A Proposed Methodology for Integrated Architectural Design of Smart Hospitals

INTRODUCTION: Urgent need has recently emerged to transform hospitals from buildings that not only achieve functional requirements, but also comply with modern technologies. This is so that they are able to self-adapt to external conditions and change their behavior according to users. This is compatible with emerging trends to convert cities and buildings in developing countries to smart. OBJECTIVES: To develop a comprehensive methodology for proper dealing with smart materials & systems when constructing and finishing hospitals, leading to defining principles of an integrated architectural design for smart hospitals. METHODS: The descriptive analytical approach included theoretical background on concept of smart hospitals, types of smart materials & systems and their role in hospital design. RESULTS: An integrated methodology for proper architectural dealing with hospitals to allow them to be smart, which the study recommends to follow and complement between smart materials and systems. CONCLUSION: The research conceived a proposed methodology for the architectural design of smart hospitals and identified mechanisms for utilizing smart materials and systems in developing hospital designs


Introduction
Smart hospitals are essential components of smart cities which have received great attention in most countries of the world. The interest in establishing smart hospitals is due to the intense varying requirements of patients, workers, and visitors. This requires achieving response and self-interaction with the internal environment, in addition to achieving adaptation and compatibility with external conditions, without direct intervention [1] . Moreover, it is an essential step for automating the health care field in light of the intensity of the various internal systems [2] , which provides practical solutions for medical management and treatment by relying on information technology and building network infrastructure, such as mobile or remote health care and others [3] . Also, this provides sustainable self-management of resources such as energy and water [4], [5] , reducing pollution by emissions and waste [6] . Thus, the hospital environmental performance is improved, and the operating environment is upgraded. This is carried in a manner that achieves safety, security, and user-comfort, as well as being in accordance with modern designs of hospital buildings, which focuses on transferring them from being only functional buildings to buildings that are designed, executed and equipped in a way that depends on artificial intelligence. This is as a part of computer sciences that are interested in producing smart technologies which give characteristics to buildings similar to these of human intelligence [7] . This approach is compatible with rapid technological advances and modern technologies which support interactive and integrated building construction and finishing materials (concrete, glass, etc.) in addition to supporting various systems (air conditioning, ventilation, safety and security systems, etc.). The concept of architectural design of smart hospitals and their importance will be defined below in addition to identification of smart technologies associated with their design which leads to setting up a methodology to allow for relying on these technologies in designing smart hospitals.

Characteristics and types of smart materials and systems, and their role in hospitals
Managing smart hospitals depends on the use of smart materials that are used in the construction and finishing of the building [21] , and smart systems through which the building is managed, according to the following.

Smart materials in hospital buildings
Smart materials are capable of providing a unique beneficial response when specific changes occurs in the surrounding environment [22] . They are high-tech materials that have the ability to sense and respond to adaptation to environmental, internal and climatic changes [22] . They are able to perceive and respond to many external stimuli in an organized manner [23] , stimuli that can be electrical, chemical or magnetic in nature [12] . The difference between smart and traditional materials is seen in the composition and interaction with external influences and response to external stimulus in order to control temperature changes or solar radiation [24] . Such materials form a part of the smart structural system and have the ability to sense its environment and calculate changes to the building [25] .

Smart material properties
Intelligent materials are characterized by the ability to return to their previous form, self-repair, strength, rigidity, ductility and high efficiency. In addition to the long life span, ease of manufacture, installation, aesthetics and environmental compatibility and the ability to respond quickly to hazards [11] .

Types of smart materials
According to the nature of intelligence, smart materials are divided into materials that change one of their properties (chemical, thermal, mechanical and magnetic) in response to a change in external conditions, and materials that transfer energy from one form to another directly, as in Figure1. Table 1 illustrates types of smart building materials that correspond to the requirements of smart hospitals. Figure 2 shows some of type of smart materials mentioned in the previous table. Also, Table 2 shows types of smart floors, walls and ceilings finishing materials compatible with the requirements of the smart hospital [26], [27] , Figure3 also shows types of walls and ceilings finishing materials mentioned in the previous table.

