Healthcare Design - March 2014 - 44

Systems integration

Impact Advisors' Carl Fleming
shares how design and
information technology must
come together to support
high-tech healthcare delivery
By Jennifer Kovacs Silvis

TECHNOLOGY IS BECOMING as inherent to
the delivery of healthcare as diagnosis, treatment, and prevention of disease. Whether
building a new facility or renovating an old
space, it's likely that every project on design
boards today will require plenty of thought for
information technology (IT) and integration of
all the systems that continue to be adopted
to support the continuum of care.
To help shed light on how the industry's
approach to IT planning has changed over
the years and where designs may be falling
short, Healthcare Design spoke with Carl
Fleming, principal advisor at healthcare IT
consulting firm Impact Advisors (Naperville,
Ill.). Fleming has spent 13 years working with
architects and facility planners to develop
technology groundwork that blends emerging systems with existing infrastructure
to support new workflows in a new built
environment.

Healthcare Design: How is planning for
IT different now than it used to be?
Carl Fleming: The biggest shift I've experienced in the last 12-18 months is the way in
which technology consultants are engaged
for new facility/renovation projects. In past
years, we were typically brought in by the
chief information officer and not directly integrated with the design/build team. Recently,
I've seen an uptick in the number of requests
I've received from architectural firms and
construction managers to join the integrated
delivery team and be involved from the
beginning phases of a project. Ultimately,
this allows for better coordination between
the designers, construction managers, and
the owners technology/information services
teams.
With so many different types of technology used in healthcare today, how has
that affected facility needs to support
these systems?
The technology implemented in today's
healthcare environments is no longer a
conglomeration of disparate systems but
rather a complex mesh of integrated solutions, each providing data to the others. The

HCDmagazine.com 03.14

building systems talk to tracking systems that
communicate with nurse call systems that are
integrated to the EMR and interactive patient
systems. All of this technology requires a lot of
infrastructure and large technology rooms to
contain it. As systems that used to be "dumb"
are now becoming "smart," the increased
number of smart systems results in more end
user devices, which require more infrastructure and the need for larger spaces to house
that technology.
What are common mistakes or misconceptions you see in planning for technology in healthcare?
Designers often design spaces that require
completely different patient flows and oftentimes a radically different clinician workflow
than staff experience in existing buildings.
Including the appropriate nursing and nursing informatics experts are crucial; however,
simply including them in design meetings
isn't enough. With each new concept-decentralized nursing, centralized scheduling,
in-room check-out-staff must be challenged
to consider workflow implications, specifically
regarding the clinician experience, patient
experience, and future operations in the new
space.
Also, I see technology solutions often
becoming the fallback for a design challenge.
A good example of this is found with a curvilinear hallway within a patient floor that has
a decentralized nursing model using a small/
nontraditional nurses' station. The design
results in limited line-of-sight for clinicians who
often complain once they've begun working in
the space. Too often designers jump directly
to a specific VoIP phone or real-time location
system as a solution to the issue. Often, the
purchase of these systems isn't supported
by the owner and isn't on the organization's
technology roadmap. As technology solutions
are often considered at the enterprise level, it
may be unreasonable for a one-off technology
to be implemented.
Technology often isn't considered in the
initial programming phase. I'm frequently
pulled into projects that are already through
the schematic design phase and heading fast

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Healthcare Design - March 2014

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