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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

In addition to all the latest in amenities, most hospitals being built today are paying special attention to wireless infrastructure. “I think any facility moving forward has to put in high-speed backbones,” says Dykehouse, who is using a San Jose, Calif.-based Cisco system. “They will have to begin to really build out their wireless network.”

With the increased use of wireless in new facilities, he says, wireless management systems are needed to provide a real-time overview of the wireless network that can see where devices are, check out the coverage, and remotely tune the wireless network system. Hence, Dykehouse is implementing a wireless management system at the Reagan facility.

“There needs to be a focus not just on implementation, but on the management of the systems, with the ability to respond, adjust, and tune these systems immediately,” he says. “That's the type of thing that will become more critical as more and more medical devices are implemented,” explains Dykehouse.

McDaniel has plans for the medical devices at St. Vincent's as well. He will have USB ports that plug directly into the various medical devices in the room. “So as opposed to the nurse actually having to document the information on a device, it will populate the patient chart electronically,” he says. “All she will do is verify.”

As PACS has moved into the mainstream of the hospital specialties, and CT scans move from 32- to 64-bit (and up), bandwidth is also an important consideration. At Maple Grove, Taffe has what many say is the best solution to the bandwidth issue — the hospital has laid its own dark fiber.

“It isn't cheap,” he says. “It's very expensive to have your own private fiber, but we felt that we could easily pay it back in five years by not paying rent for fiber.” Taffe says that will allow his hospital a virtually unlimited amount of bandwidth in the future.

Most CIOs involved in a new construction project are also spending a lot of time on device, communication, and application integration. Lindsey Jarrell, CIO for Tampa, Fla.-based BayCare Health System, a nine-hospital system, is using U.K.-based Philips' Emergin integration engine. He says nurses today can have pagers for nurse call, pagers for general communications, an internal wireless phone, a PDA to check drug-drug interactions and a computer on wheels (COW). “We want to take things down to one mobile device like a PDA that has phone capabilities, put it all on one device and also give them access to corporate e-mail.”

Integrating new applications into a new facility is challenging, but what about legacy systems? Does a new facility represent an opportunity for “all new”? Apparently, not many CIOs are going that route.

At UCLA, Dykehouse is putting together a new clinical portal from Orion Health (Santa Monica, Calif.) so clinicians don't have to search through multiple systems. “Many of our systems, good or bad, have been custom-developed over the years, so that's part of the challenge — we have to refresh our application portfolio.”

At St. Vincent's, McDaniel, in a sense has it easy — he has no EMR. “We don't even have order entry. It does simplify things to a great degree because basically I have no legacy applications out there, or very few that I have to convert from.” McDaniel says he does plan to preserve the few legacy investments he has by creating an application programming interface (API) that can be accessed from anywhere.

Though most agree that wireless technology and patient-centric rooms are the most popular elements in new hospital design, today's CIO has a wealth of IT opportunities to choose from, which in itself can present another challenge. “The technician in us is always drooling about virtualization, blade servers, RFID, Vocera, and all these technologies,” says Taffe. “But we made a decision early on that technology was going to be prevalent, but not overly evident. We were not going to deploy technology for the sake of a new toy to play with.”

One area he decided to downsize was RFID. Since it's possible to track virtually anything in a hospital, the project was a bit overwhelming. So Taffe says he opted to move into that area slowly. “We decided not to put RFID into everything that moves the day we opened up the hospital.” He says although there is certainly value in being able to track everything, it is costly. “We decided to make sure we're using it where we can get the most benefit.”

For Taffe, that meant tracking devices and equipment that nurses need at the bedside, but can never seem to find—like wheelchairs and IV pumps. “Our goal is really for technology to anticipate the needs of the caregivers, versus them telling us what they want, and then we go off and do it.”

The green movement has also taken hold in the hospital building arena. “The phone PBX is a good example,” says Jarrell. “It went from the size of a car to the size of a chair. So that requires less heat, less cooling.” His new hospital will be LEED certified silver (see sidebar).

Another green option is virtual machine software that runs more applications off less servers. “It reduces footprint, it reduces square footage requirements, it reduces energy requirements, it reduces the heat, and it truly reduces my cost because I don't have to buy as many servers,” says McDaniel.

At MapleGrove, Taffe is using blade servers to reduce his footprint. “We've been very conscience about greening this facility. Virtualization is in the strategic plan, and the hospital will open with virtual servers.”

For CIOs, the constant battle of how much space they can allocate for technology is a big challenge. But there's an even bigger one.

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Comments

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.

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