The future of doctor’s offices is here now. New methods of patient care and treatment will be needed in the next decade. With the President Obama lead changes to the health care industry the need for additional care professionals will be paramount.
Doctors, hospitals and insurance companies will need to change how business is conducted. Fortunately there have been advances in technology that may assist in this process. These potentials may change the design of medical facilities.
Doctors will need to see more patients and will need to reduce fees. This is possible in changes to their methods of patient care. The new doctor’s facility will need to incorporate alternate forms of diagnostic analysis. GE Imagination refers to the “Digital Hospital”. They are proposing internet based medical records that are available to the patient “Online”. There are digital hand held devices that can scan a single drop of blood within 90 seconds and not require lab work to be performed. This work can be entered in the patient database immediately directly from the scan devices. Temperature and blood pressure can be entered immediately to the patient database. All physicians may access a patient’s database for coordination among professionals. Pharmacies can provide information and drug interaction results in the patient file.
Pre-visit or waiting room diagnostics can be made available through internet based systems. The patient can access a database analysis through the internet where a medical technician can either assist or the patient can enter information prior to seeing the physician. Waiting rooms can allow the patient to enter information at the doctor’s health internet café. Medical Health technicians can assist those who are not able to enter data themselves. Prior to the doctor seeing the patient all data and analysis are performed and suggested treatment analysis is shown to the health professional. In some cases nurses may perform minor patient care rather than the doctor needing to see the patient. The analysis may include suggested drugs for patient as well. The doctor can also see from the database other previous medical history. The computer can provide continual analysis of medical history and current conditions. Special scans and MRI work can be kept and reviewed by doctors on the database.
Hospitals are now providing in room patient computer charting and information, this can be interactive with the main patient database.
Specialized patient education can be made available through streaming video instructions that are specific to the patient’s condition.
As doctors face a declining billing rate they will need to re-invent their methods of patient care and the facilities they work in.
Gary Heathcote, AIA, NCARB
gary@heathcote.net
Wednesday, March 31, 2010
Monday, March 1, 2010
Selecting a location for a Medical Office Lease
Selecting a location for a Medical Office Lease
A quick summary of issues when contemplating a medical office lease
By Gary Heathcote, AIA, NCARB gary@heathcote.net http://www.heathcote.net/
Proximity to hospital
Typically it is appropriate to be within 3 miles of the hospital which the physician serves. This is not a hard rule but one that allows a quick access to the hospital.
Parking appropriate medical parking
Most cities require 1 parking space per 200 square feet of medical lease space. In addition, a visual inspection of ease of access and parking proximity is important. If the parking is far away or on an upper level that requires the patients to have problems getting to the office it should be avoided.
Safe access for patients
Parking and sidewalk access needs to create a safe environment for patients to arrive and depart. Well lit parking and path of travel to the front door is important. Look for potential difficult neighboring uses that can create problems. Check out the site in the evening for vagrants. Will the patients have safe access to the doctor’s office.
Handicapped Access
State and Federal building regulations require multiple accommodations for the disabled. Federal Statues are in the ADA standards (American Disabilites Act) and are known to design professionals. Each state generally has disablility standards. For instance, California has Title 24 Handicapped Standards that is now incorporated into the California Building Code.
The disability standards generally include: Access from the public way, disabled parking spaces, exterior ramps, easy access doors, stair designs, interior ramps, easy reach switches, easy reach casework, lever type door handles, disabled toilet room requirements, public counter designs and other items listed in the code. Your project architect should be able to guide you through the requirements. Please note that if a lease space is existing and does not meet the requirements you may be required to make changes to the building.
Covered Patient drop off area
In some areas and with certain providers you may need to have a covered patient drop off area in the parking lot. This is especially true for ambulance requirements. This covered area will need to be from the patient loading area to the patient entrance.
Size of Suite
Prior to deciding on a suite size and location is a good idea to have your Architect draw a preliminary floor plan layout. Not all spaces can accommodate your uses equally. It is often nice to have a secondary entrance/exit for the doctor and other personnel to enter and exit the suite without walking through the waiting room. If there are special rooms such as x-ray areas or special procedure rooms compare the size room needed with equipment layouts of rooms you have been acquainted with. Just stating that you want it “big” does not help as a description.
Design of Suite
The Architect should be able to provide a lot of knowledge in the design of your space. However, he is not your business partner. You must have knowledge of how your space should operate. If there is more than one physician he must know how many is expected. This will also help you determine how many exam rooms/ procedure rooms that will be needed. Know some of the sizes from other offices that work for you. Take a tape measure and measure and become familiar with sizes of rooms. Also, if equipment is in a room the room must accommodate the handicapped. A list of rooms and sizes is an important determination to assist the Architect.
Filing Systems
Filing systems that are concentrated on a raised floor may need special consideration. Compact filing systems for patient records can be too heavy for the designed floor load of the building. This can be a particular problem when located on the second floor or above. Also be careful about loads above a parking garage. Also, tall systems require anchorage for seismic standards (earthquakes) If you are installing a system and it requires an upgrade to the floor design, it can be problematic to get to the floor framing system below your suite.
