Designing for More than Meets the Eye
Technology and the market have provided today's ophthalmologist with not only advanced service opportunities, but the option to provide these services under one roof. This new total eye care concept expands conventional centers (diagnostic and treatment) to include a full service retail eyewear boutique with lab, a state licensed Ambulatory Surgery Center, and accommodations for elective cosmetic surgical procedures.
The advanced eye clinic now provides faster and more accurate computerized diagnostic testing to evaluate eye health, identify vision problems, treat eye conditions or ocular disease and prescribe vision therapy.
The improved retail eyewear boutique sells everything from budget to designer eyeglass frames, sunglasses, contact lenses, and sports vision glasses. This important service appeals to customers looking for one stop shopping and provides enhanced revenue for the practice through the sale of frames and contact lenses. The boutique's location, adjacent to the reception area, allows patients to shop for eyewear before and after their appointment. A sophisticated lens lab is connected to the retail area which allows prescription eyeglass lenses to be ground, polished, tinted, and fitted into selected frames on site.
The new surgery component (previously hospital based) accommodates in-house laser and surgical corrections such as Lasik, and Intralase, and vision enhancements for glaucoma, cataracts, and lens implants in a privately operated state licensed Ambulatory Surgical Center setting.
Some centers offer cosmetic services (eyelid surgery, blepharoplasty) and minimally invasive cosmetic procedures such as injectable fillers and Botox. Consistent with other medical practice models, these elective surgeries and cosmetic services provide a supplemental revenue stream and an expanded patient base; therefore, the suite design must appeal to those purchasing these upscale services.
Equipment and technology
Like many other medical specialties, equipment is the cornerstone of the space planning process as almost every space in an eye center is designed around it. Prior to seeing an ophthalmologist in an exam environment, patients progress through a systematic battery of computerized diagnostic tests which measure and evaluate eye conditions and vision capabilities. This data collection alone might include stops at five or more different diagnostic equipment stations. The size, order, and arrangement of these rooms and the equipment within them are critical to staff efficiency, data collection, and patient flow.
For ophthalmologists who now provide office-based surgical services, the cost of purchasing lower volume surgical equipment can be prohibitive and the equipment itself can become quickly outdated. Accordingly, new trends include leasing premium equipment on a days-per-week basis. To the designer, this can be a challenge. When laser or other equipment is routinely transported to a facility, accommodations must be made to allow the delivery, installation, and removal of expensive and heavy equipment without damaging the interiors or the equipment. Among other considerations, this mandates wide doors, straight pathways, a structurally sound slab, special flooring adhesives, and noncushioned flooring.
Another foreseeable trend may include group-sharing of core technology. LeVino Jones client, Michael S. Jacobs, MD, of Athens Eye Associates feels that “given the heavy emphasis on technology in our specialty and the extreme expense associated with each piece of equipment, we will see a trend where other groups will share in the use of a central hub of core diagnostic modalities rather than purchase multiple machines.”
Design for an aging client market
The client base in an ophthalmology practice typically includes more seniors than other age groups. Lighting selection and design must be high in quantity, clear in quality, and be glare-free and shadow-free for seniors and low-vision patients.
Finishes, such as flooring, must also be glare-free and provide a high contrast between flooring and base mould. To further complicate lighting design, the patient is administered dilating drops during data collection and testing which creates an uncomfortable sense of excessively bright everyday lighting. The designer must isolate these areas and graduate light levels accordingly.
Referring to patient flow, an important driver in the space planning process, Jacobs notes that “the ability to minimize the number of steps required by each older patient is crucial while still achieving the ability to obtain all of the appropriate tests.”
During a typical visit, the patient can be moved four or five times for diagnostics, another two times for dilation, and once again to get to the exam room. Barring the need for additional tests, treatment or consultation, the patient progresses to checkout, and to purchase eyewear. The patient flow should require minimal physician travel outside of the clinical corridor. The clinic must be an efficient racetrack in which traffic is one way, accessible by all ages, and in which there is (I'm not kidding) a sense of calm and order.
The well-designed suite provides wheelchairs at check-in, seating at checkout, and companion accommodations throughout. Additionally, walls between exam and testing areas must be soundproof to minimize the transmission of louder conversations between doctor and a patient with hearing loss.
As with all medic
al practices, the architecture and interior design of the facility provides a reinforcement of the practice values and enhances the patient experience: the new eye care centers are no exception. They are progressive in appearance include creature comforts such as plus-size seating, refreshment bars, and wide-screen TVs. They are thoughtfully designed to appeal to discriminating patients without appearing ostentatious.
Patient experience expectations
This is an interesting profession where lifelong relationships often exist between the physician and the patient. Because of this, the clinic is a place where patients expect the most space-age, cutting-edge technology and the “warm-fuzzies” at the same time.
A LeVino Jones client, Debbie Raasch, is the Chief Operating Officer for Woolfson Eye Institute and Woolfson Eye Institute Lasik Clinic in Atlanta, the recognized refractive leader in the country. She describes their practice goal as “one which delivers a 360-degree patient experience out of necessity rather than a luxury, and one which continually views the patient process from ‘outside of the box' to stay competitive.” Similarly, client Donald E. Poland, MD, of Georgia Eye Associates notes that “more and more of our business is surgical elective procedures such as Lasik and premium implants with cataract surgery. Patients have a greater expectation of the facility when they are purchasing these elective services.”
The eye center of the future
The three practices profiled: Athens Eye Associates, Georgia Eye Associates, and Woolfson Eye Institute all progressively integrate new information technology including electronic medical records (EMR) (conversion in progress), computerized inventory, wireless internet access for family reception areas, and online appointment request form downloads to shorten the check in process.
When these centers complete the integration of EMR and system upgrades the physician will be able to use a handheld wireless device which will direct him to the next waiting patient. The handheld devices are used during consultation to reference and update the patient's medical information and to automatically print prescriptions.
Athens Eye Associates is a current test site for a new PACS software system that allows the physician to view the results of various diagnostic machines from any computer with Web access. Consequently, each exam room now has dual monitors to enable the doctor to simultaneously see many years worth of data from several different diagnostic modalities. This has tremendously impacted how Jacobs works relative to speed and information access.
Designing ophthalmology centers is a precise collaboration between design team, physician, contractor, and equipment/ technology consultants. The contribution of each plays a significant role in the success of today's new total eye care model and as with any medical center design includes more than meets the eye. HD
Alison LeVino Jones, ASID, AAHID, IIDA, LEED AP, is President and Sandy Boyette, AAHID, NCIDQ, is a Senior Project Manager at LeVino Jones Medical Interiors, Inc., in Atlanta. For more information, visit http://www.levinojones.com. LeVino Jones Medical Interiors provided space planning and full interior design services for Woolfson Eye Institute expansion/renovation and Athens Eye Associates and full service interior design for Woolfson Eye Institute Ambulatory Surgical Center and Georgia Eye Associates. Partnering architects included Robert Scott, Architect, Loia Budde and Associates and Zanardo Architects, PC Healthcare Design 2010 January;10(1):32-37