Rapid_City_POR.pdf

PROGRAM OF REQUIREMENTS

Amendment #1

INDIAN HEALTH SERVICE

Rapid City Health Center

Rapid City, South Dakota

June 2016

GREAT PLAINS AREA OFFICE

INDIAN HEALTH SERVICE

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Rapid City Health Center POR – Amendment 1 3

AMENDMENT #1

RAPID CITY HEALTH CENTER

RAPID CITY, SOUTH DAKOTA

TABLE OF CONTENTS

I. INTRODUCTION

II. PROJECT INFORMATION

III. DESIGN STAFFING & WORKLOAD SUMMARY

IV. SPACE SUMMARY

V. SUPPLEMENTAL CRITERIA and REQUIREMENTS

VI. SPACE SCHEDULE

Additional Services

Clerical Support Community Health Representative Alcohol/Substance Abuse Podiatry Native Women's Health Clinic Specialty Care Diabetes Program Area OEHE DFM Pharmacy Area Consultant

Administration

Administration Business Office Health Information Management Information Management Purchased & Referral Care

Ambulatory

Security Audiology Dental Care Eye Care Primary Care

Ancillary Services

Diagnostic Imaging Laboratory Pharmacy

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Rehabilitation Services

Behavioral Services

Behavioral Health

Facility Support

Clinical Engineering Facility Management

Preventive Care

Environmental Health Health Education Public Health Nursing Public Health Nutrition Wellness Center

Support Services

Education and Group Consultation Employee Facilities Housekeeping & Linen Medical Supply Services Property & Supply Public Facilities

LIST OF TABS

Tab A HSP Building Summary Report Tab B HSP Workload Summary Report Tab C RRMNA

Rapid City Health Center POR – Amendment 1 5

AMENDMENT #1

RAPID CITY, SOUTH DAKOTA

I. INTRODUCTION

ORIGINAL POR

The Program of Requirements (POR) Document for a proposed replacement health care facility at Rapid City, South Dakota was approved on September 16, 2008. The original POR outlined details of the proposed replacement facility. In the POR, current inpatient and emergency room services would be discontinued; however extended hours of operation will provide evening and weekend urgent care services. Authorized health care programs and services were ambulatory care (audiology, dental, eye care, primary care, podiatry, and specialty care), ancillary services (diagnostic imaging, laboratory, pharmacy, and physical therapy), behavioral health (mental health, social work, alcohol & substance abuse, and a psychiatric consultant), and preventive services (environmental health, health education, public health nursing, public health nutrition, and wellness center).

The design staffing level was 356 employees, consisting of 339 IHS employees identified by the RRM and 17 non-RRM tribal 638 contracted positions. The size of the proposed health care facility was to be 12 764 gross square meters (gsm). Subsequent to the original PJD, building 29 was evaluated and determined to be sufficient with modification/renovation to house the outdoor equipment storage. This space renovation will still be part of this project and cost is included in the construction section of the budget estimate. The total estimated project cost was

The original POR identified twenty (20) existing buildings (totaling 8 660 gsm) and 2 existing structures to be demolished. Nine (9) existing buildings and 1 structure would undergo renovation and/or mitigation per historic preservation requirements. The design of the new facility and renovation/mitigation of the remaining buildings will still be performed in a manner that ensures it blends with the aesthetic features of the Sioux San historic district and its existing buildings. The Historic Preservation Consultation Report can be found in the original POR under Tab D. Section V, part A, 34. Condition of Existing Buildings located in the original POR provides an in-depth analysis of each building and structure on the Sioux San campus.

POR AMENDMENT #1

For this amendment #1, HSP version 2014b was used to generate projected user population, workload, space and staff to a projected FY2025. The FY2025 user population is 20,668 for the same service unit communities specified in the original planning documents. This amendment revises the original POR to reflect the revisions and updates made and approved in amendment #1 to the Project Justification Document (PJD).

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The updated design staffing level is 573 employees, consisting of 522 IHS employees identified from the RRM and 51 non-RRM tribal 638 contracted positions and other positions. The size of the health care facility is 18 932 gsm. The project will still include modification/renovation of building 29 and the demolition/renovation/mitigation of the existing buildings and structures on the Sioux San campus as identified in the original PJD and POR.

This amendment #1 to the POR provides the updated design notes, concepts of operation, discipline space summaries, for all of the departments in the proposed facility, along with the related supplemental design criteria and performance requirements as well as disposition of existing buildings.

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TABLE 1: EXISTING AND NEW SERVICES

EXISTING SERVICES PROPOSED SERVICES

Primary Care Primary Care

Specialty Care Specialty Care

Eye Care Eye Care

Audiology

Dental Dental

Emergency

Native Women’s Health Clinic1 Native Women’s Health Clinic

Diabetes Program Diabetes Program

Tribal Heart Program

Health Education Health Education

Public Health Nursing Public Health Nursing

Environmental Health Environmental Health

Public Health Nutrition

Tribal CHR Tribal CHR

Inpatient Services

Diagnostic Imaging Diagnostic Imaging

Laboratory Laboratory

Pharmacy Pharmacy

Rehabilitation Services

Behavioral Health Behavioral Health

Alcohol/Substance Abuse Alcohol/Substance Abuse

Psychiatric Inpatient Services

Administration Administration

Information Management Information Management

Business Office Business Office

Health Information Management Health Information Management

Purchased & Referral Care

Education/Training Department Education/Training Department

Wellness Center Wellness Center

Security Security

Podiatry

Property & Supply Property & Supply

Dietary Services

Housekeeping Housekeeping

Facilities Management Facilities Management

Clinical Engineering Clinical Engineering

1 Program not currently housed on the Sioux San Campus

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II. PROJECT INFORMATION

A. Site: The selected site of the new facility is located in Rapid City, South Dakota, within the boundaries of the existing IHS hospital campus. The interior terrain of the acreage is relatively flat, but the overall campus is elevated on a hill overlooking the western portion of the city. The site is not in a flood plain and there are no other environmental concerns that would detract from using this site. The Indian Health Service owns the land on which the campus is located.

