Build IT Right: Guidelines for IT Planning for Healthcare Construction Projects

May 2011

By Guy Scalzi
Principal, Aspen Advisors

The economic downturn of the last few years has put significant constraints on hospital and health systems’ capital budgets causing new and replacement healthcare facility construction projects to be placed on hold. Of course, some construction has continued as many critical services such as emergency rooms, imaging centers, and surgery areas have continued to need almost constant refreshing and expansion. Additionally, specialty facilities such as cancer treatment centers and pediatric hospitals also continued to see some new building growth. However, there is pent-up demand that will explode on the scene as soon as the economy improves. In fact, according to Modern Healthcare’s 32nd annual Construction & Design Survey published March 14, 2011, the healthcare construction industry continues to show signs of rebounding as a result of a resurgence in new projects, including work restarted post-recession.

This makes it more important than ever to get the information services right the first time when designing and building any new facility; we need to understand the lessons of past mistakes and successes.

Very early in the planning phase for any construction project there are key considerations for technology deployment that will accelerate implementation of new hardware and software, cut unnecessary costs, and assure successful outcomes. We will review the technology issues facing executives undertaking new construction of healthcare facilities and those remodeling existing space, often to make better use of technology in clinical workflow. We will also review the obstacles, trends, available options, innovations, and best practices from many similar projects.

Timing is Everything

All healthcare construction projects involve many players who have to communicate effectively and openly to achieve a successful outcome. IT professionals need to be involved as soon as possible in the planning, or design specification stage, and stay actively plugged in throughout the project lifecycle.

IT – A Critical Element of Design

Everything usually begins with the architects and designers meeting with the clinical staff and other professionals who will be working in the new or enhanced space. A design specification is generated based on considerations such as workflow, patient volumes, types of activities, proximity to key partners, and the basic necessary infrastructure such as heating, ventilation, and cooling.

It’s critical that IT be involved in the design specification stage before the specification is generated. Key decisions at this point in the process include defining what applications and technology will be used in the new or remodeled space. From an IT perspective, everything that’s planned should be within the guidelines of the IT strategic plan for the organization. It is fine to test new technology, but it should be part of a vision for the larger organization.

By the time the project moves from the design specification stage to the actual design work, IT should have a solid understanding of the applications that are planned for use in the new or renovated space by clinicians and others who will be working in the area. It’s important that as soon as required work space is estimated, the space needs of the hardware to support the activities are included and that the plans reflect those needs. This includes places for desktop computers, dedicated space and docking stations for laptops, docking stations for remote devices, charging stations for clinical carts with laptops telecom devices such as wireless phones, other wireless devices that support clinical mobility, and workstations for reviewing images. Too often, these requirements are only estimated late in the design phase, and everything has to be redesigned or made to fit (often badly) in existing space. This is the time to get it right, so the workflow will be enhanced by the space and not compromised.

The overall project budget should be estimated at this time, incorporating the IT requirements. Many times, the square footage needs to be reduced or the planned services have to be scaled back to fit within the amount of available dollars. In space where existing programs are to be moved, a common mistake at this point is to try to retrofit old IT equipment into the space to save on the budget. This rarely works satisfactorily due to the equipment being at the end of its lifecycle or not being powerful enough to run the current software that has evolved in features and functions. If at all possible, the hardware should be purchased specifically for the new space and deployed in a way that maximizes the utility of the workflow.

Best Practices and Next Practices

The new space should always be designed to make optimal use of the next release of the major software applications and additional functionality. For example, hand held devices such as iPhones and iPads will be incorporated into all new releases of HIS software. That will mean fewer requirements for viewing data on workstations but a heightened need for docking stations and additional places to enter data. This will be true for bar coding as well as it is fully deployed. New space will most likely take advantage of RFID tags for biomedical device tracking and patient flow, and generally richer user interfaces requiring powerful hardware.

Additionally, the strong monetary incentives available through the American Recovery and Reinvestment Act (ARRA) and its HITECH component make it worthwhile to put a robust technology infrastructure in place in any construction project to allow for compliance with Meaningful Use requirements. Some of the direct cost can be recouped if the government’s requirements are met. Additionally, there are studies available that show efficiencies and enhanced patient safety can be achieved through more and better IT systems.

Not a Night and Weekend Job

Depending on the size of the construction project, there needs to be one or more IT staff people dedicated from design to opening. Questions will arise on a daily basis concerning specific locations of hardware, power requirements, back-up power, and air conditioning; connectivity of wired and wireless networks; ordering equipment and staging it for deployment; etc. The staff utilized on these construction projects may have downtime when they can do other things, but for the most part, they will have to be available any time construction is taking place. Rather than slow down the work, bad decisions will be made when there is a lack of knowledgeable IT input.

New Sandbox for Strategic IT Direction

New construction can be viewed as an opportunity to pilot new processes, systems, and technology in greenfield space. There’s no reason to move workflow, applications, or hardware that are only marginally acceptable, or failing, into new construction. While beta testing of applications in new space should be avoided, technology that is proven at other locations or facilities but still new to yours should only be piloted in the space. It’s the right place to break old habits and the “It’s the way we’ve always done it” syndrome. People are more amenable to trying something new when the venue changes, and there’s excitement about a new or rehabbed building. Don’t miss this opportunity.

Test, Test, and Test Again

At the stage where the construction is nearing completion and most of the hardware, networking, and applications are in place, it’s time to begin trial runs of all the technology to see how it functions together. You can pre test in other locations; however, there’s no way to tell how it all reacts to the specific new location, processes, and people other than trying it out there. This might require taking staff away from their regular jobs to go to the new work area and use the systems in a simulated dry run. The project budget should have money to pay for overtime or backfill of some kind, so that the day-to-day operation doesn’t suffer from the loss of this staff.

A few weeks before the opening of new healthcare space, the entire area should be fully staffed for two or three days with “test patients” cycling through the systems. The volumes should be kept to half of what’s expected at peak volume. Data can be entered in a test database, so that it is easy to review at a later time but won’t interfere with the production database. If possible, software and hardware vendor support people should be on site during the test period. Necessary changes can be implemented quickly and be ready for the next test session. Every day of testing should include lessons learned from experience on previous test days. If all systems are tested together a few times, the staff will feel comfortable to function at higher volumes by the time of the actual opening.

Blanket with Support

On opening day, it’s important to have as many of the organization’s IT people as possible on site, during all hours of operation, even some who will not normally work in the new facility or necessarily even provide support. The objective is to blanket the staff of the new area with as much support as possible. While they are in a learning mode, they will be receptive to new ideas and new skills, and a lot of progress can be made in a short amount of time. And all vendor organizations should also be represented by as many of their support staff as they can provide. This heightened level of support should continue for a few days and then taper off as the situation stabilizes.

Conclusion

With the pent up demand for new and remodeled healthcare facilities combined with the need to ensure these projects are as efficient and effective as possible, it’s important to apply the lessons learned from past initiatives. Critical success factors include involving IT as early in the process as possible; including technology considerations in the design process; planning for new technology formats, features and functions; allocating dedicated IT staff to partner with the construction team throughout the project lifecycle; testing sufficiently; and providing adequate support. By applying these and other industry best practices, IT can be strong partners in ensuring healthcare facilities meet the needs of patients and practitioners alike to deliver high quality, cost effective care.