July Issue: Technology—Rx for Change

High-tech MOBs raise the bar for building systems.
Orange Regional Medical Center

Orange Regional Medical Center in Middletown, NY will provide high-tech outpatient services.

Medical office buildings are no longer merely conventional office properties fitted out with doctor’s office-size spaces. As an evolving healthcare system increasingly relies on outpatient facilities, the technology that informs the design of MOBs similarly demands fresh strategies.

“Technology is also a driver of the movement of medical services out of the hospital and into outpatient and retail settings as treatments and diagnostics such as digital imaging have become more mobile,” noted Colliers International in its 2015 Medical Office Outlook. These high-tech tools allow outpatient facilities to take over many treatment and exam functions that were once the bailiwick of hospitals, a trend that is also intended to help keep the lid on costs.

One-Stop Shops
Medical office buildings are growing in complexity, becoming in many ways hospitals without beds. A case in point is Orange Regional Medical Center’s $99 million expansion of its campus in Middletown, N.Y. When two new buildings open late next year, they will consolidate services from multiple locations to the hospital’s main campus.

The larger of the two facilities, a 153,000-square-foot medical office building, will feature a lineup of high-tech diagnostic tools, such as positron emission tomography, wide-bore magnetic resonance imaging and nuclear medicine. Among other resources, the medical office building will offer four outpatient operating rooms, five procedure rooms, cardiac rehabilitation facilities, a diabetes care center, laboratory services, a primary care office and classrooms. Also underway is a 26,000-square-foot, single-story facility dedicated to cancer treatment services.

More than 2,000 miles away in Sierra Vista, Ariz., serving as a one-stop shop is also the mission of Medical Office Building 2. Located on the campus of Canyon Vista Medical Center, the 55,000-square-foot facility offers advanced wound care with hyperbaric oxygen, adult and pediatric rehabilitation, and chemotherapeutic infusion.

“The consolidation of all of these services under one roof will drastically improve clinical integration and increase efficiency in care,” noted Dean French, CEO of Canyon Vista Regional Health Center.

Also shaping the new generation of medical office buildings is their linkage to hospitals. “Taking a more strategic approach to fully analyzing the viability and impact of existing outpatient facilities and medical office buildings has become critical to healthcare systems,” noted a recent JLL report on the medical office sector.

In Waltham, Mass., a western suburb of Boston, Massachusetts General Hospital intends to open a 21,300-square-foot Outpatient Oncology and Infusion Center. The facility will provide cancer patients with evaluation, planning, treatment and follow-up services after diagnosis. It’s intended to provide care without requiring travel to Mass General’s main campus in Boston.

High Standards
As MOBs adopt many traditional functions of hospitals, that presents new challenges for the facilities and the technology that serves them. Margulies Perruzzi Architects, based in Boston, recently renovated an 80,000-square-foot office building in Woburn, Mass., to accommodate doctors from Winchester Hospital’s outpatient departments and affiliated physician suites.

Highlights include new mechanical systems that meet standards of the American Society of Heating, Refrigeration and Air Conditioning Engineers. The building’s air handling equipment provides ventilation, filtration and exhaust to ensure a healthy environment for patients and staff.
Technology is also helping patients navigate the new generation of MOBs. About 70 miles north of Los Angeles, patients at Kaiser Permanente Antelope Valley Medical Offices wait in a first-floor outdoor courtyard. While waiting for a blood test, a prescription or any number of other functions, they keep an eye on a large, LED-illuminated message board. The sign displays ID numbers that tell visitors when it is their turn.

It’s a patient-friendly, 21st-century way to say, “Take a number.” And one that’s crucial for traffic control, as well. At 136,000 square feet, the building supports a wide variety of specialties by offering 94 exam rooms, plus a lab, a pharmacy, an infusion center, imaging, physical and occupational therapy space, and more.
Medical office properties pose special HVAC requirements because they must meet the needs of healthcare providers and their patients, explained John Sobieski, founder & CEO of J. F. Sobieski Inc., a diversified mechanical contracting firm headquartered in Wilmington, Del.
“For example, reception areas will need plenty of lighting and easily adjustable temperature controls,” he noted. Examination and treatment rooms need individually zoned temperature controls to ensure patient comfort. Also, rooms where specialized treatments occur—such as dialysis or chemotherapy—provide individualized control of heating and cooling to manage quick temperature changes.

At the Tallgrass Medical Group’s new building in Topeka, Kan., the HVAC systems include variable air volume, chilled water and indoor air-handling units serving fan-powered boxes with electric heat. An outdoor air-cooled chiller supplies chilled water to each air-handling unit. In addition, the mechanical contractor, McElroy’s Inc., installed and programmed a Solidyne automation system that controls the facility’s HVAC equipment and monitors tenant energy usage.
Energy usage is another consideration. Kent Hospital employs a variety of strategies at its 60,000-square-foot outpatient facility in Warwick, R.I. Its roof is painted white to reflect heat; interior and exterior lighting uses energy-saving components; and computerized controls run the building’s HVAC system. Efficient equipment and landscaping minimize water use.

Staying Flexible
One of the key considerations in designing a modern MOB lies beyond the technology that initially goes into the facility. To give a medical office building the longest possible service life, the development team must build in the capacity to handle repeated technological change.

Flexibility brings multiple advantages. Modular exam rooms can serve a succession of specialties over time without needing extensive makeovers. Doctors’ offices can occupy the same footprint as exam rooms, allowing them to be transformed into clinical space. In the future, those spaces could also be networked as locations for telemedicine—another up-and-coming trend in healthcare.

As Colliers International noted in its report: “Technology is enabling a more open, flexible and collaborative layout, similar to changes in utilization of traditional office space. Doctors and staff require an open design that enables them to move freely throughout the space and utilize multiple work stations rather than being anchored to a single location.”

And as the caregiving model shifts from the lone practioner to a team of providers, that flexibility is crucial.