The growth and potential benefits within the connected world require buildings and places that can adapt and accommodate to ever-changing technology. It requires designers to find innovative ways to bring together different vertical markets, such as health care, pharmaceutical locations, and academic organizations. Many of these markets face significant challenges caused by limited resources and are all lagging because of the slow adoption to technology.

Innovation comes at a price, and most building owners want to spend their budgets on tried, tested, and proven designs. They want a facility that supports technological advancement but at the lowest cost. Some view innovation as an investment with no guaranteed payoff. As engineers, we need to provide the use cases to illustrate the environmental, social, and economic benefits of technology integration.  

Technology integration needs to be part of the initial planning of every project. It should be an essential part of the project charter and be interwoven throughout the project planning and execution. Technology integration cannot merely be a cherry on top. It cannot be an afterthought, because this will lead to an inefficient infrastructure design that cannot handle the true requirements of technology integration. For example, the traditional specification for mechanical-electrical-plumbing (MEP) systems, medical equipment, and fire-life safety systems will not support new technologies if they’re not properly thought through. Early conversations with a technology integration specialist will help to detail the requirements of the specified systems as they relate to technology and how they will be used to help in the realization of the technology integration goals.

The future of design, when it comes to buildings and places, will be focused on safety, wellness, occupant experience, and personalized feedback. The ecosystems are now being designed to collect data from sensors that are located throughout the building. This data is analyzed to provide building intelligence information to optimize the user experience, better manage the facility, and make enterprise system decisions.     

Creating a better understanding of the technology solutions within a reasonable budget also requires educating clients on how to create standard operating procedures and safety protocols to acclimatize and thrive in this new connected world. Innovation advisors need to be working for owners to help them convert their visions into actionable technology designs.

Technology Integration in Health Care — Smart Hospitals

A smart hospital is a building that uses data and technology to improve building operations and patients' well-being. For a smart hospital to be a reality, we must use technology to foster sustainable growth. This means leveraging technology to maximize the use of precious building gross square feet and scarce resources and encourage sound choices by all players in the health care space. This means more likely leveraging sensor technology, behavioral economics, and artificial intelligence (AI) to alter not only physical infrastructure but also the clinical decision-making process.

Understanding the difference between "digital" and "smart" is also important. Digitization of several systems and processes in hospitals does not make the hospital smart by default. Implementing robotic surgical processes, such as the Da Vinci and other robotic automation, is a step in the right direction but does not make a hospital smart. Creating a digital hospital is one in which some of the manual processes are converted into automated processes, such as electronic medical records (EMR) software. Digitizing a hospital can help a designer capture valuable data that can guide a facility on its path to becoming a smart hospital.

The term Internet of Things (IOT) describes physical objects with sensors, processing abilities, software, and other technologies that connect and exchange data with other devices and systems over the internet or other communications network. A smart hospital will utilize the IoT and five other innovative technologies to achieve its technology goals. These are:

• Artificial Intelligence (AI) — The use of computers and other machines to learn, think, make decisions, and provide actions that can reduce the workload of health care providers, building engineers, and other building operators.
• Big Data Analytics — Collecting, analyzing, and using data to make decisions. This is the real innovation that will improve decision-making and optimize building operations. Data collection is the most important part of creating a smart building.
• Augmented Reality (AR) and Digital Twins — AR is an interactive experience that enhances and overlays a user's physical world with computer-generated input. In architecture, AR is the overlay of 3D digital building or building component models embedded with data onto real-world sites. A digital twin is the next step in AR in which a digital replica of a building is created, which includes systems that can be used to simulate and test various real-life scenarios before they are implemented into the building.
• The Internet of Bodies (IOB) — The ability to remotely monitor patients who are in hospital beds and can record patients' vitals and biometrics, powered by authentication systems.
• Cloud Platforms — a means of aggregating and analyzing a large amount of data that smart hospitals require. The data center spaces available in most hospitals are not enough to provide the storage and analytical requirement for a smart hospital. This is where cloud computing can be used to save valuable hospital square footage and improve the hospital system's flexibility.   

A smart hospital should be designed to enable administrators to assimilate data through a complex network of sensors and integrated systems. On the clinical side, integration begins at the patient's home and throughout the patient's journey in entering and navigating the hospital space. On the infrastructure side, it begins in the patient's room, where different MEP and control systems, like lighting, climate control, shading, and entertainment, are all combined into one infrastructure platform (total patient room automation).

Improving Patients’ Journey

To improve the patients' journey in hospitals, a digital front door is needed. This can be done by creating a virtual experience for patients by allowing them to communicate remotely with their health care providers and mobile devices to help them have a seamless in-person facility journey.   

The best way to enhance the patient experience and, by extension, improve treatment outcomes is to provide delivery of care that is simple to understand, intuitive to use, and promotes the health and wellness of patients and their supporting families throughout the treatment and healing process.

