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Telehealth is changing where care is delivered, but it is not making healthcare buildings obsolete. A 2018 report found that virtual visits, remote specialists, monitoring, kiosks and telehealth carts can extend a facility’s reach while increasing demands for privacy, connectivity, power, equipment storage and carefully designed workflows. The practical result is a hybrid estate: homes and community sites handle some encounters, while clinics, emergency departments and dedicated virtual-care hubs continue to provide care that technology cannot safely move elsewhere.
This article uses the reporting published November 30, 2018, in Building Design + Construction. Its project sizes, savings figures and references to 2018 guidance are historical examples, not current national benchmarks or a substitute for checking the rules that apply to a project today.
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What does telehealth change about healthcare space?
Telehealth moves part of the encounter away from the traditional consulting room. A patient may speak with a clinician from home, a rural site may connect to a remote specialist, or a school, pharmacy or grocery-store kiosk may provide a controlled point of access. A hospital can also place a telehealth cart in an existing room so a specialist can examine a patient without travelling to that site.
Those changes alter circulation, room use, technology support and staffing patterns. They do not establish that clinics or emergency departments can be removed. In the 2018 reporting, NewYork-Presbyterian viewed telehealth as improving emergency-department efficiency, but not yet reducing the department’s physical footprint. The design question is therefore not “How many rooms can be eliminated?” It is “Which clinical tasks can be delivered elsewhere, and what space and infrastructure are needed to make that safe?”
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Where can a telehealth encounter take place?
The care setting determines the building requirements. A home visit may need only a reliable connection and a suitable private area, while a remote examination requires calibrated devices, infection-control procedures and a trained person at the patient’s side.
| Delivery setting | Typical use | Facility implications |
|---|---|---|
| Patient home | Routine video consultation, follow-up or monitoring | Patient instructions, connectivity support and a way to escalate to in-person care |
| Existing clinic or emergency department | Remote specialist input, triage or examination supported by staff | Private room or bay, camera position, peripheral devices, infection-control workflow and clear sightlines |
| School, pharmacy or grocery-store kiosk | Community access for selected consultations or monitoring | Visual and acoustic privacy, accessibility, cleaning procedures, secure equipment and dependable network service |
| Dedicated virtual-care hub | Multiple remote services coordinated by clinicians and support staff | Workstations, monitoring, resilient power, technical support, acoustical control and space for future change |
These are complementary models rather than mutually exclusive choices. A health system may use home visits for low-complexity follow-up, a staffed clinic room for an ear examination, and a central hub for remote specialist coverage.
How should architects protect privacy and the patient experience?
Telehealth space should deliver the safety, privacy, quality and patient experience expected from an in-person conversation. That principle, attributed to Facilities Guidelines Institute research vice president Ellen Taylor in the 2018 article, means treating the camera and microphone as part of the clinical environment rather than as office accessories.
Visual privacy
Position the patient so people passing a doorway, corridor or kiosk cannot see the screen or the patient’s face and body unnecessarily. Movable privacy screens can make a multi-use room workable, but they need enough width, stability and cleanable surfaces to block the relevant sightlines. A screen that leaves the monitor visible from a corridor is not a privacy solution.
Acoustic privacy
Speech must not be intelligible outside the encounter area. Room location, door seals, partitions, sound-absorbing finishes and background-noise control all matter. In a shared clinic, schedule and circulation decisions can be as important as the wall assembly: a confidential consultation beside a waiting line creates avoidable risk even when the room is enclosed.
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Camera framing and eye contact
Mount the camera at a height and distance that produces a natural, face-to-face view. The patient and clinician should not appear to be looking down at a laptop on a low table, and the patient should not have to twist toward a monitor. A fixed mount can provide repeatability; an adjustable mount can support different room layouts. Either way, test the field of view against the actual chair, examination table and equipment positions during design coordination.
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Lighting
Use even, diffuse light on the patient’s face. Strong backlighting can turn a face into a silhouette, while overhead sources can cast shadows into the eyes and create glare on screens. Control daylight and reflective finishes, and coordinate luminaires with camera placement rather than adding a camera after the lighting plan is complete.
