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The health sector is a complex beast for architects to tackle. And the demands of Information Communication Technology (ICT) in both the public and private sectors add another layer of complexity to the design process.

This article highlights the fact that healthcare complexity is currently exceeding healthcare budgets. This is despite the fact that the UK and US Governments are focusing on healthcare ICT as a way of reducing the cost of administration and medical errors.

Therefore the selection of healthcare design is likely to be influenced by the need to incorporate new and old technology to optimise the efficiency in hospitals, rather than to make capital cost savings.

The successful architect will need to understand how healthcare ICT is used and how it will impact on healthcare to meet these drivers. They will need to hear the opinions of the many individuals that hold the knowledge behind ICT healthcare.

INCREASING COMPLEXITY The health sector consists of many departments that contain a multitude of functions and operational tasks. According to the Department of Health costs report (2005), there are in excess of 35,000 different treatments from over 600 NHS providers.

The sector is dependent on information, knowledge and communication to perform its task. Efficiency hinges on how this knowledge and information is stored, accessed and communicated across the health sectors.

The examples shown below demonstrate this complexity:

there are more than 100 million patient records held by the NHS.

These records need to be accessed constantly and communicated between treatment centres;

modern-day intensive-care units use a huge amount of specialist knowledge and resources to keep pace with the technology revolution;

complex information from EMR Scans and other imaging data needs to be communicated between health sector staff;

as the pharmaceutical industry evolves, so does the amount of drug information communicated between doctors, nurses, pharmacies and patients.

The increasing number and complexity of treatments leads to increased budgets. The National Health deficit is currently running at around £700 million and the pressure to bring the cost down from governmental bodies is increasing.

INCREASING DEMAND FOR HEALTHCARE ICT America, a market leader in health technology, is continuing to increase its healthcare technology budget. A new directive from President Bush has been issued to target medical errors and decrease healthcare administration. This initial technology is intended to bring long-term efficiencies.

As America takes the market lead and the cost of technology research and clinical risk reduces, there are signs the rest of the world is following.

After the introduction of The British National programme for IT in 2002, the UK is currently increasing ICT healthcare capabilities and will continue to do so over the next six years.

This programme aims to bring all patient records into an electronic format, taking communication between health staff to the Internet.

Other European countries such as Germany and Switzerland are already users of this system.

HEALTHCARE DESIGN DRIVERS In the Agency for Healthcare Research and Quality's October 2005 paper Healthcare Research and Quality, the requirements for design selection were outlined as the following:

focused patient care and improved staff satisfaction and safety;

the need to incorporate new technology;

more efcient and cost-effective operations rather than capital spending; and exibility to meet new hospital guidelines and regulations.

We could say that healthcare building design is heavily inuenced by the availability and sophistication of services and facilities rather than by capital costs. Governments aim to bring operational costs down using technology.

SATISFACTION OF ICT REQUIREMENTS The building design should not only cater for the new technology, but new and existing technology should also be selected and positioned to help satisfy other requirements.

For example:

PC terminals and network points need to be positioned in the correct treatment rooms to give doctors access to electronic patient booking and record systems;

imaging technology may require wall shielding to prevent external interference and oor recesses to cope with the equipment height; and the careful positioning of information screens and publicannouncement systems is required for safety.

There are three key areas of healthcare technology:

the hospital information system: this includes information such as nance, purchasing, and patient ow/booking;

the clinical information system: this includes clinical data, decisions and communication; and facilities technology: this includes mechanical and electrical maintenance, energy monitoring, estates management, security, cleaning, catering, waste management, laundry, portering, equipment management, deliveries etc.

ICT DESIGN ADVICE AT THE RIGHT TIME The complexities of the healthcare sector mean the architect will need to be informed prior to and throughout the design process.

Healthcare consultants, ICT consultants, structural engineers and sound engineers may be required as part of the design process.

In addition, the sheer diversity of health consultants and patient demographics impacts on design requirements.

The architect will have a pressured position to carefully balance and co-ordinate requirements from an early stage if they are to optimise the design.

PLANNING AND DESIGNING FOR ICT Proposed hospital design will usually consist of a mixture of new and existing technology.

An understanding of which technology will be maintained and which technology will be purchased new is essential. This involves key decision-makers inspecting the existing equipment for capabilities against market alternatives.

Once this is determined, architects need to understand the following:

how the staff will use the technology;

how the technology will effect the environment;

how the environment will affect the technology;

how the building should house the technology;

how the technology will interface with other technology; and how the technology will interface with staff and patients.

The table above shows how these technologies (hardware and software) may be used. Time-efcient and cost-effective operation may be achieved by integration of the three divisions of health care technologies, as seen in the diagram above-left.

Making decisions on the procurement of ICT can be achieved in a number of ways:

interviews with staff who used the equipment;

presentations, demonstrations and interviews with the technology vendors;

interviews with in-house IT staff that have managed the equipment; and interviews with ICT healthcare consultants who have to use integrated healthcare technologies (existing and new ICT).

During design, consideration must be given to:

how technology affects staff and patient safety;

integration of technology: additional technology may be required to bridge the gap between technologies. This is expected when using a mix of new and existing technology;

future exibility: an example is the laying of dark bre (spare cables) which is used if systems are moved or new systems are brought in;

dual redundancy of the system: the technology may need to be duplicated in case of failure; and co-ordinating the location and sizes of the communication rooms, cable runs and network sockets.

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