BIM for Healthcare

While the emergence of building information modeling is no doubt providing huge advantages in cost and time savings on all types of projects, perhaps no other building type stands to benefit more from BIM than healthcare facilities, where cost and schedule are crucial and where quality control can literally be a matter of life and death.

“BIM is a perfect fit for healthcare because of the complex nature of these buildings, the repetitiveness of the activity within the building, and the need to really nail process,” says Dan Noble, FAIA, FACHA, principal and director of design with HKS, Dallas, which has used Autodesk's Revit BIM software on a number of healthcare projects, including the Capital Health System replacement hospital and medical office building in Hopewell, N.J., and the new Boca Raton (Fla.) Community Hospital. “Having a fully integrated BIM model allows us to simulate process and material distribution, patient and staff flow, and M/E/P activities—and how all that interrelates.”

By modeling healthcare projects, the early adopters of BIM are seeing reduced project costs, shortened schedules, and increased project quality. The biggest gains are the result of improved coordination of ultra-complex building systems and the ability for real-time visualization with Building Team members and clients, says Jens Mammen, principal and Health Studio leader in the Chicago office of SmithGroup.

“An office building may have four moving parts, whereas a hospital will have 50 or 100 moving parts,” says Mammen, who has worked on several BIM-designed hospitals, including the Comer Center for Children and Specialty Care at the University of Chicago Hospitals. There, the architectural team collaborated with the structural, mechanical, and electrical engineers to create an integrated BIM model to map out the complex building systems design.

The process not only shortened the design schedule, but also reduced interferences between M/E and structural systems, all but eliminating costly change orders and reducing the construction schedule. The design team had just six RFIs during bidding, compared to hundreds using traditional 2-D coordination, according to Mammen.

A similar approach is being employed by DPR Construction, Redwood City, Calif., for the 250,000-sf Camino Medical Group medical office building currently under construction in Mountain View, Calif. DPR is using JetStream from NavisWorks to integrate disparate 2-D and 3-D design models from the HVAC contractor, plumbing engineer, fire protection engineer, and electrical contractor.

“We've had zero requests for information and changes having to do with the M/E systems overhead, where normally on a project of this size we'd have hundreds of RFIs,” says Dean Reed, DPR's coordinator of lean/virtual building. The four major subs are co-located on the job site with the architect and DPR, where they can work through design and construction issues in real time using the integrated BIM model.

“We're getting all the problems resolved before the field crews go out there to do the work,” says Reed. The team is expecting a 20% reduction in M/E/P and fire-protection labor costs as a result of fewer incidents of interference and the ability to prefabricate many of the building systems.

Seattle-based NBBJ is so convinced of the benefits of this type of real-time BIM collaboration on the job site that it's starting to install large flat-screen monitors in construction site trailers so Building Teams can more easily collaborate on BIM models created in the TriForma Extension of MicroStation, from Bentley Systems. The firm is currently employing this “BIM war room” approach on a 251,000-sf inpatient expansion building at the Harborview Medical Center in Seattle.

“Rather than using 2-D drawings, we're coordinating construction and working on conflict management in real time on the site using the BIM model,” says Richard Dallam, partner-in-charge of NBBJ's healthcare practice. Even though some team members may be working in the field office while others are working on the phone or online, Dallam says “issues become apparent very quickly when everyone is working together in one integrated model.”

Creating a clear vision

Of course, the benefits of real-time 3-D coordination and visualization go well beyond working out design and construction issues within the Building Team.

Progressive teams are using the power of BIM to more effectively communicate a project's program requirements and design intent with hospital administrators and staff. BIM allows design teams to create interactive 3-D walkthroughs, virtual prototypes, spatial planning diagrams, and even play out multiple “what if” scenarios for clients.

“The biggest differentiator of BIM is the ability to manipulate a room in front of a user group,” says Mammen. “A nurse might ask, 'If we move the tower column over in this direction, can I still see the patient's head from the nursing unit?' If you've built the model right, with a couple of key strokes and manipulations, you can spin the model around to check for alignment.”

On the Comer Children's Hospital project, for instance, hospital staff members were presented with a BIM model walkthrough of the trauma rooms to test for clearances and mobility. “We were able to quickly tweak clearances of the equipment and the location of windows from a small control station in the trauma room right on the spot,” says Mammen. “It was very effective.”

