Health services must now manage their considerable real estate assets more like conventional businesses. Property no longer vital to a healthcare organization’s strategy should be monetized, freeing up funds needed to revitalize and expand core facilities. Interactive web-based portals can effectively publish Geographic Information System ("GIS") maps to support strategic planning for property management activities. The portal hosting technology also promises to bring GIS functionality to the desktop without requiring that the user be a GIS expert.

Public Health has long used GIS technology to track disease, study market penetration and even to map and plan healthcare delivery within facilities. Today health services must manage their considerable real estate assets more like conventional businesses. Property no longer vital to a healthcare organization’s strategy should be monetized, freeing up funds needed to revitalize and expand core facilities.

Decision-makers require GIS to inform their instincts on a broad range of location-based issues. GIS can be used to map and display dispersed assets, linking databases to the properties. Such data might include descriptions of the property, third party reports (appraisals, environmental studies), digital photos and additional maps. Of more importance is the strategic role GIS can play in showing hospital owned assets as themes relative to the pattern of surrounding land use, changing demographics and market competition.

GIS improves strategic decision making with its capacity to model alternate "what if" scenarios, displaying analysis visually through varying map views. However, conveying GIS information to third parties, outside an internal intranet, has proven problematic. A relatively low cost web portal can act as a simple interface. It can replicate the functionality of GIS within confined parameters. An organization need not have dedicated resources to enjoy the advantages of a GIS system.

An association of Andersen’s Pacific Northwest Real Estate Consulting Group and WebPE, an Edmonds, Washington based internet data-management service, has designed an interactive web portal to manage complex real estate and facility portfolios. The solution is well suited to any healthcare clients with real estate needs.

Real estate must be managed to enhance overall performance just like any other financial asset. Historically, hospitals bought and developed real estate as a necessary commodity to fulfill their mission to provide healthcare to the local community. As communities grew, they first surrounded once spacious campuses, then population shifts moved demand out to suburbs. Many hospitals diversified services, and began to own medical office buildings, congregate care homes and even warehouses. Foundations supporting the service mission often took disparate property as contributions in lieu of cash. Land-locked centrally located hospitals sought to buy up adjacent sites to ensure room for future expansion.

In the late 1990’s Federal reimbursement policies for Medicare and Medicaid patients changed, putting many institutions in the red. Consolidation and reorganization accelerated. In this uncertain financial climate, real property ownership and deployment requires much greater scrutiny.

Some of the pressure points include:

• With unprecedented demands for capital, some experts argue hospitals have no business owning real estate in the first place.
• Federal legislation will shift the dynamic of medical office ownership from convenient hospital-physician collaborations to neutral third parties.
• Seismic upgrades now imperil the utility of hundreds of acute care facilities nationwide, particularly on the West Coast.
• Changes in healthcare delivery force expansion of outpatient facilities where growing patient populations are actually settling.

As an asset class, real estate is typically illiquid. It can pose severe risk if contaminated or when improvements are found deteriorated. Real estate is obviously fixed in place, so when demand shifts require that services be moved or closed, the asset can become a drag on operations, if not the balance sheet.

In a strict business context, companies should align their real estate assets with corporate strategy. They should plan their real estate activities, including acquisition, finance, management and disposition, to enhance productivity and value.

Health care organizations may be confronted with any number of opportunity triggers demanding they better account for their real property assets:

• Cost cutting initiatives
• Business expansion or contracting
• Merger or acquisition
• Normal strategic planning.

In one case, a regional hospital located in a growing suburban area determined to implement an institutional strategic plan integrated with a master plan to govern its core facilities. This hospital was not alone among healthcare providers in the assignment challenges it presented, including:

• Widely dispersed real estate holdings
• Inadequate parcel descriptions
• Scattered/missing records
• Poor internal communication
• Unclear/nonexistent policies regarding development/disposition

The first task was to simply identify all the holdings and enter them onto a single Excel spreadsheet. Successful real estate management involves treating those assets like investments in a portfolio. The property all needs to be arrayed on a single page before needs can truly be assessed.

Street addresses were matched up with property tax parcel identification numbers. Systematic field inspections cured the data set further. The parcels were then mapped with ArcView and county parcel data. The resulting maps displayed the following themes:

• Dispersion of assets - using a regional map to show location points
• Parcel ownership around central campus- emphasizing key unowned inholdings
• Vacant and underutilized land around campus- suggesting development opportunities.

