The new healthcare is bringing together disparate elements of planning and activity as never before. Twenty years ago, building a hospital was a relatively straightforward process, based on decades of tradition and precedence. Certainly, pioneering hospital executives and clinicians were evolving toward a variety of concepts around the patient-centered hospital, improved clinician workflow, and other laudable innovations. But the core physical plant was fundamentally familiar to building contractors in the same way it might have been 50 years prior.
No more. Today's replacement hospital facility is fundamentally different from that of 10 or even five years ago, in at least one critical way: it will usually be a “smart” hospital, with a built-in technological foundation and capabilities that will change the delivery of patient care - and will require a new kind of construction planning altogether. No longer will the CIO be brought into the discussion after the building is nearly physically complete; instead, the chief information officer and her or his team are now increasingly at the table much earlier.
Just consider the following:
At the 675-bed Parkland Hospital and Health System in Dallas, Jack Kowitt, senior vice president and CIO, and his team, have been planning a total replacement for the 56-year-old facility. As planning proceeds for the 2.1-mill.-sq.-ft. facility (to replace the current 1.1-mill.-sq.-ft. one), it is becoming clearer every day how essential IT's involvement has been to the design and construction process, Kowitt says.
In northern Ohio, healthcare IT executive John Britton is helping manage two coordinated smart-room-based hospital construction projects, at the 99-bed Fisher-Titus Medical Center in Norwalk (where he is vice president of information services), and at the 25-bed Magruder Hospital in Port Clinton (where his title is consulting CIO). Both construction/IT projects are moving the hospitals towards virtual paperlessness, as well as a completely new room design, for both facilities. In addition, the planning will produce a first full implementation of electronic medical record (EMR) and computerized physician order entry (CPOE) systems at both hospitals, in anticipation of obtaining funding under the federal ARRA-HITECH Act, Britton reports.
In Boston, Sue Schade, vice president and CIO of Brigham and Women's Hospital, has been involved in three new construction projects in the past 18 months. Brigham and Women's Hospital has not only built a new 136-bed cardiovascular care center on its own campus; it has also been involved in two collaborative construction projects, one involving an ambulatory care center it is co-sponsoring with Massachusetts General Hospital, a sister organization within the Partners HealthCare system; the other, a collaborative cancer center involving the Dana Farber Cancer Institute and nearby South Shore Hospital and the Harbor Medical Group. While each of the three projects has been different, they share a common bottom line from the CIO standpoint. “The early planning and connections with the facilities people are critical,” Schade says. In order to achieve success, she says early work “You can't start talking about the IT needs too soon.” And, she says, early work must focus on patient flow and clinician workflow, in order to achieve success.
In Phoenix, construction is proceeding apace at Phoenix Children's Hospital, whose executives are building a new patient tower that will hold 626 beds, reports vice president and CIO Bob Sarnecki. The current patient tower (with 300 beds) will be used for certain specialized types of care once the new patient tower is opened next year, Sarnecki says. With the opening of the new tower, Phoenix Children's Hospital will be the largest pediatric hospital by bed size in Arizona, and one of the largest in the U.S.
At Northwestern Memorial Hospital in downtown Chicago, executives realized some time ago the great importance of coordinated planning for new construction and for IT development, so much so that last year, the hospital elevated Tim Zoph from vice president and CIO to senior vice president of administration and CIO, recognizing not only Zoph's personal talents and capabilities, but also the fact that it was his division, IT, that helped to seed successful project management strategies across many divisions at the 785-bed [CHECK] academic medical center. Zoph is now in charge of all new construction at Northwestern Memorial, which has been a pioneer in new construction among teaching hospitals in recent years.
“If you're even considering constructing a digital building, you must involve your CIO and IT people, because the infrastructure for a digital building is totally different, particularly in terms of the requirements for a very high level of built-in reliability.”-Tim Zoph, senior vice president of administration and CIO, Northwestern Memorial Hospital, Chicago
Technology, industry, evolving forward rapidly
In fact, Zoph says his own organization's experience with design and construction in the past decade or so reflect the strong changes that have taken place in information technology in the past ten-plus years. For example, between the time that Northwestern Memorial executives completed the construction of the Feinberg Pavilion, the replacement facility for the hospital's main patient tower, in 1999, and the time that they opened the replacement facility for Prentice Women's Hospital in 2007, “Advancements were very significant,” Zoph says. As a result, he notes, “We opened Feinberg as something of a hybrid building that was partly digital; but by 2007, we had opened Prentice Women's as a 100-percent digital building.” The key takeaway? “If you're even considering constructing a digital building, you must involve your CIO and IT people, because the infrastructure for a digital building is totally different, particularly in terms of the requirements for a very high level of built-in reliability.”
