The Role of Building Information Models in Efficient Delivery of

Sustainable Healthcare Buildings

Kristen Parrish Arizona State University, Kristen.Parrish@asu.edu
Abstract. Building information models (BIMs) have become increasingly common in the
construction industry, and have consequently begun to change workflows and project
delivery methods. The healthcare sector, in particular, has seen the impact of BIMs in the
design and construction process -- BIMs have helped to program space better, reduce
project delivery time, and improve energy performance in hospitals. BIMs have changed
the design process, allowing designers to better communicate with owners and builders
about space planning, design intent, construction sequencing, etc. Similarly, BIMs have
impacted the construction process, as a BIM can serve as a real-time record of installation,
an as-built, and a comprehensive set of construction documents. Beyond the project
delivery process, facility managers are beginning to use BIMs to aid in building operations.
BIMs can store information about maintenance requirements, predicted energy consumption,
and serve as more accurate representations of the as-built condition of the facility (so-called
as builts). Thus, they enable facility managers to better plan for maintenance activities and
assess building performance. In healthcare facilities, these capabilities may enable healthier,
more efficient spaces that are maintained and managed to promote health. For instance,
filter maintenance schedules can be included in the BIM and can interface with maintenance
software to alert the facility manager that specific filters need to be replaced, and the
locations of this work can be highlighted in the BIM. This not only helps to automate
maintenance planning, it reduces the risk of infection transfer, in turn promoting employee
and patient health in the facility. A group of healthcare providers in Phoenix, Arizona is
assessing how enhanced BIMs could impact future healthcare facility design and operations.
This paper describes motivations for this effort and potential outcomes of their work.
Introduction. Emerging BIM capabilities (e.g., more detailed system modeling, scheduling
capabilities, estimating capabilities, etc.) have provided value to healthcare designers,
builders, and owners. However, BIMs have not yet been connected to performance data in
a manner allows designers and builders to change the way they design and build
healthcare facilities. That is, data about healthcare operations has not yet been included in
BIMs to aid in making design decisions. For example, healthcare facilities may track air
quality, but this information has not yet been used to improve ventilation layout or
operations. This paper discusses data streams that have been identified as of interest to
healthcare facility owners to improve the healthcare facility design and delivery process.
Proceedings of the International Symposium on Sustainable Systems and Technologies (ISSN 2329-9169) is
published annually by the Sustainable Conoscente Network. Melissa Bilec and Jun-ki Choi, co-editors.
ISSSTNetwork@gmail.com.
Copyright 2013 by Kristen Parrish. Licensed under CC-BY 3.0.
Cite As:
The Role of Building Information Models in Efficient Delivery of Sustainable Healthcare Buildings. Proc. ISSST,
Kristen Parrish. http://dx.doi.org/10.6084/m9.figshare.815884. v1 (2013)
Copyright 2013 by Kristen Parrish
A task force of healthcare facility owners is being convened to discuss performance data
tracking and reporting, and this paper presents the findings of this task force to date.
Specifically, this paper presents data streams of interest, the owners of these data streams, and
the possible impacts of this data in facility design and delivery as well as the delivery of
healthcare services to the patient. Where data collection challenges exist, the author discusses
these as well. The author also explores how operational performance data contributes to
sustainability efforts, from an environmental and economic perspective. Finally, we discuss
the feasibility of forming a task force like this one for other building sectors.
Benefits of BIM. The architecture-engineering-construction (AEC) industry has implemented
some form of BIM for most of its existence. However, three-dimensional (3D) models have
only become commonplace in the past decade (Eastman et al. 2008). These 3D models have
enhanced design conversations, allowing building owners, designers, and constructors, to
develop shared understanding of projects and begin to collaborate in new ways (Ghosh et
al. 2012; Parrish et al. 2009). Moreover, BIMs can link to building performance simulations
(e.g., energy simulations) to provide more insight to how changes in a building design may
manifest changes in building performance (Bazjanac et al. 2011). BIMs also show promise
for allowing designers to rapidly explore sets of design options (e.g., (Gane et al. 2011).
Though this list of benefits is by no means exhaustive, it addresses many of the benefits
that seem of most interest to the healthcare community; in particular, the ability to use
simulation and performance data to influence design decisions.
Barriers to BIM Implementation. Despite the benefits of BIM, barriers exist to its
implementation. Over time, as designers and builders became more specialized, they also
became more fragmented, and in order to optimize internal processes, many developed
proprietary software programs to assist them in their tasks. Though each of these programs
served the needs of the developers or the intended user, very few are able to communicate
with other programs (Azhar et al. 2008; Howell and Batcheler 2005; Jung and Joo 2011).
Thus, for designers and builders to use BIM most effectively for the project, rather than for
their own operations, the BIM must be collaboratively developed, which often requires
learning a new software program (e.g., Revit) that may not include all of the capabilities
of the proprietary, discipline-specific software. Note that as BIM software evolves, many
programs are moving toward a more collaborative approach, allowing data to transfer
between programs. This transfer is not yet seamless, which presents another barrier to
implementation, but at present, these barriers seem outweighed by the benefits.
Changes in the Healthcare Design and Delivery Process. With the aging of the Baby
Boomer population in the United States, and with people living longer worldwide,
healthcare providers seek new means of healthcare delivery, ranging from virtual healthcare
to new facilities (Edwards 2012). Healthcare facilities are becoming more patient-centered
(e.g., (Bromley 2012), in part due to findings from evidence-based design (e.g., (Shepley et
al. 2012; Ulrich et al. 2010; Ulrich et al. 2008) that tout the increased patient throughput
based on natural views, and in part due to the changing modes of healthcare delivery.
Goals. The Task Force hopes to identify data streams that can be integrated into BIMs to
improve healthcare facility design and subsequently reduce operating costs at healthcare
facilities. Gary Aller, the Director of Arizona State Universitys Alliance for Construction
Excellence (ACE), was inspired by data-driven design in other sectors, e.g., retail, and
convened a Task Force to examine the feasibility of using BIM to facilitate data-driven design
for healthcare facilities. To do so, a multi-disciplinary Task Force was convened, consisting
of healthcare facility designers, material suppliers, builders, owners, providers, and
Copyright 2013 by Kristen Parrish
operators, as well as BIM software developers.