For its 500,000-sf Providence Park Hospital project in Novi, Mich., NBBJ created 3-D prototypes of typical patient room design options to help work through issues related to placing the bathrooms inboard versus outboard. There were a host of competing concerns, says Dallam, including sightlines for the patient and nursing staff, the impact on natural light and space in the room for family, and potential impact on the exterior design. Multiple renderings were produced to demonstrate the spatial relationships of the different configurations, helping the client to understand the impact of their decisions on the room, corridor, and exterior.

To help clients appreciate the impact of design decisions related to major medical equipment, such as MRI machines, architects in the Minneapolis office of Omaha-based Leo A Daly are using Revit to create animated simulations of treatment rooms. The interactive 3-D prototypes simulate the complex machines down to the finest detail—even the movement of the MRI magnet—allowing users to visualize the impact of machine positioning on the overall design and functionality of the room.

“I would not start modeling every piece of equipment in detail,” says Elizabeth Niedzwiecki, VP and director of healthcare for Leo A Daly's Atlanta office. “But some of these expensive, intricate devices, like MRIs, are important to model because they are so crucial to healthcare operations.”

Dallam sees huge potential for BIM with regard to medical equipment planning.

“On a typical hospital project, we may go through two or three upgrade cycles on medical equipment between design and construction,” he says. As a result, design teams are constantly revising design drawings to accommodate the latest specification data on equipment. Upgrading equipment specs is “a big, frustrating issue in healthcare design,” says Dallam.

To address this issue, NBBJ is using BIM to set up a flexible infrastructure that allows the team to defer such decisions till the last possible moment, as opposed to re-specifying equipment multiple times. For example, at Seattle's Swedish Orthopedic Institute, the design team used BIM to model permanent structural framework for the attachment of overhead medical equipment in the ceiling space above each operating room. Rather than “tuning” this framework to a specific piece of equipment, it is modeled to anticipate a wide range of conditions; this makes it possible to defer decisions on equipment without having to alter the permanent structure by adding other structural elements.

“The electrical, mechanical, and data systems are sized to support a range of anticipated loads for the building, and the routing of these services is coordinated with the permanent, flexible structural equipment framework,” says Dallam. “It's much easier and cheaper to route these systems to the medical equipment than it is to modify the structure that supports the medical equipment.”

Entering the fourth dimension

Parametric modeling can also provide a clearer vision of construction phasing for both the Building Team and the client. This is especially crucial for healthcare projects that involve renovations and additions to existing facilities and campuses that must remain fully operational during construction.

By adding a fourth dimension—time—to the BIM model, teams can better plan for construction sequencing, materials and equipment staging, and temporary egress to the existing facilities.

“With parametric modeling, you call literally screenplay the entire construction project before you even dig a hole,” says Niedzwiecki. “Four-D modeling is not only about constructability in terms of making sure the contractor can phase things properly, it's also about conveying to the client that they'll stay operational through construction.”

By including hospital administrators and staff in the 4-D modeling process, conflicts between construction and operations can be easily pinpointed, says Jim Jacobi, PE, CIO and principal with Houston-based structural engineer Walter P Moore. He recalls how 4-D modeling paid off big on a hospital project for one of his colleagues.

“The design team was showing the hospital staff a sequencing model of the entire construction progress, from the floor plates going up, the steel being set, and the cranes moving around,” says Jacobi. “During one of the sequences, a staff member noticed that the boom of the crane would interfere with the flight path of the hospital's medical helicopter. Based on that feedback, the contractors shifted the process a bit and the problem was solved with no impact to the cost or schedule. Those types of tangible issues are hard to see with a pile of 2-D drawings.”

Looking ahead, some BIM experts envision its application in the facility management side of healthcare, helping hospital administrators with space management, planned equipment upgrades, future additions/renovations, and tracking building systems.

Dallam says the technology is available, but it would require a considerable investment in time and labor, and the demand just isn't there yet.

“The difference between the BIM model and the finished building is like the difference between traditional design drawings and as-builts,” says Dallam. “I don't know anyone who has gone back and attempted to revise their BIM model based on what was built. It would be a complicated, time-consuming task.”