B. The campus consists of 29 buildings, of which 19 are categorized as historical; and 3 structures, of which 2 are categorized as historical. The building foot print of the new health center will not interfere with any of the existing buildings, however, new parking areas, sidewalks, and streets will be constructed in the same location as some existing buildings. The project shall include the demolition of 20 existing buildings (see outline below) and 2 structures. The existing sidewalks and streets will be demolished or modified to accommodate the new health center.

C. Project Schedule: The following project schedule for the proposed facility is based on the IHS Cost Estimating System.

D. Cost: The following cost estimate for the proposed facility is based on the above schedule and the IHS Cost Estimating System.

E. Evaluation of Existing Buildings: The Great Plains Area previously evaluated the existing buildings for potential use concluding that none of the existing buildings are suitable for use for the new health center and that the existing on-site water supply system, water storage system, and existing steam supply tunnels are not suitable for use for the new health center. A few buildings will remain for purposes specified in Section V of the original 2008 POR. These conclusions were based on detailed engineering discussions of each building, as well as on functionality, age, current building deficiencies, and replacement upgrade costs.

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III. DESIGN STAFFING & WORKLOAD SUMMARY

The staff requirements are based on an application of the Resource Requirement Methodology (RRM2007) and analysis of the results as they apply to the Rapid City IHS Health Center. Additionally, staff outside the scope of the RRM program that has been justified and approved is included. The approved design staffing level is 573 employees, consisting of 522 IHS employees and 51 non-RRM tribal 638 contracted employees and other positions. The staffing levels were approved by the IHS Office of Clinical and Preventative Services on February 23, 2016. The table below shows design staff level which is 100% of the RRM requirement; this is done to size the facility for future growth.

WORKLOAD SUMMARY

Workload

Approved PJD PJD Amendment No. 1

Actual Projected Actual Projected

FY2005 FY2015 FY2015 FY2025

User Pop 11,153 13,657 15,147 20,668

PCPV 43,368 52,195 67,814 92,556

OPV 76,829 104,233 135,425 184,834

Optometry Visits 3,497 4,825 6,892 9,408

Dental Service Minutes 312,036 1,297,415 ‐ ‐

Dental (RVU's)* ‐ ‐ 84,101 114,752

* Relative Value Units are now used to calculate Dental program space.

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SUMMARY OF AUTHORIZED STAFFING

Department Current 2006 Additional Total RRM

Authorized

PJD

PJD Amend #1

Requirement

HSP RRM Supported Staffing

Administration 9 11 0 20

After Hours 0 4 0 4

Alcohol & Substance Abuse 0 0 4 4

Ambulatory Nursing 23.5 8.5 24 56

Ambulatory Nutrition 0 0 10.5 10.5

Audiology 0 2 2 4

Behavioral Health ‐ Mental Health 5 3 3 11

Behavioral Health ‐ Social Services 0 5 5 10

Behavioral Health Supper 0 0 9 9

Business Office/PRC 3 25 40 68

Clerical Pool (Behavioral Health) 0 2 2 4

Clerical Pool (DI, Lab, Pharm) 0 2 1 3

Clerical Pool (Fac. Sup.) 0 2 1 3

Clerical Pool (Opt, Aud, PT) 0 2 1 3

Clinical Engineering 0 2 0 2

Dental 19 39 ‐1 57

Diagnostic Imaging 0 4 4 8

Driver 0 0 2 2

Eye Care 0 8 2 10

Facility Management w/MVO 9 8 ‐4 13

Food Service 5 ‐5 0 0

Health Education 1 2 2 5

Health Information Management 5.5 24.5 21 51

Healthy Lifestyle Program 0 4 ‐4 0

Housekeeping 6 8 2 16

Information Technology 1 3 9 13

Laboratory 4 3 5 12

OEHE 1 0 3 4

Pharmacy 4 11 13 28

Physical Therapy 0 2 9 11

Podiatry 0 7 ‐4.5 2.5

Primary Care 5 12 11 28

Property & Supply 1 3 2 6

Public Health Nursing 3 18 ‐4 17

Public Health Nutrition 0 4 ‐1 3

Security 0 5 5 10

Telemedicine 0 1 1 2

Wellness Center 0 0 12 12

SUBTOTAL 105 230 187 522

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Other Staffing for Space

Community Health Rep (Tribal) 12 0 0 12

Alcohol/Substance Abuse (Tribal) 5 0 4 9

Diabetes (Tribal) 5 0 ‐5 0

Diabetes program 0 0 21 21

Women's Health Clinic (Tribal) 2 0 1 3

Area OEHE DFM 0 0 5 5

Pharmacy Area Consultant 0 0 1 1

SUBTOTAL 24 0 27 51

TOTAL DESIGN STAFFING 129 230 214 573

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IV. SPACE SUMMARY

GENERAL SERVICE SPACE

ADDITIONAL SERVICES 629.00

ADMINISTRATION 2,277.00

AMBULATORY 4,515.00

ANCILLARY 2,136.00

BEHAVIORAL 925.00

FACILITY SUPPORT 228.00

PREVENTATIVE 1,056.00

SUPPORT SERVICES 1,757.00

DEPARTMENT GROSS SQUARE METERS 13,523.00

BUILDING CIRCULATION & ENVELOPE (25%) 3,381.00

FLOOR GROSS SQUARE METERS 16,904.00

MAJOR MECHANICAL SPACE (12%) 2,028.00

BUILDING GROSS SQUARE METERS 18,932.00

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V. SUPPLEMENTAL DESIGN CRITERIA & PERFORMANCE

REQUIREMENTS

A. DESIGN CRITERIA

The design criteria reflect the work of an advisory group established at a National level within the IHS Facilities Management program. Work group members reviewed previously written design criteria documents with the single purpose of developing and/or adopting existing health facility design criteria necessary to accommodate current health care procedures and to provide a desirable environment for patient care at a reasonable facility cost at all newly designed IHS health care facilities.

