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Healthcare Facility Planning Tools and Guidelines Volume 2, Number 3 |
Summer 2009
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In This Issue
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Planning Clinic Space: Considering Two Different Approaches Digital Physician Visits Are Slowly Gaining Traction Increasing Regulations for Surgery Performed in Physician Offices The Physician Can be in Two Places at Once With Remote Presence and the InTouch Robot |
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Feature Print (PDF) |
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Planning Clinic Space: Considering Two Different Approaches BACKGROUND
PLANNING APPROACH A number of factors were identified that would ultimately impact the overall size of the new clinic facility as follows:
CALCULATION OF CLINIC SPACE FOR 30,000 ANNUAL VISITS The comparison of the "lean" versus more "generous" approach to planning the clinic space is shown below:
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CONCLUSION Using the lean approach, operational processes would be reengineered to improve exam room utilization thus increasing the average annual visits per exam room. By combining three distinct clinics into a single flexible space, only 18 exam rooms would be required in lieu of the 30 at present. The current exam room size of 95 NSF was used in the lean model versus planning all the new exam rooms at 120 NSF. The more generous space layout required additional internal corridors to accommodate the three separate clinics resulting in a larger NSF to DGSF factor. A larger DGSF to BGSF factor was required with the more generous approach to accommodate an atrium, expanded lobby space, and additional space for shared public corridors, elevators/stairs, and mechanical space due to the larger footprint. Assuming an overall project cost of approximately $200 per BGSF, the generous approach would require $2.4 million more (over two times as much) to construct the new clinic building than with the lean approach. Ultimately, the physician leadership decided to consolidate the three clinics using the lean approach which they felt would both increase their profitability and improve customer service. They decided, however, to increase the size of the exam rooms to 110 NSF to accommodate a desktop computer workstation as they transitioned to electronic data entry. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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In the News |
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Digital Physician Visits Are Slowly Gaining Traction OVERVIEW
The most common digital physician services include scheduling appointments, sending lab results, prescribing medications, and paying bills. According to Manhattan Research LLC, nearly 40 percent of physicians surveyed by the company said they have communicated with patients digitally this year. LIMITATIONS The Health Insurance Portability and Accountability Act in 2006 created lengthy policies and procedures to protect patient health information. Providers must take certain precautions to protect patient information being transmitted electronically. Because of this, physicians do not use commonly available Web-conferencing software. Instead, they may have to go through an insurer or another provider with software that meets the security requirements. Physicians are also concerned with malpractice liability, disruptions to the typical office work flow, and limitations to what kinds of ailments can be treated online that are either self-imposed or specified by the American Medical Association. For example, a physician may schedule an e-visit with an established patient but not with one who has not been seen in over a year. Another physician may be willing to treat only minor ailments like the flu. The Mayo Clinic Florida has been using Web conferencing and digital communications for about three years but only between two physicians and most often when the patient is out of the U.S. and is seeking a second opinion. Blue Cross has not yet proven it can reduce medical costs but it is hoping more insurance companies will pay for e-visits with the transition to electronic medical records. COMPLETE ARTICLE The complete article "Digital Visits Slowly Gaining Traction" is from the Jacksonville Business Journal, July 17, 2009. back to top |
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Trendline Print (PDF) |
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Increasing Regulations fro Surgery Performed in Physician Offices BACKGROUND
Some facilities that call themselves “surgery centers” are often nothing more than glorified physician offices that are not accredited or certified by Medicare. For example, to qualify as an ambulatory surgery center, a facility cannot share waiting space or other business operations with non-surgical patients and additional quality control processes for anesthesia and a formal backup procedure for medical emergencies are required. CURRENT TREND Due to some highly publicized cases where a patient died while undergoing surgery in a physician’s office, states are beginning to regulate the estimated 35,000 to 45,000 physician offices in the U.S. that also perform surgical procedures ― representing about 17% of all outpatient surgical procedures. Only a fraction of these physician offices are accredited. California, New York, Florida, Indiana, Nevada, and Arizona are now regulating these procedures. For example, in New York, the state’s roughly 3,000 physician offices that perform surgery under moderate to deep sedation must have their facilities inspected and accredited by independent review agencies or face penalties from the New York state medical board. CONCLUSION This may force physician to rethink performing surgery in their offices and result in the transition of the. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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Technology |
