Healthcare Design - December 2018 - 34

The

Center

VIRTUAL REALITY

The rise in telemedicine services demands new
care spaces that ensure quality and accurate
diagnoses By Debra Levin

HREE TIMES a year, a small group of senior-level executives from some of the larger healthcare systems in the
U.S. get together as part of The Center for Health Design's
Built Environment Network (BEN). Together, they strategize with colleagues and share their experiences and expertise. At a recent meeting in St. Louis, the group spent a
good part of the two-day agenda exploring design considerations for telehealth/telemedicine.
The next decade will see a significant change in healthcare, as more care
will be delivered remotely using telehealth thanks to consumers becoming more comfortable with the model. It's happening already. For example,
a 2017 survey of U.S. consumers by American Well, a telehealth service provider, found that 74 percent of American consumers are interested in seeing
their primary care physicians through telehealth.
This trend has the potential to change healthcare delivery in three significant ways:
1. After-hours care. Telehealth visits are becoming a popular way to seek
care after clinics close; however, the ER remains patients' first choice. We
may see this shift in the next few years, though, especially for noncritical care
like high fevers.
2. Primary care. Nearly three-fourths of consumers participating in the
American Well survey said they would rather have an online visit than an inoffice visit for common things like prescription refills and managing chronic
conditions.
3. Choosing a doctor. Sixty-four percent of those surveyed said they'd be
willing to see a doctor via telehealth, and 7 percent said they would switch
primary care doctors to those offering telehealth options.
Telehealth not only creates a convenience for healthcare consumers in
how they might access services from home, but also assists healthcare systems in bringing specialty services to rural settings. For example, telehealth
might be used to support consultations with dieticians or dermatologists
during a primary care visit, better leveraging limited resources.
This entire evolution in care will impact the design of healthcare facilities.
Yet, even with the rising shift to telehealth, it was interesting to hear from
BEN members that many health systems aren't fully aware of the unique
design considerations that are vitally important for virtual care spaces to
ensure quality and accurate outcomes.
To help this, a new section of the Facility Guidelines Institute's (FGI)
Guidelines for Design and Construction addresses the design of telemedicine
spaces. As a member of the FGI Health Guidelines Revision Committee
(HGRC), Ellen Taylor, vice president for research at The Center, prepared a
matrix of common findings and themes from several sources of evidence and

DECEMBER 2018

HCDMAGAZINE.COM

created draft guidelines language for review
by an HGRC working group. She's identified a
variety of design considerations for diagnostic
telemedicine spaces where the patient is in the
healthcare setting and the doctor is located remotely. They include:
* Select a room that's large enough to accommodate the patient, family members, an on-site
healthcare professional, and the additional
equipment needed for telemedicine visits.
* Ensure the space meets healthcare standards
for safety, is well lit, and has comfortable seating and minimal external noise.
* Provide audio and visual privacy and allow
for observation of patients, whether they're
sitting or moving for diagnostic purposes, so
providers can observe potential issues.
* Choose rooms without windows to reduce
potential camera glare. Rooms with daylight
should be equipped with shades and blinds.
* Consider light levels and light colors, because
poor lighting can hinder diagnosis of certain
conditions or symptoms-for example, by affecting the appearance of skin color.
* Think about the number of outlets in the room
as well as placement to avoid creating tripping
hazards.
* Camera angle is vitally important for diagnostic reasons. For example, different angles
could potentially make the same person look
depressed, reserved, or sad versus happy,
engaged, and approachable. A 2007 research
study by Tony Tam and colleagues, published
in the article "Perception of Eye Contact in
Video Teleconsultation" in Journal of Telemedicine and Telecare, found that a camera
angle of 7 degrees yielded better results in
videoconferencing than a 15-degree angle.
These are just a few of the design elements that
need to be considered when embarking on a telemedicine space. In 2019, FGI will publish a paper
by Taylor as part of its "Beyond Fundamental"
series, which will expand on these ideas.
As we wrap up 2018, I want to wish all of you
a very happy holiday season and new year and
thank you for your continued support of The
Center and our work. 
Debra Levin is president and CEO of The Center for
Health Design. She can be reached at D L E V I N @
H E A LT H D E S I G N . O R G .

http://www.HCDMAGAZINE.COM

Healthcare Design - December 2018

Table of Contents for the Digital Edition of Healthcare Design - December 2018