Further, the intent is to utilize the most up-to-date accepted codes and standards of the health care facilities industry. Design innovations are encouraged.

1. Code Standards and Guidelines. The project shall conform to the latest published editions of the codes standards and guidelines as listed in the latest edition of IHS Architect/Engineer Design Guide.

2. Primary Criteria. The current edition of the Facility Guidelines Institute (FGI) Guidelines for Design and Construction Hospitals and Outpatient Facilities is adopted as the primary standard for health care facility design criteria, further clarified within the IHS Architect/Engineer Design Guide and HSP criteria.

Standards adopted herein will supplement but not supplant criteria contained within this publication unless stated specifically.

3. Supplanting Criteria. Any Health Facilities Advisory Committee Decisions shall be used in lieu of those cited above.

4. Supplementing Criteria. The following standards or issuances will be used as guides in making decisions which deviate from or are not covered in the above referenced Primary Criteria.

OSHA (radiology) Health Facilities Advisory Committee Decisions NOAA Climatological Data GSA’s Metric Design Guide State and local codes and standards

5. Criteria Updating or Issuance of New Criteria. Current editions of basic criteria referenced above shall be used for design of new facilities. Criteria changes occurring during design of a project will be applied to the extent it is practical.

6. HIPAA Compliance. The health center shall be designed to provide all necessary physical security and patient privacy to comply with the Health Insurance Portability and Accountability Act.

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B. PERFORMANCE REQUIREMENTS

1. Health Departments Relationships Space relationships are either described in the HSP narrative or diagramed for each of the departments. The facility will have a comprehensive health care delivery program including primary care nursing and ambulatory services, as well as community health services. The narratives or attached functional diagrams are intended to describe functional activities only and, therefore, do not necessarily indicate individual spaces nor do they attempt to show accurate scale. They may include departments, services, or activities that are not included in this facility.

2. Safe Patient Handling The 2010 edition of the Facility Guidelines Institute Guidelines for Design and Construction of Health Care Facilities introduces a requirement for project planners to conduct a patient handling and movement assessment (PHARMA) as part of the sequence of predesigned functional space programming processes for new construction and renovation projects. The FGI also published the Patient Handling and Movement Assessments: A White Paper which provides a rationale and explanation of the PHAMA components. The objective of Safe Patient Handling is to eliminate manual patient lifting in Indian Health Service facilities and introduce patient lifting technologies which will support this aim.

3. Pharmacy System The Outpatient Pharmacy Unit will support all services in the facility. Drug dispensing will be provided on a pharmacy consultation basis with each patient meeting the pharmacist privately for instruction concerning the administration of medications.

The pharmacist will fill prescriptions from the patient's health record. Pre-packaged drug items for field health clinic operations will be prepared by the outpatient pharmacy. Orders from dental and pathology are small quantities which will not generate cart traffic. Bulk drugs will be delivered directly to the pharmacy. Robotic equipment will be utilized and the designer will plan accordingly in the layout and support utilities to enhance the efficiency of the pharmacy department.

4. Electronic Health Records The Indian Health Service is implementing an electronic health records system. The new facility shall be designed with Point of Care Entry/Computerized Physician Order Entry (POE/CPOE) equipment. This equipment shall be certified as UL2601/IEC60601 compliant and meet the electrical safety requirements for portable electric devices located within the patient care area and patient care vicinity in accordance with NPFA 99.

Coordinate with the Service Unit during the design phase to update medical records to include an E.H.R. system.

5. Patient Call System A patient call system shall be included for calling patients from waiting areas to treatment areas and services. The outpatient department exam rooms and nurses work station, pharmacy, laboratory, X-ray, and medical records need to call patients. This system can be part of the total facility paging

Rapid City Health Center POR – Amendment 1 15 system, but must be capable of operating separately. An emergency call system for the Dental Care exam rooms is required.

A nurse call system shall be provided as required by applicable codes and requirements in all patient and treatment areas and restrooms. The designer shall obtain staff input to determine the notification stations.

6. Equipment The designer shall provide a generic equipment list, including any special requirements, for all equipment to be incorporated into this new facility.

The designer will work together with the Area Clinical Engineering department to determine the "best" equipment to meet the needs and provide a list of recommended equipment items for approval. The "best" is defined as the most economical, that will provide the longest use at minimal maintenance, and is supportable by the Area Clinical Engineering staff. The designer is to provide detailed procurement specifications for approved equipment items, and a recommendation how the items are to be procured and installed, either (1) contractor furnished and installed, (2) Government furnished and contractor installed, or (3) Government furnished and installed.