The popularity of smartphones has revolutionized health care diagnostics, because it is now in the hands of most patients. Devices that attach to these phones can conduct continuous electrocardiography (EKG), blood glucose monitoring, diagnosis of ear infections, and even detect early signs of oral cancer. Continuous personal EKG technology is one of the most widely adopted examples of this increased connectivity. The heart rhythm is captured and transmitted to your paired smartphone, which can store the data and send it on to your doctor electronically.  

The enhanced use of smartphones has enabled the delivery of care to begin at home. Some health care providers now offer smartphone applications that allow patients to communicate with health care practitioners and schedule appointments. To step it up a level in technology would be to utilize AI to analyze and consider the wait times of all local facilities, time of day, and traffic as well as severity of the treatment requirements to direct a patient to a medical facility best suited to meet their individual needs.

Facilitating Appointment Scheduling for Patients Using AI

One of the greatest stresses that occurs for patients entering a health care facility is the challenge of getting to an appointment on time. Solving this challenge will improve the user experience and benefit health care facilities in terms of operational efficiencies.

AI-driven appointment scheduling systems can be integrated within the health care facility to help with the transport of patients from their homes and around the campus. A smart facility parking system can reserve spaces suitable to a patient's needs. Ride-share application systems, such as Uber and Lyft, can provide bookings for patients who are unable to drive themselves.

The use of mobile scheduling applications could provide health care practitioners with details, such as pretreatment requirements and information about the procedure that will be needed for specific patients. The system would inform a health care facility of a patient's arrival and will allow health care practitioners to be fully set up and ready for the patients when they enter a facility. The size of waiting rooms could be drastically reduced or even eliminated if the health care system can control the scheduling of patients.  

Consideration for a Smart Hospital

Building a smart hospital can be a complicated and expensive endeavor. Each hospital system will have different criteria for most rooms because they might be designed to serve a very specific patient population. Irrespective of the patient room design, engineering, or clinical equipment preference, there are some basic steps that are needed to design a smart hospital. These are some of the necessary steps:

Interpret Your Client's Vision of a Smart Hospital — The first step is to try to understand the unique needs of the hospital and, by extension, the health care system (organization drivers). It’s important to put together a list of stakeholders from the health care facility, which would form part of the focus group. This focus group should include different experts, such as doctors, nurses, facility engineers, and support staff.

For example, if you learn that doctors are wasting too much time locating their colleagues, then location tagging is a must for your intelligent hospital system. At this point, the team should hire an innovation advisor (IA) or technology advisor (TA) to lead the process. This individual will be independent of the project’s architectural and engineering teams. At this point, the IA will help the owner to define the key performance indicators (KPIs) and success measures for the technology design, the finance model to support the smart hospital framework, and the decision matrix for approvals.  

Evaluate Your Existing Technology and Infrastructure Specifications — Owners should work with the IA or TA to identify the existing legacy system specifications to determine what can operate as a part of the smart hospital system and what needs to be updated. Evaluation of all infrastructure in the other hospitals in the health care system — such as the mechanical, electrical (including lighting), security, and information and communication technology (ICT) systems — is important as they are all key parts of the prospective smart hospital solution. Conducting this evaluation with selected technology vendors can be problematic in achieving the smart hospital's goals. It is important to have an advisor that is vendor-agnostic for this process.

The Road to True Integration — Traditional health care facility design comes with different equipment from multiple vendors. The ideal smart hospital is one in which all the devices are interconnected, but it is impossible to get all the equipment to be properly integrated.

It is very easy for a new stand-alone hospital to create a new digitalization path where new equipment can be chosen. In this case, you can turn to a vendor-agnostic provider that will be able to build custom solutions that allow connections to heterogeneous devices. The goal is to create an integrated control platform to operate and control multiple interconnected systems. If your facility doesn't follow one of the widespread health care data interoperability standards, it would be worth investing in one. This will enable you to fit into the interconnected health care ecosystem that is needed for a smart hospital.

It is possible to integrate the following systems on one IP network: building automation system (BAS); power management; energy management; emergency power and testing; access control; intrusion biometrics; videos; real-time locating systems (RTLS), including patient, staff, assets, and wayfinding; VOIP (intercom and phone); visitor management; lighting controls; elevator controls; fire safety controls; admission and administrative systems; regulatory compliance (computerized maintenance management system [CMMS], medical gas/vacuum/refrigerator monitoring); and nurse call (code blue). This will allow the following systems to be able to be interconnected through similar communication protocols.     

Invest in Cybersecurity — Cybersecurity is one of the most important parts of a smart hospital design. The more interconnected devices and systems you have, the more exposures it offers for malicious cyber activities. The cybersecurity specialist should be an important part of your technology team to safeguard the systems from unwelcomed attacks.

Conclusion

There are many benefits of smart hospitals. A fully integrated platform in your new hospital can reduce your initial capital cost during construction because of lower equipment, software, and installation costs. It will also result in lower operating costs since the system can be operated to maintain design KPIs. It can also mean lower maintenance costs, allow for the continuous commissioning of systems, and result in lower energy costs. There are also great benefits on the clinical platform with improvement of patient care, patient/staff safety, and increased staff efficiency. There are perceived thoughts that this is more expensive than traditional hospitals, but this may not be the case.