HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 25 • Week Ending August 30, 2026 • Walt Vernon

FROM THE FIELD — PAPER ENGINEERING LION, PART 14

A running account of engineering a hospital energy system in real time

I’m now partly into Joyce Chaplin’s book, The Franklin Stove. I find it fascinating. I am not 100% certain that I completely agree with her argument, and I don’t think it’s as well written as I had hoped. But I love the book, and I find it absolutely fascinating. I keep going back and rereading parts of it, as I find it deeper each time.

The essential point of the book is that Franklin’s work was symbolic of all that was happening at that time – the changing climate in the form of the Little Ice Age, the social inequities of a white population taking land away from Native Americans and building their Franklin stoves using slave labor, and the acceleration of the Industrial Revolution, and its use of coal to transform so much about our world.

Chaplin makes the point that “As an adaptation to climate change, the Franklin stove project met only one of three desired criteria: it worked . . . but it validated a shorter-term solution – fossil fuel energy – with its own colossal drawbacks, and, at least initially, it accepted social inequities rather than confronting them.” I find this claim conflation a bit troubling. Is it necessary that every technological advance simultaneously solve all the rest of society’s inequities? I don’t have an answer, but I am, as I said, fascinated by the question.

In many ways, we face exactly such a conundrum at our UCHealth project now.

The answer we arrived at, ten days ago now, on schedule, was that we are going to move forward with heat recovery chillers using phase change materials to provide supplemental heating and cooling. I have written before about the details of this solution, but the thing that matters most, and the thing that drove the decision, was that the phase change strategy eliminates the use of cooling towers and evaporation together with its exorbitant water consumption. With this set of strategies, this hospital has the opportunity to be among the most energy efficient and most water efficient hospitals in the state, at least. It’s a terrific decision, and a very wise, forward-looking one. We hope it can set a new standard for what a hospital energy system should be.

BUT

There is still the problem of the diesel generator. Hospitals must have a way to generate large amounts of electricity at a moment’s notice. Because the owner wants N+1, the design now contemplates two large diesels, and their fuel. The primary generator will serve during utility outages of between 60 and 80 minutes, on average, per year. This will probably be among the most expensive electricity, per kwh, ever. The other diesel will only run if the first one fails, or mostly, for testing. The generators will have to be tested, and the fuel will have to be maintained. The diesels are so dirty they are restricted in their run time, so they are only allowed to operate a very few hours per year. To supply the needs of the hospital, then, the utility, the region, the country will have to provide more electricity.

And, we have shown (Kaiser Ontario, Valley Children’s Hospital) beyond doubt that there is no way to provide enough standby power to a hospital through on-site solar or batteries. The project with diesels will not advance the State’s priorities with respect to microgrids, including increased local generation, taking load off the grid, providing resilience to critical facilities, and making better use of required backup assets.

Hospitals constitute about a tenth of one percent — roughly one in a thousand — of the nation’s commercial buildings. They have unique needs for large amounts of energy, and for an extended time. Today, and for the foreseeable future, this cannot be done with renewables and storage alone, except in the form of stored fuels. Applying the same standards to hospitals as to other buildings is very poor policy. Trying to do so creates conflicts, such as the one between Colorado’s Energy Code and its Microgrid Roadmap.

So, after deciding to move forward with the Phase Change Strategy, the owner called me to ask whether there might still be some way to move forward with the fuel cells.

And that brings me to the environmental question. The fuel cell solution achieves all of the benefits envisioned by the state’s Microgrid Roadmap, but it does so at a cost. Our envisioned design with phase change materials and all-electric systems and a relatively clean local utility mean will generate, on site, more carbon if we add the fuel cells.

How you count matters.

Now, let’s look at the fuel cell question through a set of widening concentric circles.

The Colorado Low Energy and Carbon Code, and the Colorado Building Performance Standards regulate what can be built and what can be operated without penalty in the state, from an energy and a carbon perspective. Both of them encourage efficient buildings, and UCH has now committed, as I said, to build what will probably be the lowest energy, lowest water consuming hospital in the state; maybe the country. That is a fantastic achievement.

