Author: Silvio Napoleone

Hospital redevelopment projects provide a unique opportunity to build for the future

The increasingly critical role of technology in patient care has resulted in a dramatic increase in demands on communications and information technology infrastructure in hospitals, but aging facilities pose significant challenges to the staff who support and maintain these systems. Many hospitals in Canada were constructed well before the emergence of modern information technology, which typically means telecommunications equipment is squeezed into undersized spaces without sufficient power or cooling to ensure these important systems stay operational.

IT spaces added as an afterthought to existing construction In older buildings, telecommunications spaces have gradually expanded as the systems grow, creating a
number of challenges:

  • Locations are often chosen based on what space is available, rather than what is appropriate, meaning that the size and shape of the rooms may not properly support the equipment, or the site may be adjacent to
    wet piping or sources of interference.
  • Addition and removal of equipment over many years often results in an inefficient layout and lack of appropriate cable management or identification, making maintenance more difficult.
  • Supporting services, including power and cooling, may not have the appropriate capacity or redundancy for IT loads, and equipment shutdown for maintenance and repairs can impact the availability of these services.
  • Limited ceiling space in older facilities can impact the ability to add services (i.e. chilled water loop) or new communications cables.

Limitations have a significant budget impact
All of these challenges can have a significant impact on operational and capital costs, and can add up to multiples of what is typical of a new installation with properly designed spaces and systems.

The greatest impact is seen in operational costs, where limitations make the systems more difficult to maintain, support and upgrade. From a user perspective, network performance can be affected by things such as heat or interference, which can create unnecessary delays in accessing information or even unplanned network downtime – a condition which critically impacts patient care across the entire facility. However, capital costs are not immune to these conditions either; overheating, dust and vibration can reduce the lifespan of equipment, meaning it must be replaced sooner.

Redevelopment with the future in mind
Hospital redevelopment provides the opportunity to build new IT systems that can withstand the test of time, and to address issues with existing systems in order to support expansion. While no one can predict the needs of technology decades from now, the following principles will help avoid creating similar challenges in the future:

  • Engage users early on in the planning process, and design IT systems to align with the technology vision for the hospital. This approach facilitates adoption later on and helps ensure IT systems can support the
    unique needs of the facility.
  • Consider the facility as a whole when implementing new IT systems and infrastructure; design decisions for new spaces can have a significant impact on existing IT infrastructure, and a gap analysis can help prevent unpleasant surprises later on.
  • Provide additional capacity and flexibility in infrastructure, spaces and supporting systems so they can be adapted as technology progresses.
  • Aim for consistency in services throughout the facility. Differences in system performance or user experience can impact adoption, staff satisfaction and, in the case of clinical life safety systems, even patient safety.

It is also worth investigating which challenges can be addressed in place and which would benefit from a “greenfield” solution. For example, building a new data centre in a newly constructed area of the building is often less complex and cheaper than mitigating issues with the existing location. Many redevelopment projects use this opportunity to create a space that is properly sized and designed to support critical IT systems for the entire facility. The practicality of options should be evaluated as part of the planning process.

Ultimately, redevelopment projects are a chance for hospitals to create efficient and cost-effective IT systems capable of supporting the critical nature of technology in healthcare, and support the highest standard of patient care.

Author:

Kim Osborne Rodriguez,P.Eng., RCDD
kim.osbornerodriguez@hhangus.com
Published June 2016 in the Canadian Healthcare Engineering Society website

The Minto flywheel project in Ontario is a “mechanical battery” that stores electricity in the form of kinetic energy — one ingenious solution to the search for the “holy grail” of the electricity system. To read more - Download Issue >

Congratulations to our client – TD Bank Group – on achieving the WORLD’S FIRST WELL™ Gold certification for their TD23 project of the WELL Building Standard. This ground-breaking achievement is a new milestone in the development, growth and expansion of the WELL™ Certification program.

HH Angus is proud to have participated in the first project to be certified WELL Gold by the International WELL™ Building Institute (IWBI) through version 1 of its WELL Building Standard (WELL). We congratulate TD Bank Group for the success of their pilot project – the 23rd Floor of Tower One at the Toronto Dominion Centre. The project provided us with an excellent understanding of the WELL™ certification process.

The WELL™ Building Standard is the first of its kind to focus on the health and wellness of building occupants. It identifies performance metrics, design strategies and policies that can be implemented by owners, designers, engineers, contractors, users and operators of buildings. We believe that the Standard has the potential to be widely embraced and adopted in conjunction with current LEED practice, so we’re very pleased to be involved with WELL™ in its early stages.

HH Angus’ Commercial Division has worked with TD Bank Group on portfolio optimization for several years. This work has been geared to implementing a broad infrastructure renewal. The Optimization project also represented Canada’s first Integrated Project Delivery contract for a commercial interior, and was the first TD corporate interior to obtain LEED Platinum Certification.

