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.

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The 80,000-square-foot, acute-care facility and 30,000-square-foot administration building was designed by HGA Architects and Engineers, with offices in Los Angeles, and will be constructed by DPR Construction, headquartered in Redwood City, Calif.
Construction will begin on the $80 million project in early 2014 with a tentative completion date of 2016. The project is aiming for LEED Silver certification.

Founded in 1902, the BRH lies just outside of downtown Los Angeles and adjacent to Elysian Park. Architects were charged with designing a building that did not appear as if it were built 100 years ago, but also to not disrupt the historic, park-like setting of the 25-acre campus.

“We could not retell the history but at the same time the building needed to say it was a brand new, state-of-the-art building and a new identity for Barlow,” said Satoshi Teshima, AIA, LEED AP, project designer with HGA.

The three-story building, which will replace the existing facility built in 1927, is also larger than the other structures on the campus. The architects decided on the size of the building because they wanted to blend in with smaller structures but also be significant enough to not be hidden in the background, Teshima said.

The structure of the building is a gentle S curve, which mimics the in and out motion of easy, flowing breathing. The design of the S curve developed from strategies in the planning process. As architects studied nursing pods, which occurred in eight-bed pods, a triangular or saw-tooted pattern began to develop, according to Joey Kragelund, AIA, principal with HGA.

“From there it started to refine itself as we started to learn more about the kind of care they provide and the softness of the S curve started to materialize,” Kragelund said.

The S curve also works with the topography of the site, which is situated against a hillside, and provides views of the surrounding natural scenery to all patient rooms. Additionally, the formation eliminates all sharp corners and does not disrupt the historic context of the campus.

“It was actually generated by planning with an overlay of the specific context in which this building is located in and that resulted in this soft S curve, which makes this building much more intriguing and also tells a great story about the act of breathing itself,” Teshima said.

The challenge to finding a balance on the exterior design of the building also occurred in the interior design, Teshima said. Because patients at BRH have an average stay of 30 days, the architects are creating an environment that is both clinical in function but organic and home-like in atmosphere.

“It has to feel warm and welcoming,” Teshima said.

The 48 all-private patient rooms are patterned after themes of “tide” and “metamorphosis” to symbolize the act of easy breathing while creating a serene, organic environment for patients and their families. The organic and warm tones of the interior materials were specifically used to evoke emotions of nature, Teshima said.

“If you can evoke that consciously or unconsciously it makes people more comfortable. At the end of the day, you might get bored looking at a certain image or a certain color, which happens to be a trend, but you’ll never get tired of looking at the ocean or the sunset,” Teshima said.

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