EAI Endorsed Transactions on
Smart Cities Online First 2 3 A Proposed Methodology for Integrated Architectural Design of Smart Hospitals Figure 1. Types of smart materials [28]  Collect and store the thermal energy materials used to cool the vacuum in the summer or heating in the winter.
Its state changes when absorbing thermal energy or its release from a solid to a liquid state or vice versa Aluminum coated panels They are aluminum panels with a rough surface, and these panels reduce energy consumption by 15%.
Used to store solar or wind energy and broadcast it in the building for heating and sound absorption Fluoropolymer panels They are air-pressed transparent polymeric panels, one, two or three layers, which form the building sheath and are surrounded by a metal frame.
It provides heat insulation and UV protection and is self-cleaning and anti-combustion Microscope Slides 1 mm strips of acrylic and glass have small holes, when the sound waves are joined to it, the sound energy converts to thermal one, decrease the noise It is used for acoustic insulation, and electrical energy for heating due to the heat produced Aerogel Glass Porous, dry gel materials with little thermal conductivity. When exposed to heat, they quickly clot, the color of the glass changes to a semi state Provides sound insulation and fire extinguishing ability, and reduces temperature.

Photovoltaic Glazing
Transparent materials and when exposed to the sun, begins to disperse and reflection begins and turns to the visible spectrum at more rays.
To reduce solar heat gain, and thus reduce the cooling load, it generates little clean electricity Thermochromic Glass Change optical and thermal properties according to the ambient temperature and solar radiation intensity.
Achieves shading, the glass remains transparent at lower temperatures and becomes opaque when raised Gasochromic glass The idea of its work depends on pumping the hydrogen gas H2 or O2 oxygen into the cavity between the glass plates, absorbing the sun's heat

Intelligent systems in hospitals
Smart systems are defined as a set of inputs that are prepared in specific ways that achieve certain desired goals [15] . They compose of a group of interconnected elements such as sensors, motors, controllers, and computers that are managed together to control the main functions of buildings and control subsystems such as heating, ventilation, cooling, etc [30] . Specific software are that linked to hardware such as switches, communication media, and connectivity materials such as wires, equipment, and data entry means [31] . This plays an important role in building economics and management [10] , as well as energy conservation through various effective programs, to obtain optimum performance and help with operation and maintenance .

Components of smart systems
It consists of three components: Input Systems for collecting information on factors associated with the building, using reception devices such as internal sensors distributed in the rooms according to the type of sensor and the shape of the space [32] , or external sensors that attach to the top of the rooms or on the exterior [31] . Information processing is carried out to obtain information, data from input, analyze and process them to control other systems in an integrated manner [33] . Then the Outputs System includes the output of the data processing, through which clear decisions are enforceable. The response to this is either internal, such as responding to wind loads, or external as changing the intensity of lighting, or opening or closing doors automatically [33] . Its role in the building can be determined in making it an architectural product capable of knowledge, decision-making and selfresponse [1] .

Characteristics of smart systems
Intelligent systems are characterized by their high efficiency when using high quality insulating and conductive materials, the possibility of simultaneously combining several activities and controlling several services such as lighting, air conditioning. In addition to the ability to receive several variables from different sources in a highly complex way, such as lighting several rooms with varying degrees of lighting intensity. Also this includes the ability to handle and manage peak periods by reducing loads, monitor and analyze internal and external environments and implement operational functions without human intervention. This is to remotely control systems via the Internet [34] . With the importance of the role of automation in developing architectural environments by relying on technical equipments and communication devices [35] , the effect of virtualization, communication technologies, the Internet, and virtual reality .

Types of smart systems
Smart systems include three types: control and access control systems, direct digital control systems, and communication systems, as shown in Table 3. .

Modern design requirements related to smart hospital thought
The link between smart hospital and modern hospital design shows the importance of achieving interactive functionality, technology, user desires, environmental needs, and security and safety.

