May 17, 2020

How to Utilize BIM to Advance Hospital Construction Project Schedules

hospital construction
Big Data
Hospital Operations
Big Data
Admin
7 min
If a hospital's BIM model is followed closely, off-site fabrication and construction of the project can be done on-time and under budget.
Do you think your architect and contractor could design and construct a 12-story, 280,000 square foot Ambulatory Surgery Center with 12 ORs in less than...

Do you think your architect and contractor could design and construct a 12-story, 280,000 square foot Ambulatory Surgery Center with 12 ORs in less than 18 months?

What if your site already had foundation and setback approvals in place for office/hotel use and any changes would require you to resubmit for planning approvals? What if it was located in a major metropolitan area? What if you had an estimated $12.6 million in tax incentives based on achieving substantial completion in 18 months?

Our team did. And here is how we did it.

Montefiore Medical Center is a premier academic health system and the University Hospital for Albert Einstein College of Medicine. Combining nationally-recognized clinical excellence with a population health perspective that focuses on the health needs of communities, Montefiore delivers coordinated, compassionate, science-driven care where, when and how patients need it most.

Montefiore’s regional delivery system consists of six hospitals and an extended care facility with a total of 2,059 beds, a School of Nursing, and state-of-the-art primary and specialty care provided through a network of more than 150 locations across, including the largest school health program in the nation and a home health program.

With the three-fold goal of improving the patient experience, meeting increased demand for outpatient ambulatory care services and improving efficiency, Montefiore recognized the need for a new state-of-the-art ambulatory care center, a hospital without beds.

In addition, Montefiore wanted to take advantage of the Industrial and Commercial Abatement Program, or ICAP, a program available through the NYC Department of Finance. Approximately $12.6 million in lease savings was available. The caveat: substantial completion of the building had to take place by December 2013. 

Looking for available parcels, they identified a property adjacent to an existing Montefiore facility that had already received zoning approvals – a plus regarding the schedule, as securing zoning approvals in NYC can often be a long and arduous process. However, the zoning approval had been for a hotel that featured significant setbacks and floor plate size restrictions. In order to proceed without obtaining a variance, which would result in significant cost and schedule impacts, the footprint and setbacks could not be altered. 

Montefiore selected Array Architects as planners, designers and to act as Montefiore’s liaison with Simone Development, the owner of the building. Since the core and shell was originally designed as a Class “A” office building with a hotel on the upper floors and had received approvals, any major changes to the foundation plan would jeopardize the December 2013 substantial completion date. 

After a thorough investigation to incorporate Article 28 requirements set by the New York State Department of Health, Array developed a floor plan around existing columns and core locations (set by piles) to meet the project schedule and budget targets. 

Taking BIM to the Next Level          

Specializing exclusively in health care design, Array was one of the first firms in New York City to adopt REVIT as a design platform and recognize the benefits of implementing Building Information Modeling (BIM) on projects. To meet the aggressive schedule, Array recognized that the entire design team: architect, MEP engineers, general contractor and trade contractors – needed to work from a single BIM model and collaborate extensively.  

Located in the Bronx, the project was a non-union job. While BIM has been used by design and engineering firms for approximately three years, construction firms and trade contractors have not embraced the technology as rapidly, especially non-union firms. Recognizing the need to bring the trade contractors up the BIM learning curve in order to meet the schedule, the General Contractor, MCG, hired Liberty Mechanical Contractors, LLC in a dual role as the plumbing trade contractor and as the project-wide BIM coordinator. 

Up until this project, Liberty had not worked exclusively with BIM, but recognized that this was an opportunity to learn the “ins and outs” from Array. Liberty dedicated a BIM manager exclusively to the Montefiore project. To educate all the subcontractors, Array and Liberty conducted weekly coordination meetings in a “War Room” located at Liberty’s offices. 

With the lead BIM coordinators from each trade present, Array and Liberty led discussions to develop a BIM Execution Plan that clearly identified specific milestones and each trade’s contribution to the design and construction of the project. This streamlined the process and contributed to significant time savings.  Utilizing a project website to facilitate communication, Array and Liberty made the BIM Model “live” and available to the entire team. This allowed revisions to be seen in real time significantly reducing change orders. Similarly, with their “marching orders,” each trade was able to contribute to the BIM Model in real time as well.