Individual parcel descriptions now included county assessment information, a digital photo and a digital parcel map. Properties sorted by use and location could then be placed in the same binder as a tangible deliverable. However, more than a static asset list, the inventory reflected a dynamic portfolio with many of the properties in play for development or disposition. Given the broad governance of a community hospital required keeping disparate stakeholders informed on a regular basis.

What about acquiring new sites or keeping track of properties of interest? GIS provides an unparalleled perspective to evaluate alternatives given a robust database. Available sites can be mapped in a given area, then overlays can be generated to view growth patterns, patient census or diagnostic groups. Hospitals need GIS to properly evaluate the siting of appropriate facilities in areas of growth or increased competition. In a contracting market, decisions must be made on what facilities to close and what to hold open and maintain. GIS provides the overview so that one-off transactions will not damage the integrity of a portfolio.

In this example, the web portal was designed to allow an in-house property manager view and monitor assets that ranged from houses to office buildings, along with a growing hospital district.

Resources dedicated to property management are often scarce, so few health organizations seem likely to invest in a GIS to monitor and evaluate these assets. Yet, conveying GIS information to third parties outside an internal intranet has proven problematic. Opening and manipulating GIS files requires having both the program and as often the proprietary databases loaded on one’s personal computer. This is seldom practical.

Commercial mapping software, like Esri’s ArcView, still requires capacity and speed beyond conventional laptop specifications. Within larger firms, like Andersen, intranet firewalls and licensing issues require that GIS be maintained on stand-alone servers. Thus, communicating electronic maps is limited to sending images via e-mail as JPEG files, just as digital photos are typically conveyed. Of course the data behind the map presentation cannot be opened through the image.

The Andersen solution has been to publish GIS maps from ASP servers over hosted sites on the web through an Oracle based web portal. The portal links digital images with maps, photos, spreadsheets and important documents from appraisals to environmental assessments.

The Andersen Real Estate Portal provides quick visual access to properties in the portfolio with its custom three-view display. The display shows a thumbnail photo of the subject, a digital parcel map (taken from an ArcView screenshot JPEG image) and a brief description. Protocols administered by WebPE assure security. Each user can be provided a custom view. Each thumbnail can then be clicked to open a full resolution image or slide table linked to multiple images. Click on the description view and one can drill down to any number of linked documents for further detail.

While the portal does not yet allow for manipulating a fully interactive GIS, in reality most GIS analysis is saved as an image, once a particular task is accomplished. By publishing these images to a remote server, the analyst allows the user to open and view images much faster than waiting for files to open and close, or for maps to be tediously redrawn in a live application. The portal provides the security framework for selective access to the underlying information. Users can customize their individual views to filter the portfolio to just the parcels or content pertaining to individual tasks. These features make an on-line real estate portfolio easy to use and maintain, and virtually eliminates the need for user training.

The portal mirrors the set-up of a tabbed portfolio or notebook. An "asset overview" tab may be opened to an interactive regional map where the cursor can pass over a point where a roll-down menu references linked parcels and their images. A "library" tab can be opened for live links to related websites. The "inventory" tab can be designed to query and sort any parcels in the database. The portal thus allows real time access to disparate databases. As parcel information is updated, those changes can be periodically uploaded through the administrator and the views refreshed.

Decision-makers need the convenience and versatility of web-based tools to view real estate data as property management becomes integral to healthcare strategies. An association of the Andersen Real Estate Consulting Group and Web PE has designed an interactive web portal to manage complex real estate and facility portfolios. The solution is well suited to healthcare clients.

The web portal puts all the data on the same page, allowing decision-makers to see the big picture. Indeed, the portal may be the best way to view GIS maps and data layers, absent an internal cartography department. The portal can publish GIS maps from ASP servers over hosted sites on the web, linking digital images with maps, photos, spreadsheets and critical performance databases or reports. It captures changes in the market and assets in real time. For cost-conscious healthcare organizations, the portal technology offers a high value/low cost GIS application, easy to use and customize.

P. Barton DeLacy: leads the Andersen Healthcare Real Estate team, working as an appraiser and land use expert to plan strategies for clients in the Pacific Northwest. An MAI member of the Appraisal Institute, DeLacy earned a Masters in Urban Planning degree from Portland State University and B. A. from Willamette University.

Fred Illich: President of WebPE, Inc. leads his firm in the development, deployment and hosting of web-based solutions to the engineering and health care service markets. He holds a Civil Engineering degree from Stanford University.