All equipment will be incorporated into the IHS approved CMMS system for the new facility. CMMS shall be a web based application accessible from any computer that is connected to the internet. The designer shall consult with the Area IHS Facilities Engineering Program prior to provision of the CMMS system in order to ensure the CMMS system is tailored specifically to the needs of the area facilities program.

a. Elevator(s). If the site conditions cause a need for a multistory structure for the health care facility, a minimum of two elevators are to be provided. These elevators are to be sized and equipped to transport passengers, medical patients on gurneys, and cargo between the building levels.

b. Communication Equipment. Two-way radio communications will be installed at this facility in accordance with the current Federal Communications Commission (FCC) regulations.

c. Biomedical Equipment. All contractor installed medical equipment shall be provided with three copies of service, maintenance, parts, and operation manuals; plus installed ("as-built") drawings and schematics. In the layout design, adequate space shall be allowed for the installation of fixed equipment. The design shall include in the construction specifications a training schedule for biomedical personnel.

d. Maintenance Program. The construction contractor shall develop a training program for operation and preventive maintenance of building systems and equipment as part of the construction contract, provide training for maintenance personnel, and to furnish the Service Unit with guidance for a comprehensive preventive maintenance program in accordance with equipment manufacturer’s recommendations. The construction contract shall include the responsibility to prepare and furnish three hard copies and one electronic copy (PDF format) of a complete operating and maintenance manual for all mechanical and electrical equipment. The manuals shall contain a description of the systems and how they interact, general operating instructions, maintenance instructions followed by tabulated manufacturers descriptive literature, shop drawings, performance curves, rating data, spare

Rapid City Health Center POR – Amendment 1 16 parts list, and maintenance manuals. These items shall be delivered 60 days prior to substantial completion of construction.

All training shall be recorded and supplied to the facility for use in future training of staff. The designer will be required to provide guidelines for the construction contractor to perform start-up, testing and commissioning process of the facility to include startup and calibration of all building systems.

e. Building Maintenance Accessibility. The design of the health center is to consider the maintainability of the facility in the provision of accesses for the servicing and repair of the utility systems and built-in fixed equipment. (Such as providing roof top equipment with no service elevator or host near rooftop location.) No accesses are to be placed in the way of any operation or preclude the use of any room, space or corridor.

7. Systems Monitoring and Control A computerized system shall be used for equipment monitoring and control, lighting control, peak load shedding, fire alarm, fire suppression, security, exhaust systems, HVAC systems, emergency generation of power, air alarms, water softening, and autoclave monitoring. For the portable medical gases, independent alarms will be provided by the vendor in accordance with applicable regulations. In addition to ensuring continuation of utilities, energy conservation shall be considered and maximized during the setup of the building controls system. Metering criteria shall conform to IHS Technical Handbook Chapter 72-3 IHS Metering Plan.

8. Supply System Supplies will be delivered via carts from general supply to appropriate units/departments.

9. Linen Clean linen will be delivered via carts from Central Housekeeping Stores to the appropriate units/departments.

10. Sustainability Energy Efficiency, Water Conservation, and Commissioning fall under the general heading of sustainability. This project will be designed and constructed to comply with IHS Technical Handbook Chapter 21-17 Sustainability Guidelines.

a. Sustainability Certification This building shall be built to be certified by

U.S. Green Building Council

b. Environmentally Beneficial Landscaping The design is to incorporate the requirements contained in the April 26, 2003, Presidential Memorandum on Environmentally and Economically Beneficial Practices on Federal Landscaped Grounds. Where cost-effective and to the extent practicable, regionally native plants are to be used; the construction practices used are to minimize adverse effects on the natural habit; pollution from the use of fertilizer, pesticides and pest management techniques are to be prevented and or reduced to comply with the reduction goals established in Executive Order No. 12856 - "Federal Compliance with Right-To-Know Laws and Pollution Prevention Requirements;" and water-efficient practices and landscaping practices are to be followed to meet the requirements of Executive Order No. 12902 - "Energy Efficiency and Water Conservation at Federal Facilities."

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11. Solid Waste Disposal System Solid waste including Hazardous Medical and non-Medical Waste, Recycling, and Garbage will be collected in appropriately labeled and/or color coded bags, sealed and picked-up by housekeeping staff at regular intervals (usually daily) as specified in the Housekeeping Unit Concept of Operations, which contains the procedures for handling, collection and temporary storage of all solid waste, until it is disposed of in accordance with applicable Environmental Protection Agency (EPA), applicable state, and local regulations, by hauling away from the facility.

12. Water System The water supply for the new facility will be connected to the city water system with new water mains, hydrants, and water meters in accordance with applicable standards and codes. The water supply system will include new water mains, water service lines, hydrants, and other appurtenances to serve existing buildings as needed. A reverse osmosis unit for distilled water shall be provided within the new facility for the diabetes and pharmacy space.

13. Emergency Electrical System The need for alternate electrical power is to be evaluated by the designer in accordance with the IHS Technical Handbook for Health Facilities, Chapter 21-5, Section 21-5.2, Alternate Power for Health Care Facilities. The content of this guidance states that all applicable regulatory codes will be adhered to, and provides guidance for a risk calculation to evaluate the need for full standby power. The designer shall pay careful attention to NFPA 99 as it relates to Emergency Preparedness and its application to the proposed facility. If authorized by the Director of OEHE, standby power shall be provided for the new health center.

14. Security Depending on the personnel loading and area of the health care facility, appropriate security is to be provided in compliance with the most current edition of, President of the United States Memorandum for Executive Departments and Agencies, Subject: Upgrading Security at Federal Facilities.

Physical security control monitoring system is to be installed to monitor controlled areas and all entrances to the health care facility. System shall be in full compliance with HSPD-12 requirements. The designer shall incorporate the following items into the Health Center:

a. Entrances – shall be equipped with dome or wall mount security camera(s) with a view of persons entering the door, two or more may be required.

These entrances include:

1. The main entrance,

2. The employee entrance,

3. Entrance(s) to Pharmacy,

4. Emergency Department/Room Entrance.

b. Security – Security Office should be located with direct viewing access to the Emergency Department. If no Emergency Department the main entrance should be directly viewable.

c. Parking Area – patrons and employee parking area(s) will be lighted at sufficient levels to provide for safety and video monitoring.

d. Loading Dock – shall be equipped with dome or wall mount security camera(s) with a view that can see the entire space, two or more may be required.

