Category: Ideation
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
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
The information technology needs of health care institutions are rapidly expanding, which makes it critical that the communications infrastructure is planned strategically.
Authors: Kim Osborne Rodriguez, P.Eng., RCDD | Megan Angus, RN, MBA, Lean, EDAC
Published September 2015 in the Canadian Consulting Engineer Magazine
Download complete article - Future-Proofing Hospitals – September 2015 >
Today's Building Automation Systems provide a host of detailed data that is for identifying problems, but they also require that operators receive appropriate training.
As building owners require more data on the operational and energy efficiency of their facilities, building automation systems (BAS) are evolving to keep pace with this need for smarter buildings.
In HH Angus` role as consulting engineers for the design, engineering and commissioning of building systems, we are seeing numerous developments in the BAS products offered by manufacturers, and increasing use of the data available through the BAS.
One recent development in the BAS field is in graphical representation. According to Mike Loughry, P.Eng., senior mechanical engineer at HH Angus, “Most BAS companies have made significant improvements in how they represent mechanical systems. We’re finding much more operator-friendly displays that convey detailed information in a more accessible interface. They include better use of colour, more animation and increased isometric or 3D drawings.”
The clearest advantage of the new graphics,” Loughry says, “is that they more realistically reflect the arrangement and layout of the equipment, which makes the operator’s job easier. The graphic display is more intuitively understandable compared to the older-style abstract diagrams. Owners and operators can more readily understand the information presented on the screen and can react faster and more appropriately to new data.”
Continuous commissioning advantages
Loughry also cites as an important development the availability of continuous commissioning systems. “These software packages monitor the operation and performance of building systems 24/7, looking for unusual events and calculating, for example, energy consumption. This helps to identify operational anomalies: if there is equipment failure, a spike in energy consumption or unusual system activation, the system will advise the operator. For example, if the BAS sees that a fan scheduled to operate from 7 a.m. to 7 p.m. is operating round the clock, the system will flag this.” Also it is becoming easier to take measurements at the specific system or equipment level. The building engineer can then identify systems that are the high energy users and focus improvements where they are most effective.
When it comes to upgrading existing buildings, Mark Benedet, P.Eng., a senior mechanical engineer and group manager in HH Angus’ technology division, cites the example of a building where systems dating back to the 1960s had been upgraded to pneumatic systems. That upgrade worked for a while, but the current occupants and facility managers are now demanding better results. In these cases, “We perform an evaluation to match available options with the client’s goals,” explains Benedet. “The clients can’t always upgrade the entire system at once, but there are a lot of levels of ‘doing better’ in energy efficiency. We can design new systems that will allow the electronics to talk to the control system or, if necessary we can update older systems with ‘interpreters’ so that those systems interface with new controllers. We also advise clients on energy grants that may assist them financially with equipment changeovers.”
Operations staff may need more training
With the new, highly functional BAS features, owners should be cognizant that their operations staff may need more training since their experience with these systems varies greatly. Engineers are learning to be much more detailed as to the type of training they specify when designing a sophisticated BAS system that includes complicated operating strategies. These strategies provide great benefits in energy consumption and flexibility. But in order to ensure the owner’s staff can operate the BAS equipment and efficiently deal with the range of data it provides, the training sessions have to be tailored to the knowledge level of the participants.
As Loughry points out, “Building owners rely on us for our expertise and for our knowledge of the various BAS technologies on the market. An operator may look at the BAS as a simple tool for starting/stopping equipment and adjusting temperatures. But we look at it from the point of view of providing many features, including ease of operation, equipment monitoring, innovative design, long-term energy consumption, and safety and code compliance. Clients count on us to understand and evaluate the options, make recommendations and inform them of the consequences of selecting particular systems. So it’s important that the required training is specified in the design documents to ensure the realization of the value of the systems being provided.”
How much is enough? … That depends
Determining the degree of sophistication required of a BAS depends on the purpose of the building in question. Data centres require high-quality equipment and an extraordinary degree of system redundancy across the board to meet uptime guarantees. Healthcare facilities must comply with stringent codes and the equipment must offer ease of service. They also have specialized requirements such as air pressure controls for infection control procedures. Commercial developers owning office buildings require BAS systems that can deliver reasonable temperature control measures, but perhaps without the expensive bells and whistles. Since they may not intend to operate the property long term, investing in comprehensive and expensive systems is not a priority for them. On the other hand, owner-occupied buildings such as hospitals are looking to maximize the life of their operating systems and minimize their maintenance costs, so a BAS that can address their controls automation needs now and for the next 50 years is a realistic and desirable investment.
“Consulting engineers have a responsibility to be very knowledgeable and to bring these technologies to the table during the design development stage. That’s part of the value we bring and where we can show leadership.”
- Senior Project Manger at HH Angus
Dovas estimates it will be a few years still before BAS equipment is standard in base building specifications, but that day is coming: “It’s important that the technology selected be web accessible and, if necessary, we need to educate our clients to make them aware of the power of the data they can measure. The days of controlling and measuring only the low-hanging fruit, for example lighting, are over. We know where the energy savings are, and the BAS trend data backs that up.”
Author:
Kirsten Nielson - Communication specilist, HH Angus
From Canadian Consulting Engineer - August-September 2015 print and digital issue, page 37-39.