The Affordable Care Act (ACA) was signed into law in March 2010, with its major provisions starting implementation in 2014. Created to give access to healthcare to those that desperately needed it, this law has drastically influenced the healthcare industry in more ways than one. One of the primary impacts of the ACA is improving the quality of health care through design by promoting safe and effective standards of care in hospitals and other healthcare facilities. For example, the law currently prohibits insurers from denying coverage to individuals if they have pre-existing conditions and states are mandated to make sure that children receive coverage who do not have access to it through their families. This is a positive initiative, but it has also increased the demand for available healthcare facilities immensely. Many moving factors go into the creation of facility renovations, and to meet these needs promptly requires collaboration from many different industries and the use of state-of-the-art technology. It is critical for architects to be engaged in process improvement at an early stage of design. This is where e-PlanREVIEW® comes into play.
e-PlanREVIEW® (EPR) is a plan review software that aids government, permitting agencies, and additional organizations in streamlining their review processes electronically. Accessible in the cloud, through Amazon Web Services, EPR consists of a collaborative platform that is used for team-based design review, permitting, inspection, and site assessment. Designed by industry experts in the AEC field, EPR also aids state, county, and municipal agencies in maintaining code compliance.
In relation to the healthcare industry, the Office of Statewide Health Planning and Development (OSHPD) currently uses EPR to interface with hospitals and healthcare facilities during their design, documentation and permitting submissions for construction projects. OSHPD is responsible for overseeing all aspects of the design and construction of general acute care hospitals, psychiatric hospitals, and skilled nursing home and intermediate care facility construction in California. Their responsibilities include establishing building standards that govern the construction of these types of facilities; reviewing the plans and specifications for new construction, alterations, renovations, or additions to health facilities; and observing construction in progress to ensure compliance with the approved plans and specifications. For this reason, only OSHPD can issue building permits and code compliance is key in relation to hospital planning because California has its own building codes for hospitals, which are also mandated by this organization.
Michael Chegini is pictured with the panelists of the 2019 CMAA Breakfast of Champions.
[Pictured from left to right: Michael Chegini, e-PlanSoft™ CEO; Diana Navarro, AIA Supervisor Health Facilities Review, North LA, OSHPD-Facilities Development Division; Eric Schilt, Vice President of Planning, Design and Construction at Loma Linda University Health; Chuck Coryell, Director of Planning, Design, and Construction, Children’s Hospital Los Angeles; Craig Beam, President of Petra ICS; Dianne Lee, Director at Kitchell, Board of Director for CMAA]
To discuss the importance of collaboration initiatives in the healthcare industry further, the Construction Management Association of America’s Southern California Chapter hosted a Breakfast of Champions on August 15, 2019. e-PlanSoft™ was a proud sponsor of this event since they work closely with OSHPD, who currently uses the e-PlanREVIEW® software.
“It was extremely rewarding to see the reaction and the recognition of that attendees expressed when our review software was presented as a solution by OSHPD’s Diana Navarro,” stated David Avila, National Sales Director for e-PlanSoft™. During the gathering, industry professionals reflected on the growth of Los Angeles, and the Inland Empire which would lead to increased needs for healthcare facilities overall.
[Pictured is Nicole Collier, e-PlanSoft™ Project Manager, who oversees the OSHPD partnership.]
One hospital represented at the breakfast was the Children’s Hospital Los Angeles (CHLA), which was founded in 1901, and is a worldwide leader in pediatric and adolescent health. CHLA has been associated with the University of Southern California Keck School of Medicine since 1932 and the Saban Research Institute of CHLA is one of the most productive research facilities in the United States.
Organizations such as CHLA are working quickly to meet the needs of their patients through the construction of new wings and research centers dedicated to the very best patient care. During the Breakfast of Champions event, CHLA took this opportunity to emphasize the necessity for cooperation between decision-makers and construction providers. There has been a definite need for increased utilization and workspace since the implementation of ACA. However, hospital construction is complicated, and compliance has to be thought out prior to presenting to authorities having jurisdiction.