And, as in the Northwestern Memorial situation, when the construction involves an entirely new building, as opposed to retrofitting a wing or section of a building, both the opportunities and challenges are many, says Phoenix Children's Sarnecki. “What's cool in our situation,” he says, “is that we're getting to put new technology into a building into which you can build in new technology very well. In our current hospital, our technology closets are scattered all over the place, and it's a mess.” On the other hand, he adds, successfully planning new construction involves many layers of planning. As a result, he and his colleagues in IT and those on the facilities side at Phoenix Children's have been working with a consulting firm that specializes in IT planning for new hospital construction. “We've been working with them on some of the RFP [request for proposal] process for some of the technology going in, as well as for the purpose of simply understanding our current state of technology. For example,” he says, “we've had to very quickly study the current state of technology for nurse-call systems, distributed-antenna systems, and the network wireless technology we'll be putting in.” Using a specialized IT-planning consulting firm has been a real boon because of how time-consuming the detailed planning needed to be successful quickly comes, he emphasizes.
As if there weren't already enough complexity involved in IT planning for the construction of entirely new hospital buildings, when more than one business organization is involved, the complexity multiplies very rapidly, say CIOs who've been involved in multi-organization projects. Brigham and Women's Hospital's Schade, for one, says she can absolutely attest to that element. Not only did the construction of the Dana Farber/Brigham and Women's Cancer Center involve three very different organizations at different stages of overall IT development, it also involved collaboration among three organizations with different core-clinical vendors; as Schade puts it, “The complexity went up because of the number of integration points for applications”; as well as some complex levels of planning among very diverse teams of IT professionals from the different hospitals.
Looking to the future, “plan big”
Most importantly, say all those interviewed for the future, IT planning for new construction these days inevitably means looking as far into the future as practicable, while working with the resources of today. And that means envisioning what patient care delivery changes might be in store, says Parkland's Kowitt. “In my opinion, what will change the most in the years to come will be the patient experience and the patient room. We're looking to build a very patient-centered experience,” he continues, “and are moving away from the centralized nursing station concept and towards the nursing pod, which essentially involves a mini-nursing station in front of every two rooms.” And with such design changes inevitably come a host of practical issues, such as the placement of technology closets, that must be decided very early on in any building project.
“The reality is that I pretty much have to plan here for technology in a facility that will be locked into place for at least 10 years.”-Bob Sarnecki, Vice President and CIO, Phoenix Children's Hospital
As information technology advances rapidly, new construction projects are becoming far more complex to successfully plan, with regard to IT.
CIOs and their teams must be at the planning table from the outset, working very closely together with facilities executives and other leaders within their organizations, to plan effectively and cost-effectively for new construction projects.
As new hospital facilities are built more and more from the start as “digital hospitals,” the degree of “fail-safe” technological reliability that must be built into them is rapidly intensifying.
CIOs must work closely with their colleagues from all the other stakeholder disciplines to plan for potential changes in patient care delivery, as well as ongoing changes in information technology, years into the future, particularly given the lengths of time the facilities being built now will need to last.
The bottom line in all this? “You just have to plan big,” Kowitt says. “So on the one hand, any area of a new facility might end up being repurposed at any time; on the other hand, you can't just move a technology closet.” As a result, planning must necessarily involve a lot of “what-if”-type rumination about future changes in patient care delivery patterns and other phenomena, he emphasizes.
If all of this makes it sound as though CIOs need to be psychics as well as planners, those interviewed for this article agree that all CIOs can do is their strategic-planning best. “If you can get out even three years ahead in your planning, you're doing well,” shrugs Phoenix Children's Sarnecki. “And the reality is that I pretty much have to plan here for technology in a facility that will be locked into place for at least 10 years.” So, for example, he and his colleagues will open the new tower with a huge data center, only one-fourth of whose floor space will be filled at the outset. As a result, special preparations have been made for the efficient management of the HVAC (heating/ventilation/air conditioning) resources involved.
Clearly, says Brigham and Women's Hospital's Schade, there are some very basic things CIOs must do in all this. “The early planning and connections with the facilities people are critical; you can't start talking about the IT needs too soon,” she insists. “You need to look at really basic things including phones and network, and so on; not to mention intensive planning regarding flow, including patient flow.”
Finally, there is the leadership element, emphasizes Northwestern Memorial's Zoph. “CIOs should recognize that they can bring a contribution to the overall building of a building that goes beyond IT,” he says. “We've got a lot of process knowledge, of project management knowledge; and we can see the building of a building in a unique way. So think of yourself as a leader who is contributing to this project beyond just your domain knowledge in IT.” Creating the hospital facilities of the future, he says, “will take a team of knowledgeable health care leaders who bring not only their domain knowledge to the table, but who recognize that collectively, the work of opening a building is a management exercise that will be very challenging, but also exciting, for the organization's future; so be a leader.”
Healthcare Informatics 2010 May;27(5):10-14