As a hospital's IT needs grow, sometimes it makes more sense to move the data center off-site.
Sides says Cerner probably hosts about 60% of its clients' data centers—either at its Kansas City headquarters or at its facility in Lee's Summit, Mo.—but says many are reluctant to give them up because of the “enormous investment” they made in building a special facility with a water-proof ceiling, raised floors, and expensive heating, air conditioning and ventilation systems.
Faulkner notes that “there are others who grit their teeth when they hear ‘off-site.' Often, frankly, it depends on their age.”
R. Stephen Spinazzola, vice president of the Dallas-based architectural design and engineering firm RTKL Associates and head of its Mission Critical group, says a typical data center could include a 10- to 25-person staff and take up 15,000 to 50,000 square feet.
“With most hospitals being landlocked, as data centers grow, it just makes a lot of sense to put them off-site,” Spinazzola says, though he adds that his preferred model involves building a data center off-site and keeping the old one as a backup or disaster recovery unit.
Spinazzola says that most hospitals have evolved with separate IT systems on the department level instead of a unified team for the whole hospital. As the need for a central IT department emerges, he says what people want is a 24-hour help desk and a command center for monitoring traffic, and these functions don't require being under the hospital roof.
“There are still some institutions clinging to that business model, but I think it's going to fade away,” Spinazzola says of hospitals with fragmented IT departments. “Having an IT group in one spot is more important than having the IT split up and closer to the hospital.”
As hospitals transition to electronic health records, rooms that used to hold shelf after shelf of paper patient records are being converted to new uses.
Moore says the 600-square-foot file room at 555-bed St. John Medical Center in Tulsa, Okla., that Haskell worked on was transformed into a 12-cubicle office space. Lambert says that 279-bed Carle Foundation Hospital in Urbana, Ill., turned its “zero revenue” file room space into revenue-generating clinical offices.
As with data centers, however, the file rooms also were built with a huge investment. Floors needed reinforcement to hold the surprisingly heavy load of the paper files, and many rooms were equipped with expensive movable shelving units that Moore says many hospitals are hoping to find another use for before disposing of them.
For Kaiser Permanente, which earlier this year completed the full implementation of its KP HealthConnect EHR system, “all that goes away in an instant,” says John Kouletsis, Kaiser Permanente's national director of strategy, planning and design.
The EHR system was rolled out at Kaiser's 431 medical offices and more than two dozen hospitals. “That was the biggest undertaking in the history of our organization,” says George Peredy, physician leader for KP HealthConnect.
And Kouletsis predicts from this massive project, many small things will some day come. “We're starting to see some interesting trends,” he says. “In some outpatient clinics, actual face-to-face visits are dropping off.”
The EHR system is helping replace the traditional doctor's office visit with a virtual visit or e-consult, which Kouletsis says indicates that it could be time to scale back the infrastructure.
He says Kaiser has already built two “micro clinics” in Georgia strip malls that are staffed with a doctor and nurse practitioner, and consist of small exam rooms with no imaging or laboratory equipment.
“Would it be possible without electronic health records?” he asks. “Yes, but it would have been difficult without an EHR, and it would have been far less effective.”
More micro clinics are planned, and “If you have micro clinics, why not micro hospitals?” Kouletsis says, explaining that he envisions 30-bed facilities that would be located on the “suburban-rural fringe.”