But how you count matters. And how you count the electricity source emissions matters enormously.

Start at the first circle, the building itself, and the building as seen from the perspective of these particular codes. Under the codes, where that electricity is generated matters. If we get our electricity from off-site, then it does not matter how dirty it is. It does not matter how much is lost in efficiency of generation. It does not matter how much is lost in transmission over the grid and the local distribution system. All that counts is whether it comes from off-site. On the other hand, if we bring natural gas onto the site, and if we use it in a process, even if not combustion, that creates carbon emissions, then, for exactly the same electrical need, we have to count the emissions. This rule fails the fuel cells under both codes.

I have argued that this double standard is unfair to this instance of on-site generation, and that this amount of natural gas consumption should be set aside, just as the emissions from the grid are set aside. Some of my colleagues argue that my objection is unfair – that a building should be accountable for what it does on its own site, especially when the local utility claims to be moving towards low carbon generation.

Both arguments have merit.

But they answer different questions.

The building boundary says one thing. The utility or regional or national boundary may say another. None of these boundaries is inherently right nor inherently wrong. The mistake, I think, is pretending that one of them is.

How you count matters.

The second circle is the serving utility — in our case, a rural electric cooperative. When we met with them, they told us they had achieved an 80% reduction against their 2005 baseline. Their 2005 baseline was coal-heavy, so 80% better is not zero. In fact, it is actually a rather considerable amount of emissions, even though less than 2005.

In 2026, UP is generating 271MW from its own natural gas, purchasing 380 MW from the grid (a pretty dirty grid), and generating 8 MW from its solar plants. It is also buying unbundled, older RECs to establish its claims.

The utility is forecasting that its consumption of natural gas will drop in 2028, and that more grid purchases will pick up the slack. They forecast that this will continue into the future. The key question is, where will that capacity come from?

The forecast is that the utility will build batteries into its system and will begin to buy only renewable electricity to put into them. In 2045, they say their own installed generation will be 91% from burning fossil fuels. But they say that they will buy only renewable electricity from the grid, and that they will build a huge battery infrastructure to distribute that renewable electricity temporally and spatially.

This is a great claim.

How you count matters.

To their credit, UP has actually contracted to purchase large blocks of solar and wind generation. The problem is, they are not in the UP territory, they are elsewhere, and they must be delivered.

That leads to the third circle, the market and balancing authority, the Southwest Power Pool (SPP). Since April the SPP has operated the wholesale market and balancing authority for this part of the Western Interconnection. This entity dispatches electricity and balances supply and demand. The question is going to be whether there is enough renewable energy arriving at the right times to keep the batteries charged with renewables, or whether the batteries end up actually taking from natural gas generation when wind and solar fall short.

This is not merely theoretical. Through July and August, SPP’s new western balancing area was under near-continuous conservative-operations advisories, declared an Energy Emergency Alert, and on one July day avoided outages only by appealing for voluntary conservation after a sudden loss of imported power left it with razor-thin reserves. The Department of Energy issued an emergency order directing SPP to dispatch additional generation and authorizing backup generation as a last resort before shedding firm load. The causes SPP named were precisely this combination: high peak loads, low output from wind and other variable resources leading into the peak, and increased resource outages.

And then there is the Western Interconnection, the “western grid.” This grid is connected across a vast geography, but transmission is not unlimited. Electricity cannot simply be moved from wherever renewable energy happens to be plentiful to wherever demand happens to occur without regard to transmission capacity, congestion, timing, or the actual physical state of the system.

And then there is the fourth circle, the nation’s energy system.

Because here is the real dilemma.

Let’s concede that United Power will find a way to build out its battery fleet and to fill it with renewable electricity from outside at a cost its customers will be able to afford.

Let’s concede that.

Then the question becomes what happens at the regional and national levels?

One thing we know for sure is that, inside the Western Interconnection and inside the nation as a whole, electricity demand is rising much faster than it has in decades. This growth comes at a time when the grid has insufficient generation capacity in important places; insufficient transmission capacity; aging infrastructure increasingly vulnerable to wildfires; and vulnerability to the increasing frequency and ferocity of severe weather events. Into this, the grid and its regional components are being asked to ramp up at a scale that is new, in the face of tremendous financial and permitting pressures that make such growth hugely problematic. And firm dispatchable capacity is retiring in places faster than equivalent firm capacity is being replaced.