Requirements for functional interactivity
Recently, hospital design requirements are concerned with achieving: (a) Flexibility and self-response to changing in functional requirements leading to an improvements in the internal environment of occupants, (b) Functional expansion to accommodate future growth, (c) Interactive management of operational cost control aspects, (d) Adaptation to changes in uses, to achieve certain economic and technical aspects [36] , (e) The possibility of adding security and fire protection systems according to the requirements [37] , (f) Moving towards the digital space, enhancing medical services, using a model that provides business requirements, information technology, and improving work flow, (g) Integration of systems and technology to serve users, interact with functions and capabilities of remote communication, periodic maintenance works, facilitate work movement, and internal communication [17] , (h) Development based on information technology, (EMR), and using of information regarding medical treatment and operation, as shown Figure4 . [40] .

Figure 4. Identification of Smart Assets in Hospitals
EAI Endorsed Transactions on Smart Cities Online First 6

Technological considerations
Hospital designs are concerned with the requirements of: (a) Enhancing the participation of patients and companions in the medical process, by simplifying communication between them and service providers, (b) Improving work flow using the internet and mobile technology, (c) Reducing patient frequency rates on the hospital and waiting for them and sending notifications of service delivery times, (d) Ease of access and finding the way to and within the building to meet the needs of users [17] , (e) Relying on "Smart Planet", using sensors and transmitting information using the Internet of Things and artificial intelligence [23] , (f) Providing electronic health records for patients [2] , (g) Avoiding paperwork to counter the abundant information that is newly produced by medicine [38] , (h) Automated operations dependent on information and communications [17] , (i) Use of radiofrequency identification (RFID) systems and the participation of doctors and nurses in parallel [39] , (j) Monitoring building elements and providing a comfortable environment for occupants, using data transmission infrastructure networks, (k) Integration of technological systems for elevators, airconditioning, lighting, fire and security, and communication systems (telephone, fax and internet) [12] . (l) Using Internet and satellite communication for internal communication, automation, and building management [17] , such as Trinitas Regional Medical Center, New Jersey.

Achieving environmental considerations
The hospital is dealing with requirements: (a) Compatibility with the environment and sustainability by exploiting renewable energy sources and controlling light, heat, and ventilation [41] , (b) Reducing the use of traditional energy resources, and their cost [42] , (c) Reducing environmental pollution by reducing noise, gas emissions, and providing indoor air quality [43] , (d) Achieving quality for internal environments including: Physiological Comfort (programming the temperature, humidity and type of required ventilation according to users), Thermal Comfort (providing comfortable thermal conditions with thermal balance between the body and the environment), Visual Comfort (changing the level of lighting automatically according to the function and without stress), Audio Comfort (outer envelope acoustic treatment and insulation of internal spaces), Saving Time and Effort (supporting communications and technologies, monitoring, safe and safety systems, and communication with equipment) such as the University of Missouri Health Care, Columbia, Longterm Cost Savings (construction, maintenance, operation, automatic control of lighting, and ventilation of unoccupied spaces) [44] , (e) Providing environmentally friendly materials and systems that achieve social, and technical goals [3] , (f) Reducing risk, use less paper, recycle and generate less waste [45] . (g) Improving environmental performance by improving site capabilities and preserving water and materials [17] .

Achieving users' desires
Hospitals are concentrated on the requirements of: (a) responding by changing the behavior of materials according to the needs of occupants, in terms of adapting to external conditions, (b) Integrating electronic tools and means to provide comfortable environments and enhancing employee safety according to work changes [1] , (c) Managing resources automatically to increase the efficiency and satisfaction of occupants, (d) Linking automated control systems with information systems, to address occupant requirements and make buildings responsive, (E) Modernizing the building's electronic systems and equipment without the need to replace existing electrical connections to address future requirements [10] , (f) Providing climate control, energy, air-conditioning and ventilation systems for the users comfort [17] , (g) Electronic control of communication networks and fire-fighting systems according to the user's desires [46] , (h) Application of technology in storing patient data, reducing traffic distances for workers to reduce stress, waiting, and stay times [47] , (i) Utilize mobile and Internet of Things technologies to provide effective communication between patients and caregivers such as the Ohio State Wexner Medical Center, Columbus .

