Designing an Implementation and Process Map
Integrating a new, comprehensive EHR system starts with designing a well-planned implementation and process map. To begin, the map should be mutually agreed upon by the facility owner, architects, engineers, contractors and other stakeholders, as it helps everyone involved successfully schedule the implementation process, from planning through design, construction, and system activation.
The process map includes comprehensive documentation of all required project steps. It starts with a building analysis, which can help minimize cost escalation and surprises as a project progresses. Next steps include code compliance; the selection of general contractors; costs of design, construction and technologies; detailed EHR construction documentation; safety-permit construction documents; clear identification of locations for new or renovated IT rooms; and comprehensive schedules incorporating work processes managed by owners, architects, contractors, and design/build trade partners.
Another element to consider is a campus-wide analysis of existing architectural and engineering systems and their mechanical, electrical, wireless, and data conditions. Facilities may also identify flexible spaces for use during phased construction, so that neither the patient experience nor caregiver workflow is disrupted. Flexibility is key, in order to accommodate unforeseen complications or surprises.
Staff training to ensure buy-in with the new EHR system, and to enhance work processes and decision-making, is also suggested. The implementation and process map also needs an attainable go-live date for the EHR system.

Instigating Infrastructure Upgrades
Developing an integrated, facility-wide EHR system includes infrastructure upgrades. These upgrades usually begin with routing new cabling and wiring, installing power and data outlets, and enabling Wi-Fi access. IT rack rooms or closets, located and identified in the implementation and process map, are moved and/or renovated.
Most health care facilities are already complex, multichannel organizations incrementally built over the years. Thus, existing systems should be leveraged wherever possible. Still, some existing infrastructure can create renovation challenges, even to simple cable updates. For instance, state and Federal codes often stipulate that if a new system touches an older system, then the older system (or room) and path of travel must be upgraded to meet current codes.
Also, as the architect identifies appropriate locations for new or renovated IT rooms-whether in offices, utility closets, or storage spaces-careful consideration must be given to other systems currently in use or nearby. For instance, is computer modeling reveals a potential increase in heating or cooling loads, HVAC upgrades may be necessary.

Measuring Success
A well-integrated EHR system is based on common-enterprise computer architecture, data standards, and privacy and security guidelines. Included in the system are such features as information model, standards and configurations; secure data exchanges; user identification and authentication; access management; clinician-access channels and event notification; and business intelligence enablement.
Thus a health care facility’s EHR implementation and process plan shouldn’t end with go-live activation. The new EHR system, in complement with additional technological infrastructure upgrades, should include a program for measuring the EHR system’s success with regard to health care quality, safety and security, and productivity.
As the evolution of tablets and smart phones ensures technology becomes more mobile, the patient and physician benefits of EHR systems will grow. In large health care facilities, for instance, patients may already be accessing their personal health information from their smart phone. At home, using a laptop, they will literally tap into the organization’s EHR system in order to easily communicate with their doctor, specialist, or pharmacist from a remote location.
Conversely, physicians and other medical personnel can share patient statistics across locations to ensure proper diagnosis and care. Outside of urban hubs, in more suburban or rural locations, EHR systems virtually bridge distances between locations, so that patients can remain safely in their homes while receiving consultations and care. For these reasons, new protocol for measuring the success of EHR systems is critical.

Conclusion
Such sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, also the U.S. population becomes more mobile, national health care networks are increasingly used to facilitate the sharing of health care-related information among various stakeholders and participants.
EHRs add another level of complexity to systems integration. But the benefits of EHRs to health care organizations and their patients – secure access that eases communication between caregivers, specialists, and patients – will grow as mobile technologies continue to drive advances in communications within the health care industry.

About the Authors
Joey Kragelund, AIA, is associate vice president and health care principal with HGA Architects and Engineers in Los Angeles.

Beth Young, AIA, LEED-AP, is project manager with HGA Architects and Engineers in Sacramento.

About HGA
HGA is an integrated architecture, engineering and planning firm. With offices in Los Angeles, San Francisco and Sacramento, California; Minneapolis and Rochester, Minnesota; Milwaukee, Wisconsin; and Washington DC, the nationally recognized firm has developed expertise in the health care, corporate, government, arts, community, education, and science/technology industries since 1953. Our culture for interdisciplinary collaboration, knowledge sharing and design investiga¬tion helps prepare our clients for the future with responsive, innovative and sustainable design. Visit www.HGA.com or follow the firm on Facebook or Twitter.

The post Designing for Electronic Health Records in the 21st Century Facility appeared first on HCO News.

The 500,000-square-foot multilevel hospital is set on 70 acres on Camp Pendleton in Southern California. It is the Navy’s largest American Recovery and Reinvestment Act (ARRA) project. It will provide medical services for surgery, patient overnight stays, dental care, intensive care, and general medical and emergency care. It will include a central utilities plant, a 1,500-space multilevel parking structure (with an additional 1,000 spaces outside the structure) and site development. The contract requires that the project achieve LEED Gold certification.

The new facility will replace the existing naval hospital on Camp Pendleton. The main goal of this project was to provide a facility that meets all of the latest seismic requirements, said Commander Dude Underwood, resident officer in charge of construction for the project.

The project team consists of HKS Inc. as the architect and a joint venture between Clark Construction Group and McCarthy Building Companies as the construction manager. All three companies have offices in San Diego nearby Camp Pendleton.

The $446 million design-build contract, awarded to the Clark-McCarthy team, required an aggressive timeline from conception to final commissioning of the hospital because the delivery method allowed the project team to start construction without having every detail of the design completed, said Carlos Gonzalez, project director for the Clark-McCarthy joint venture project. The contract also included planned modifications for furnishings, fixtures and equipment. Gonzalez said it is rare to have the same entity complete both for a project of this kind.

While the design-build delivery method allowed for efficiencies, the time limit on the project also served as a challenge. Because the project was funded by the ARRA, the project’s funding came with an expiration, so the project team had a specific window of time to get the project done.

“We needed to organize our design so that we could start construction as early as possible,” Gonzalez said. “What we did was create six separate packages and organize them in terms of a time and research standpoint.”

Another challenge was the project requirement to benefit the local economy. That meant that 45 percent of the subcontracts had to be awarded to small businesses. The project met and exceeded that goal, delivering more than 75 percent of small business participation, Gonzalez said.

Underwood said the northwest corner of the building stands out the most in terms of design. “The building was essentially opened up by taking this portion of the building and pulling it away from the rest, creating a crown above it with a reflecting metal surface.”

Gonzalez added that he agrees this section will become iconic for the hospital. He also said that the location of the facility, situated along Interstate 5, gives the building a prominent display.

Both Underwood and Gonzalez also agreed that the safety record on the project has been significant for the team. Gonzalez said that so far the team has completed 2.6 million hours with zero lost-time incidents.

The connection between the project team and the mission of the project was another key factor for all of the workers involved. “It’s inescapable to all of us — the connection of what we’re doing in building a health care facility to treat the men and women in uniform, including wounded warriors, and their dependents,” Underwood said. “As I make my way around the site, I talk to those involved in construction, and they all are immediately aware of the reason and benefit of doing it well.”

Gonzalez added that the mission allowed for them to have better success in terms of meeting the safety, quality and schedule goals. “When you can look at the workers in the eye and say, ‘The sooner you finish, the sooner wounded warriors can be treated and every dollar you saved is a tax dollar that doesn’t have to be spent,’ it actually makes a difference and allows us to engage them on a much more personal level,” he said.

The post PROJECT OF THE MONTH: Replacement Naval Hospital appeared first on HCO News.