Imagine being a physician prepping for surgery with mere sketches as a guide. You must perform the coronary bypass without accurate data: no X-ray fluoroscopy, no echocardiogram, no heart cath. Your only map is a pencil drawing of the patient's body from 10 years ago, and who knows what has changed since then.

Of course this would never happen in surgery today—but it occurs every day in healthcare architecture. The architect renovates a healthcare space with the aid of one tool—CAD, which as tools go is only slightly less primitive than the pencil. Why do we create our most critical facilities using antiquated tools and based on data that may be years out of date?

The hospital: A complex organism

Hospitals are some of the most complex buildings in our civilization. A modern hospital is a technological marvel, a strategically controlled nexus of air-handling systems, electrical systems, uninterrupted power supplies, environmental monitoring, gases and oxygen systems, and countless tons of equipment. Moreover, a hospital is the only type of building constantly under construction, with ongoing renovation and expansion to accommodate new modalities, new protocols, new technologies.

So today's healthcare architect designs hospital facilities as platforms of infrastructure, essentially creating stage sets that can be rearranged to house the continual reinvention of medicine. Designing a hospital is much like assembling a jigsaw puzzle—a three-dimensional jigsaw puzzle that is constantly in motion, and with the pieces constantly changing shape.

The map: A better solution

BIM—Building Information Modeling—is to CAD what the Porsche Carrera GT is to the stone wheel. This groundbreaking application delivers what healthcare facilities managers and architects truly need: an easily updateable 3-D model and linked database of the entire building's life cycle, allowing for a seamless transition from design, to construction, to facility operation and facility upgrades.

Building Information Modeling is to CAD what the Porsche Carrera GT is to the stone wheel.

In addition to its benefits of enhanced visualization and data management, BIM streamlines the traditional project/development relationship, reducing design time and resource requirements, and improving specifications and estimating. It also coordinates construction documents to reduce system conflicts before construction begins. In the case of hospital operations and renovations, BIM helps the facility manager to control risk, errors, and costs, maintaining patient safety by anticipating problems that need to be solved ahead of time.

BIM not only helps in design and construction, it becomes a “living” repository of all building information. In November 2006, the General Services Administration (GSA) mandated that new buildings designed through its Public Buildings Service use BIM in the design stage. For an organization with $12 billion of facilities in design and construction, this is a major step. The long-range plan is that BIM's detailed modeling will give facility managers easy access to critical building information for operations and maintenance, renovation, and expansion. By connecting the spatial representation to data, facility managers can quickly calculate a building's heating costs or see where anticipated infrastructure upgrades won't fit together. Because the GSA is the largest public real estate organization in the nation, with an inventory of more than 342 million square feet, it is easy to see why they recognize the business need for such a management tool.

The facility: A body of work

So if a hospital is like a body, with the exterior as the skin, the structure as bones, and the mechanical, electrical, and plumbing (MEP) as the circulatory system, BIM is rather like the results of an MRI, showing what's going on under the surface.

BIM is only a tool for humans to make better decisions and get to the real healing in a faster, smarter way.

While the exterior and the structure are important, the most vital component of modern hospital design is the building's circulatory system. Telecommunications, electricity, medical waste, gases, water, and numerous other elements must be transported in and out of the hospital, without disruption. Thousands of details and deliveries, currents and connections, affect each other and must be considered and coordinated.

This is even more complicated in older facilities designed solely with traditional masonry dimensions and no technology considerations. After all, back then, air conditioning was considered to be cutting-edge technology, and many facilities didn't even have that. So the creation of a modern facility's complex MEP circulatory system within the bones and skin of an older hospital is quite a challenge. In this situation, seeing the big picture is crucial to determining the project's cost, efficiency, and effectiveness.

The future: Smart progress and new possibilities

BIM represents a paradigm shift in how facilities are built and managed. However, as with healthcare innovations, there is no substitute for the human touch. BIM is only a tool for humans to make better decisions and get to the real healing in a faster, smarter way. It helps collect, communicate, monitor, and track a project's information and administrative elements, leaving more time to focus on the needed healing space and to design a more “human” environment. We know from evidence-based design that better structure creates better outcomes, a reduction of medical errors, and better staff retention. BIM is a smart way to address the hospital's changing infrastructure needs while maintaining focus on the human issues.

Just as we couldn't practice modern medicine without state-of-the-art diagnostics, we shouldn't build or rebuild a healthcare facility without the information and efficiencies of BIM. The streamlined collaboration, communication, and analysis BIM provides are just that essential. HD

John Cooper, AIA, ACHA, is a Principal with Morris Architects.