Achieving
The hospital is currently concerned with requirements: (a) Electronic control of building systems in order to protect from fire, and mitigate dangers [17] , (b) Continuous monitoring of systems to achieve conditioning and dealing in emergency situations [48] , (c) Providing hospital automation systems and methods of control, monitoring of materials, and their internal installation [10] , (d) Electronic programming of hospital components and systems according to the expected possibilities which allows them to act and adapt accordingly, to overcome the negative effects of the environment [49] . (e) Restoring building systems safely, quickly and easily, (f) Making quick decisions with regards to energy management, maintenance, communications, fire protection, safety, etc., and achieve integration between systems to achieve maximum safety for its users [50] , (g) The use of remote communication systems to control transmission of infection [17] .

A proposed methodology for the integrated architectural design of smart hospitals
The methodology is based on five main stages, as shown in the Figure 5.

Mohamed Helmy Elhefnawy
First stage: Defining modern design requirements related to smart architecture thought In this stage, modern design requirements, previously identified in item 4 will be studied, and a reference to local conditions, operating policies, user requirements, and stability is required to utilize the premise of using smart materials and systems. Second stage: facing the main challenges impeding hospitals to become smart At this stage, challenges encountered by designers when dealing with the design of smart hospitals will be identified, including: (1) Conflict in priorities among requirements mentioned in the previous section (2) Weaknesses pertaining to dealing with smart hospitals such as the system failures, human errors, natural disasters, failure to link devices to systems, insufficient physical security of components, noncompliance with regulatory standards and user behavior. These challenges are addressed by referring to officials, operating policies and future plans of services, in order to address weaknesses, using smart materials and systems in addition to achieving integration among them.

Third Stage: Defining the proper basics of the architectural design of smart hospitals
This stage defines the principles of architectural design that meet the goals and requirements of smart hospitals and face the challenges associated with them, Figure6, including: A-Providing information in an adaptive manner that achieves interaction with the environment and changes functional requirements to suit user needs. B-Providing high flexibility, and achieving information security [28] . C -Self-control and change of status of materials according to changes in the surrounding environment and users' desires. D -Coordination between hospital systems and devices in a way that allows for the integration and analysis of data [51] . E-Providing information to patients under care during their stay. F-Smart rooms in hospitals allowing patient and relatives to see medical information. G-Using smart technology and mobility systems such as tablets and smart phones [3] . H-Using smart technologies like WiFi, active RFID, sensors and integration platforms. I -Combining existing hospital technologies with new smart programs to reducing required time for providing services. J-Internet of Things (IoT) applications for detection and follow-up, using artificial intelligence. K-Overcoming the disadvantages of the traditional information systems, and building the basic network environment [52] . L-The tele-care system, expanding hospital boundaries and reducing frequency of visits. M-Identification systems to track and document patients or employees and infection control. N-Availability of communication and integration of smart devices to provide the correct information in the right place and time. O-Using building management software to monitor its services, energy conservation, operation and maintenance. P -Patient monitoring and automatic data transfer, with automation of special units such as Intensive Care (ICU) [53] . Q-Remote voice, video, storage, and forwarding technologies [53] . R-Intelligent automatic operations and task automation to achieve safety for patients and convenience for doctors. S-Real-time location system (RTLS), hand-washing monitoring, nurse call system, communication control, employee messaging, call-bell and notification of medical staff assistants on mobile devices, emails [20] .

Figure 6. The Basics of architectural design of smart hospitals
Fourth Stage: Defining the role of smart materials and systems in the architectural design of smart hospitals At this stage, defining the contribution of smart materials and systems to achieve the basics of the architectural design of smart hospitals mentioned in the previous stage is determined, as shown in the following Table4.

