Where do facility planning and IT infrastructure and strategic planning issues intersect in today’s hospitals and health systems? One who knows exactly where the overlaps are is Rich Pollack, vice president and CIO of Virginia Commonwealth University Health System (Richmond, Va). Pollack helped oversee the construction of a new critical-care facility (known as The Critical Care Hospital) on the campus of Virginia Commonwealth University Hospital, VCU Health System’s flagship; and he continues to supervise the planning for the IT elements of future construction at the health system. Because of his knowledge and experience, Pollack will be presenting at the upcoming X3 Conference, to be held May 5-7 in Durham, N.C. Pollack will participate in the “Meet the Experts” panel, to be held 10:30 a.m. to 12:30 p.m. on Thursday, May 6 (see www.x3summit.com for more information about the conference). Pollack spoke recently with HCI Editor-in-Chief Mark Hagland regarding some of his perspectives on the issues. He will also be featured in HCI’s May cover story package on facility planning and IT issues.
Healthcare Informatics: Tell us about your recent planning and development experience.
Rich Pollack: We built a new, 15-story, 250-bed, all-private-room, critical-care hospital, and it is entirely digital; built from the ground up with layers of distributed technology. Ground had been broken on the new facility in December 2005, before I came here; the facility opened in October 2008.
HCI: You’re an academic medical center, correct?
RP: Yes, we’re the only academic medical center in central Virginia. We’re a $1.4-billion organization; we used to be called the Medical College of Virginia. We’re now a 780-bed hospital. Our health system was formed a decade ago with the coming together of the hospital with a physician practice plan and a health plan.
HCI: What were the biggest challenges involved in the planning and execution of the critical-care hospital project?
RP: The biggest challenge was applying a workflow-based process to the facility planning process in order to make sure that the nursing units were going to be enabled on a communications basis to still provide high-quality care, even though the same staff was going to be covering two, three, or four times the actual square footage they were used to. The reality is that while crowded space on nursing units can be challenging, it is also true that communication flow is relatively easy. But when you take that same group of nurses and spread them out across a football field-sized area, and have to monitor or the patients or get in touch with physicians, you can’t rely on traditional modes; you have to use technology to compensate for that.
HCI: What kinds of changes took place as the process moved forward?
RP: They had actually broken ground in 2005, before I got here. So I was pulled into the process almost immediately, to be part of the oversight committee for the new critical care hospital. And almost immediately, it became apparent that there had been a pretty significant shortfall on accommodation for all things IT. They had contractors and consultants, but they really had a pretty naïve view of what was going to happen with IT. For example, they had put the Ethernet cable network into the building, but hadn’t thought about wireless, hadn’t thought about the end-user devices, including PCs, COWs, tablets, all those kinds of communication devices. They hadn’t planned for the actual network gear; they hadn’t planned the technology closets.
There were a bunch of shortfalls, to put it mildly. So I had to say, you’re missing all these things. And I spent a fair amount of time with my executive peers educating them not only on what it meant to be a state-of-the-art digital hospital, but even on how we could leverage technology to improve patient safety and care quality. That was quite an interesting educational experience. I was unabashedly taking advantage of the fact that I was still on my honeymoon as a CIO! In the end, they had to swallow about $4 million in additional costs, though that was out of a $180 million project.
HCI: What have been the biggest lessons learned in all this?
RP: Number one, don’t underestimate the complexity. And don’t be shortsighted — you want to be able to build an infrastructure that’s going to be able to accommodate unforeseen technological requirements. And since we opened The Critical Care Hospital, we’ve had a couple of changes we hadn’t envisioned, actually. For example, last year, our radiology department began testing several portable x-ray machines from Kodak that produce digital images and are able to wirelessly transmit those images back to our PACS system. And why is that important? In a critical-care hospital, sometimes a patient’s condition begins to deteriorate rapidly; and one of the things an intensivist will do is to call for a portable chest x-ray. In the old days, they’d roll up a portable x-ray machine, and they’d develop films, the physician would look at the images. Now, they roll these images up to the bedside, do the x-ray, and the image is made instantly available to the intensivist at the bedside, and it immediately transmits to the PACS, and is immediately available to the radiologist down in Imaging, and the two physicians can instantly consult about it. And of that all rides on the wireless infrastructure. Those are the kinds of things that need to be envisioned and planned for as hospital organizations move into the future.
