Technology is becoming as inherent to the delivery of healthcare as diagnosis, treatment, and prevention of disease. Whether building a new facility or renovating an old space, it’s likely that every project on design boards today will require plenty of thought for information technology (IT) and integration of all the systems that continue to be adopted to support the continuum of care.

To help shed light on how the industry’s approach to IT planning has changed over the years and where designs may be falling short, Healthcare Design spoke with Carl Fleming, principal advisor at healthcare IT consulting firm Impact Advisors (Naperville, Ill.). Fleming has spent 13 years working with architects and facility planners to develop technology groundwork that blends emerging systems with existing infrastructure to support new workflows in a new built environment.

Healthcare Design: How is planning for IT different now than it used to be?

Carl Fleming: The biggest shift I’ve experienced in the last 12-18 months is the way in which technology consultants are engaged for new facility/renovation projects. In past years, we were typically brought in by the chief information officer and not directly integrated with the design/build team.

Recently, I’ve seen an uptick in the number of requests I’ve received from architectural firms and construction managers to join the integrated delivery team and be involved from the beginning phases of a project. Ultimately, this allows for better coordination between the designers, construction managers, and the owners technology/information services teams.


With so many different types of technology used in healthcare today, how has that affected facility needs to support these systems?

The technology implemented in today’s healthcare environments is no longer a conglomeration of disparate systems but rather a complex mesh of integrated solutions, each providing data to the others. The building systems talk to tracking systems that communicate with nurse call systems that are integrated to the EMR and interactive patient systems. All of this technology requires a lot of infrastructure and large technology rooms to contain it. As systems that used to be “dumb” are now becoming “smart,” the increased number of smart systems results in more end user devices, which require more infrastructure and the need for larger spaces to house that technology. 


What are common mistakes or misconceptions you see in planning for technology in healthcare?

Designers often design spaces that require completely different patient flows and oftentimes a radically different clinician workflow than staff experience in existing buildings. Including the appropriate nursing and nursing informatics experts are crucial; however, simply including them in design meetings isn’t enough. With each new concept—decentralized nursing, centralized scheduling, in-room check-out—staff must be challenged to consider workflow implications, specifically regarding the clinician experience, patient experience, and future operations in the new space.

Also, I see technology solutions often becoming the fallback for a design challenge. A good example of this is found with a curvilinear hallway within a patient floor that has a decentralized nursing model using a small/nontraditional nurses’ station. The design results in limited line-of-sight for clinicians who often complain once they’ve begun working in the space. Too often designers jump directly to a specific VoIP phone or real-time location system as a solution to the issue. Often, the purchase of these systems isn’t supported by the owner and isn’t on the organization’s technology roadmap. As technology solutions are often considered at the enterprise level, it may be unreasonable for a one-off technology to be implemented.

Too often technology isn’t considered in the initial programming phase. I’m frequently pulled into projects that are already through the schematic design phase and heading fast to design development review. By this time, changes for technology and the supporting infrastructure are tough and costly. A scenario that often plays out is that space must be reconfigured to increase the size of the technology rooms and shifted so the rooms can be stacked.


What about the programming phase, specifically? What issues are you seeing arise on the technology front?

Functional programs aren’t as prevalent as they were a few years ago. Each of the projects I’ve been involved in over the last three or four years has lacked a functional program. While most projects have a well-defined space program, the space program seems to no longer have a complementary functional program.

I’m unsure why this is the case, but I can say with 100 percent certainty that a document outlining the intended use of a space is extremely useful a year or two into the project when the team is trying to remember/understand why a space was designed a particular way, the details of how clinicians are intended to use the space, and, ultimately, what appropriate technology treatment should be implemented to support both the space and the users within.

Also, when planning spaces, I see designers determining that because a previous client had self-rooming or another workflow concept, that means that a current client should do the same. There are likely multiple technology solutions that must be integrated to support a new proposed workflow—for instance, a concierge arrival solution, scheduling, room tracking, clinician “on-time” status, etc. You must consider what other accommodations/sacrifices were made on a previous project and whether that’s possible on the current project.


Looking 10 years into the future, how do you see IT integration and facility design evolving, and coming together? 

Facilities designed and built in the next decade must combine efficient design with innovative and emerging technologies, to create an environment that enhances the way patients experience and engage a new building while accelerating employee productivity, increasing revenue, and providing a safe environment. The physical space and technology within should come together to blur the lines between phases along the care continuum. 

Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at