Getting CIOs Involved

HMT Healthcare in the U.S. is experiencing a major building boom. Estimates place it at more than $56 billion in new construction and $20 billion in renovation, underway as of April 2007. Some reports also state that the hospital industry spent more than $100 billion (inflation adjusted) on new facilities in the past five years and, according to the U.S. Census Bureau, there has been a 47 percent increase in facility spending from the previous five years.

The industry is also experiencing new design requirements and trends such as the move to all private rooms or acuity adjustable rooms. The size of patient rooms is increasing as space is added for family, patient amenities, staff work areas and additional technology. We are also seeing the development of "smart rooms." Not only do these rooms contain technology, such as monitors and workstations, they also can recognize caregivers and display their names to patients when the clinicians enter the rooms, while simultaneously calling up relevant patient data for the clinicians.

The industry is experiencing a dual phenomenon in that, while the facility design is driving the technology needs, at the same time the technology needs are driving the facility design. For example, as facilities increase in size (i.e., larger emergency departments or larger operating room suites) technology can be employed to overcome the resultant increased distance between caregivers, supplies and facilities.

Likewise, technology requirements drive the facility design. The electronic medical record (EMR), digital imaging, wireless communication, clinician/patient/supply tracking all impact the facility design — from size and layout, to patient amenities, to underlying infrastructure (e.g., wiring). All chief information officers (CIO) and information technology (IT) departments have at one time or another dealt with facility limitations that impact the deployment of new technology, whether space for workstations, network equipment and placement of monitors, or the lack of needed network drops.

CIOs Must Be Involved

It is critically important for technology professionals to be involved at the outset of the facility planning effort. Too often, however, either the health-delivery organization (HDO) executives fail to include the CIO in the planning, or the technology professionals wait to be given the requirements so they can propose the technology solutions. These professionals need to shift from this reactive posture to a proactive approach and share their knowledge with the design team.

This lack of participation by IT professionals in the facility planning process can result in severely negative consequences for the HDO, including:

Inadequate Funding:The funding necessary for the desired technology may not be included in the project’s capital budget, or the construction budget may not be adequate to support the necessary facility design requirements to accommodate the IT. This may mean that other IT projects and users suffer as their budgets are reduced to accommodate the shortfall in the construction budget.

Lack of IT Resources:Without appropriate planning, the IT staff may not be available to support implementation or technology deployment when needed. This can result in project delays due to resource availability, negative impact on other projects (if IT staff are pulled from current projects), or higher cost to contract with external resources to fill the void.

Sub-optimized Technology:Without adequate lead-time, the HDO may not be able to implement full functionality, which can negatively impact operational processes, reduce return on investment and increase the project cost.

Inadequate Space Planning:The space and infrastructure required to support the technology may be inadequate to address needs for device placement, wireless communication, wiring, network closets and clinician work space, which in turn can result in additional cost and rework, or construction and implementation delays.

Poor Decisions:The IT professionals may be forced into quick (not well planned) decisions, which may have unintended consequences and negatively impact the HDO for many years.

Increased Costs or Implementation Delays:There may be unanticipated changes needed for existing applications resulting from design or process changes that are not currently supported by the applications (such as new process workflow).

New or renovated facilities are driven by and support the overall business strategy of the HDO (i.e., cardiac service line). In the same way, the information systems strategy and technology planning efforts must align with and support the new or renovated facility construction. As the HDO proceeds through the process of defining its operational future state (e.g., scheduling, intake, triage, registration, universal beds), basic decisions about capability will be driven by the computer systems that are currently in use, or by those systems that are available in the marketplace.

It is critically important for technology professionals to be involved at the outset of the facility planning effort. Too often, however, either the health-delivery organization executives fail to include the CIO in the planning, or the technology professionals wait to be given the requirements so they can propose the technology solutions.

Without an overall understanding of the current information systems, the planned future systems and other market capabilities, it is difficult to predict the technological infrastructure that will be needed to support new operational requirements. The technologies clinicians will need tomorrow may not have existed a few years ago. Will you use the new construction as a pilot for deploying new departmental or enterprisewide applications? What new technologies will be necessary to enable your planned operational model? What changes or enhancements will be necessary for legacy applications in order to meet your goals?

A traditional facility planning approach includes space and program design, building construction and building occupancy, and involves information management (IM), information systems (IS) and information technology (IT) in a more limited role, often relegating the technology representatives to the "electrical team."

An integrated plan and strategy is needed. As Yogi Berra said, "If you don’t know where you are going, you will wind up somewhere else."