Clash Detection Plus

Based on an interview with Jan Reinhardt, Program Manager East Coast, Turner ViCon

At Turner ViCon—Virtual Design and Construction—our initial approach to BIM is to coordinate the virtual models and designs created by Turner subcontractors, in particular those involved in MEP. These are integrated into a 3-D model that is displayed on a whiteboard for all to see during collaborative “Design Validation” meetings in what Turner calls the iRoom. Using special algorithms, ViCon displays any mistaken intersections, or “clashes,” of mechanical, electrical, or plumbing components, enabling those assembled in the iRoom to redesign and work around such problems early in the design stage. We don't discuss problems, we discuss solutions.

Clashes of structural elements

To me, this is not just a matter of technology. I think of it as a construction-related interaction and management process among the coordinators of the project participants. It is a much more intense and thorough approach to planning that results in fewer clashes, less onsite disruption, and more predictable costs. Change orders, at least as they related to constructability, are significantly reduced, often nil.

We were able to implement this process very successfully at numerous healthcare projects, such as the Yale-New Haven Cancer Hospital in New Haven, Connecticut, the Massachusetts General Hospital in Boston, and the Harborview Medical Center in Seattle. At the Harborview Medical Center our approach allowed us to reduce time needed for coordination by half. We now have 23 more projects using this process.

In addition to the Design Validation efforts, we are using BIM for other activities, such as 4-D scheduling and preconstruction tasks.



By Rob Rothblatt

How Skidmore, Owings & Merrill is entering the BIM era

The latest tools in healthcare design are not new—but they are reaching maturity in this dynamic building sector. Skidmore, Owings & Merrill (SOM) has, from the earliest days of computer design, viewed the visionary side of treating buildings as databases by not only designing them systematically and comprehensively, but moving towards eschewing the entire concept of “drafting” a building. In short, don't “draw” it, design it. And, even more succinctly, BIM it.
Image courtesy of skidmore, owings & merrill

The acronym means Building Information Modeling—essentially, making a full digital model of the building in the computer, a data clone. BIM software has reached adolescence, providing us with a solid foundation for computer-based design while having enormous potential for future development. SOM has jumped into the forefront of exploring BIM's use and potential.

Why? For a start, BIM keeps track of the myriad complexities of buildings, leading to better conformed drawing sets. BIM can help check and coordinate, so that ducts don't run through beams or rooms don't violate code sizes. Those are among the technical benefits.

Even better, BIM supports expressive design, handling complex mathematical geometries (or “parametric design,” which can magically change and update itself based on algorithms). BIM is well-suited for complicated infrastructure and institutional buildings that generally have complex programs and spaces and are saddled with many conditions, such as healthcare projects. In BIM, there are no lines—only smart objects, doors, walls, equipment, and so on. Every team member works from one central digital model that is continually updated with each designer's work. Instant teamwork and coordination gives more flexibility to designers, allowing them to concentrate on their own architectural ideas.

Currently, BIM comes in two main flavors, and SOM uses both: “Digital Project” (DP) is an evolution of the engine CATIA, and particularly adapted for curving elements and mathematical nuanced geometries. The other “flavor,” REVIT, has been used by SOM on four-to-six projects so far and for several of our signature towers, such as the Freedom Tower at the World Trade Center in New York.

SOM/NY is currently designing two healthcare projects using REVIT: a combination clinical laboratory/ambulatory care facility in Manhattan, and the other, a flagship Women's Hospital building for Long Island Jewish (LIJ), the largest healthcare provider on Long Island. For this 10-story building (with five-floor addition), the team began using BIM in schematic design, finding it perfect to keep track of all the programmatic areas, especially such repetitive and cellular areas as patient rooms. In other words, design one in BIM, and you've designed them all; change one, and you can change them all. The idea is refreshingly intuitive, but difficult to do until recently.

Obviously, a vast component of any hospital project is the equipment inside it—whether giant donut CT machines, other imaging devices, or boom systems for operating rooms. All of these products—industrially designed objects in their own right—are becoming available in BIM and thus a part of the model of the building. For LIJ, for example, all equipment will be in a 3-D database.

And the future? Well, BIM is best (so far) for the certainty of later design stages and, naturally, for construction drawings. However, we are still looking into how to use BIM, or other add-on programs, to capture early, tentative, and yet pivotal design stages, as well as for quick studies and concepts, stacking, and diagrams. Another potential area for growth: landscape design.

Not everyone is ready for the new “BIM Lifestyle.” Certainly there are teething issues to be sorted out. We were amused to discover, for instance, that there are no 3-D revolving door files yet; though revolving doors are complicated, they are a staple of healthcare (and airport) design, and perfect candidates for future development in this area. As technology progresses, eventually CAD drafting will resemble a 19th-century crutch. It is doubtful, when BIM is fully mature, that we will ever look back to our pre-BIM childhood with anything other than historical interest. Some sort of BIM will be the standard “model” of healthcare design for all of us.