Technology has played an increasing role in the delivery of healthcare over the last 20 years, driven by the expansion of the internet, Wi-Fi, and network-based systems.
From building automation and control, nurse call, television, motorized shade specifications, and IT-based interactive patient and locating systems to medical equipment such as IV pumps, smart patient beds, and other auxiliary equipment, the quantity of systems to be integrated in today’s healthcare environments is staggering.
However, hospital technology implementations often don’t meet functional requirements and clinical needs. This is because the functionality for new technologies are not being sufficiently defined nor implemented correctly. Issues include improper device locations, misunderstood technology utilization, scope issues, technology changes, and necessary adaptable spaces.
Design teams can help healthcare providers improve outcomes by assisting clinicians, IT and facilities staff, and administrators in understanding the realistic capabilities of healthcare technology.
Breaking down challenges
Oftentimes challenges arise during the procurement and implementation of healthcare technology, most often in budgeting efforts. For capital projects, healthcare technology will fall into two budget categories: owner provided and contractor provided.
Managing these two budgets is critical to ensure successful implementation. A detailed responsibility matrix is a valuable tool, which lists all healthcare technologies and assigns responsibility for planning, design, budgeting, purchasing, installation, and verification.
This tool helps the design team confirm all the technology systems are included and identifies budgeting and purchasing responsibilities. For example, security cameras might be provided by the construction team, but the licensing and recording software might be provided by IT. Additionally, there are maintenance and support costs that need to be accounted for years after the project is completed.
There’s also the challenge of the different silos in a typical healthcare system: IT, facilities, biomed, and clinical staff often operate in their own organizational structures and are only brought into construction projects when required.
Issues arise because groups don’t work together to make sure that the total system is fully functional. A good example is an interactive patient room system that uses an in-room TV as a digital interface for the patient to access entertainment, medical records, and patient education, as well as links with the building controls to adjust lighting and temperature.
Each of these systems can be functioning properly, but if the different hospital champions don’t work together, the overall experience will not be realized. A solution is to bring together the different owner groups (controls, network, facilities) to clearly document the requirements and assign responsibilities for design, review, and implementation.
Finally, scheduling and procurement issues are always a possibility in today’s construction climate. To successfully implement most technologies, the project team must closely coordinate the construction, procurement, implementation, training, and go-live process.
Most often, the construction team is focused on the substantial completion and project closeout without coordinating with the owner-furnished technologies, which tend to be installed in the last phase of a project. Even more rarely does the team plan sufficient training and implementation time.
If users are not trained properly, they will dismiss the technology “as too hard to use” or simply “broken.”
When planning for technology, it’s important to design spaces that not only address users’ needs at the time of the project but can evolve over the building’s lifespan.
For example, most spaces used to house technology like data centers and telecommunication rooms are designed by asking IT how many racks and cabinets are needed to support the equipment. While data continues to move to the cloud, that’s not always the case.
Meanwhile, more devices are now powered over ethernet, which utilizes more network switches that require more rack space. Similarly, an increase in the power consumption of processors is driving higher power consumption by servers, which drives more electrical power service.
Plus, increasing power needs in high-performance computing and research may soon require alternate cooling methods such as immersion cooling. In the end, these considerations typically require more space than initially thought for telecommunications rooms.
Furthermore, electrical power requirements cannot be determined by solely asking for the specifications for each piece of equipment that IT has planned to install in server cabinets in a data center or telecommunications room. Instead, it’s important to plan for future cabinet expansion. This is done by providing adequate space and planning for increased power densities by standardizing based on a future capacity such as 5-10 kW per server cabinet. A standardized approach makes the power systems easier to maintain and easier to expand.
Another aspect of futureproofing is to build flexibility in the design of healthcare IT devices. For example, a facility may want to implement registration kiosks or tablets only to scrap the solution after six months due to low usage. Often, the problem isn’t with the kiosk or the tablet but with the way these technologies were implemented and the lack of options for those who are not able to use them.
A better way is to provide multiple options for a task, such as mobile registration via a smartphone, kiosks, or tablets, and a smaller-staffed registration point. These options provide multiple ways for technology to enable the patient experience goals of the healthcare system and allow the owner to adjust their approach over time.
4 tools for success
Given the challenges of implementing technology-driven projects, there are some valuable tools that can be used to ensure a successful project.
- First, begin with a comprehensive team composed of design consultants, an owner’s executive team, core clinical leadership, IT, physicians, and hospital support departments. After the team is assembled, determine the technology decision-making group that will provide strategic direction and the smaller functional teams that will eventually work out the technical and integration solutions.
- Technology visioning sessions can be conducted to understand how different technologies will enable the overall project vision. These meetings should result in a “technology roadmap” that provides a concise and clear document that summarizes the technologies to be implemented during the project and future upgrades, as well as a corresponding budget.
- Conducting a pilot program is extremely beneficial, as well. First, it allows time to work out all the technology requirements to ensure systems can communicate, such as firewall and cyber security systems. Next, this step affords the team the ability to bring in the clinical team and ensure that all workflows and processes are supported by the integrated systems. Valuable feedback is gained during these clinical work trials, which can then be used to improve the design.
- As projects progress from design to construction, periodic checkpoints with the entire team are imperative to keep the project on track, implement feedback from pilot programs, and react to new changes in the selected technologies. These collaborations are critical to ensuring that a project doesn’t deliver outdated technology and that all integrations are realized.
Implementing healthcare technology successfully requires focused involvement from a comprehensive team, from early conceptual planning through go-live and for many years of upgrades.
The most common challenges lie in understanding emerging technologies and the complex integrations that will support the clinical and operational use cases.
Taw North, RCDD, LEED AP, is principal and director of technology consulting at TLC Engineering Solutions (Orlando, Fla.). He can be reached at [email protected]. Ted Hood is a managing principal at TLC Engineering Solutions (Brentwood, Tenn.). He can be reached at [email protected].