A New Approach

The solution to this problem is a more robust predesign planning approach, beginning with a comprehensive understanding of how this project and IT align with the enterprise strategy, and how the HDO’s "concept of operations" will drive the design considerations. For example, a strategy to expand the cardiac service line may include the construction of a new ambulatory facility to support this service. However, without a more robust understanding of expected volume and the needs of patients and physicians, the HDO and facility planners may not adequately plan for patient throughput or they may overlook the need to accommodate bariatric patients. These oversights can prove extremely costly if discovered too late in the design and construction process. Likewise, uncertainty regarding workstation type and placement (e.g., mobile carts, bedside monitoring, wireless laptops, digital image viewing stations) may result in delays and additional cost.

HMT A more collaborative approach incorporates traditional planning activities and illustrates the need to begin with the enterprise strategy and an understanding of its impact on people, process and technology (or IM, IS and IT). Once the HDO has aligned the enterprise and IM, IS and IT strategies, it is in a better position to understand and document how the enterprise strategy will impact the HDO’s concept of operations, which in turn impacts the facility and IT requirements.

In addition to planning capabilities for the new facilities, it will be critical for your patients, clinicians and employees that a smooth and seamless transition occurs with the existing and new information systems and technologies. Such transitions require fully thought-out concepts and detailed planning. Failure to take these issues into account can threaten the best laid plans for new facilities and operational improvements.

What interim states will be required as departments and work functions are moved from one facility to another? What will be the impact of multiple systems (or systems in transition) on administration and reporting? How can planned legacy system changes be implemented as quickly as possible, perhaps allowing for operational efficiencies even before the new facilities come online? These questions must be answered prior to moving into building construction and building occupancy.

Integrating with Enterprise Strategy

The IM track focuses on the people strategy, which should address the impact of enterprise strategy and new facility on the IM organization, including what services will be required to implement and support the technology in the new facility and how those services will be delivered.

For example, IM may need a program management office (PMO) and dedicated project manager to effectively manage the technology related planning and implementation activities for the new facility, from predesign through occupancy. Additional technical support staff may be required or may need to travel from another physical location. These considerations should be addressed during the planning phase.

The IS track focuses on the process strategy, which should address process changes required to support enterprise strategy, facility construction and technology initiatives. If it does not already exist, the HDO will also need to develop the PMO, including staff, tools, practices and procedures.

The IT track defines the specific IT solutions needed to enable the enterprise strategies and the organization’s concept of operations in the new facility
(e.g., EMR, biometric identification, wireless tablet PCs, workstation placement). The IT track examines the technology options and establishes priorities for investment, including leveraging current technology and identification of required new technology.

Integrating with ConOps

Concept of operations (ConOps) is an approach to facility, operational and IT planning that considers all the various components of patient-care delivery, from patient bedside interactions to clinical and administrative support systems and their impact on facility and technology requirements. There are three key elements to concept of operations: customer experience, provider/space effectiveness and space efficiency. Each of these impacts and influences the functional operations of the HDO.

ConOps provides a framework for process innovation, functional planning and space programming, as well as facility design and technology requirements. ConOps involves an in-depth examination of operational processes, behaviors and culture in patient care delivery, research and teaching. It also considers care delivery models and operational assumptions for the future, which may impact the design of the new facility. If done correctly, ConOps incorporates a discussion of what works well, including identifying best practices across the healthcare industry and what opportunities there are for improvement in the current systems.

When IM, IS and IT planning becomes integrated with ConOps, the HDO develops a holistic plan for supporting the new facility design and operations.

Conclusion

There are a number of benefits to this integrated approach to facility planning, in addition to avoiding the risks identified earlier. First, if the CIO is not already involved at the executive level in strategic enterprise initiatives, this approach will help the CIO to become an active partner in both enterprise and IT strategy, and provide vision and leadership to the organization.

A planning approach focused on ConOps offers the opportunity to bring innovation. A new or redesigned facility, with new technology offers the HDO an opportunity to innovate current processes and make substantive improvements in the areas of operational efficiency and customer experience. The future state of technology to support clinical care and service can be identified, reviewed and incorporated into the innovation plan. In addition, stakeholders can be engaged to identify barriers and enablers to change and determine how to overcome the barriers.

Customer benefits may include improvements such as streamlined patient access; including registration, scheduling and financial clearance, in addition to reduced length of stay or wait times. Patient families perceive benefits in areas such as customer amenities (e.g., wireless Internet access in waiting and patient rooms and family space in patient rooms).

Positive financial benefits can result from improved patient flow, reduced wait and procedure time, and increased productivity, which can be assisted by integrating operational, facility and IT planning. Improved customer experience can provide a competitive advantage, as a preferred provider, resulting in additional service revenue.

Whether it’s new construction or renovation, it is an opportunity to think about how you will deliver care today and in the future.

John Vitalis (left) is senior principal, Information Management and Systems, and Frank D. Kittredge, Jr. (right) is senior principal and national practice director, Facility Planning for Noblis Center for Health Innovation, Falls Church, Va. Contact them at john.vitalis@noblis.org and frank.kittredge@noblis.org.