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e. Waiting Rooms – shall be equipped with dome or wall mount security camera(s) with a view that can see the entire space, two or more may be required.

f. Reception Points – all reception points will be equipped with a “panic” switch to the master alarm

g. Security – camera systems will be monitored by a digital processor(s) capable of viewing all cameras simultaneously and/or separately, system will have “watch dog” capability, and digital storage device of no less than 3 days for all cameras, monitor will be a minimum of 24” and Energy Star rated.

h. Pharmacy Dispensing Area – shall be with dome or wall mount security camera(s) with a view that can see the entire space, two or more may be required.

i. Pharmacy Dispensing Area – shall have a monitored alarm system that utilizes contacts on doors AND motion detection within the space.

j. Pharmacy Dispensing Area – construction standards will include floor to deck wall construction and no windows within the drug dispensing or storage area, doors will be equipped with “peep” holes or similar.

k. Behavioral Health Counseling - all patient rooms will be equipped with a “panic” switch to the master alarm, a local alarm at the nurses or clinical station.

15. Fire Suppression System To conform to IHS Technical Handbook Chapter 24-

11 Installation of Fire Sprinkler Protection in Indian Health Service Owned Installations a fire suppression system shall be provided for the entire health care facility.

16. Utilities Distribution on Project Site On the project site, all utilities are to be distributed underground, at the proper depth for the regional weather conditions, in accordance with applicable codes and regulations. Utility lines are to be placed in the road right-of-ways where practical.

17. Information Technology The designer shall include in the specifications and drawings the requirement for the construction contractor to install conduit, cable trays, and IT cabling. The IT cable shall be Cat 7 or the category and quality of cable that is currently available at the time of design. The design installation shall also include fire cones for wall penetrations and cable hooks for suspending cable runs. Drops shall be installed liberally after obtaining input from IT staff with needed connections. The designer shall plan for server rooms and closets with air cooling as necessary to maximize the useful life of the equipment.

18. Emergency Preparedness The Indian Health Service has a plan for Continuity of Operations Plan in accordance with NFPA 99, Chapter 12. The Indian Health Service is also implementing a Hospital Emergency Incident Command System at every facility. This new facility shall be designed to be in compliance with these emergency preparedness programs.

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VI. Space Schedule

Clerical Support (X01)

Clerical Support to be located in the Laboratory and Pharmacy space, one office each. This was a program addition to the approved RRM.

Space Program…Clerical Support (X01)

Space Name RFN Qty Area Total Remarks

OFFICE, OPEN, CLERK OFOC1 2 6.00 12.00 Lab, Pharmacy

Discipline Net Square Meters 12.00

Community Health Representatives (X02)

MISSION

To provide in home and community support, education, and transportation for the health care requirements of the community. Education and support is provided with regards to the maternal child health, health education, elderly, diabetes, alcohol, and Red Shirt programs.

HOURS OF OPERATION

Monday – Friday 8 am – 5 pm

STAFFING

Position # @ Day Shift Total FTE

Supervisor 1 1

Community Health Representatives 10 10

Clerical 1 1

TOTAL 12 12

CONCEPT OF OPERATION

The service is administered at the Service Unit level but provided at the community level. Rapid City being a high population has specialization within its CHR staff, while smaller communities are represented by a single CHR staff. The productivity goal is approximately a 30 at risk patient load per CHR.

ADJACENCY PARAMETERS

Desirable: Wellness Center, public health nursing, health education, behavioral health programs

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ROOM/SUITE SPECIFIC ISSUES

The office suite needed to oversee the Service Unit program must allow easy access and parking for the CHR staff that spends a large percentage of their day traveling from home visit to home visit. Record keeping for the Rapid City patients is completed in the administrative suite, while CHRs for outlying communities will visit the department at least once weekly. Staff will be in the office at various times with peak times being first thing in the morning and/or late in the afternoon. The department will gather for weekly meetings. A work space must be provided to allow two to three staff to work together on certain issues. Very limited patient interface will happen at the department.

In the future this function will be transitioning to a Home Health Care organization.

Space Program…Community Health Representatives (X02)

Intake Counseling OFIN1 1 7.00 7.00

CHR OFOC1 8 6.00 48.00

CHR Supervisor OFSP1 1 11.00 11.00

Shared Work Area OFSW2 1 14.00 14.00

ALCOVE, COPYING ALCP1 1 4.00 4.00

STORAGE, SUPPLIES/FILES 1 STSF1 2 4.00 8.00

Discipline Net Square Meters 92.00 Net to Gross Conversion Factor 1.15 Discipline Gross Square Meters 106.00

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Alcohol/Substance Abuse (X03)

MISSION

The program mission is to reduce the incidence of alcohol and substance abuse and reduce mortality related to alcohol and substance abuse.

HOURS OF OPERATION

Monday – Friday, 8 am to 5 pm

STAFFING

Position # @ Day Shift Total FTE

A/SA Program Manager 1 1

A/SA Counselors 8 8

TOTAL 9 9

The Alcohol and Substance Abuse program will provide outpatient counseling for individuals and families affected by the misuse of alcohol and other substances. They will provide group counseling, therapy and organize special programs depending upon the group to be served. All programs will be designed to incorporate native spirituality and cultural relevance. The program will work closely with the other behavioral health departments (mental health and social services) in carrying out their mission.

ADJACENCY PARAMETERS

Required: Mental health and Social Services

Desirable: Health Education

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Space Program…Alcohol/Substance Abuse (X03)

CONFERENCE, FAMILY CFFM1 1 11.00 11.00 Family therapy

OFFICE, SHARED OFSH1 2 11.00 22.00

OFFICE, TYPICAL OFTY1 4 9.00 36.00 Counselors

OFFICE, SUPERVISOR OFSP1 1 11.00 11.00 A/SA Supervisor

Discipline Net Square Meters 80.00

Net to Gross Conversion Factor 1.40

Discipline Gross Square Meters 112.00

Podiatry (X06)

MISSION

Based on the anticipated workload, a podiatry department has been planned. Space to support one podiatrist has been added to HSP as an additional service. Podiatrist (1 FTE), podiatrist assistant (1 FTE), clerical (0.25 FTE), and receptionist (0.25 FTE) have been added to RRM as a deviation.

