In May 2011, my HKS colleague Jennie Evans posted a blog titled HKS: IT Changes Everything.” Her comments focused on how poor interfaces with planned technology can stall the implementation of planned operational processes. She closed by asking the question: “How should information technology be integrated into the design process?” 

Back in May 2008, I wrote an article with John Vitalis that discussed the significance of getting the CIO involved in the planning process and identified the importance of understanding information management, information systems, and information technology, and their respective impacts on the planning and design process for new or renovated buildings. 

As technology has become an ever-more important aspect of facility planning, I have needed to use this framework to help explain when various aspects of technology should be considered. Here are my current definitions: 

  • Information Management (IM) focuses on the organization of and control over the structure, processing, and delivery of information. Typically, senior leadership in a hospital or health system is responsible for information management.
  • Information Systems (IS) focuses on understanding the available types of technologies, which enable operational processes, for both care delivery and care support functions. Typically, operational planners and architects, in concert with service line leaders and department directors, need to be responsible for Information Systems.
  • Information Technology (IT) focuses on the vendor hardware and software necessary to support the technology-enabled processes with the gathering, processing, storing, transmitting, retrieving, and reporting information in a secure environment. Typically, technology and medical equipment planners specify clinical and business information technology.

The following chart expands on these definitions to illustrate the focus for technology during the stages of the pre-design, design, construction, and occupancy processes.


From my experience, an understanding of information systems is of the greatest importance to the integration of technology and operations. Echoing the issue raised by Jennie Evans, when we are developing the processes for care delivery and care support, we need to understand how technology can enable these processes.

However, we do not need to be concerned yet with specific types of information technology (hardware and software); this is detailed planning that will come later. 

Let’s consider a few examples:

  • How do we want patients and their families to be able to access their medical information? Registration? Scheduling? Does information technology exist to enable these desired processes? (For example, kiosks)
  • Will different legacy information technology be able to communicate (for example, medical records and surgical scheduling)? At this stage, we only need a yes or no, not how.
  • Will we rely on wireless technology throughout the building? Again, we only need to know yes or no, not how or which vendor.
  • What is the planned type and number of imaging modalities? At this stage, the actual vendor is not important.
  • Will we employ an RFID-type system for equipment? Patients? Staff?
  • Will we use bedside bar coding for medication?
  • How will we prepare and update patient charts? (Bedside? Voice?)
  • What processes may change and/or be replaced with the electronic health record? 

As technology-enabled processes become more critical in healthcare, we need to understand the importance of developing processes that enable care delivery and caresupport, and can and will be implemented with the appropriate information technology.