Healthcare Design - April 2021 - 36

room because you can conduct telemedicine visits in a much smaller
space, " she says. Furthermore, clients are also scrutinizing the impact
of telemedicine on existing and future exam rooms and waiting spaces,
as fewer patients come into their buildings. " It's a discussion point on
what is the role of telemedicine and is that going to change the physical
footprint or design of the building going forward, " Douma says, adding
that the jury's still out on the degree to which it will be affected.
Kara Friehoefer, director of research at HGA (Milwaukee), says most
providers in the firm's study noted they preferred an integrative approach, with telemedicine visits conducted between in-person visits
in the clinic to still allow some inperson engagement and connecADVOCATE AURORA HEALTH
tion with patients. To accommodate
this, she says designers need to think
IS RETHINKING ITS CLINIC
about adjacencies and the right type
MODEL, IN EXPECTATION THAT
of technology in exam rooms as well
30-40 PERCENT OF PATIENT
as the use of teleconference rooms
versus actual exam rooms or officVISITS WILL BE VIRTUAL.
es. " There's a lot that goes into understanding what type of workflow
they're trying to achieve and then accommodating for that, " she says.
Understanding an organization's infrastructure and whether it uses
a decentralized model, where telemedicine is deployed by service line
or department, or a centralized platform, where services and providers
are organized in one location that serves as a command center, is also
important, Radford says. In some cases, she adds, clients will start with
decentralized deployment with the goal to move to a centralized model
in the future. " Then the conversation is about how to scale it and how
do we pull it out of that clinical setting to a nonclinical, cheaper real
estate space, where it can be that command hub for the entire enterprise, " Radford says.
When it comes to the best environment for providers to conduct video appointments, industry views differ. Some clinical environments
include specific quiet rooms or offices for telemedicine while others
design exam rooms that feature additional components such as technology and video screens to support either in-person or remote visits.
HGA's report notes that one of the most popular adjustments to outpatient facilities has been the addition of micro-offices or small booths
that enable auditory privacy on telemedicine calls. Other ideas focused
on supporting connectivity in exam rooms, including integrating technology into the planning and infrastructure so exam rooms can be
equipped for telemedicine at a future date, or using mobile devices and
carts so that technology can be brought to a patient or provider anywhere in a facility.
Based on expectations that 30-40 percent of patient visits will be virtual in the future, Advocate Aurora Health is rethinking its clinic model, reducing the size of standardized rooms for telemedicine and then
backfilling space with services that support a wellness program or other components, such as a retail pharmacy, gym, and community kitchen. The new hybrid model, which could reduce the clinical footprint
by 30 percent, is expected to open in several locations in 2022. " Over
30 clinics have been a standardized kit of parts, built on efficiency and

APRIL 2021

HCDMAGAZINE.COM

throughput and designed primarily around
a physical visit, " says Mike Doiel, senior vice
president at HDR Architecture (Chicago),
which has partnered with Advocate Aurora
Health on its clinic program. " This hybrid or
virtual-visit model kind of turned things upside down and with that could present more
flexibility in operations and space allocation. "
Houston Methodist is also rethinking its
clinical spaces, including evaluating the number of exam rooms assigned to each provider
based upon the amount of in-person visit
activity. " Additionally, we've started to add
huddle rooms to our primary care group locations, which have a video conferencing capability that enables the provider to perform
virtual visits from this room, if they don't
want to do it from their work area or an exam
room, " says Jeff Carr, vice president, finance,
administration, and managed care at Houston
Methodist/TMH Physician Organization.
GROWTH YEAR

The last 12 months have pushed the industry
to deliver a rapid-fire environment for implementing and growing telemedicine. Nelson
says he anticipates another year of lessons
learned; but in the end, he expects the acceptance level of telemedicine is here to stay.
" One of the silver linings of COVID-19 is that
a lot of patients learned that you don't need to
physically visit a [facility] to get good or better healthcare, " he says.
Friehoefer at HGA says she expects clients
will continue to explore what's best served by
telemedicine. " It's adaptable to certain service lines more so than others, " she says. For
example, she says a majority of mental health
visits could be done within a telemedicine setting, while other processes, such as screening
or check-ups, also might benefit.
HOK's Radford says she'll be spending the
next year focused on preventing clients from
regressing. " If you know you can do 40 percent of your visits via telemedicine, why go
backwards? " she says. " Let's grow it. " 
Anne DiNardo is executive editor of Healthcare
Design. She can be reached at A N N E . D I N A R D O @
EMERALD.COM.

http://www.HCDMAGAZINE.COM

Healthcare Design - April 2021

Table of Contents for the Digital Edition of Healthcare Design - April 2021