Special Uses/equipment
Special equipment may require floor load considerations. If you have heavy equipment it may be best to be located on the first floor of the building. In some cases heavy shielding may be required. With CT/PET scanners even a regular slab on grade floor may need to be replaced with a stronger floor anchoring system. In addition to potential weight of the equipment some equipment requires special electrical needs. It would be important to make sure that large electrical loads can be easily accommodated. A new main service or new transformer can be costly. If bulk gases are needed such as oxygen for Hyperbaric wound treatment facilities oxygen tanks need to be typically 50’ from the building. Also surgical facilities where the patient is unconscious an electrical generator will be required for surgical centers. Other gases may need special consideration as well. Special permits for certain medical uses can be required.
Know the issues prior to completing the lease documents
It is recommended that you hire an Architect prior to completing your contract for leasing a space to help you with the issues and in some cases assisting in comparisons of spaces and the complexities of each space choice. In some cases the lease is contingent upon obtaining a permit to construct the space.
A quick summary of issues when contemplating a medical office lease
By Gary Heathcote, AIA, NCARB gary@heathcote.net http://www.heathcote.net/
Proximity to hospital
Typically it is appropriate to be within 3 miles of the hospital which the physician serves. This is not a hard rule but one that allows a quick access to the hospital.
Parking appropriate medical parking
Most cities require 1 parking space per 200 square feet of medical lease space. In addition, a visual inspection of ease of access and parking proximity is important. If the parking is far away or on an upper level that requires the patients to have problems getting to the office it should be avoided.
Safe access for patients
Parking and sidewalk access needs to create a safe environment for patients to arrive and depart. Well lit parking and path of travel to the front door is important. Look for potential difficult neighboring uses that can create problems. Check out the site in the evening for vagrants. Will the patients have safe access to the doctor’s office.
Handicapped Access
State and Federal building regulations require multiple accommodations for the disabled. Federal Statues are in the ADA standards (American Disabilites Act) and are known to design professionals. Each state generally has disablility standards. For instance, California has Title 24 Handicapped Standards that is now incorporated into the California Building Code.
The disability standards generally include: Access from the public way, disabled parking spaces, exterior ramps, easy access doors, stair designs, interior ramps, easy reach switches, easy reach casework, lever type door handles, disabled toilet room requirements, public counter designs and other items listed in the code. Your project architect should be able to guide you through the requirements. Please note that if a lease space is existing and does not meet the requirements you may be required to make changes to the building.
Covered Patient drop off area
In some areas and with certain providers you may need to have a covered patient drop off area in the parking lot. This is especially true for ambulance requirements. This covered area will need to be from the patient loading area to the patient entrance.
Size of Suite
Prior to deciding on a suite size and location is a good idea to have your Architect draw a preliminary floor plan layout. Not all spaces can accommodate your uses equally. It is often nice to have a secondary entrance/exit for the doctor and other personnel to enter and exit the suite without walking through the waiting room. If there are special rooms such as x-ray areas or special procedure rooms compare the size room needed with equipment layouts of rooms you have been acquainted with. Just stating that you want it “big” does not help as a description.
Design of Suite
The Architect should be able to provide a lot of knowledge in the design of your space. However, he is not your business partner. You must have knowledge of how your space should operate. If there is more than one physician he must know how many is expected. This will also help you determine how many exam rooms/ procedure rooms that will be needed. Know some of the sizes from other offices that work for you. Take a tape measure and measure and become familiar with sizes of rooms. Also, if equipment is in a room the room must accommodate the handicapped. A list of rooms and sizes is an important determination to assist the Architect.
Filing Systems
Filing systems that are concentrated on a raised floor may need special consideration. Compact filing systems for patient records can be too heavy for the designed floor load of the building. This can be a particular problem when located on the second floor or above. Also be careful about loads above a parking garage. Also, tall systems require anchorage for seismic standards (earthquakes) If you are installing a system and it requires an upgrade to the floor design, it can be problematic to get to the floor framing system below your suite.
Special Uses/equipment
Special equipment may require floor load considerations. If you have heavy equipment it may be best to be located on the first floor of the building. In some cases heavy shielding may be required. With CT/PET scanners even a regular slab on grade floor may need to be replaced with a stronger floor anchoring system. In addition to potential weight of the equipment some equipment requires special electrical needs. It would be important to make sure that large electrical loads can be easily accommodated. A new main service or new transformer can be costly. If bulk gases are needed such as oxygen for Hyperbaric wound treatment facilities oxygen tanks need to be typically 50’ from the building. Also surgical facilities where the patient is unconscious an electrical generator will be required for surgical centers. Other gases may need special consideration as well. Special permits for certain medical uses can be required.
Know the issues prior to completing the lease documents
It is recommended that you hire an Architect prior to completing your contract for leasing a space to help you with the issues and in some cases assisting in comparisons of spaces and the complexities of each space choice. In some cases the lease is contingent upon obtaining a permit to construct the space.
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