At HH Angus, we believe that the WELL™ Building Standard has the potential to one day be widely embraced and adopted in conjunction with current LEED practice, so we’re very pleased to be involved in the early stages of this standard, and to be able to support a valued client in this effort.

Read the Canadian Green Building Council article on TD23’s WELL certification.

On January 13, Toronto’s Emerging Leader Forum (ELF) hosted an engaging discussion on Digital Health focused on informing young leaders in healthcare. The event was led by Dr. Darren Larsen, Chief Medical Information Officer at OntarioMD, who facilitated the discussion with:

  • David Denov, Senior Manager, National Health Services at Deloitte
  • Dr. Trevor Jamieson, Virtual Care Lead, Women’s College Hospital
  • Laurie Poole, VP, Telemedicine Solutions at Ontario Telemedicine Network
    Throughout the discussion, key themes of patient-driven care, improved outcomes, reduced cost and better coordination of care emerged as central drivers for the adoption of digital health.

What is Digital Health ?

Digital health is empowering people to better track, manage, and improve their own and their family’s health, live better, more productive lives, and improve society. (Wikipedia)

 Despite having a relatively straightforward label, the concept of digital health encompasses a complex set of ideas that differ greatly between sectors and people. While many associate digital health with smartphone apps and telehealth, Dr. Trevor Jamieson is quick to differentiate between virtual health and digital health, noting that “how you use data to drive better decision making” forms the core of how digital health impacts how we care for patients. Many would agree that data has become critical in the delivery of healthcare across varying sectors from acute to primary care, and the ability to manage and apply data efficiently will likely become future differentiators for providers in the healthcare market. 

Unfortunately, one of the primary challenges of delivering on this definition of digital health is a lack of interoperability and integration both within and between healthcare organizations, which means that data cannot be leveraged to maximize its value. It’s not just enough to have astronomical amounts of data; it has to be delivered to the right person at the right time.

What’s holding back the adoption of digital health?

A combination of limited funding and a conservative approach to technology seem to be the biggest obstacles to the adoption of digital health in Ontario, but Laurie Poole is optimistic: “Technology used to be an afterthought, so there has been a big shift from even four years ago.”
However, funding models that reward physical presence rather than virtual care, and privacy legislation that limits how organizations store and share data are two big barriers noted by David Denov and Dr. Jamieson. “Hospitals and providers have convinced themselves that change has to be incremental, and that disruption is undesirable,” says Dr. Jamieson. “You will never have innovation without a bit of risk.” Clearly innovation needs to be balanced with the risk and potential consequences for patients and their data.

How can Canadian hospitals become leaders?

Looking to other health systems that have achieved widespread adoption of technology and digital health, it appears that that big changes have to be driven (or at least strongly supported) from the top down – and not just within the hospital, but from health systems or regional leadership in healthcare. Poole points out that integrated health systems in the US have leveraged their power as a closed system with a single HIS to drive mainstream adoption of virtual care, but that a lack of integration in Ontario has been a key challenge in achieving the same adoption. Many G8 countries are facing similar challenges of constricted spending, limited infrastructure and an aging population, and consolidating leadership at a regional or provincial level may help coordinate adoption. “Every [Ontario] hospital has an independent board of directors,” Dr. Jamieson adds, which may contribute to the challenges in achieving widespread adoption.
This might imply that Ontario hospitals are stuck in siloed information systems without a strong mandate from provincial leadership, but momentum is building and there are a number of initiatives which are working towards broader integration. Initiatives such as ConnectingGTA and the current [as of 2016] provincial hold on new Hospital Information System implementations may be the first step towards standardization.

Where do we go from here?

From the patient perspective, there is a growing expectation of digital health integration throughout their healthcare journey regardless of care location. Many of our Ontario hospitals have been able to leverage digital health effectively within their own organizations and work with healthcare partners on a community level, but growing pressure from patients will likely continue to push for provincial and even national initiatives which improve on inter-organizational integration. It is certainly clear that digital health has the opportunity to transform how care is delivered to the patient – from improved data analytics & big data to driving better patient outcomes through 360-degree healthcare coordination, digital health is becoming an essential part of effective healthcare.

 

Author: Kim Osborne Rodriguez, P.Eng., RCDD

HH Angus was recently part of the team that delivered upgrades to TD Bank’s 23rd Floor project at the Toronto Dominion Centre.  The project is on track to achieve Canada’s first corporate International Well Building Accreditation.

At HH Angus, we believe that the Well Building Standard has the potential to one day be widely embraced and adopted in conjunction with current LEED practice, so we’re very pleased to be involved in the early stages of this accreditation standard, and to be able to support a valued client in this effort.