Today we find ourselves at a unique moment in the history of healthcare. Around the world, healthcare professionals, and the architects and designers that serve them, are grappling with the best ways to keep pace with the rapid development and rising costs of new technologies designed to improve the safety and quality of care delivery. Technology is playing a central role in the future of healthcare, and central to the effort to improve financial and clinical outcomes is better integration of technology across the entire industry. Design professionals, hospital administrators, and clinicians alike, are considering the impact that new technologies are having-both on clinical work flows and the physical space.

This past June, the first X3 Summit, an executive-level event which explored the unique challenges and considerations of integrating technology into healthcare facilities and care processes, was launched. The Summit brought together industry leaders from multiple disciplines including architects, design professionals, hospital administrators, clinicians, and technology consultants in a dynamic conversation that could help to initiate real change across the healthcare industry. Among the participants, several Pebble Partner representatives attended this interactive event including:

  • Wellstar Health System, Dallas, Georgia

  • Alberta Infrastructure, Calgary, Canada

  • Provincial Health Services Authority, British Columbia, Canada

  • Sacred Heart Medical Center, Springfield, Oregon

  • Palomar Pomerado Hospital, Escondido, California

  • Children's Memorial Hospital Chicago, Illinois

  • Nurture by Steelcase, Grand Rapids, Michigan

  • Waukesha Memorial Hospital, Waukesha, Wisconsin

A roundtable discussion, exclusively attended by the Pebble Partners in attendance, was formed to talk about a wide variety of issues currently facing the healthcare community. David Allison, professor of architecture and director of graduate studies in architecture and health at Clemson University, was the facilitator for this roundtable discussion and raised three questions to the roundtable participants:

  • How does technology allow us to contribute to a healthier, more humane, more efficient building?

  • How might technology change points of care? and

  • How should technology be integrated into the physical environment in such a way as to become ubiquitous?

Three major themes emerged from the participants' discussion and were reinforced throughout the Summit, which included new and innovative trends in technology, the importance of modeling/role playing as a means of understanding the relationship between IT and clinical work flows, and the need to utilize flexible IT solutions.

New and innovative trends in technology

A range of technology platforms are having a transformative impact on the healthcare industry. Molecular medicine, which focuses on predictive targeted and more industrialized treatment strategies, is changing the way we think about diagnosing patients. Specifically, biomarkers, molecular diagnostics, targeted therapies, and clinical decision support tools are changing the decision making process for both patients and clinicians. Advances in technology are radically changing how clinicians are using and thinking about diagnostic imaging devices like CT angiography, high-intensity focused ultrasound, and mobile imaging. These devices focus on less invasive analytical techniques combined with diagnostic/treatment capabilities.

Major advances are also occurring in communication technologies, especially those focused on telemedicine, virtual consultations, and staff-to-staff communication. These advances are changing the way patients access information, how clinicians are interacting with patient records, and how hospital staff are managing patient tracking. Although these new technologies are transforming patient care in many positive ways, in some cases, there are substantial space and cost implications that must be considered, which often have a significant impact on the decision making process.

Relationship between IT and clinical work flows, and the use of role playing/modeling

Considering IT implications along with clinical care changes at the beginning of the design process proved to be one concept common among Pebble Partner participants at the X3 Summit. Provincial Health Services Authority in British Columbia, Canada, is committed to not moving forward with the architectural design process until they have gone through a complete mini-design process for all operational planning, which includes integrating IT and clinical work flows. Bob Breen, chief project officer of Provincial Health Services Authority believes this mini-design process is essential because, “ideally we think that instead of waiting until the facility flows are established then thinking about IT flows that these two areas should be in constant communication from the very beginning of the design process.”

Pebble Partner Alberta Infrastructure in Calgary, Canada, also feels that it is necessary to integrate the clinical, IT, and operational considerations from the beginning of the design process. One of their strategies to address the challenge of integrating new IT solutions into the design process is to use simulations or mocked-up environments, which enable stakeholders to run through scenarios to better understand the clinical and IT flow process in a comprehensive way. The Mayo Clinic's SPARC Program and Sidney R. Garfield Health Care Innovation Center have been identified as examples of off-site test centers where simulations occur. At these centers, hospital administrators, clinical staff, IT, and design professionals are able to come together to work through challenges associated with successful integration of IT, clinical, operational, and patient flows before final decisions are made on any new or renovated facility.

Flexible IT solutions

When deciding on which IT solutions to implement on a particular building project, the larger X3 community identified flexibility as a primary and essential consideration. How a project defines flexibility varies greatly from increasing the range of motion that clinicians have in their interaction with patients to built-in adaptability of the IT infrastructure. One example given at the Pebble roundtable included a discussion on technology integration within the patient room environment for family members. WellStar Health System in Dallas, Georgia, is considering using a vibrating pager, similar to the ones found in restaurant settings, to allow family members the freedom of movement while waiting to get news on the condition of a loved one.

Mark Haney, senior vice-president of WellStar Paulding Hospital noted that his team is trying, whenever possible, to adopt the notion that a patient, “should only be in the bed when sleeping during the night; and during the day, they should be using the entire room.” He went on to say, “When thinking about flexibility and how a nurse can continue care when a patient is not in their bed, we feel that a laptop or handheld tablets are ideal solutions for increasing flexibility in the care delivery process.”

Later in the X3 summit, during a moderated discussion with representatives from Johns Hopkins University, the panelists identified the development of freestanding patient kiosks as another innovative IT solution, which can further enhance the flexibility experienced by both patients and loved ones. These new self-contained devices can quickly verify patient identification, list appointments, assist in the completion of admission forms, and improve wayfinding. Such innovation reduces wait times, eliminates paperwork, facilitates throughput, and redirects resources from administrative tasks to more complex hospital functions.

The issues raised at the X3 Summit are reflective of the wider discussion now underway at healthcare organizations around the world. As we move into the future, the integration of technology will continue to play a bigger role not only in the delivery of healthcare, but how we must design our healthcare environments. The emergence of new technologies is having a profound impact on every facet of the healthcare industry. HD

To learn more about the SPARC Program visit their Web site at For information about Kaiser Permanente's Sidney R. Garfield Health Care Innovation Center go to the Innovation Center's Web site at To learn about Johns Hopkins University, visit their Web site at http://www.hopkins

Healthcare Design 2009 August;9(8):44-48