Space for podiatry includes 2 exam rooms, team room workstation, one office and storage for a gross department area 69.00 SM.

Space Program…Podiatry (X06)

WAITING WTGN1 2 1.60 3.20

EXAM ROOM, PODIATRY EXPD1 2 11.50 23.00

EQUIPMENT STORAGE,

PODIATRY

STEQ8 1 6.00 6.00

OFFICE, SUPERVISOR OFSP1 1 11.50 11.50 Lead Podiatrist

TEAM ROOM WORKSTATION OFOC2 1 4.00 4.00

Discipline Net Square Meters 47.70

Net to Gross Conversion Factor 1.45

Discipline Gross Square Meters 69.00

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Native Women's Health Clinic (X10)

MISSION

The Native Women’s Health Clinic provides Obstetric and Gynecology Services for the female population of the Rapid City Service Unit and surrounding area.

STAFFING

Position # @ Day Shift Total FTE

Supervisor 1 1

Administrative Assistant 1 1

Billing Clerk 1 1

TOTAL 3 3

The staffing and space is for administration of the Native Women’s Health Clinic is defined under this “Additional Service”. The direct care workload for the Native Women’s Health Clinic has been accounted for in the Primary Care workload for the new facility. The Native Women’s Health Clinic accounted for approximately 12% of the service unit PCPV workload during FY 2012-2014. The Native Women’s Health Clinic will operate within a portion of Primary Care or Specialty Care departments.

Space Program… Native Women's Health Clinic (X10)

Native Women's Health Director OFSP1 1 11.00 11.00

OFFICE, OPEN, CLERK OFOC1 2 6.00 12.00

Billing, admin assist

STORAGE, SUPPLIES/FILES 1 STSF1 1 4.00 4.00

Discipline Net Square Meters 27.00

Discipline Gross Square Meters 31.00

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Specialty Care (X11)

This department should be organized in accordance with the enclosed functional diagram. The functional diagram indicates relationships to the building circulation and exterior, control issues and room-by-room requirements.

HOURS OF OPERATION

Dependent on co-located/supporting service(s).

STAFFING

Staff will come with the Surgeon or Specialty Provider or temporarily from another service in the facility.

CONCEPT OF OPERATION

This department provides specialty care exam and diagnostic/treatment areas to accommodate specialized clinical practitioners. Patient waiting and reception/control areas should be provided through immediately adjacent, or co-located, services of compatible function.

Bed and Chair multi-specialty exam rooms are provided. These rooms will accommodate typical diagnostic functions requiring a chair exam, i.e. ENT, Pulmonary Function, etc. or a bed exam, i.e. ECG, EEG. The equipment purchased to support these rooms will be at the facilities discretion.

ADJACENCY PARAMETERS

Required: Primary Care

Desirable: Public Toilets

Space Program…Specialty Care (X11)

EXAM, SPECIALTY CARE EXGM1 2 10.00 20.00

TOILET, PATIENT TLPP1 1 5.00 5.00

WAITING WTGN1 1 8.00 8.00

STORAGE, EQUIPMENT, OP, GENERAL STEQ1 1 10.00 10.00

Discipline Net Square Meters 43.00

Discipline Gross Square Meters 62.00

Rapid City Health Center POR – Amendment 1 25

Diabetes Program (X15)

MISSION

This is an out-of-template department and will be sized to support its specific facility.

The DM adult program mission is to reduce the incidence of diabetes and its complications within the population at the Rapid Ci ty Service Unit.

The program mission is to improve the health of the community residents and increase the level of understanding regarding the importance of living a healthy life style and receiving routine health maintenance exams.

The architect should discuss early in the concept phase the operational integration of Diabetes Program Space with Primary Care and Wellness Center Space.

HOURS OF OPERATION

Routine Outpatient Schedule

STAFFING

Position Planned Daytime Health System Specialist 2.00 Health Technician 5.00 Medical Support Assistance 2.00 Clinical Nurse – Diabetes 2.00 Supervisor Health Technician 1.00 Health Aid 1.00 Registered Dietician/CDE 1.00 Health Educator/Case Manager 3.00 Data Collection Coordinator 2.00 Program Coordinator 1.00 Joslin Vision Network Technician 1.00

TOTAL 21.00

Rapid City Health Center POR – Amendment 1 26

The DM program uses two Hea l th Sys tem Spec ia l i s t s to provide oversight to a community based Diabetes Prevention Program, and a Clinical focused program The Health Technician focus on prevention and control of diabetes, cardiovascular diseases, and other health problems through exercise and physical fitness. As the patients present to the exercise area their vital signs and weight are monitored and a patient specific exercise regimen is developed, with instruction on exercise machines and techniques provided by the Health Technicians. Medical Support Assistants wil l schedule appointments for the diabetes program. Ensures Diabetes Standards of Care are met by performing chart reviews on patients with scheduled appointments daily. Clinical Nurses will provide nursing care to patients with diabetes by monitoring and coordinating patients’ health care needs according to the standards of care. Nurses will work with providers to deliver diabetes education. Supervisory Health Technician will oversee the Wellness Center staff and activities provided there. This position is certified in Fitness Training, to provide individualized fitness plans for patients with Pre-Diabetes and Diabetes. Health Aid will provide the clerical support needed at the Fitness Center. Registered Dietician/CDE will oversee provides guidance on diet, special nutritional needs for patients with diabetes, weight control and other dietary needs specific to the diabetes and cardiac patients, and other patients at risk of developing serious medical conditions. Health Educator/Case Managers would help manage the diabetic population in the clinic setting with the teams of providers assisting with coordination of care. Data Collection Coordinators will be responsible for collecting and added data for the diabetes and pre diabetes programs. Program Coordinator will be responsible for the collected data and necessary patient documentation in the Special Diabetes Program for Indians (SDPI) database and Electronic Health Record (EHR) along with maintenance of the diabetes management system (diabetes registry). Joslin Vision Network (JVN) Technician to perform DM screening Eye exams using the JVN technology.