Fifth Stage: Achieving integration between smart materials and systems inside smart hospitals
In this stage, ways to integrate the elements of the smart building (materials and systems) are specified to achieve functional compatibility and integrated buildings management. In addition to locating equipment and linking systems, devices and programs in a common structure and enhancing sustainability in buildings. This is done by referring to the schedule of requirements and types of smart materials and systems in the previous stage of methodology. Then identifying alternatives for smart materials and systems necessary to achieve each of the architectural design standards. Furthermore, determining the most appropriate systems according to operating policies and capabilities available in the hospital, then determining the mutual effect between smart systems and materials in the fourth stage in addition to stipulating its link with the functions of the different spaces in the hospital. Furthermore, to determine the relationship between smart materials and systems according to modern design requirements, mentioned in the first stage, and ensure the integration between smart materials and systems that directly and indirectly affect the architectural design, as shown in the last cell at Table4. This stage ends with a reassessment and testing of the methodology by returning again to the first step and making sure that modern design requirements related to smart architectural ideas are met .

Conclusions & Recommendation
The following are the most important conclusions and recommendations of the research.

Conclusions
(1) There is a close link between the premises and principles of smart architecture and fulfillment of design requirements of modern hospitals.
(2) The use of smart materials and systems contributes to achieving functional interactivity, technological considerations, environmental considerations, user needs, and enhances security and safety.
(3) The integrated architectural design of smart hospitals can be achieved by a proposed methodology consisting of 5 basic stages that start with defining design requirements and ending with ways of achieving integration between the elements of the, as shown in the Figure5. (4) The concept of using smart materials and systems meets various design requirements for smart hospitals, according to their nature and characteristics, directly or indirectly, as shown in Table3. (5) The use of smart building materials allows responding to changes in functionality, while smart floor finishing materials generate clean energy and control movement in special spaces. (6) The architectural designer must review operating policies and design requirements of the hospital for an appropriate selection of materials and smart systems used within it. (7) Various types of smart glass are considered to have an influential role regarding the use of renewable energy and reducing energy consumption, thus reduce operating costs. (8) Integration in the architectural design of hospitals is achieved by monitoring the operations of all the systems used and providing utilities to link them with smart materials and achieving an appropriate level of comfort, convenience, safety and efficiency for workers. (9) The use of transparent concrete, phosphorous ceramics, smart sensors and (WAN) network contributes to achieving design requirements of smart hospitals in a way that exceeds other approaches. (10) Integration between smart materials and systems is achieved by taking into account the characteristics of smart materials and systems, and determining their relationship with the design requirements of smart hospitals. (12) Most smart materials and systems are concerned with improving the internal environment, and achieving thermal, audio, and visual comfort, as they affect energy, time, effort savings, and reduce costs. (13) The role of smart systems is apparent in achieving effective communication between smart hospital users and in self-controlled, systems according to their requirements.

Recommendations
Through the study, analysis, and results of the research, the research recommends the following: (1) Follow the proposed methodology when designing smart hospitals to achieve integration between elements of smart architecture.
(2) Promoting using smart materials and systems.
(3) Giving attention to achieving modern design requirements in hospital buildings, using smart architecture elements, including smart materials and systems. (4) Encouraging studies and research that develop smart materials and invent new interactive materials to keep pace with technological development in hospital design. (5) When designing smart hospital buildings, focus is given to activating integration between smart materials and systems and taking attention to materials and systems that meet more than one design requirement without affecting on any other requirement. (6) Activating the role of smart systems and materials in obtaining smart hospitals with responsive and interactive properties. (7) Preparing methods for assessing smart buildings on an environmental basis, to know the extent of their impact accurately on the surrounding environment and its conservation. (8) Carrying out studies on smart systems to work together in an integrated way so that the building, is able to think and make decisions based on the variables surrounding it. (9) Preparing international and local codes for the architectural design principles of smart buildings, the most important of which are hospitals.