According to the Energy Information Administration’s 2026 outlook, even under the scenarios that produce the greatest development of renewable generation, there is no plausible future in which natural gas simply disappears from the electric system. Across EIA’s cases, electricity demand grows substantially for decades. Natural gas, as well as solar and wind will also grow. Even as enormous amounts of new wind and solar are built, natural gas will remain an important part of the generation mix. Critically, methane will continue to play an important role at the dispatch margin.

EIA’s improved modeling of the hours when wind and solar are actually available has, in fact, increased its projections of natural gas use, because the need for dispatchable generation becomes clearer when the system is modeled hour by hour.

In other words, renewable generation grows enormously — and so does the system it must serve and so does the need for methane as a fuel.

Now, it would be wrong to say that when United Power contracts for a renewable resource, it simply takes a fixed amount of renewable electricity away from somebody else. A PPA can cause additional renewable resources to be built. That matters.

But neither does the PPA make the physical grid disappear.

At the hour the hospital adds load, the interconnected system still has to balance that additional load with whatever generation, storage and transmission are actually available. The carbon consequence therefore depends not only on the resource attributed to the hospital, or to United Power, on paper, but on what the interconnected system must actually dispatch because the hospital is there.

And that is where the accounting becomes very interesting.

If we say that an all-electric hospital has zero on-site emissions, that statement is unquestionably true.

If we say that its additional electricity demand causes no additional emissions anywhere in the interconnected system, that is a much more difficult claim.

And if, at the same time, an on-site fuel cell — producing electricity electrochemically rather than through combustion, with extremely low criteria-pollutant emissions and among the lowest carbon emissions available from a natural-gas-based power source, and without transmission losses — is penalized because every molecule of carbon associated with its fuel is counted at the building boundary, while the marginal consequences of the building’s imported electricity disappear outside that boundary, then we have made an accounting choice.

Maybe it is the right choice.

But it is a choice.

How you count matters.

I should be honest about where I stand, because it matters to how I reach my conclusion. I do not like the carbon emissions either. I am a climate zealot, and have been for decades. I have solarized three houses I have lived in, and put a geothermal heat pump system in my home in New Hampshire. I drive only electric vehicles. This Wednesday, I will accept a renewable energy award. I believe, deeply, in using as little as we can, and in getting all we can from renewable sources. So I do not arrive here as someone indifferent to carbon, or looking for a reason to burn something. I arrive here the other way around — wanting the purest answer, and forced by the extreme needs of hospitals, the realities of the grid, and the honest trends in technology and generation to admit that grid plus diesels will not be our best solution. And so I have come to favor pragmatic solutions. Not the ones that try to solve every problem and end up solving very few — but the ones that solve some problems, now, with the best path we can try to create towards a better future.

I want to create the best solution I can. And I want to create the best solution I can.

It seems to me that Benjamin Franklin was the ultimate pragmatist. In everything that he did, in all of the circles he worked in, he sought for solutions that worked. Author Joyce Chaplin said as much when she conceded that his stove, while failing to solve slavery, at least had the virtue of helping people suffer less from the changing climate where they were.

One thing that was fascinating was that Franklin was working on the flow of heat inside of a room. He was trying to engineer an atmosphere. In doing so, it helped him to start to think about the external environment, and how heat might move there, leading to his conjectures about the Gulf Stream. He sought solutions that worked, and he tried to learn from them for scales beyond those in which he was working.

And perhaps that is the part of Franklin’s story that speaks most directly to this project.

Franklin began with the atmosphere inside one room. But following the movement of heat forced him to look beyond the room — to weather, oceans, and eventually the Gulf Stream.

The boundary of the problem kept getting larger.

Ours does too.

I think, as I said, it is a fascinating question, whether every technological advance must also embody solutions to other connected problems.

When I think about the fuel cell for UCH, I think about exactly the same questions. I also think about balancing perspectives.

