The Leaflet Article
Telemedicine: Comparing Facility Design Models
Telemedicine as a mode of patient care delivery is here to stay. With the $1.5 trillion Consolidated Appropriations Act, 2022, coverage has been extended for telemedicine services, sending a message of support to ensure better healthcare access. Over 80% of surveyed physicians agree that patients have better access to care due to the availability of telemedicine (AMA 2021 Telehealth Survey Report).
Increasing professional satisfaction, telemedicine has allowed providers to find better work-life balance. According to a 2019 survey by American Well there is a correlation between physicians' interest in using telemedicine and physician burnout. Specialists are among the most burnt out and are also most willing to practice via telemedicine.
Patients like it, too. A Jones Lang LaSalle survey shows that seventy-six percent of all respondents who have had a telemedicine visit since July 1, 2021 would prefer to use this option in the future. For parents with multiple children, not having to find childcare or not having to take both healthy and sick children in for a clinic visit is a huge satisfier. The ability to do a virtual visit after hours and not have to take time off work for minor illnesses saves precious paid time off.
Architects are asked to help our clients figure out effective and affordable ways to implement this care model. What are best practices when designing telemedicine spaces? It depends on the situation.
Two Scenarios: Care Team Integration
To ensure the continued success of telemedicine, it needs to be integrated into the care team continuum. While technology allows us more mobility and flexibility, it needs to be deliberately planned, tested, and implemented.
Two scenarios need to be considered.
One telemedicine version is where a patient is in-person at a healthcare facility and interacts with care givers at a different location, either on or off site. This might be a visit with their provider and additional care team, such as social workers, pharmacists, psychologists, and other coordinated care. FGI 2018 Guidelines provides requirements for this scenario which include acoustics, lighting, finishes, patient orientation and equipment placement. These will be expanded in the upcoming FGI 2022 version.
The second telemedicine option is when a provider and/or staff interact with a patient and either the patient or both patient and caregiver are remote. According to the AMA 2021 Telehealth Survey Report, 80% of physicians are in a clinic during a virtual visit, while 64% are at home. 95% of patients typically connect from their home setting.
Three Models: The Comparison
There are three programmatic areas architects plan with clients to achieve this integration.
Model 1: Existing Exam Room
This option gives providers the ability to do both virtual and in-person clinical visits within the same work period without having to physically relocate. The same support staff is available to the provider during these visits and the same clinical supplies and tools are also available without duplication. This is a familiar and branded experience for the patient since the visual background they see is the same as during an in-person visit.
There are downsides to using an existing exam room. Renovations may be required to provide the right environment and infrastructure for connectivity. This might mean that additional equipment such as a microphone or camera would need to be added. Using an existing exam room also ties up space that could be used for in-person visits. And our clients are sharing that it can be challenging for providers to switch back and forth between a synchronous virtual visit to an in-person visit. The fact that you don’t need as much physical space for a telemedicine visit also makes this an inefficient option for a healthcare facility from a $/SF standpoint. Along with the size of the room, a virtual visit would not require the same medical equipment/amenities in the existing exam room for telemedicine.
Model 2: Dedicated Telemedicine Room
A dedicated room can be smaller and simpler, so organizations don’t overspend on equipment, millwork, and plumbing. Having these rooms also frees up traditional exam rooms so that more care can be provided at the same time. As with using an existing exam room, the same support staff and supplies are readily available.
What gets omitted from projects when clients can’t afford everything they want? Often, it’s staff support areas. We’ve been riding the prioritization wave of “patients’ needs first” for the past 15+ years in healthcare planning. There is now a shift to a more holistic systems approach, in which the entire life cycle of providing quality healthcare is considered and prioritized. When not in use as telemedicine space, these rooms can flex as multi-purpose use, small meeting, dictation, off-stage or staff respite space.
While simpler and less expensive, in an existing facility there is still the cost of space reallocation and renovation in creating dedicated telemedicine rooms. These rooms are ideally near the provider. In a new project, this can change the planning module of the department and add additional space to the overall footprint.
Model 3: Separated Space/Call Center
The final option we look at with our clients is a separate or off-site facility. This can range on a spectrum of one provider working out of their home to a large call center type of office space. The lower cost of construction and overhead for this space type makes it worth investigating and it (or the provider) can be located anywhere. This is a big advantage for facilities with a limited footprint, as they can prioritize available square feet for higher acuity care.
Another benefit to a physically separated space is that it can more easily adjust to varying volume demand. When rent is cheap and lease terms are short, it is not difficult to relocate. Because of this scalability, healthcare organizations can more easily increase quantities of providers and potentially reach new patients, even outside of a demographic area.
However, expanded access of virtual care to a wider population increases the responsibility of healthcare organizations to ensure their providers’ licenses and credentials are in good standing (“Managing provider licensure amid expanding Telehealth” April 2022). During the Public Health Emergency of COVID-19, all 50 states waived state licensure requirements. Now that most states have reinstated them, healthcare systems that want to use a large call center to reach patients in various states need to monitor that their physicians on staff are licensed in those locations.
The demands of technology on an organization can be a barrier to having off-site virtual visit locations. A healthcare system’s IT department may not be set up to manage the demands that arise, especially when it occurs in a provider’s residence.
Another drawback to a separated virtual visit model is that the support team and resources are not all in the same location. It may not be practical to use a synchronous care team approach (MA + Physician in one visit) from a staffing and scheduling standpoint. This could lead to additional work for staff. There is also the risk of less oversight and accountability.
And finally, patient experience might be diminished if there are too many steps or transitions in the virtual visit process or if it feels disconnected from the healthcare organization. Sure, it is convenient to be able to speak with a physician at 9:00 p.m. while they are in their living room. But doesn’t it feel just a little weird and unprofessional? For this reason, health systems need to work hard on the technology piece to make sure it feels familiar and consistent with the quality of care one would get during an in-person visit.
There is no one-size-fits-all solution for telemedicine. My recommendation is that as stewards of our clients’ buildings, we should “be flexible but stick to [our] principles” (Eleanor Roosevelt). Design spaces so they can adapt to new technologies and uses, but don’t overbuild. Work with your clients to help them figure out what will serve their needs best. If one thing has become clearer over the past couple of years, it’s that we are scrappy and resilient and need to do more with less. And we can!