Increased use of telehealth impacts healthcare design

We speak to Joseph Doherty, a healthcare sector principal at architectural practice, FCA, to explore how the increasing use of telehealth will shape hospital design in the future

Uptake of telehealth services has increased during the Coronvirus pandemic

Q: What role has telehealth played during the Coronavirus pandemic?

A: For those health systems that were prepared with the equipment and infrastructure, the transition to telehealth was an easy one.

We have been hearing from our clients that welfare visits and follow-ups are easy to do via a telehealth visit. But there are some visits that are not as effective - particularly mental health visits.

The physical connection to a person in a one-on-one setting or in group sessions is so important.

And feedback from our behavioral health clients indicates the patients that were responding to therapy and were thriving in the pre-Covid world are not getting the same benefit from their telepsychiatry visits.

Healthcare providers and designers need to make sure that telehealth and telepsychiatry are not yet another barrier for those patients getting access to the care they need

However, when bringing a patient into a healthcare environment, it exposes them to other severe health risks, so telehealth is a good alternative.

We often think of how patients react to telehealth using our own circumstances as an example.

I have a computer with a camera and a smartphone, so I can connect with my doctor or psychiatrist remotely with ease.

We need to also consider those who do not have access to these tools, such as people experiencing homelessness and poverty.

We need to think of the privacy and connectivity issues of the caregivers, and also the need for a similar set-up on the patient side.

Are there kiosks near the entrances of hospitals and out in the community that can be accessed?

Poor and homeless people can be among the population with the most-serious mental health issues and healthcare providers and designers need to make sure that telehealth and telepsychiatry are not yet another barrier for those patients getting access to the care they need.

Q: Do you think it was already gaining traction prior to the outbreak?

A: I think that telehealth was gaining traction prior to the pandemic.

Joseph Doherty

If anything, the pandemic acted as a catalyst for moving healthcare providers toward telehealth more rapidly.

Many of our projects have made provisions for telemedicine stations or rooms for the providers to use, or for patients and providers to speak with a specialist that is remote.

There have been eICUs in place for over a decade where all of the ICU and CCU rooms are monitored by a second, or multiple, set of eyes watching physio monitors and CCTV from patient rooms in a remote location.

And I think of these arrangements as also being a form of telehealth.

Moving to electronic medical records (EMR) may have slowed the progression of telemedicine over the last decade, but was a necessary predecessor for its growth.

As health systems focused on transitioning to EMR and getting their teams up to speed with using the hardware and software there was less of a focus on the technologies for telemedicine.

Epic rollouts seemed to be a discussion on every project.

Q: How do you think it will continue to impact on services once we have got through this crisis? And what needs to be done to ensure it continues to gain traction?

A: I think that the popularity of telemedicine will continue to grow.

As younger caregivers move up through the ranks and the younger generation of patients become more-frequent users of healthcare services, they will demand that they have options.

The generation that grew up with computers and smartphones will find in-person appointments an outdated concept.

And, during the pandemic, the older generation of patients and caregivers, who may have been resistant to the new technology, saw that it was not as difficult as previously believed.

Post pandemic, patients and caregivers, with input from the insurance carriers, will decide which interaction can be virtual and which must be in-person.

We, as designers of healthcare spaces, need to continue the conversations regarding how the patients and caregivers in the next 5-15 years will communicate most effectively and design flexibility into each project to allow for change

We, as designers of healthcare spaces, need to continue the conversations regarding how the patients and caregivers in the next 5-15 years will communicate most effectively and design flexibility into each project to allow for change.

Q: What impact does the increased use of telehealth have on the built environment? i.e. what infrastructure is needed, and how can estates and facilities managers build this into existing buildings

A: We have seen some older hospitals make significant investments in their IT infrastructure to allow their hospitals to come into the 21st Century.

We are seeing that IT infrastructure has become as important to the hospital as electrical, HVAC, and medical gases.

Over the past decade, we have seen wireless connectivity added to many projects as a matter of convenience for the patients and in support of wireless technologies.

As IT becomes more critical to the delivery of care; we may see wireless technology be dedicated to convenience and portable devices and some of the more-essential technologies related to patient care move toward wired solutions.

We have seen the impact of increased IT infrastructure impact the size of IDF and MDF rooms.

And we are just beginning to see the impact of telemedicine to space needs.

Telemedicine and telepsychiatry spaces have largely been additive to programmes.

The provider-to-exam room ratio hasn’t changed drastically at this point, but we may see a post pandemic shift as more appointments shift to virtual and care providers start to understand what percentage of their day is spent physically with their patients in exam rooms or in talk rooms.

This will be an ever-changing dynamic as medical devices that allow monitoring and testing from the home become more prevalent and affordable.

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