Investigative Method. Though this Task Force has clearly articulated goals, they are still in
their infancy (they have convened twice at the time of this writing). Thus, a discussion of
methods may be premature. However, preliminarily, the Task Force is leaning toward action
research and pilot cases where operational data from current healthcare facilities is
embedded into a BIM. That same BIM will be used for facilities operations and maintenance
at the pilot site. Finally, the pilot sites will use the enhanced BIM to inform design decisions
about future facilities.

Once the Task Force completes its feasibility assessment, the hope is that healthcare
facilities designers implement set-based design and rapid prototyping (e.g., (Parrish et al.
2008; Ward et al. 1995) during the earliest phases of design. The Task Force is particularly
interested in looking at better operating room designs, as these facilities are mission-critical
for most hospitals and represent large operational costs due to intensive ventilation and
cooling requirements.

Results. Though the Task Force has only met twice as of this publication, they have
already enumerated benefits of and barriers to data-driven design for healthcare facilities.
Table 1 lists the benefits of data-driven design and Table 2 lists barriers to it.

Table 1. Benefits of Data-Driven Healthcare Facility Design
Type Benefits


Economic
BIMs could support life cycle cost assessment
Lower construction insurance costs due to better construction planning
BIMs support modular construction and associated cost savings
BIM can support ROI calculations and influence decision-making
Environmental
Healthcare facilities interested in energy efficiency, energy performance modeling
supported by BIM

Social
Data collection is now required by healthcare regulations, so data is available for
BIMs
BIM can provide the facility a rich data set to use in operational decision-making

Table 2. Barriers to Data-Driven Healthcare Facility Design
Type Barriers

Economic
BIMs could support life cycle cost assessment
Lower construction insurance costs due to better construction planning
BIMs support modular construction and associated cost savings


Environmental
Infrastructure and equipment may need to be decoupled in the future, posing data
accounting issues for environmental certifications
Need BIMs to talk to other existing facilities management software (i.e., be
interoperable) and this is currently not the case


Social
Healthcare equipment highly regulated which hinders innovation
Difficult to allow surgeons to make changes to equipment/process given long lead
time for procuring design services and equipment
Difficult to include surgeons behavior in the BIM as its non-standard
Who will maintain the BIM post-design? Post-occupancy?

These benefits and barriers led to a proposed new design process. Figure 1 illustrates this
process. While it is shown as linear, this is a best-case scenario. That is, the mockup is a
Copyright 2013 by Kristen Parrish
perfect instantiation of the model, and the full build out is perfect replication of the mockup.
In reality, there is feedback at each of these steps to facilitate continuous improvement.


Figure 1: Proposed New Healthcare Facility Design and Construction
Process.

Conclusions. The Task Force on BIM in Healthcare Design and Delivery is in its infancy.
Nonetheless, they have already developed new ideas about the impact of new healthcare
delivery models on healthcare facility design. Though their scope is not yet clearly
articulated, this inter-disciplinary group will continue to meet until, at a minimum, a clear
research agenda is defined for how to embed performance data into BIMs in support of
data-driven healthcare facility design.

Acknowledgements. The author thanks Arizona State University and their Alliance for
Construction Excellence for providing funding for this research. She also gratefully
acknowledges the support of Gary Aller for convening the Task Force and allowing her a
seat at the table.

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