For instance, there are three phases of the construction of hospitals in California currently. On average, a hospital construction project can last up to eight years. This is partly because “in California, no property is zoned for hospitals” and “all hospitals require discretionary approvals from municipalities or counties when they choose to build new buildings” or add to their existing buildings (Understanding the Hospital Planning, Design, and Construction Process, p.5). Phase 1 consists of creating a strategic plan that covers reasons for the improvement of facilities, consideration of department needs, and an overview of necessary compliance such as Senate Bill 1953 for seismic upgrades. A concept design is prepared that includes floor plans, elevations, building sections, diagrams, and site plans, in addition to a total project cost calculation.
Phase 2 is marked by the submittal of soil samples to the Bureau of Mines and Geology by OSHPD in order to determine the seismic zone that the building would be placed in. Once this process has been completed, the construction documents and building permit applications are submitted with specifications to OSHPD for approval. During this review phase, EPR helps OSHPD streamline the process by automatically grouping and managing reviewer comments and correction requirements. Comments are then easily communicated back to the applicant for correction. Once a corrected set of plans is approved by OSHPD, phase 3 begins. In phase 3, the actual construction of the healthcare facility will take place. Frequently, updates to staff, policy, or other “change orders” may arise during this time, requiring the construction plans to be modified, and resubmitted to OSHPD for review once again. This process has the potential to be very costly. EPR’s collaboration and organization technology helps keep the process efficient and streamlines communication.
In addition, seismic safety mandates are being reviewed closely across California due to recent earthquakes. This further emphasizes the importance of using electronic plan review software that allows for collaboration between the architects, engineers, and/or contractors working on a project alongside OSHPD. For example, on July 4th, 2019, Ridgecrest Regional Hospital was evacuated following a 6.4 magnitude earthquake in the area. While the building did not collapse, the hospital had previously spent $72 million to be seismic ready and the earthquake still caused water damage. This damage led to compromised operating rooms and elevator shafts resulting in immediate closure. This has led to a discussion across California about the seismic standards that should be implemented in 2030, which could result in the closure of some hospitals.
The estimated cost for the 2030 seismic standards will approximately total $143 billion for hospitals, but it has been demonstrated in the case of the Ridgecrest Regional Hospital, that it may be the price needed to pay for everyone’s overall safety. Therefore, natural disaster precaution is even more of a reason for state agencies to continue working with technologies such as EPR to keep projects moving and decrease the cost.
If you’d like to learn more about e-PlanREVIEW® and how it can aid the collaboration in your industry, schedule a demo with us today.
California’s Office of Statewide Health Planning and Development (OSHPD) is the leader in collecting data and disseminating information about California’s healthcare infrastructure. OSHPD promotes an equitably distributed healthcare workforce and publishes valuable information about healthcare outcomes. OSHPD also monitors the construction, renovation, and seismic safety of hospitals and skilled nursing facilities and provides loan insurance to assist the capital needs of California’s not-for-profit healthcare facilities.
About Children’s Hospital Los Angeles:
Founded in 1901, Children’s Hospital Los Angeles (CHLA) is a 501(c)(3) nonprofit institution that provides pediatric health care. CHLA is a provider of more than $316.2 million in community benefit annually to children and families. As the first pediatric hospital in Southern California, CHLA relies on the generosity of philanthropists in the community to support compassionate health care, leading-edge education of caregivers, and innovative research efforts that positively impact children around the world.
e-PlanSoft™ develops cloud-based electronic document review software that assists governmental agencies, construction and manufacturing industries, developers and owners for their plan review, design review, product review, construction and asset review management in real-time.
Beam, Adam. “California Hospitals Question 2030 Earthquake Standards After Powerful Ridgecrest Quakes.” AP NEWS, Associated Press, 4 Aug. 2019, www.apnews.com/ee92215e72c04b41947d2be418a5c944. Accessed 22 Aug. 2019.
KTLA 5. “California Hospitals Question 2030 Earthquake Standards after Powerful Ridgecrest Quakes.” KTLA.Com, Associated Press, 4 Aug. 2019, ktla.com/2019/08/04/california-hospitals-question-2030-earthquake-standards-after-powerful-ridgecrest-quakes/. Accessed 22 Aug. 2019.
Millsap, John. “Understanding the Hospital Planning, Design, and Construction Process.” California Healthcare Foundation, Feb. 2007.
Wikipedia Contributors. “Patient Protection and Affordable Care Act.” Wikipedia, Wikimedia Foundation, 25 Feb. 2019, en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act. Accessed 22 Aug. 2019.