More and more Healthcare projects are exploring the use of prefabrication strategies in their construction projects. There are several reasons speculated for this shift. Increased demands for hospital beds and requirements for decreases in facility downtime are significant factors, but first and foremost appears to be the shortage of skilled labor and craftspeople in the construction industry currently. Many industry experts believe that the healthcare sector is suffering more than others from this scarcity because their facilities require a higher level of skill from these positions. Reduction in labor and quality control are two key advantages of prefabricated construction that can help alleviate some of these labor shortages.
Adoption of Telemedicine
There has been a rapid rise in the adoption of telemedicine recently due to the COVID-19 pandemic. However, the popularity of telemedicine was on the rise even before the pandemic. In recent years, telemedicine has been discussed as a possible solution to respond to the need to reduce the cost of care. Savings related to utilizing telemedicine strategies can reduce ER visits, reduce transportation costs, and allow for better healthcare staff utilization. Other factors driving telemedicine’s adoption include the increase in FDA and additional regulatory approval, improved patient engagement with appointment reminders, in-app scheduling tools, remote physician consultations, the increased accessibility to doctors and specialists, and convenience.
What is Telemedicine Healthcare
Telemedicine healthcare has many definitions; however, one of the simplest is “the remote delivery of healthcare services.” For the design world, the Facility Guidelines Institute (FGI) 2018 Guidelines for Design and Construction Documents for Hospitals and Outpatient Facilities defines telemedicine as “The use of electronic information and communications technologies to provide and support health care when distance separates the patient and medical provider” and goes on to add that “Clinical applications of telemedicine may encompass diagnostic, therapeutic and forensic modalities. “
Per the FGI Guidelines, typical applications include pre-hospitalization assessment and post-hospital follow-up care, scheduled and urgent outpatient visits, medication management, psychotherapy, and consultation. Patient and provider consultations, medical imaging, remote monitoring, and education are all additional services that can be provided via telemedicine. A variety of technologies, including video conferencing systems, internet-based websites, digital phones, and secure e-mail, can be used to deliver telemedicine services. Telemedicine facilitates the exchange of health information, services, and education between providers and providers or patients through electronic means.
There are many factors to be considered when designing for telemedicine healthcare. Prescriptive code requirements lay out the minimum requirements for the spaces, the types of consultations and services to be employed, which factor in determining the specific needs, and the impacts of a building’s infrastructure all should be considered when planning environments for Telemedicine Healthcare.
Design Code Requirements
The 2018 FGI Guidelines for Design and Construction establish the minimum requirements for telemedicine spaces and offer additional recommendations supported by research and best practices. In general, FGI notes that the design of telemedicine spaces should facilitate natural communication for the broadest range of participants, including elderly patients, those unaccustomed to electronic communication, and those with vision, hearing, or cognitive impairments. Design for these spaces should strive to produce the same level of care as in-person facilities when it comes to patient experience, quality of care, and privacy.
When clinical telemedicine services are provided in a health care facility, the FGI Guidelines prescribe specific requirements for space allocation, privacy, acoustics, lighting, interior surfaces, site identification, and support areas for telemedicine bays, cubicles, or rooms. In addition to the code requirements, several additional design considerations should be addressed.
Types of Telemedicine Healthcare
Telemedicine Healthcare breaks down into four types of solutions, store-and-forward, remote patient monitoring, interactive medicine, and mobile health. Knowing which type or types that will be utilized will impact the design of the environment as well as the technical requirements and support.
Store and Forward is a method by which healthcare providers share patient medical information like lab reports, imaging studies, videos, and other records with a physician, radiologist, or specialist at another location. Data from the patient is gathered and then sent through a secure e-mail or messaging service to a cloud-based platform for a healthcare professional to analyze, diagnose, and create a treatment plan.
Remote Patient Monitoring (RPM) uses a range of technological devices to monitor the health and clinical signs of a patient remotely. Digital technologies collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.
Interactive medicine can provide immediate advice to patients who require medical attention by allowing patients and physicians to communicate in real-time, typically by using a computer or phone with video capabilities.
Mobile Health or mHealth uses mobile communications devices, such as smartphones and tablet computers, and software applications for these devices to support healthcare. However, it is not typically considered in Telemedicine Healthcare design because it does not require physical space.
In addition to specific room requirements (e.g., display and audio considerations, equipment, lighting), telemedicine can impact the network infrastructure, building services, and power distribution. IT infrastructure requirements for telemedicine need to be considered because remotely connecting through traditional means is no longer reliable or secure. Telemedicine programs will need access to broadband internet with sufficient bandwidth to transmit audio and video data, imaging technology and peripheral devices to see and hear patients even when they are miles apart, and access to technical support and training. Additionally, networks need to be scalable to meet future demands without costly renovations. It is essential to make sure that all IT infrastructure requirements for telemedicine are met. If not, the telemedicine network may experience dropped connections, security risks, and dissatisfied clinicians and patients.
Flexibility for Future Evolution
Although it is impossible to predict what types of new technology will be developed for telemedicine, there are some ways to design for flexibility to accommodate future technologies. For example, adjustable workstations that can be easily reconfigured or moved, raised access flooring that allows for power and data systems reconfigurations, and demountable partitions to enable spaces to be reshaped as needed. Additionally, universal design approaches, e.g., products, systems, and environments designed to be as usable as possible by as many people as possible regardless of age, ability, or situation, can help spaces with interchangeability and additional flexibility. By applying adaptive design strategies, we can be better prepared for the future evolution of Telemedicine Healthcare.
Gretchen Kurzawa, AIA, NCARB
Senior Project Manager