Designing with Holograms

Advancements in technology have transcended the limits of discovery and innovation in the world of modern healthcare, not only in terms of scientific discovery but also in the way hospitals do business. Physician and hospital personnel have incorporated technology into their everyday routine by switching over to electronic medical records and scheduling. We are living longer, finding cures to the so-called “incurable” and designing new and improved techniques to teach the next generation of doctors because of these recent developments.

One of the latest technological advancements that may change the way we design healthcare space is the partnership between global medical technology company, Stryker and Microsoft. The two companies have teamed up to create a new method of designing operating rooms. Using Microsoft HoloLens and Stryker software, hospitals can better visualize plans for their new operating room with 3D holograms. No more need to push and move around expensive and heavy equipment to see the design of the room. With the HoloLens you can move and shape the equipment with the pinch of two fingers to create an operating room that satisfies the needs of all departments.

In addition to making healthcare architecture more efficient, Case Western Reserve University and the Cleveland Clinic have been using it to teach the next generation of physicians human anatomy in completely new ways. Students can see human anatomy layer by layer by isolating specific systems and organs. For example, students are able to gain a deeper understanding of the inner workings of a heart before ever opening a human chest. We are excited about the Stryker and Microsoft HoloLens technology and the possibilities it creates for medical teaching and scientific discovery.

For more information on this promising new technology click here.

Trends in ED and Inpatient Services

In March, an interesting article was published examining the trends in the supply of beds in California’s emergency departments in relation to those in inpatient services. This retrospective analysis reviews the supply and demand of beds from 2005 – 2014. It addresses several factors contributing to the ebb and flow of bed availability across the state and presents a new methodology for analyzing trends. The new metric – ‘beds per visit’ –  suggests the State of California has an inadequate supply of ED and specific inpatient beds.

While this study looks only at the State of California, the issue of ED overcrowding continues to plague hospitals across the United States. We are interested in better understanding this phenomenon and how the hospitals in which we work strive to manage this symbiotic relationship between emergency departments and inpatient services.

Design Review in VR

Elliot Hospital team members review proposed design for new Urgent Care center.

As the dust settles from the recent explosion in Virtual Reality [VR] technology, one thing is becoming clear: it is changing the way we interact with the digital environment. Up until recently, developments in CAD and BIM technologies, as impressive as they are, had been stymied by the limitations of computer monitors and print media. The arrival of VR headset technology breaks through the traditional limitations of the screen and puts people “in” the design to experience, evaluate and comment from a first-person perspective. Over the past few years, we at E4H have been exploring ways of incorporating VR in the design review process, starting in the office and then bringing it to our clients.

At the Office

One of the most important things an architect can do is open their work up to their peers for review and commentary. This has historically been by pinning up work on the wall or showing things on a monitor, but lately we have been incorporating VR into these informal design review meetings in the office. One of our team rooms in the Boston office doubles as VR Lab, with furniture moved to the side to create an open space for walking around the virtual model without bumping into physical objects that can’t be seen with the VR goggles on. Team members can give feedback based on what they are seeing, including the “feeling” of the room using the true-to-scale nature of the software. Using IrisVr’s Prospect software, we can cycle through preset locations for doing multi-room reviews, add markups to the model, draw in space, and take snapshots for sharing these notes with others later

These VR design reviews also help to eliminate the distance between our offices and allows the opportunity to get feedback from our diverse group of designers across the country. Using our high speed network and multiple VR headsets, teams in Texas can review a project in New York and share comments based on their own recent work.

With Our Clients

In addition to reviewing the our work as a team, we also conduct VR design reviews during typical meetings with our clients. We recently used this during a final design development review at Elliot Hospital, with multiple users from different departments. We gathered feedback on equipment locations, casework configurations, outlet quantities and furniture arrangement. The perspective from the goggles is duplicated on via projection for everyone else to follow along and continue to offer feedback. Once the group gets past the initials fears or hesitancy to try them out, they often forget they are still sitting in a conference room. The technology has been a great facilitator of discussion with users of all kinds including doctors, nurses, administrators, facilities staff and more.

Find out more about our VR capabilities.

The 3P Workshop

In architecture school students are introduced to Louis Sullivan’s modernist mantra ‘form follows function’. This mantra follows a strict two-step chronology:

  • First, the function of the space is defined, vetted and communicated. Here the needs of the client and the space are outlined. Traditionally, this step is completed by the client with or without outside consultants.
  • In step two, designers are invited to explore the form or how the established function is spatially organized.

