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MCDM AG.COM | JA N UA RY/ F EBRUA RY 2018 | Medical Construction & Design 35 architects to serve this "in- between" population, providing a facility that feels more like a hotel than hospital, with cozier interior design. This includes private, suite-style rooms and specialized air and water fi ltration systems to protect immune-suppressed patients. Rather than an inpatient charge nurse, a uniquely skilled con- cierge service provides front- desk response for patients' daily needs. TREND #3 Move to malls As the delivery of healthcare continues to improve, an in- creasing number of same-day services and procedures may be performed outside hospitals, in community locations chosen for ease of access and im- proved customer convenience. Established retail locations are and will become even more at- tractive to developers of micro- hospitals, outpatient imaging, urgent care and ambulatory surgery centers and medical offi ce buildings. This approach serves not only convenience-minded pa- tients, but also providers inter- ested in growing market share. Factors that retailers such as Wal-Mart and Panera consider for their locations — demo- graphics, quality of highway or transit access and parking — also translate to healthcare. In Kingston, New York, Health Quest is transforming a former Macy's retail space into a new state-of-the-art outpatient medical services facility. It will enable consumers to access ur- gent care, ambulatory surgical care, primary care, diagnostic imaging and oncology services in an easy-to-reach location. TREND #4 Microhospitals According to U.S. News & World Report, microhospitals are operational in 19 states across the U.S., providing ser- vices similar to larger hospitals (ED, pharmacy, lab, radiology and surgery) in a smaller enve- lope. This model off ers greater accessibility and convenience for residents and is a cost-eff ec- tive market growth strategy for providers. These mini-hospitals are roughly 15,000-50,000 square feet, open 24/7 and maintain between fi ve and 15 inpatient beds for observation and short-stay use. Recent changes to Centers for Medicare and Medicaid Services policy regarding reimbursement schedules for satellite facilities — authorizing microhospitals with dedicated emergency departments as eligible for both 340B discounted drug pricing and the Outpatient Prospective Payment System — will make microhospitals an increasingly popular option. TREND #5 Making space for telehealth Both for patients at home and those in medical facilities, telehealth is an increasingly integral mode of healthcare delivery. Healthcare consult- ing fi rm Sg2 projects that in the next two years, the volume of virtual healthcare patients will rise 7 percent and in-home healthcare services will rise 13 percent. Installation of sophisticated patient monitors with robust communications platforms is enabling patients to consult seamlessly with physicians and care team professionals. Increasingly, telehealth is being utilized for specialty services like radiology, psychiatry and dermatology as a way to obtain a specialist's opinion with- out the inconvenience of an additional offi ce or hospital visit. Healthcare organizations should start thinking about how to best incorporate telehealth services into their master plan. Telehealth aff ects facility design in several ways, includ- ing how treatment rooms are confi gured to accommodate remote consultation and providing infrastructure for the technological equipment. Lighting, privacy and aesthetics of rooms used for confi dential telehealth consultations are all important concerns that need to be addressed. Telehealth technology is also transforming lobbies, common spaces and admissions areas. Increasingly these areas are being designed to include accessible areas for kiosks or tablets from which patients can register, view their records or videoconference with a provider. TREND #6 Growing acute care needs This year, healthcare services will continue to move from inpatient to outpatient facili- ties, but hospitals will also see growth in patient-day numbers. As Baby Boomers age, 10,000 Americans will turn 65 every day for the next 20 years, and the total demand for inpatient care will only grow. Additionally, as services are pushed to outpatient facili- ties, remaining inpatients will increasingly be the sickest and most acute, requiring longer stays. Maximizing the effi - ciency of space and movement of medical staff to serve this inpatient population, to include more private rooms and fewer shared rooms, is critical to healthcare facility design. TREND #7 Virtual reality becomes critical planning tool More healthcare clients will benefi t from virtual reality technology as they partner with architects to imagine and design complex spaces like op- erating rooms. VR technology is becoming smaller and more mobile, enabling architects to take VR equipment directly to end users in order to harvest their insight interactively and obtain immediate design feedback. The ability to use VR goggles and headsets to visualize space in 3-D and coordinate both the room design and placement of equipment is improving facility effi ciency and safety. VR head- set technology breaks through the traditional limitations of a screen to put people "in" the design to experience, evaluate and comment on everything from casework confi gurations to outlet quantities and furni- ture arrangements. This year will see continued changes in how healthcare pro- viders are designing and equip- ping their facilities to meet both patient and market needs. Add in the pressures of rapidly evolving regulations and pay- ment models, and healthcare design has never been more dynamic than it is now. Jason Carney, AIA, NCARB, is a part- ner at E4H Environments for Health Architecture. From left: More facilities are embracing designs that provide a hotel-like atmosphere. > A growing number of healthcare clients will benefi t from virtual reality technology as they partner with architects to imagine and design complex spaces.