The architect should discuss early in the concept phase the operational integration of Diabetes Program Space with Wellness Center and Primary Care Services.

ADJACENCY PARAMETERS

Required: Physical Therapy, Wellness Center

Desirable: CHR, Health Education, PH Nutrition, Education and Group Training space.

Handicapped accessibility throughout the department.

Rapid City Health Center POR – Amendment 1 27

Space Program…Diabetes Program (X15)

CONTROL, RECEPTION CNRC1 1 9.00 9.00

WAITING AREA WTGN1 1 8.00 8.00

EDUCTION CONFERENCE CFET2 1 22.00 22.00

STORAGE STEP1 1 10.00 10.00

STAFF NOURISHMNT ALCV ALNR1 1 4.00 4.00

OFFICE, SUPERVISOR OFSP1 2 11.00 22.00

OFFICE, SHARED OFSH1 2 9.00 18.00

OFFICE, TYPICAL OFTY1 7 9.00 63.00

TOILET PATIENT TLPP1 1 5.00 5.00

Discipline Net Square Meters 161.00

Discipline Gross Square Meters 185.00

AREA OEHE DFM (X04)

STAFFING

Position # @ Day Shift Total FTE

Area Facility Engineer 4 4

Area Safety Officer 1 1

TOTAL 5 5

Program to provide service to support the operation of healthcare facilities to accomplish its ultimate goal of delivery of health care to the Great Plains Area.

Space Program… AREA OEHE DFM (X04)

OFFICE, TYPICAL OFTY1 2 9.00 18.00

OFFICE, SHARED WORK OFSW1 3 6.00 18.00

STORAGE, FILES STFL1 1 9.00 9.00

Discipline Net Square Meters 45.00

Discipline Gross Square Meters 52.00

Rapid City Health Center POR – Amendment 1 28

Pharmacy Area Consultant (X05)

HOURS OF OPERATION

Monday – Friday, 8:00 AM – 5:00 PM

STAFFING

Office space assigned to Great Plains Area Pharmacy Consultant and locate within Pharmacy Department.

Space Program… Pharmacy Area Consultant (X05)

OFFICE, PHARMACY OFPH1 1 10.00 10.00

Discipline Net Square Meters 10.00

Discipline Gross Square Meters 12.00

Administration (AD)

This is an out-of-template department and will be sized to support its specific facility.

This department should be organized in accordance with the enclosed functional diagram. The functional diagram indicates relationships to the building circulation and exterior, control issues and room-by-room requirements.

HOURS OF OPERATION

Routine Outpatient Schedule w/possible after hour nursing staff access for extended hour facilities.

STAFFING

Position Planned Daytime Accountant 1.00 Administrative Assistant 1.00 Administrative Officer 4.00 Clerk, Quality Assurance 1.00 Clinical Director 1.00 Driver 2.00 Employee Health Clerk 1.00 Employee Health Supervisor 2.00 Filing Clerk 4.00 Executive Staff 6.00

TOTAL 23.00

Rapid City Health Center POR – Amendment 1 29

The Administration Unit personnel are responsible for managing the fiscal, human, and physical resources allocated to the proposed facility by the Indian Health Service. Functions include hospital and nursing administration, fiscal management, personnel, training, mail, quality assurance and safety.

ADJACENCY PARAMETERS

Desirable: Business Office, Information Management

Beneficial: Easy access from Main Entrance

ROOM/SUITE SPECIFIC ISSUES

The Administration Unit should be designed so that reception will be the first point of contact for all visitors.

Open office space throughout the facility shall be planned and equipped with systems furniture to efficiently utilize space and to provide privacy.

The mail room and the duplicating equipment and supply space may be designed together as one room.

Exterior windows will be provided to the majority of the enclosed offices.

A staff member should not have to enter the administrative suite to access the mail and/or the reproduction room.

At facilities authorized an Administrative Conference Room, its entrance should be designed to minimize interruption of the office suite.

Rapid City Health Center POR – Amendment 1 30

FUNCTION SKETCH

Rapid City Health Center POR – Amendment 1 31

Space Program…Administration (AD)

CONFERENCE ROOM CFEX1 1 28.00 28.00

MAILROOM MLRM1 1 10.00 10.00

OFFICE, OPEN OFOC1 1 6.00 6.00 Facility Safety Officer

WAITING AREA WTGN1 1 8.00 8.00

ALCOVE STAFF LOUNGE ALLG1 1 3.00 3.00

TOILET, STAFF TLPS1 1 5.00 5.00

ACCOUNTANT OFOC1 1 6.00 6.00

ADMINISTRATIVE ASSISTANT OFOC1 1 6.00 6.00

CLERK, QUALITY ASSURANCE OFOC1 1 6.00 6.00

CLINICAL DIRECTOR OFSP1 1 11.00 11.00

EMPLOYEE HEALTH CLERK OFOC1 1 6.00 6.00

EMPLOYEE HEALTH SUPERVISOR OFTY1 2 9.00 18.00

FILING CLERK OFOC1 4 6.00 24.00

OFFICE, SHARED OFSH1 2 11.00 22.00 Exec Staff

OFFICE, SHARED WORK OFSW1 5 6.00 30.00

OFFICE, SUPERVISOR OFSP1 1 11.00 11.00 Exec Staff

SERVICE UNIT DIRECTOR OFEX1 1 17.00 17.00

DUPLICATING EQUIPMENT &

SUPPLY

WRCP1 1 11.00 11.00

UNIT SUPPLY & FILING STSF1 5 4.00 20.00

Discipline Net Square Meters 248.00

Discipline Gross Square Meters 347.00

Rapid City Health Center POR – Amendment 1 32

Business Office (BO)

This is an out-of-template department and will be sized to support its specific facility.

