Ask an expert: Hospitals, health care facilities: Automation and controls
Boothe has more than 24 years of experience in the health care industry. As Principal/Senior Electrical Engineer, he has led numerous projects, including new greenfield hospitals and additions and renovations to existing health care facilities.
In his role as Vice President and Health care Practice Director, Chrisman coordinates strategy for the company’s health care projects nationwide. His areas of technical expertise include fire protection and code consulting.
As Senior Electrical Engineer, Divine has spent 21 years in the consulting engineering field, with the past 17 years designing and engineering health care facilities. He is responsible for power, lighting and fire alarm design for hospital and health care projects.
As a founding Principal of Certus Consulting Engineers, Koppenheffer brings 24 years of experience in the MEP consulting engineering industry specializing in health care facilities. He has a range of expertise in mechanical and plumbing engineering.
As principal, Martin oversees multidiscipline engineering teams with a focus on national and international health care markets. He originally joined the firm as an electrical project engineer.
Phillips works with consulting engineers, customers and internal business development staff. He is responsible for educating them on the solutions offered through controls and building automation.
As Health care Team Leader in the company’s North Carolina Building Systems Division, Torres works with organizations such as Duke Health, UNC Hospitals and Rex Health care. He has been with RMF since January 2001.
As vice president and mechanical department head of Florida building systems for the company, Woods has played a key role in engineering mechanical solutions for major health care projects. She has facilitated sustainable design for several successful green building projects.
CSE: From your experience, what systems within hospitals, health care facilities and medical campus projects are benefiting from automation that previously might not have been?
Phillips: The first is operations, benefiting from the collection of data available from modern systems with standard protocols over flat internet protocolnetworks. The data are used for analytics that can help the facility operators bring their energy costs under control and allocate their limited maintenance resources better. The second is HVAC equipment. Energy saving sequences of operations can become more complicated than they use to be but can easily be performed by modern direct digital controlsystems. The third is lighting. As these facilities strive for a better patient experience, the ability to customize lighting according to the patient needs is beginning to get some attention.
Martin: Day-to-day operation of equipment, the ability to trend data and use such data for preventive maintenance through fault detection analysis has been a growing trend in the industry.
Woods: We’ve seen for years how sophisticated controls systems have helped to improve energy efficiencies in health care facilities, but we are in a whole new era where sophisticated automation will stretch beyond just infrastructure and into patient experience. This will allow more control by the end users, including the patients and staff. As our society continues to seek more technological advances, giving the key stakeholders more flexibility will be demanded.
Koppenheffer: Codes and standards require regular testing of several systems in a hospital and regulatory agencies such as The Joint Commissionrequire strict compliance reporting. Among these are the emergency power supply system, room pressurization and humidity range compliance. Performing these tests and their associated compliance documentation can be tedious and time-consuming and lend themselves to human error. Automation is a great way to mitigate the risks associated with errors and noncompliance and aid in reduced operation and maintenance costs by freeing up valuable man-hours and increasing the reporting accuracy.
CSE: What types of system integration and/or interoperability issues have you overcome for these projects and how did you do so?
Woods: Antiquated controls systems and integration into new systems continue to be a struggle. As singular platforms and nonproprietary systems continue to make their presences into the marketplace, more seamless systems will be able to be used to allow for better user interface and functionality.
Phillips: Integrating to HVAC equipment that is using packaged factory controls can be a challenge because the sequences often do not perform exactly as expected. One way to overcome this is careful preplanning with the engineer of record and the equipment supplier on how best to achieve the required interoperability of that equipment into a larger temperature control scheme. Another issue to overcome might be the need to take different systems from different suppliers that are supplied by different contractual divisions and create that unified room control system. The first example that comes to mind is lighting. Modern lighting is now just another controlled device, but how well does it integrate with the main building automation system?
CSE: Is your team using building information modelingin conjunction with the architects, trades and owner to design a project? Describe an instance in which you’ve turned over the BIM to the facility maintenance team for long-term operations and maintenanceor measurement and verification.
Koppenheffer: Using a BIM model in a collaborative team approach to design and construct is becoming the norm. The key to success is a true partnership with an understanding of each team member’s best value to the process and establishing a trust amongst the team. The information in the model is still often different between designers and trade partners. Cloud-based models using platforms such asAutodesk BIM 360allow everyone to be working in the same model simultaneously. In this approach, constant communication becomes even more important, as the model can be changing in real time and different team members can start chasing each other in circles. The model can be an important tool for O&M. For this to be effective, the team, working with the owner, needs to understand agree on what information needs to be included in the model and who populates what information.
