projects. This creates a pressure to have technology spaces like network distribution rooms, wire tray routes, and workstation jacks defined on the blueprints even if the IT Department has not yet weighed in with their needs. This can lead to costly change orders or a technology design that poorly fits your needs.

My advice to CIO's and IT Directors is to get engaged as early as possible. Well defined networking and communication system specifications are a great to have for early preparation and jump start the technology design for the new facility. Understand the time requirements that will be involved in the planning process, between your organization and the engineering team there will be multiple FTE involved at certain points in the process to specify all of the requirements for the technology and communication systems to be installed, determine needs for cooling and electrical distribution, and get these properly designed for both vertical stacking and horizontal distribution in construction design documents.

Beyond design, there is significant work in technology system ion, procurement, project management of the installation and activation. This will require manpower as well to be dedicated to getting this accomplished on time and on budget.

So engage early with your hospital's planning team, ask to get actively involved in helping to the technology design firm that your hospital will use in the construction. Make sure the folks you involve understand current healthcare technology requirements and are well versed on the dozens of systems that will need to be installed, and understand the types of things mentioned in the story such as integration of VoIP and nurse call, environmental requirements for data centers and distribution rooms, and wireless network arrangements that will support such disparate things as wireless VoIP, RFID tracking, bedside WOWs or PDAs.