While this two-step process is widely accepted as the logical progression of a design, today many architects are being invited into the first step: defining function.

Often, our clients come to us questioning the needs and processes of a facility or department. The hospital has an interest in exploring a change of function, but the new requirements have not yet been defined. For example, we are often asked to examine metrics collected by a hospital and translate patient population projections into spatial requirements. Other times, when a department is interested in exploring a new treatment methodology, we are asked to explore the consequential spatial impact. We appreciate these requests as they seek to engage us in the entire process of defining both the form and the function.

To further provide services in line with our clients’ growing needs, several of our architects and designers have been trained in Lean and Six Sigma strategies. Lean is a process designed to reduce waste and increase efficiencies. Its principles and tools have been widely embraced by the business and planning professionals within the healthcare industry.

One Lean exercise we have found particularly useful is the 3P (Production Preparation Process) event. In these three to five day events both the process (function) and design (form) of a facility are carefully examined. The event is unique in its inclusion of all key stakeholders and users. It is not just healthcare executives making decisions regarding the future state of care delivery, but also physicians, nurses, support staff and patients. At each event current and future state flows are outlined and design solutions vetted across disciplines.

Our Lean Design Team recently hosted a 3P event for Lifespan Health System in Newport, RI. Across three days, more than 70 attendees informed the schematic design of a new 13,100 SF Emergency Department at Newport Hospital. The facility incorporated state-of-the-art strategies for emergency care, increases the number of treatment bays, expand triage capacity, expand waiting room and entrance space, and host a dedicated Rapid Treatment Area, Clinical Observation Unit, and Behavioral Health Suite.

Build for Humanity

An independent affiliate of Habitat for Humanity International, Habitat NYC has worked since 1984 “toward a world where everyone has a decent place to live.” Their mission is to ensure that every New Yorker has a decent, affordable home.”

“Build for Unity” is HABITAT for HUMANITY’s way to bring attention to our country’s growing cultural intolerance and discrimination. Last weekend, many nationalities, faiths, ethnicities and ages, worked side by side to help in the construction of 15 affordable housing units for low-income families to own. It demonstrated that we can all work together altruistically to achieve positive change for the lives of others.

It is an excellent opportunity to do for others while gaining useful construction experience in route to understanding about constructability (what’s easily built from the details we draw). It is rewarding in so many ways and I recommend it for everyone especially our junior designers and detailers. There are few weekends, better spent.

Promising New Treatment for Sepsis

Sepsis is a life-threatening condition associated with an inflammatory response to infection that has the potential to cause multiple organ failure. Sepsis kills more people in the hospital than any other disease. Worldwide, Sepsis is estimated to impact 15 to 19 million people annually with a mortality rate approaching 60% in low income countries.

Many people in the scientific and medical communities are hoping that the findings of Dr. Paul Marik in the Journal Chest will revolutionize the treatment of Sepsis. Dr. Marik, working from preliminary research findings by Dr. Berry Fowler and his colleagues at the Virginia Commonwealth University (VCU) in Richmond, began treating septic patients with an intravenous cocktail of vitamin C, low dose of corticosteroids, and thiamine (another vitamin).

After Dr. Marik treated 50 patients, he submitted his results to Chest. Of 47 patients treated with the vitamin C cocktail, only four died in the hospital. Of the four deaths, all were from their underlying diseases – not from sepsis. For a control, Dr. Marik looked back at 47 septic patients treated previously in his hospital without vitamin C infusion and found that 19 had died. While the data is still suggestive, the outlook is promising.

Dr. Fowler and his laboratory at VCU was recently awarded a $3.2 million grant from the NIH to run a controlled study to examine the use of vitamin C to treat sepsis. The study will be conducted at several universities and be double-blinded (information about the test kept from the testers and participants) as to limit bias, both intentional or unconscious.

We are excited about the potential of this research and the tremendous potential this will have on both patients and the healthcare industry.

We learned of the success and studies from NPR, in their article Doctor Turns Up Possible Treatment for Deadly Sepsis.

“Behavioral Health Is Part of Overall Health”

“Behavioral Health is part of overall Health,” said Debra Osteen, NAPHS board chair and president of behavioral health, Universal Health Services, Inc. at the start of the recent NAPHS Annual Meeting in Washington, DC. This statement came as no surprise to the many Mental Health professionals attending this yearly conference.

