Three 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 in-office 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 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