What technology and building infrastructure does a telehealth facility need?
Reliable connectivity is the baseline. Wi-Fi coverage must be designed for the rooms where care occurs, not assumed from coverage in adjacent offices. Network capacity, authentication, equipment segmentation and a support process for outages should be addressed with the clinical and information-technology teams.
Large or heavily used virtual-care facilities may also require more electrical capacity, redundant backup power and automatic transfer switching. The 2018 reporting presents these as design commentary, not as a universal specification. The appropriate capacity depends on the number of workstations, displays, cameras, carts, servers and other loads, as well as the consequences of an interruption. A remote monitoring operation has a different continuity requirement from a room used for occasional scheduled video visits.
Plan cable pathways, outlets and data points where equipment will actually be placed. A camera mounted across a room from the patient may require a different pathway from a cart that moves between bays. Provide charging and secure parking for mobile carts without blocking egress or housekeeping routes. If equipment is shared, designate a cleanable staging area and a process for battery checks, software updates and disinfection.
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How can telehealth equipment fit into ordinary clinical rooms?
Telehealth does not require every encounter to happen in a purpose-built suite. The article describes Avera placing cameras, controls and monitors early in clinic and emergency-department planning, then using carts fitted with equipment such as otoscopes and stethoscopes. That approach makes the technology part of the room’s workflow instead of a late add-on.
For a remote examination, a digital otoscope or other specialized peripheral can transmit information that a standard webcam cannot. Selection should be based on clinical compatibility, image quality, infection-control procedures, connection method, storage and the clinician’s workflow. The existence of a device category does not by itself establish that a particular model is suitable for every specialty or setting.
Map the encounter from arrival to discharge before choosing furniture. Decide who positions the camera, who connects a peripheral, where disposable covers and cleaning supplies are kept, how the clinician requests an in-person escalation, and how equipment is removed when the room returns to ordinary use. A cart that contains the right instruments but cannot turn beside an examination table will slow care rather than improve it.
Do dedicated virtual-care hubs need a different building strategy?
Yes. A hub concentrates people, technology and clinical responsibility, so it needs deliberate zoning and resilience rather than a simple collection of video booths. Separate quiet consultation or monitoring areas from noisy collaboration zones. Provide ergonomic workstations, acoustic separation, secure equipment storage, staff support space and a clear route for maintenance without crossing confidential areas.
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The 2018 article reported two examples. Mercy Virtual Care Center in St. Louis opened in October 2015 as a four-story, 125,000-square-foot facility. Avera eCARE’s Sioux Falls hub was reported at 34,000 square feet and supported services connected to 400 healthcare sites in 17 states. These figures show that hub scale can vary widely; they are project descriptions from that period, not a recommended size or a current industry average.
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A hub also needs a failure plan. Identify what happens when a network link, camera, power source or peripheral fails during an encounter. Redundant systems may be justified for services that operate continuously, but redundancy has a cost in capital, maintenance and space. The design team should match resilience to clinical consequence instead of applying the same solution to every room.
Can telehealth reduce travel and improve access without shrinking a hospital?
It can improve access while leaving the core facility in place. The 2018 report cited a University of California at Davis School of Medicine study of records from July 1996 through December 2013. For 19,426 patients, the reported analysis described nine years of travel time, five million miles and $3 million in cost savings. Those are historical results from the cited study population, not a forecast for every telehealth program.
Remote specialist coverage can also change how scarce clinical expertise is distributed. Gensler healthcare leader James Crispino told the publication that telemedicine was changing how services were accessed and providing access to more people. A facility may therefore serve a larger geography without adding a full specialist team at every site. That benefit does not remove the need for examination rooms, treatment areas, emergency capacity or staff who can handle cases that cannot be resolved virtually.
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Start with the clinical task, then select the setting. A routine conversation has different requirements from remote auscultation, otoscopy, glucose monitoring or emergency consultation.
- Define the encounter. List what the clinician must see, hear, measure or manipulate. Separate tasks that can be completed by video from those needing a trained assistant or physical examination.