This department should be organized in accordance with the enclosed functional diagram. The functional diagram indicates relationships to the building circulation and exterior, control issues and room-by-room requirements.

HOURS OF OPERATION

Routine outpatient schedule

STAFFING

Position Planned Daytime Business Office Manager 1.00 Health Benefits Coordinator 7.00 Patient Accounts Technician 18.00 Patient Registration Technician 17.00 UFMS Clerk 1.00

TOTAL 44.00

The Business Office Unit is responsible for registering and admitting patients, for helping patients determine their eligibility for Medicare, Medicaid and private insurance benefits, and for processing claims (billing and collection). Registration information is updated every time a patient presents for service. Business Office Unit personnel interview each patient arriving at the facility and, using computer terminals, update the patient registration data in the Resource Patient Management System (RPMS). In some situations, a representative of the patient may provide the updated information on behalf of the patient. The hours of operation for the Business Office Unit are the same as for patient care delivery at the facility (i.e., if a patients are provided care 24 hours a day, the Business Office Unit will be open 24 hours a day).

The Indian Health Service Business Office Unit uses a decentralized patient registration system in which patients who make appointments with a specific department or clinic, report directly to it when they arrive at the facility. Clinic staff or Business Office Unit personnel at this point of contact will update the patient medical record in the RPMS.

Patients who do not have a patient record on file are seen first at the Business Office, where Patient Registration Technicians obtain demographic and alternative resources information to update or initiate the registration by entering data directly into the RPMS. If patients have private insurance or are eligible for Medicare or Medicaid, they are referred, to the Health Benefits Coordinator, who obtains detailed information required to bill Medicare, Medicaid, and/or private insurance. The Health Benefits Coordinator helps

Rapid City Health Center POR – Amendment 1 33 patients determine the extent of their eligibility for Medicare, Medicaid, and other benefits.

After patients are seen in the Business Office Unit, they are directed to the appropriate clinic or health care provider. The Health Information Management Unit is asked, via computer message, to retrieve the patient chart and deliver it to the appropriate outpatient unit.

Patients who are scheduled to be admitted to the hospital are pre-registered. Upon arriving at the facility for admittance, all pre-registered patients are directed to the appropriate inpatient unit from the Admitting Section of the Business Office Unit.

Non-emergency patients, who require hospitalization and who have not been pre-registered, are registered at the Business Office Unit prior to admission. In some situations, registration information is obtained through interviews with family members. During the registration process, admitting personnel obtain information to update demographic and alternative resource information; determine the patient's eligibility for private insurance benefits and Medicare/Medicaid assistance; and, if appropriate, refer the patient to a Health Benefits Coordinator. The information obtained is entered by the Admitting Section into the RPMS. Notice of the patient's admission to the hospital is provided by the Business Office Unit staff to the private insurer and/or the agency that reviews Medicare and Medicaid eligibility. The Health Benefits Coordinator obtains information required to bill private insurance and/or Medicare and Medicaid.

Upon the patient's discharge from the outpatient or inpatient unit, information on services and medication provided during the visit is coded by the Health Information Management Unit on the Patient Care Component (PCC) form, which is sent to claims processing in Patient Accounts and Billing. This information is used to bill private insurers and/or Medicare/Medicaid for reimbursement. Records of reimbursement claims are maintained in the Claims Processing area.

ADJACENCY PARAMETERS

Required: Ambulatory Care Entrance

Desirable: Ambulatory Care, Pharmacy

Beneficial: Health Information Management, Administration

ROOM/SUITE SPECIFIC ISSUES

The Patient Registration and Admitting area should be accessible to patient waiting area(s).

The Patient Accounts and Billing area should be accessible for patients but need not have immediate access to waiting areas. The Patient Registration and Admitting and Patient Accounts and Billing areas will be designed to ensure confidentiality of the information being provided during interviews.

Rapid City Health Center POR – Amendment 1 34

The Unit Supply and Filing area should exclude patient, visitor, and other unauthorized access to records but should be easily accessible by the Patients Accounts and Billing and other Business Office Unit personnel.

Duplicating Equipment and Supply space should be accessible for all interviewing and processing areas.

FUNCTION SKETCH

Space Program…Business Office

(BO)

HEALTH BENEFITS COORDINATOR OFTY1 7 9.00 63.00

PATIENT REGISTRATION AND

INTERVIEW

OFIN1 17 7.00 119.00

WAITING WTGN1 1 8.00 8.00

ALCOVE, STAFF LOUNGE ALLG1 1 3.00 3.00

TOILET, STAFF TLPS1 2 5.00 10.00

BUSINESS MANAGER OFSP1 1 11.00 11.00

PATIENT ACCOUNTS AND BILLING OFOC1 18 6.00 108.00

UFMS Clerk OFOC1 1 6.00 6.00

DUPLICATING EQUIPMENT AND SUPPLY ALCP1 1 4.00 4.00

UNIT SUPPLY AND FILING STSF1 9 4.00 36.00

Discipline Net Square Meters 368.00

Discipline Gross Square Meters 515.00

Rapid City Health Center POR – Amendment 1 35

Health Information Management (HIM)

This is an out-of-template department and will be sized to support its specific facility.

T…