Making the BIM Model ‘Team Friendly’

Array had been working with the developer, Simone Development, and Montefiore for six months developing test fits for the building, taking into consideration the existing foundations and piles. As a result, there was a robust BIM model of the core and shell, MEP and structural infrastructure and foundations available which Array turned over to Liberty. Liberty took the MEP model, and through a program called Navisworks, began to translate the MEP drawings directly into fabrication lengths, again saving significant time and effort in engineering coordination.

With 12 state-of-the-art operating suites, this was a very complex building from an MEP perspective. Floor plate size limitations, due to pre-approved set back and height requirements, necessitated a very unusual stacking solution. ORs and support spaces had to be located on separate floors: ORs, patient prep and recovery on the 3rd and 4thfloors, staff lockers and support on the 4th floor and central sterile on the 5th floor all connected by dedicated elevators and stair.  

With fabrication of piping and ductwork being done offsite to expedite turn-around time, it was critical that the model and drawing show clash detection and clearances for all access panels accurately in these areas. There was no time to re-fabricate or have change orders in the field. 

Liberty developed a unique tool in the BIM model called an Access Circle that mapped Reach Distances – i.e. the area that could be easily reached by maintenance personnel through the access panel once the building was completed. Identifying Reach Distances was critical to the success of the stacked program. 

The Access Circle supported clash detection by ensuring that any object, MEP, structural, ceiling, etc. could not cross the Access Circle sphere. It allowed the design and construction team to visualize the Reach Distance from all access panels to shut off valves and gauges. In addition to facilitating the construction process, this model will be turned over to Montefiore’s facility management team and will be an invaluable resource for maintaining the building.

The Model that ‘Ruled the World’

With the model so integral to the design, off-site fabrication and construction of the project, it was imperative that the building reflect the BIM model exactly.  When changes were made in the field, the BIM model had to be updated as well. To give you an idea of the level of detail included in the BIM model, all copper piping one inch or larger was modeled, as were all medical gases, every valve and shut off switch.

This also expedited other field trades such as electrical subcontractors. Because the BIM model so accurately reflected the actual construction, snapshots of different columns could be extracted from the BIM model, measuring distances between all columns, allowing accurate offside fabrication. This reduced the need for field sketches of transitions and saved significant time. 

The BIM model was developed to support actual construction sequencing. For example, some floors had piping completed before ductwork, while other floors had ductwork completed first. All materials were color coded on the BIM model, and then delivered to the site with color coding to facilitate installation.

The BIM Model “ruled the world.” For example, if an issue arose with an item during construction, the BIM model was checked and it was quickly apparent that the item was not installed following the pre-determined location identified in the BIM model. The BIM model didn’t change, but rather the field location of the item was changed.

Collaboration Is Key

Collaboration among team members was critical to the success of this 280,000 SF “hospital without beds.” Team members met in the War Room on a weekly basis. Shop drawings were reviewed by the group on screen based on the BIM model allowing the coordination drawings to be approved in half the time of a conventional project. The result was a complex project designed and built with minimal field revisions utilizing BIM to meet an extremely aggressive schedule. 

Jason Lee, Senior Project Manager with Array Architects, can be reached at [email protected] or (212) 689-3110. For more information, visit www.array-architects.com.

 

 

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Jun 13, 2021

How healthcare can safeguard itself against cyberthreats

#Cybersecurity
#cyberattacks
#digitaltransformation
#covid19
Jonathan Miles
6 min
Jonathan Miles, Head of Strategic Intelligence and Security Research at Mimecast, tells us how the healthcare sector can protect itself from attacks

One of the most fundamental lessons from the COVID crisis is that health should always be a priority.  In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.

The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics. 

From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world. 

Going digital 

The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years. 

This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate. 

Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.

To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care. 

Strengthening defences

Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change. 

It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device. 

These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.

Despite this, there are fundamentals that any organisation should implement: 
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.

In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.

Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents. 

Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.

This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents. 
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.

Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.

As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.  

Fighting future threats

With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.

To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced. 

This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.

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