While building information modeling (BIM) is a very powerful electronic tool—potentially enabling unprecedented efficiencies and savings in the design, construction, and operation of healthcare facilities—its learning curve is steep. As the design and construction industry gradually learns how to utilize its great potential, the key will be effectively sharing and standardizing that knowledge.

Why BIM for healthcare?

“Of all the industries that are going to benefit from BIM, healthcare is probably the leading one,” claims Mario Guttman, AIA, senior vice-president, firmwide CAD director, HOK, San Francisco.

Explains David Throssell, 3-D CAD and data management leader for the London-based construction giant Skanska, “Because hospitals are very complex buildings with an awful lot of building services to coordinate with the structural elements, the idea of building a virtual model before you build it on-site is very attractive.”

Also emphasizing BIM's key role in the industry, Mieczyslaw (Mitch) Boryslawski, Associate AIA and founder of View By View, a San Francisco-based multimedia firm providing BIM support services, classifies BIM as a “must have” due to the complexity of the mechanical, electrical, and plumbing on a typical healthcare project. “The BIM process, properly implemented, can streamline design, approvals, construction, and operations/maintenance for the healthcare sector's massive projects,” Boryslawski asserts.

Realizing this, many healthcare facilities are now requiring the inclusion of BIM as part of the preconstruction bid process.

In addition, BIM is turning out to be a great way for experienced designers to train younger team members. “Working on one file forces the team to communicate more, which leads to more ideas,” explains Matthew Petermann, design application technician, Perkins+Will, Minneapolis. “As each team member works on the model, others can see and comment on their work, which helps the entire team learn. It also provides us with the potential to recognize and resolve challenges earlier on.”

2-D to 3-D

Even with all these benefits, making the transition from 2-D to 3-D hasn't been so simple.

“We're still finding the tools in the box and trying to figure out how to use them,” says Roy Pedersen, AIA, principal, KlingStubbins, Cambridge, Massachusetts. “But once those tools are discovered—for example, using colors and patterns to make building elements pop out visually on the model—we can then share them with other team members and use them on other projects.”

Similarly, Guttman admits, “We're still figuring it out and learning how to build buildings using BIM.”

Prioritizing the transition to BIM, HOK has put in place five different CAD managers throughout the firm, calling them “Building Smart Champions,” to provide technical support for their designers. In fact, one current HOK success story has been the use of BIM for a giant, 1.2 million-square-foot healthcare project in the United Kingdom. When completed in 2013, the Royal London Hospital, with its 6,000 rooms inside two 18-story towers, will be the largest hospital in the city.

“With this project, we've raised the bar for BIM,” claims Miles Walker, vice-president and firm-wide CAD manager, HOK, London.

Not only did the firm determine that the size and complexity involved with coordinating more than a half-million pieces of equipment for the project absolutely required BIM, but by delivering the architectural design as a BIM model, the contractor, Skanska, and subcontractors were encouraged to follow suit. With limited BIM experience, Skanska proceeded to hire Throssell, who is now spearheading a major BIM mentoring effort within the firm. What started as individual teaching and coaching, along with weekly group workshops, has slowly been taken over by the building team members themselves, Throssell explains.

Using a similar approach, KlingStubbins has established a BIM Leaders Group for which one appointed individual per BIM project meets with other BIM leaders weekly to share experiences. One staff person is in charge of keeping a library of BIM details, so that whenever a designer draws a door in BIM or modifies what was provided in an equipment manufacturer's electronic specification, those data are added to the firm's personal BIM library. Skanska's Throssell has authored a BIM project, data management handbook to establish firm-wide standards for issues such as clash prevention strategies, model naming conventions, and how to review, comment, and approve models. Skanska has also been working towards the goal of expanding the usefulness and application of BIM data. “We don't want to just give the building over once construction has been completed,” Throssell explains. “Instead, we want to maintain the integrity of the BIM data and make it available for the operations and maintenance facility management staff.”

Also on Throssell's plate has been the task of keeping up with development plans for the software. “By the time the London project is completed, there's bound to be a number of revisions to the software we're using,” he notes. By keeping informed, Throssell will then be able to mentor building team members when the software is upgraded.

Coping with information overload

As design and construction firms go through the BIM learning process, one critical aspect will be figuring out how to take control of data management, as users can easily become distracted and confused by an overwhelming amount of nonpertinent data. “The question always comes up: How many details to incorporate into the BIM model?” says Boryslawski. “Today, computer memory is so cheap that large files are no longer a problem, but the decision must be made as to how much detail to provide.”

In Petermann's opinion, “It is important to work with experienced team members who can help extract the relevant information from the model in the most pertinent form possible in order to focus on the problem at hand.”

For example, if the design team needs to analyze a certain aspect of the exterior curtain wall, it's important not to get bogged down with information about interior glazing or other opaque exterior wall types. “By filtering out excess information, this will allow the team to make the most informed decision. For example, the curtainwall's cost or heat gain, might change where and what type of curtainwall will be used, which, in turn, will affect the extent to which patients are provided with outdoor views and natural light to help speed up the healing process,” Petermann explains.

One interesting development along the BIM learning curve has been efforts on the part of manufacturers to provide electronic specifications and 3-D models of their equipment. While this is certainly useful, it is one area in which information overload can be a problem. “Manufacturers of healthcare equipment tend to give us models of how the equipment is constructed, which is way too detailed,” says Guttman.

Similarly, Pedersen has had experience with a lighting manufacturer providing “tons and tons” of BIM data on their lighting fixtures. “We really just need to know the size and shape to populate our model. Anything else is overkill,” he says.

At the same time, Petermann acknowledges that there is a need for more established BIM content. “This is recognized by many in the industry and progress is being made, but in the meantime, we rely on content generated in-house, outsourcing content creation and making use of the very limited manufacturer-provided libraries.”

Another big issue that must be addressed industry-wide is interoperability. “This is an area that needs a lot of attention,” says Boryslawski. “After all these years talking about it, we still have problems accessing all the data.”

Fortunately, the software industry is aware of this issue and is working to “develop standard languages that allow the importing and exporting of BIM data between different platforms in order to use all the tools available to fully study and analyze the complex nature of healthcare projects,” says Petermann.

“Industry Foundation Classes (IFCs) are becoming the standard for file transfers and have a long way to go, but it's a good start in the right direction,” adds Boryslawski. The IFC data model is an open-source specification developed by the International Alliance for Interoperability to facility interoperability in the building industry, and is most commonly used for BIM.

Moving Forward

“We're an industry in transition,” says Pedersen. “Right now, the construction managers and contractors are working hard to get the subs involved. Once that happens, I believe we'll see a greater adoption on the part of the owners.”

But even more, the healthcare industry stands to play a unique and valuable role in the process. “Among building owners, the healthcare sector will undoubtedly be in the front ranks in pushing for the early adoption of the BIM process,” predicts Boryslawski. HD

Barbara Horwitz-Bennett is a frequent contributor to publications and organizations dealing with building and construction. She can be reached at



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Healthcare Design 2008 November;8(11):20-22