Designing for technology

Hospitals are beginning to embrace new high-tech tools

E-mail messages, electronic data storage, laptop PCs – we take these technologies for granted. But they have a profound impact on how medical facilities operate on a day-to-day basis, and more fundamentally, on how these facilities are designed.

Dr. Sanjeev Jain, medical director of the Columbia Asthma and Allergy Clinic, uses an electronic medical record system. When designing his clinic, Jain said, "technology was extremely important" in creating an efficient clinic. Jain’s electronic medical record system is integrated with his business management software, as well as with various medical machines such as the lung function machine.

"Technology has come late to the medical field," said Jain, "but is now coming in a big way."

Wireless networks
Jain considered installing wireless technology in his clinic, but in the end decided on a hard-wired network; each of his six exam rooms contains a computer. To support these computers, Jain designed a special server room, which has extra cooling capabilities and an extremely efficient ventilation system. He contracted with Blairco Heating and Cooling to design the server room.

Although usually technology affects the design of the building, sometimes the design of the building can affect what technology is best. For example, one of the reasons Jain decided against a wireless network is that his building uses metal framing, which potentially could interfere with wireless signals.

Legacy Salmon Creek has three networks: a hard-wired network, a secure wireless network and a Wi-Fi network that allows patients to connect their laptops at "hot spots" in their rooms. The wireless network has affected the design of the hospital, as has its electronic health records system.

Legacy practices "bedside registration," in which patients are taken immediately to their rooms and a nurse takes insurance information and other registration details using a wireless "workstation on wheels," also known as a WOW. With no long lines of patients waiting to give their information at a central desk, Legacy’s waiting rooms can be smaller. The extra space has been used to make patient rooms, exam rooms and operating rooms bigger.

A standard hospital operating room, said Legacy administrator Jonathan Avery, is about 350 to 400 square feet. Legacy’s are 650 square feet. These larger rooms can accommodate state-of-the-art medical equipment, such as digital x-ray machines, which can take up as much as 15 square feet themselves. And because the x-ray machines are digital – meaning no film to develop – there is no need for chemical storage and development space. Again, the high-tech system shifts space usage away from "static" space to patient care space.

Avery said that a team of 30 experts worked in Clark County for 18 months selecting, planning and implementing the various technologies at Legacy. These technologies affect how the 460,000-square-foot facility was designed, enabling Legacy to devote more square footage to patient care, and less to clerical, storage and waiting room space.

"Technology was a significant part of our planning every step of the way," said Avery. "It was a huge paradigm shift."

At the heart of this shift are two core technologies: electronic health records and portable access to information.

Electronic health records
Historically, patient information was kept in a paper file. With electronic health records, all patient information is stored digitally. Paper-based information, such as lab reports, is scanned into the system, and then the paper is destroyed.

With an entirely electronic records system, said Avery, Legacy can get by with only 10 percent of the normal paper-based storage space. In addition to freeing up space used for storage, the digital system gives doctors quicker access to medical information via computer.

Like the Columbia Asthma and Allergy Clinic, Legacy Salmon Creek uses an automated medicine dispensing system, which has a computerized physician order entry. The CPOE sends the medicine request directly to the pharmacy, where it is reviewed and approved. Then the physician or nurse can obtain the medicine from a Pyxis machine, a vending machine accessed via bio-sense technology – fingerprints.

These Pyxis machines have dramatically affected the floor plan of the hospital, said Avery. The machines are located throughout the hospital – in some units they are in every room. Since there is no manual handling of prescriptions, less clerical space is required. In addition, the pharmacy can be smaller because it doesn’t have to store as many medications. And, said Avery, the entire medicine-dispensing process now takes 10 to 20 minutes, instead of up to several hours.

In addition to the Pyxis machines, Legacy has 640 wired PCs and 160 WOWs. Deciding the optimum place to put each wired and wireless computer installation for the greatest efficiency was a "giant undertaking," said Avery. There are 1.5 million feet of wiring – almost 300 miles –
in the hospital. To accommodate the wiring, a tube 3 feet wide by 5 inches deep runs through the ceilings of the entire hospital.

Return on investment
According to a study published in the American Journal of Medicine in 2003, care providers achieved a net benefit from implementing an electronic health records system of $86,400 over a five-year period.

"You spend a fair amount of money on getting the equipment," said Jain, "but you quickly recover the cost in terms of efficiency."

With its positive effects on both medical facility space usage and on the quality of decision making and patient care, Jain said incorporating technology into the design of such facilities was a "win-win" situation.