- Assign the safest location. Consider the patient’s privacy, accessibility, digital literacy, travel burden and ability to obtain in-person escalation. A convenient kiosk is not appropriate if it cannot protect confidential speech.
- Specify the equipment. Identify cameras, displays, microphones, examination peripherals, carts, cleaning materials and storage. Confirm that each item works with the clinical platform and can be maintained.
- Design the room around the workflow. Set chair, table, camera, monitor, outlets and staff positions together. Check door swings, wheelchair turning space, clearances and visibility from public areas.
- Engineer continuity. Document network paths, electrical loads, backup power, automatic transfer requirements and manual fallback procedures. Decide which failures require an immediate transfer to in-person care.
- Validate operations before construction. Have clinicians, infection-prevention staff, facilities personnel, accessibility specialists and information technology review the plan. Confirm cleaning, scheduling, security, equipment transport and after-hours support.
What common design mistakes undermine telehealth?
- Adding technology after the room is finished. This often produces awkward camera angles, visible cables, inadequate outlets and furniture that blocks equipment.
- Treating privacy as a curtain alone. A curtain may not control sound, block a screen from a corridor or meet cleaning requirements.
- Ignoring glare and background light. A technically functioning camera can still deliver a poor clinical image if the patient is backlit or the monitor reflects a window.
- Underestimating storage. Carts, chargers, otoscopes, stethoscopes, covers and cleaning supplies need secure, accessible locations.
- Assuming virtual care equals spare rooms. Existing rooms may still be needed for physical examinations, emergencies, isolation, observation and patients who cannot use remote services.
- Planning for average conditions only. Network outages, power failures, software changes and equipment cleaning are routine operational realities, not edge cases.
- Using historical guidance as current code. The source discusses the Facilities Guidelines Institute’s 2018 Guidelines for Design and Construction, including space, privacy, acoustics, lighting, interior surfaces, identification and equipment storage. The applicable edition and local requirements must be confirmed for the project’s jurisdiction and date.
What should be on a telehealth construction checklist?
Before approving a design, document the following decisions:
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- Which encounters are virtual, hybrid or in-person, and what escalation path applies?
- Where can confidential conversations occur without visual or acoustic leakage?
- Does every care position have dependable network service and appropriately located power and data?
- Are camera height, field of view, eye contact, lighting and glare resolved for each patient position?
- Can carts and peripheral devices move through doors, turn beside the examination surface and be cleaned between patients?
- Where are equipment, batteries, disposable covers and cleaning supplies stored?
- What backup power, automatic transfer and manual fallback are required for the service?
- How will accessibility, wayfinding, infection prevention, cybersecurity and staff training be maintained after opening?
- Which current building, healthcare, privacy and telecommunications requirements govern the work?
The durable lesson from the 2018 reporting is that telehealth is a facilities strategy as much as a software strategy. It redistributes care across homes, community access points, existing clinical rooms and specialized hubs. Projects that plan the physical environment, workflow and resilience together can extend access without compromising the spaces needed for hands-on care.
Frequently Asked Questions
Can telehealth replace examination rooms entirely?
No. Virtual care can redirect selected consultations and bring remote expertise to a patient, but examinations, procedures, emergencies, observation, infection control and escalation still require physical clinical capacity. A sensible plan treats telehealth as one layer of a hybrid care network.
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Not necessarily. A hub can centralize staff, equipment and support, while existing rooms may be cheaper and closer to patients for occasional remote consultations. The right choice depends on encounter volume, clinical complexity, geography, staffing and the resilience the service requires.
What should happen when the connection fails during a consultation?
The operating plan should define a recontact method, a time limit for attempting reconnection and the threshold for switching to telephone or in-person care. Critical services may need redundant connectivity or power; lower-risk visits may use a documented rescheduling process.
How early should clinicians be involved in telehealth room design?
Clinicians, infection-prevention staff, facilities teams and information technology should review the layout before equipment and furniture are fixed. Early input exposes workflow problems—such as an unusable cart position or poor camera view—when they can still be corrected without construction changes.