Carbon is one question.

Resilience is another.

Finance is another.

Relief to the grid is another.

And maybe most important, carbon in the context of the larger energy system is another.

But behind all of these is a single question about boundaries — and I have come to think that here, there are three sets of boundaries that matter and that intersect.

There is the boundary of space; the building, the utility, the market, the grid, the nation. Draw it at the fence line and the on-site generated electricity looks dirty; draw it around the whole interconnected system and you have to ask what that system actually dispatches because the hospital is there.

There is also a boundary in time. Draw it at this moment and the fuel cell consumes natural gas. Draw it across the life of the building and the same device has a path to hydrogen, on a grid that is straining now and will strain for years before it eases. The honest answer is a bridge, and you cannot see a bridge if you only look at where you stand today.

And there’s an even more important boundary - the boundary between types of buildings. A hospital is a critical facility, with an energy density far greater than most of the buildings. It is a building with an obvious need for lots of firm, on-site power all the time — and especially in the emergencies when everything else fails. It is a building that demands the installation of significant amounts of on-site energy generation. It is very nearly the perfect use case for this technology. Hospitals are roughly one in a thousand of the nation’s commercial buildings, and the attributes that make them rare are exactly the attributes that make on-site, non-combusting, always-available generation the right tool for them. Surely it makes sense to treat such buildings differently from other buildings. Drawing the building boundary correctly means counting a hospital as a hospital, not as one more of the thousand.

Draw all three boundaries correctly — the whole energy system in space, the full horizon in time, and the hospital as its own kind of building — and match them together against available solutions, and the fuel cell stops looking like a compromise. For this building, on this grid, in this decade, it starts to look like the right answer.

Franklin’s stove did not solve every problem confronted by his world. It did something more modest: it made one part of that world work better, while helping its inventor see a larger system.

Perhaps that is the standard we should apply here.

The fuel cell does not solve climate change. It does not eliminate our dependence on natural gas. It is not emission-less. But if it can make a critical facility more resilient, reduce its demand on an increasingly constrained grid, replace rarely used diesel infrastructure, make productive use of on-site generation assets, and ultimately provide a pathway toward lower-carbon generation technologies, then perhaps it is enough.

The question is whether, when we draw the circles broadly enough, it makes the system better.

Maybe not for all the problems we face.

But maybe, for enough.

How you count matters.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. The grid can’t move the power — and now it has a price

The clearest signal this week is that the cost of physically moving electricity across the grid is escalating even where the electricity itself is cheap. Transmission congestion costs in the PJM interconnection reached roughly $6 billion in the first half of 2026, up 43% year over year, with real-time wholesale costs climbing to about $29.4 billion from $20.4 billion a year earlier. Northern Virginia, Baltimore, and Delaware were hit hardest by high-voltage transmission constraints. (Utility Dive / PJM IMM)

Infrastructure implication: Commodity energy cost is only one part of the problem. Congestion, capacity scarcity, and transmission limits raise the delivered cost of power even when natural gas is inexpensive — which means peak reduction and firm-megawatt management now address several cost vectors at once, not just demand charges. For a hospital, where it sits on the transmission system is becoming as consequential as how much energy it uses.

2. Firm megawatts and flexible megawatts are separating

PJM’s most recent capacity auction again hit the $325 per megawatt-day price cap while still falling roughly 6.8 gigawatts short of its reliability target, and PJM has proposed an Interim Resource Adequacy Service under which large new loads that do not bring their own capacity could face curtailment ahead of ordinary customers beginning in 2027. Meanwhile Texas set repeated demand records — ERCOT reached 90,353 megawatts on August 20 — even as the state screens speculative data-center load after the governor’s August 3 verification directive.

Sources: PJM capacity / IRAS • ERCOT records / EIA STEO

Infrastructure implication: Firm utility capacity is becoming a scarcer, differently priced product than flexible capacity. A hospital that can hold down its firm imported demand — with storage, thermal systems, and on-site capacity — gains an advantage over an equally large but inflexible load, and may avoid the curtailment exposure now being written into large-load tariffs. “Reduce the firm megawatts you ask of the grid” is turning from a cost tactic into a reliability strategy.