Woods: BIM has continued to help develop our designs into a more robust database of information that can be used beyond just a blueprint for construction. In conjunction with an energy model, these tools can allow facility maintenance teams the ability to provide high-quality long-term O&M of the systems, while also upholding the established benchmarked energy efficiency goals. At Dell Children’s Medical Center in Austin, Texas, the first LEED Platinum hospital in the world, we could see in real time how the energy model could be used as a baseline tool against the measurement devices installed. Continual fine-tuning of the systems has allowed the facility to continue to meet the energy goals established and pinpoint when anomalies in the system operations are occurring to allow for more instantaneous correction.
Boothe: Nearly all our projects are designed in BIM (typically Autodesk Revit). For many projects, our Revit models are now cloud-based so that updates happen in real time and we are always in sync with other consultants’ models. Also, on many projects, our Revit models are shared with the construction manager or general contractor so that they use this information for construction coordination. As of yet, we’ve not seen any of our end clients (hospital owners) use Revit for O&M manuals.
Phillips: BIM is handled by the mechanical design-build contractor. It is rare if not unheard of for a traditional building automation contractor to have the in-house resources to contribute directly to a model. We work closely with the mechanical design-build contractor to ensure that our components are represented in the model.
Martin: We regularly use BIM technology in conjunction with architects and trade partners throughout a project design. Recently we completed a series of new construction projects with a savvy owner who wanted to have a BIM facilities model returned to them for each project. More and more owners are realizing the benefits to having this type of information in their database for O&M through the life of a building.
CSE: Have you included virtual realityor augmented realityin the design of such a project? Describe the application of such tools.
Martin: We do use our VR capabilities for testing workflows and analyzing complex central utility facilities supporting hospitals and on occasion an intricate mechanical space within a building. Thus far, much of the VR experience for an owner is lead through either our architectural or construction partners and tend to more focused on spacing, equipment position and arrangements within critical care spaces.
CSE: In what way is the need for more smart technology and features in such buildings affecting your work on these projects?
Phillips: In some ways it may give us a slight competitive edge because our firm is first and foremost a technology company. As the subject matter experts in new building technologies, unified room controls and “internet of things” applications, this aligns well with our business model. As smart building become more mainstream, it generates interest from the traditional design consulting community and provides opportunity for us to educate that community about what is possible.
Martin: The use of smart technology in building operations has impacted our work in health care in the sense that health care information technologyhas grown to become such an important element in the overall design and planning process. Years ago, all you needed was an IT closet or two and you were set. Now, with the extent of digital requirements for buildings and the anticipation of what those needs will be in the future has brought planning and coordination of these systems to the forefront of the conceptual planning stages.
CSE: Has the “internet of things” come up in discussion or been implemented on such projects? How has this integration impacted the project?
Phillips: IoT is part of the general questions discussion on the convergence of technologies as a trend and the operational efficiency now available with big data and data analytics. IoT and flat IP networks make this possible or at the very least, easier than it was before, to implement on both large and small scales. The challenge is that not everyone and not all manufacturers and suppliers make products that are IoT ready. Unfortunately, in the recent past it is easier to give examples of where interoperability has not worked well because IoT was not a priority in the beginning than where it has worked. And that proves the point that using older technologies that have a negative impact because a particular vendor has not yet bought into the IoT movement.
CSE: Cybersecurity and vulnerability are increasing concerns. Are you encountering worry/resistance around wireless technology and IoT as the prevalence of such features increases? How are you responding to these concerns?
Martin: Preventing unwanted access to critical information through cyberattacks is an increasing concern for health care systems. Access through the building automation systemhas been getting more and more attention in recent years as well. Detailing system architecture and protocols for BAS with both the facilities group and the IT group is crucial to improving security against these threats.
Phillips: The cybersecurity threat landscape is real. We have been educating our clients for the past five years on how we all play a role in protecting our networks and data and the steps that we can take to achieve a more secure system. We also offer specific plans and requirements in the form of specifications and procedures within our design that help our clients gain confidence that the systems we provide are going to meet or exceed current cybersecurity standards. We have several end users that are very aware of and keep their systems secure. And there are others that do not understand the complexities of the new world that the IoT has created. This can create a barrier to the more forward-thinking projects.
CSE: How has your technology team worked with facility managers to implement security technology (biometrics, card-scan, etc.) in hospitals, health care facilities and medical campuses?
Martin: Security in health care is certainly not a “one size fits all” approach. Each organization has different requirements and goals for various buildings and departments and each requires a customized approach. To get it right, an immersive coordination effort needs to be accomplished not only among the security and technology teams, but also with door hardware, users, building automated controls and interior programming efforts. We’ve found that to be successful, consistent interaction during all phases of a project is required. With all the intricacies involved in security systems we’ve found a more pressing need for design team involvement during the construction and implementation phases of a security system installation.