Speaker after speaker talked about the state of mental health care today and the need to seamlessly integrate Mental Health services into the overall medical care provided by family practice physicians and patient care facilities of all types. Because of “parity” legislation passed in congress in 2008 and the passage just last year of legislation for $1B funding  for mental health care for 2017 and 2018, one would have thought a mood of jubilation or at least a sense of well-being would have been present in the conference hall of the Mandarin Oriental Hotel Conference Center.  Instead, the general mood was one of despondence.

The increasing effects of the opioid pandemic are on the minds of all health care professionals. The number of baby boomers who are aging and will need increasing medical services is clear to everyone. Yet, no one knows or can accurately predict how the repeal of the ACA and the proposals for new Republican health care legislation currently being debated in the House of Representatives will affect the future delivery of health care services in America. Various presenters spoke about how funding for Medicaid will be decimated, how future Medicare changes might likely come about, how billions of dollars will be removed from the budget for health care and how millions of Americans will lose access to services. One questioner, at a lunch session presentation by Hemi Tewarson, acting director for National Governors Association Center for Best Practices, Health Division stated, “No matter how you slice and dice it, Congress is proposing to remove $800 B from the budget for healthcare services and nothing is being proposed to replace it.  How then are we, the health care professionals, going to deliver services to the most needy or to anyone, for that matter? ” General applause greeted this question. And no real answer was forthcoming.

Changing Perceptions: Contemporary Artworks in a Healthcare Environment

“Patients First” has always been Cleveland Clinic‘s guiding principle. A place for experimentation and innovation, the leading medical institution constantly seeks to improve patient outcomes. Their Art Program does just that.

Established in 2006 “to enrich, inspire and enliven patients, visitors, employees and the community,” the Program added 3,000 artworks to the Clinic’s existing eclectic collection. Today, over 5,000 artworks in all media: prints, works on paper, photography, sculpture, and video fill in the Clinic’s 23.5 million square feet of real estate.

“Art provides color and warmth, distraction from personal anxiety, Joanne Cohen, Executive Director and Curator of the Cleveland Clinic Art Program told E4H. “It provides moments of levity, lightheartedness and beauty. It alleviates stress and ameliorates patients’ experience.”

Wayfinding is another consideration. The clinic often uses art as a navigational tool. People come in. They are stressed. They can’t remember how to find the doctor, where the emergency room is or where they are parked. Art can help them find their way.

In addition, all studies performed at Cleveland Clinic related to the therapeutic benefits of art revealed its positive impact on patients’ stress, their comfort levels and overall satisfaction.

“Most people said their mood had been somewhat, if not significantly, improved by interacting with the artwork,” she added. “Hopefully this mood improvement will lead to shorter hospital stays and less need for paid medication. In any case, anything we can do to give patients something else to look at or to think about, distract them and take them out of that difficult moment is a win-win situation.”

The Future of the Medical Office?

Located in downtown San Francisco, Forward is an interesting new model for healthcare delivery. It is a meld between an Apple store, a high-end medical office, and a chic members-only health club.We learned about Forward, and its cutting edge delivery model by way of TechCrunch.

The idea of incorporating technology to make healthcare more accessible to the masses has been a growing trend. Health-insurer and insurance-technology startups raised more than $1.2 billion in venture funding in 2015. For perspective, that’s more than double the $570 million raised in 2014, and 10 times the $123 million raised in 2013, according to CB Insights, a data company that tracks private startups and venture capital. With venture capital dollars pouring into the healthcare industry, many predict tech-heavy healthcare delivery models will gain more traction (and market share) in upcoming years.

Is this the future of healthcare? We are excited to see where it goes…

Breakthrough in Autism Research

An exciting breakthrough in autism research was recently published in the highly reputable academic journal, Nature. Scientists have observed brain enlargement in children with autism spectrum disorder (ASD). A retrospective analysis of head circumference and longitudinal brain volume studies in two to four-year-olds indicate increased brain volume may be an early indicator of ASD. These findings suggest an earlier diagnosis may be possible, helping those with ASD and their caregivers better respond to challenges associated with the disorder.

In any given year, 1 in 68 Americans is diagnosed as having autism spectrum disorder, according to the Centers for Disease Control and Prevention.

Jacques Black, AIA, a partner in our New York City office, has completed several projects for the Center for Autism and the Developing Brain in White Plains, NY. Together with Cathy Lord, a clinical psychologist and director of the Center for Autism and the Developing Brain, he has published and presented on the unique dynamics of the built environment and individuals with ASD.  For example, when designing for autistic patients it is important to acknowledge and address their sensitivities to noise, color, and texture.

We are excited about the potential this research has for young families across the world and will continue to seek to better understand how to design spaces which address the unique needs of patients with ASD.