Healthcare Design - Past, Present and Future A reflection on ARTEKNA's 20 years of providing healthcare design solutions - and a forecast of what the future holds. In the words of Yogi Berra, "If you don't know where you are going, you'll end up somewhere else." 20 years ago, we decided on a clear path: to be a different type of healthcare design partner, to provide solutions that are based on innovation, dedication, and personal service. Our belief that the only way to truly provide the highest degree of service was, is, and will be to completely focus on healthcare design. This focus is the foundation for our future. Although it may be cliche, change has been a constant since ARTEKNA began. We look back upon 20 years with nostalgia and amusement at the technology available to us:  Projects were drawn with pen and ink on mylar at a drafting desk. Overlay drafting using a pinbar was state-of-the-art production at the time. CAD systems soon became the standard. The cost of each CAD station cost five figure sums. Our first CAD system came with the new 386 chip - our CAD technician did not think we would ever use that much power. Word processing was DOS based. Plotters were pen based and were equally expensive. Fax machines were new technology and also expensive. We shared one with the neighboring office suite. The office shared one cell phone that was the size of a tool box. Common use of email or the internet was non- existent. Our healthcare clients also have experienced change in the last 20 years: One of the most striking trends in healthcare over the last 20 years has been the development of ambulatory alternatives to care that previously would have only been offered in an inpatient setting. Healthcare is now focused on wellness and prevention. Many of the new patient rooms that were being built 20 years ago were still semi-private. Private rooms with plenty of space and amenities for the patient and family are now universal. The concepts of patient-focused care, consumer- driven healthcare, and evidence-based design were still in their infancy 20 years ago. Infection control and patient safety have now become priorities. Technology has improved exponentially. Not much was digital 20 years ago. Few hospitals outside of the larger cities had permanent MRIs or cath labs. Even fewer did open heart surgery. Now permanent MRIs are nearly standard and quality heart programs are being developed in county hospitals. HIPPA, PACS and ADA were unknown 20 years ago. The impact of these and other agencies, programs, and codes that we know by their acronyms has been tremendous. Clinical and operational efficiencies have been developed in response to do more with less. Efficiencies have become even more critical as reimbursements are reduced and competition increases. Some of the trends that are and will be impacting the future of healthcare: Aging Baby Boomers: It is estimated that by the year 2030, 20% of the U.S. population will be age 65 and older. In addition, we as a society are living longer. This results in increases in hospital usage to treat persons suffering from age and lifestyle-related diseases and conditions, such as Alzheimer's, obesity and diabetes. Obsolescence: Many medical facilities began as structures built to the way healthcare was delivered at that age. Although many have added to and renovated existing structures, clinical and operational efficiencies are compromised. New facilities must be planned with flexibility to adapt to changes in healthcare delivery and technology. Technology vs. the Human Touch: New generations of equipment create wonderful new opportunities for care, but they also create new demands on infrastructure, namely space and utilities. Current advances in communications, electronic medical records, telemedicine, nanotechnology, information technology, imaging, genomics and robotics will have profound impact on the delivery of healthcare. Nevertheless, reliance on technology needs to be tempered by healing, sustaining environments and empathetic caregivers. Security: The design of healthcare facilities will change to better control who and what is coming in and going out. Hospitals have historically been areas of refuge during catastrophic events, but planning for the unexpected in the future will include designs to address vulnerabilities as potential targets. Ambulatory Care: With new technology comes new medical knowledge and techniques of treating disease. Minimally-invasive surgery and other techniques have resulted in quicker recoveries, furthering the trend toward treatment on an outpatient basis. Disease Management: Strategic planning for medical facilities will allow for a paradigm shift from treatment of diseases to wellness and prevention, early diagnosis and treatment, and rehabilitation of illness. The focus on individual diseases will result in the development of more specialized facilities. Modern technology, supported by health education and information, will allow an individual's ability to test, diagnose, and monitor from home. Consumer Choice: Today's consumers are more engaged in making informed decisions and finding the best value in quality healthcare. Consumers are now able to compare performance and costs of healthcare providers online. As individual choices grow, significant\significant competition between healthcare providers will increase. Healthcare facilities of the 21st Century will address this trend with strategies such as built-in flexibility (universal patient and exam rooms, modular bay sizes, prototype designs); healing environments (natural light, healing gardens); delivery improvements (larger patient and operating rooms, decentralized nursing stations); and accessibility (visibility, ease of access, wayfinding). Evidence-Based Design: Design decisions are huge investments. Important decisions made on the basis of untested propositions and hunches are risky at best and are very expensive to correct. Employing evidence-based design principals into the design process will give healthcare providers the best available information to make wise use of limited healthcare resources. Sustainability: Healthcare facilities are by their very nature huge consumers of energy and products and generators of waste. The healthcare industry is increasingly recognizing the connection between its ecological footprint and its core values of creating a healing environment. Qualitative and quantitative health and operational benefits can be realized when sustainable strategies are implemented in the planning, design, and operation of healthcare facilities. In our next newsletter, we will present some of the new strategies that are transforming how healthcare architecture is planned, designed and built. Lean, LEED and BIM are several innovative programs and processes that can revolutionize the delivery of healthcare solutions. The healthcare architects of ARTEKNA would be pleased to have the opportunity of discussing the future of healthcare with you further.