Orlando Portale isn’t your average healthcare executive. The health system he works for, like all Pebble Partner Projects, isn’t aiming to be average either. As chief technology and innovation officer for Palomar Pomerado Health (PPH), Portale plays a role that is unique in healthcare. Historically, hospitals have tended to be on the conservative side when it comes to emerging technologies and social media outlets, and do not always avail emerging technological trends. Many healthcare executives may not even be aware of the online 3-D virtual world Second Life, for example, or the potential value it could bring to their projects. Portale, who spent 20 years at the forefront of the healthcare IT sector before joining Palomar Pomerado last May sees it as his role to encourage experimentation in leveraging such innovation, not only at the organizational level, but across the healthcare industry at large.

To that end, PPH and its technology partner Cisco Systems cut the ribbon on a computer-simulated Second Life version of the real-life Palomar West Medical Campus last February. The actual hospital is still under construction and isn’t slated to open for about two more years. In the interim, virtual visitors can tour the facility—the first complete project of its kind to be built in Second Life—via the Internet and see some of the amenities of the $811 million, real-life hospital. When completed, PPH will serve California’s largest public health district in San Diego and intends to positively transform the traditional healthcare experience that is normally associated with staying or working in a hospital.

Many hospital CEOs might question the expense of developing an online version of a hospital. It’s an additional cost to what is already an expensive building project. From a PR standpoint, there are certainly more cost-effective ways of attracting attention. PPH CEO Michael Covert, who has a reputation for exceptional leadership and more than 36 years of experience in healthcare administration, challenged Portale to think about using Second Life in new ways that went beyond getting external press coverage or other promotional possibilities. As a result, the project, which Portale produced with Michael Haymaker—responsible for the execution of Cisco’s healthcare solutions strategy and initiatives in the United States and Canada—has become an enabler to help visitors visualize the hospital experience that PPH is creating and discover how technology could be aligned in the environment with the patient experience.

Palomar West has been physically designed to provide a high-performance healing environment through a constant connection with nature. Outdoor features of the campus showcased in the Second Life simulation include garden spaces; areas for dining, meeting, or relaxing; a pedestrian path and garden connecting all buildings; a green roof bringing gardens up onto the building, with views from patient rooms; and garden terraces on the nursing floor.

The virtual facility also gives PPH the opportunity to educate visitors about the principles of evidence-based design (EBD) and demonstrate the various EBD features that are implemented into the real-life facility. A number of visitor videos have been incorporated into the facility to explain the thinking and research behind these ideas.

In the virtual facility, just as in the real-life facility, the patient rooms are all same-handed and variable acuity. PPH wants to decrease patient transfers as much as possible as the research shows that this contributes to the possibility of falls and medical errors. The room design can scale from a very intensive ICU-type environment down to a med-surg environment and further avoids moving patients by bringing technology and medical equipment to their bedside. Avatar patients can experience what it’s like to undergo a simple procedure in their rooms. The virtual facility also has distributed versus decentralized nursing stations. All patient rooms have two windows with workstations so nurses can be stationed right outside the rooms.

With Cisco, PPH is looking at implementing bleeding-edge technology devices in the patient rooms. Since most of this technology won’t be available until after the new hospital opens, the Second Life version allows them to experiment and to test people’s reaction to or acceptance of new devices such as the bedside terminal. Avatar patients have access to video conferencing technology in order to talk to their family, can browse the Web, receive nurse calls, order meals online, and order on-demand television all in one device. Light fixtures can also be adjusted according to the patient’s circadian rhythm.

Since the design of the physical hospital was already in the groundbreaking phase by the time the Second Life facility was undertaken, the team didn’t see the virtual facility as a tool to solicit feedback to make changes to the overall physical or architectural design. What it does do however, is convey concepts in a much more engaging way than traditional renderings. These shared virtual experiences leave the participant with a richer, more persistent memory of a sense of place and the information presented there. Consequently, visitor feedback to the digital signage within the online model has impacted how the design team thought about wayfinding in the physical model.

Second Life facilities that represent real-world facilities are good platforms for staff training or transitioning from one system to another where it may be impractical to use the actual facility, as is the case with the new hospital.

“Now we can collaborate with our staff to figure out where equipment will be placed—it’s a very rich environment to do simulation and modeling,” says Portale. Additionally, PPH plans to use Web 2.0 technology to reach out to nursing students, get them exposed to the new environment, and stage virtual recruiting.

The idea behind the virtual project lends itself to the Pebble Project by capturing what’s being done today, and measuring those results against the actual built environment. Beyond that, Portale expects that the project can help provide thought leadership for other Pebble Partners and lead the way in testing and showcasing new technologies for healthcare.

PPH is also utilizing these virtual tours to help with philanthropy and build support for the new building complex. Moving forward, Portale is actively engaging the healthcare industry through speaking engagements and conferences to tell people about where hospitals are going in the future, and showing what leaders such as PPH and Cisco are thinking about in terms of technology. “We want to give the industry a grasp of what our thinking looks like today in the virtual world, to enable Cisco to showcase what their ideas are, and to give the world at large a chance to experience our ideas,” says Portale.

Overall, the health system’s executive team and board were pleased with how the design was captured in the virtual world. A large part of this success was due to a close collaboration between developers and the project architects to ensure that the virtual world mirrored the physical environment as accurately as the technology would allow. In retrospect, he says that they would have provided more education up-front for visitors on how to move around in Second Life to account for the steep learning curve that is typically associated with the virtual environment.

Portale credits the leadership of PPH for being willing to experiment with new technology, take risks, and think innovatively. At the end of the day, PPH sees the ability to have their constituents—patients, caregivers, and staff—experience how technology can be an enabler in the healthcare environment, as the real value in creating a project of this nature. HD

Images Courtesy of Palomar Pomerado Health and Cisco Systems, Inc.


The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at mgoodman@healthdesign.org.


To learn more about the Palomar Pomerado Second Life Virtual Hospital, watch the YouTube video:


. To see the hospital in Second Life, visit

http://www.virtualpalomarwest.org. Healthcare Design 2009 February;9(2):20-24