The Tech Conundrum: In The Race To Go Smart, Healthcare Risks Outsmarting Itself

Robot food and blanket delivery. Automated wheelchairs. Voice-activated control of window blinds. Holographic doctors.

Hospitals are going high-tech as the beginning of an innovation revolution comes to healthcare. The possibilities seem nearly endless. But with so many options and so much potential upside, choosing what to invest in is a challenge.

So far, implementation has been “rugged,” Page principal Joan Albert said at Bisnow’s Healthcare South event at the Houston Marriott Medical Center on Sept. 8. New technology comes with new pain points and the risk of wasting time, money and space, and panelists said architects, developers and hospital operators need to be savvy about what technology they implement in their facilities. 

“Innovation and bleeding edge makes me nervous because we all know how frustrated we get when our phones don’t work, right?” Texas Children’s Hospital Senior Vice President of Facilities Planning and Development Jill Pearsall said. “If you make the building too smart, [patients] are just going to be frustrated.”

Technology can solve a lot of problems. New tools can help offset the significant labor shortage and make staff’s lives easier, improve the patient experience and their care, and keep facilities online during natural disasters.

Artificial intelligence is starting to come into hospital design, and "smart hospitals" could become significant in the future.

During Winter Storm Uri in 2021, engineers at a hospital in Victoria, Texas, saw moisture rising in their pipes and an increased risk of freezing, so they did a systemwide software update to heat up components and change their set temperature, according to Enchanted Rock Vice President Todd Price, whose firm provided the hospital with a microgrid. That prevented a breakdown. Engineers also were able to see load problems beginning on the Texas power grid and switch to the in-house microgrid before anything went wrong, keeping that hospital online while the state struggled with days of power outages and burst pipes.  

Burns Engineering Healthcare Technology Lead Alan Dash said one day operators could get data like a rise in temperature in the radiology waiting room and diagnose it as coming from more people than normal being in the space, indicating doctors are backed up and that floating nurses should be sent to treat patients more quickly. 

But architects and operators deciding what tech to choose face a slew of challenges, from the years-long lead time between design and opening of a facility, the cost and expectation of maintenance, competing priorities and a wide range of patients with differing technological capabilities.  

“Innovation isn’t simply a smartphone or people working remotely at home. Innovation isn’t just applications,” Houston Methodist Hospital Chief Operating Officer Michael Garcia said. “It requires space, it requires people, it requires a lot of thought and planning that candidly we’re only trying to address now.” 

‘I Don’t Have Money To Be Flexible!’: Planning For The Unknown Is Pricey

Houston Methodist Hospital is replacing a 1960s-era hospital with a new facility slated to deliver in 2027, Garcia said.

Deciding what technology should go into it is giving him angst because there is so much to choose from, and some of the tech the system will want in the new building hasn’t even been designed yet.

On top of that, every choice can come with a hefty price tag. Surgeons at Houston Methodist asked for higher resolution monitors, but it would cost the hospital $5M to replace existing ones. Meanwhile, Garcia knows in a few years there will be even higher resolution monitors and surgeons will want those.  

“We’re trying to make decisions now, so let’s be flexible. Well I don’t have money to be flexible!” said Karen Mooney, assistant vice president of facilities planning, design and construction for MD Anderson Cancer Center. While she hates the term “future-proofing,” she said it is her biggest worry when she is developing new facilities. 

The secret to keeping up with changing innovation is to build an infrastructure chassis that can flex, according to Gaurav Khadse, Texas Children’s Hospital assistant vice president of facilities planning and development.

Khadse said his organization tries to build an IT infrastructure to last at least 15 years and acknowledges no one knows what IT will look like beyond that time frame. Though Texas Children’s builds hospitals it intends to be functional for 50 years, it does its tech master plans in five- and 10-year increments. It also focuses on building redundancies so parts of the hospital can go down without affecting others.

Another challenge for systems is keeping quality consistent across their portfolios. Having one hospital that has all the newest bells and whistles while everything else is technologically years behind gives patients the impression the “fancy” hospital has better care than the rest, Pearsall said. 

Tech: Pro Or Con?

There are five generations of patients and four generations of doctors in hospitals today, all interacting with technology, space and other humans differently, IMEG associate principal Corey Gaarde said. That makes designing facilities that cater to everyone’s preferences and comfort level a big challenge.

Different populations of patients also have different technological capabilities. Harris Health serves the lowest-income community in Houston, and Senior Project Manager Sunita Ganjoo said those patients often don’t have smartphones, so high-tech wayfinding isn’t accessible to them. 

Likewise, a suite of self-service tools like self-check-in and self-parking can be appealing to some patients, while others can get confused and have negative experiences, HDR Architecture Health Planning Principal Fernando Rodrigues said.

Sometimes the low-fi option is the simplest and most reliable, he said — a printed sign on a wall can’t glitch.

“The more ingrained you get with technology, the less you can function well without it,” Arista Southeast Team Lead Andy Brown said.

Some hospital functions are now only done electronically, putting pressure on the systems to stay up.

Memorial Hermann Hospital Chief Medical Information Officer Ryan Walsh, a practicing family care doctor, said, for example, he cannot physically write out prescriptions anymore; it must be done digitally. He and Memorial Hermann Southeast & Pearland Hospitals CEO Noel Cárdenas especially caution healthcare architects from ditching ethernet ports — an overreliance on connecting devices to WiFi causes problems, from bandwidth issues slowing equipment down to vulnerability to digital attacks.

“Things that don’t move don’t need to be WiFi, it’s only going to convolute things,” Walsh said.

Hospital systems also too often fill their facilities with technology without enough attention to the actual operation of it, panelists said.

Dash visited one hospital where half the staff said the facility had a digital wayfinding system and the other half said they didn’t. Dash went out to the hallway and found they did have the capability, but it was unused and so dusty someone wrote "Wash Me" on one of the screens.

His conclusion was that healthcare operators need to appoint a person to be responsible for technology, including educating staff on what’s available. 

Gaarde said it is likewise important to test the functionality of new innovations before rolling them out to a new project or whole portfolio. He recommends identifying one pilot building or floor to test out anything the system is considering bringing on board to see whether caregivers actually use it. 

It’s All About The Data

Pearsall said with all the potential pitfalls to patient-facing technology, Texas Children’s is instead focusing most of its tech dollars inward, on using data differently to be predictive and get ahead of problems before they happen.  

“We’re looking at data to be better operators of our facilities and not necessarily integrating it into the facility per se,” Pearsall said.

Data is growing in importance, panelists said. Hospitals are now incentivized to produce data on patient health to get reimbursed, and tech giants like Google, Microsoft and Amazon are getting into the healthcare space largely because they are drawn to the data, Johnson Controls Healthcare Technology Director Brendon Buckley said.

All of that data collection will have a positive impact on the industry, he said. 

“There’s a lot of value in that data that can really help not just from the patient and a staff [standpoint] but also building operations as well,” Buckley said. “So I think looking at it really holistically and really understanding what that data can do and what it’s telling us and how we can actually leverage it, that’s really where everyone is focusing right now.” 

In the end, panelists agreed implementing tech needs to be a thoughtful, purpose-driven decision. Thornton Tomasetti Vice President Robert Rogers said designers should only implement a certain technology if it will make patients better more quickly and more cheaply.

“If the answer is anything but that … it’s probably going to get value-engineered out because it’s not really valuable,” he said.