Diagnosing the building

If anything has held up the convergence of these myriad electronic systems, it has been that medical-equipment and building-products industries have remained apprehensive about standardizing technology. Every nurse call system on the market uses proprietary technology. Building-management systems, which have become even more comprehensive in the past five years, also suffer this fate. What that means is that a health-care client must live with a specific system for years, if not decades, since changing would require a costly wholesale replacement.

A huge motivating factor for digital convergence is the developing standard 802.11-2007 of the Institute of Electrical and Electronic Engineers (IEEE). Without adding yet more acronyms to this article and further confusing the reader, this standard basically governs wireless networks in buildings, establishing protocols for bandwidth, capacity, and speed. As an example, EDI's Leger points to telemetry, which is a wireless system that allows hospitals to track a patient's vitals no matter where they are in the building. Currently, telemetry would be on its own network, but Leger says several manufacturers are working to operate systems over the 802.11 standard. As more types of technologies converge onto the 802.11 standard, fewer wires will be needed in cable trays. However, Leger is quick to admit wired networks won't go away, since they have unparalleled reliability.

Building-management systems, provided by industry giants like Honeywell, Johnson Controls, and Siemens, among others, offer much potential for streamlining hospital operations. Devices like RFID tags, thermostats, chiller alarms, and light sensors could all communicate across a single network, which would allow other devices to be added in the future to create a digital mesh across the facility. IEEE's standard 802.15, commonly referred to as "ZigBee," governs so-called mesh networks. ZigBee is a data protocol for a low-power, low-bandwidth network, and it is the standard the industry will eventually adopt. A mesh network, as opposed to a daisy-chain approach, eliminates widespread failure because devices are connected to each other in multiple ways. A thermostat would connect to thermostats in each adjoining room, or could potentially connect to something like a light fixture ballast. Each point along that mesh is just another IP address in the network. RTKL's Sanchez considers this integration, or what we could call a "smart building," like an insurance policy against the future. "We know there's going to be more technology coming down the line," he says. "The most consolidation you can do at the beginning, the better you'll be positioned when it arrives."

Cheap energy often prevents the implementation of such building-management systems. The Sextant Group's Valenti sees this firsthand, as he helped develop the Intelligent Buildings Roadmap for the Continental Automated Buildings Association. The Roadmap, finished in April 2007, is essentially a marketing push for the adoption of comprehensive systems in buildings to combine electrical, mechanical, security, communications, data, and just about anything else currently residing on a digital network. Valenti says there is little incentive for a facility manager to implement what could be a costly system, when energy rates remain historically low. "An intelligent building would have a piece of software programmed to automate all of this," he says. Valenti imagines that a client could tie room scheduling to the mechanical system, where a vacant conference room could shut its cooling off when not in use. That may sound like peanuts, but in a 500,000-square-foot hospital, the savings add up quickly.

That's the sort of thinking that motivates the design team on the Sidra project in Doha, which is being designed as a building information model (BIM) to achieve a seamless integration from the beginning. Travis Leissner, AIA, with Ellerbe's Minneapolis office, says visitors will get a taste of the digital convergence of the hospital's systems from the moment they walk in the door. Large, wall-size LCD screens in the atrium lobbies will direct patients to their appropriate hospital-adult, women's, or children's-based on the projection of related imagery. It's a bold, digital effort at wayfinding, often a sore spot with hospital patients. Summarizing the approach to the elegant campus, which begins construction this fall for a 2010 completion, Leissner says, "The concept for the hospital was to be both high-tech and high-touch, so patients have sophisticated technology in an inviting, healing environment." Once Sidra opens and the digital systems go online, patients may find they require more than just nursing care-perhaps also some bedside IT support to assist with e-mail.