Building Information Modeling (BIM) is transforming the A/E/C industry. As the industry understanding of the process matures, our models become more complex. Information in the model takes on a greater responsibility for being more accurate and our relationships with each other are key to the successful completion of a project.

But the completion of a project is only a small part in the grand scheme of the project lifecycle. Once the construction of a hospital is complete for example, two years from start to finish, the hospital itself is designed to operate for a much longer life span-40 to 50 years. To date, BIM is only useful for approximately five percent of the project lifecycle. The key words in the previous sentence are “to date.”

The industry is changing. BIM is helping with management of services. Applications for the virtual building information model are emerging to help with facilities management (FM), building operations, first responders, and many other situations that arise in the daily use of a hospital project. The result? A new standard of care is evolving for BIM, starting with design. By legal definition, a physician's standard of care is defined as the duty of care owed by a physician to a patient. This is generally expressed in terms of reasonable care exercised by other physicians under the same circumstances. A physician has a duty to exercise the degree of skill and care expected of a reasonably prudent physician acting in the same or similar circumstances at the time of the care or treatment in question. The failure to do so is negligence. Carrying this to the hospital level, a hospital has a duty to provide the services and exercise the care expected of a reasonably careful and prudent hospital acting under the same or similar circumstances. As a legal entity, the hospital can act only through its officers or employees. A violation of a hospital's rules or policies may be evidence of negligence.

Enter BIM. Many clients are mandating the use of BIM, especially healthcare clients. A significant reason is because of the higher quality product received before, during, and after construction. Even more significant, however, are the leaps and bounds that BIM is making in information management.

Since more and more clients are making the use of BIM a part of the contractual obligations, it can be said that clients need to operate their facilities and provide the same level of services that other clients are offering under the same circumstances, thus the evolving standard of care for BIM.

Adam Lega
Adam Lega

What exactly does BIM bring to the table? Using the previously mentioned hospital as an example, let us start with project design and construction. Using BIM, almost every component in that hospital building is modeled. Initially, the use might be for discipline coordination, especially in places like corridor ceilings where space is at a premium. In one case study on a hospital project in Columbia, Missouri, the space was so jam-packed with ducting and piping that the decision was made by the electrical subcontractor to move the cable tray from the ceiling above the hallway to the ceiling above the patient rooms on the third floor. As there were weekly coordination meetings with the contractor, subcontractors, designers, and owners in attendance, everyone was made aware of this change when it showed up for review in the virtual building information model. Suffice it to say that the client was not happy with this decision to move the cable tray and a coordination meeting that was only supposed to last for thirty minutes ended up going on for almost five hours while duct and pipe was redesigned to accommodate the placement of the cable tray in the hallway.

Now, five hours, some might say that was a lot of time spent that was not profitable. And those that say it would be completely wrong. Think of it this way… the electrical sub makes the decision to run the cable tray in the patient rooms and installs it that way in the field. The client finds out about this, is not happy, demands that the cable tray is taken out, and then has the duct and pipe taken out of the hallway to be redesigned in order to accommodate the cable tray. The engineers come in to redesign after installation has already occurred, RFIs and change orders are generated, and all that time is spent fixing a condition that would never have occurred had the client known about it in advance. Essentially, a lot of time and money would have been wasted had the condition not been modeled virtually and reviewed at a coordination meeting. What might have been fifty plus lost hours in the field was five hours spent in a BIM coordination process. Ultimately, the client has received a higher standard of care as a direct result of the BIM process and that is for less than five percent of the operational lifecycle of the building.

Let us take the example to the next phase-(FM) and operations. Now that this particular hospital is complete, we have an as-built model of the facility for operations purposes. Since almost every object in the project is modeled, each one has a unique identifier that can be mapped to an FM database for tracking purposes. In the physical objects themselves, a radio frequency identification (RFID) chip can be embedded and linked to the unique identifier in both the BIM and the FM database. Now, the client has real-time tracking of assets useful in daily operations-cots for guests, portable lifting devices, etc. If this information is handled properly and managed carefully, decisions can be made about which end of the hallway to go to for that portable lifting device to help the patient move, as opposed to going without and opening up the hospital to a potential lawsuit should a nurse sustain an injury while trying to do his or her job. Carrying this just a bit further, installation manuals and operating instructions can be tied to the virtual objects in the model so that there is always a reference on how to operate and/or maintain the MRI systems, what protocols are appropriate to run on a particular system, etc. Manuals no longer have to be stored, hunted down, or sorted through. With that kind of direct access, work orders can be generated very quickly on equipment that needs service.

The BIM database also makes visual building data available to first responders in the event of an emergency-locations of entrances and exits, obstacles that might impede progress in the event of a fire, or alternate paths of travel. These scenarios are run frequently in hospitals and current use of BIM is bringing that visualization to the next level. Now, instead of a diagram that maps out locations, the rooms are modeled, so responders know what conditions to expect when they enter a lab, patient room, surgery suite, or wherever they might need to go for an emergency.

The wealth of information available to a client utilizing the BIM process can be extremely valuable throughout the lifecycle of the project, especially when managed properly. Since clients are the driving force behind this BIM movement now, it is becoming the new standard of care. In the future, those without a BIM operations model may be considered negligent. Will you be in that group? HD

Adam Lega is BIM Coordinator at KAI Design & Build in St. Louis.

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Healthcare Design 2010 February;10(2):22-26