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.”
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.”