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The Physician Can Be in Two Places at Once With Remote Telepresence and the InTouch Robot
HOW IT WORKS
InTouch Health's family
of RP-7 robots are wireless, mobile, remote presence robots that allow the
physician to be in "two places at once." Under the direct control of a
remote physician seated at a control station, the robot can move untethered
allowing the physician to freely interact with patients, family members, and
hospital staff from anywhere, anytime. The InTouch robot
The remote physician controls the RP-7 robot and interacts within the healthcare facility via the use of a specialized computer. Both the robot and the control station are linked via a secure combination of broadband, the Internet, and wireless technology. Options include a portable laptop that enables the physician to access the RP-7 robot through most high-speed Internet connections to provide care at a moment's notice. The user can simultaneously access RP-7 and the patient's electronic medical information by toggling between views. A desktop control station is also available with a dual-monitor which is ideal for a home or office setting. It also allows a physician to simultaneously view electronic medical information while using the robot. back to top Additional information can be found at InTouch Health website. |
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Rule-of-Thumb |
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Note: DGSF represents the "footprint" of a department or functional area and includes the net square feet of the individual rooms as well as the space occupied by internal circulation corridors, walls/partition, and minor utility shafts; DGSF excludes common areas such as shared public corridors and lobbies, elevator banks, stairwells, major mechanical spaces, and the space occupied by the building's exterior wall. Source: SpaceMed Guide (Second Edition). |
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Copyright ©2009 SpaceMed. All rights reserved. |
University Hospital (UH) planned to replace several outpatient clinics in a
new freestanding building. Although the current number of annual visits
(30,000) was not expected to grow significantly in the near future, three
different locations were currently in operation which was perceived to
result in operational as well as space inefficiencies. There was
considerable debate among the physician leadership regarding the planning of
the new facility. Some wished to maintain the status quo regarding their
current productivity and wanted to simply replace the three separate clinics
in new construction. Others wanted to consolidate the clinics into a single,
efficient ambulatory care space ― recognizing that reducing their staff and
facility costs would make them more profitable while potentially improving
customer service with more streamlined and better coordinated processes. The
physician leadership agreed to evaluate the impact on overall space need
(and resulting construction cost) of planning a “lean” facility versus a
more “generous” facility.
Blue Cross and Blue Shield of Florida was the first in the state to make an
e-visit a billable service. Now about 1,000 healthcare providers have signed
up for the service and the number of enrolled patients has grown to more
than 600,000. Yet despite significant gains in online communications with
patients, physicians have been slow to embrace technology that puts a
computer screen between them and a patient when treatment is required.
Outpatient surgery ―
from the removal of lumps and bumps to knee repairs ― accounts for more than
65% of all surgeries in the U.S. Due to the development of shorter-acting
anesthesia and minimally-invasive surgical techniques, a significant amount
of outpatient surgery has shifted from the hospital-based surgery suite to
outpatient facilities and physician offices over the past two decades. These
outpatient settings typically offer more convenient scheduling, improved
patient access, and lower costs. About 45% of these procedures occur in
hospital-based outpatient facilities which are operated by highly regulated
hospitals. An additional 38% of these procedures are performed in more than
5,000 ambulatory surgery centers which are typically certified by the
federal Center for Medicare and Medicaid Services, are accredited by an
independent agency, and may also have to be licensed by their state. To be accredited,
facilities must meet stringent standards for equipment, operating room
safety, personnel training, and surgeon credentials. Physicians in states
with no regulations may perform surgery solely under the physician’s medical
license with no formal licensing or accreditation requirements. Some
physicians may choose to be voluntarily accredited by one of three agencies
that perform the inspections, but the process can be costly. 
Remote presence is the
ability to project yourself to another location (without leaving your
current location) and to move, see, hear and talk as though you were
actually there. Wherever access to medical expertise is limited, remote
presence can effectively extend the physician's reach to manage patient
care, thereby removing time and distance barriers. Remote presence
technology can be applied across the entire continuum of healthcare, from
primary care to outpatient care, retail clinics to emergency services, acute
care, rehabilitation, and long term care. With the InTouch Health robot,
physicians can make informed decisions about patient care from any remote
location.
is
the only FDA-approved remote presence technology that uniquely enables
physicians to connect to FDA-cleared medical devices such as electronic
stethoscopes, otoscopes, EKG machines, and ultrasound.