3. Gas is cheap and abundant — diesel is not

Natural gas remains comfortable nationally: the EIA forecasts Henry Hub near $3.44/MMBtu in 2026 and $3.31 in 2027, with inventories projected to reach a near-record 3,985 billion cubic feet by the end of October — the highest heading into winter in a decade. The regional pattern is worth watching, though: South Central salt storage fell from 317 Bcf in mid-July to 248 Bcf by August 21 on heavy summer power-sector withdrawals. Diesel, by contrast, is forecast to average $4.80 a gallon in 2026, well above 2025, with Strait of Hormuz constraints persisting. (EIA Short-Term Energy Outlook)

Infrastructure implication: The cheap-gas, expensive-diesel split is the on-site-generation story in miniature. For facilities whose resilience still rests on stored distillate, every avoided generator-hour carries rising value — while efficient, non-combusting on-site generation running on abundant gas looks better on both economics and emissions. But abundant national supply is not immunity from local basis, transportation charges, winter scarcity, or firm-service premiums.

4. All-electric crosses from pilot to operational

Hospital electrification passed a milestone: UCI Health’s Irvine facility is now operating as an all-electric acute-care hospital, and additional systems — including El Camino Health’s proposed $1 billion-plus all-electric replacement in Los Gatos — are advancing all-electric replacement campuses. All-electric hospitals have now earned ENERGY STAR certification in states including Ohio, Colorado, Alabama, California, and Michigan. (HFM Magazine / HCO News)

Infrastructure implication: All-electric has moved from theoretical debate to operational reality — which settles the building question and sharpens the one that remains: not whether to electrify, but where the electrons come from. As this issue’s field notes argue at length, an all-electric building on a strained, gas-at-the-margin grid still has a sourcing problem to solve, and the answer runs through efficiency, storage, and the cleanest achievable on-site generation.

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THE 12-MINUTE DEEP DIVE

The $6 Billion the Grid Spent Standing Still

Six billion dollars. That is what it cost, in the first half of this year alone, to move electricity across the PJM interconnection — not to generate it, not to buy the fuel, but simply to push it through a transmission system that increasingly cannot carry what the market wants to send. Congestion cost, the industry calls it: the premium you pay when the cheapest available power is on the wrong side of a constrained wire and a more expensive plant has to run instead. It rose 43% in a year. And it rose while natural gas — the fuel that sets most of the price — stayed cheap.

Why this is the number that matters

For two years this newsletter has argued that the grid’s binding constraint is no longer how much power can be generated but whether it can be delivered and timed. The PJM congestion figure is that argument rendered in dollars. Generation was not the problem in those constrained corridors around Northern Virginia, Baltimore, and Delaware. The wires were. And the cost of the wires being full did not show up as a fuel bill or a generation shortage — it showed up as $6 billion in congestion, quietly added to what everyone downstream pays. A hospital in one of those corridors paid part of it, whether or not anyone told them that is what it was.

This is the piece that a focus on clean energy alone keeps missing. A renewable energy certificate can make a hospital’s carbon accounting look better. It cannot relieve an overloaded transmission interface, cut a demand charge, provide firm capacity, accelerate an interconnection, or keep the lights on when the grid fails. The physical problem — getting real electrons to a real building at the real moment it needs them — is not something an attribute purchase can solve. And the physical problem is the one now costing billions.

What a hospital can actually do about it

The response that keeps proving out is to reduce the amount of firm grid capacity a building demands in the first place. Not its annual energy — its firm, at-the-peak, must-be-delivered megawatts. A campus that can hold its firm import down through efficiency, heat recovery, thermal storage, batteries, and carefully chosen on-site generation does four things at once: it lowers its utility cost, it reduces the grid infrastructure it requires, it shortens the time to energization, and it improves its resilience. In a congested, capacity-short interconnection, that is not an efficiency play. It is a way of stepping partly out of the very scarcity that is driving the $6 billion.

And the tariffs are beginning to reward exactly this. PJM’s proposed Interim Resource Adequacy Service would expose large new loads that bring no capacity of their own to curtailment ahead of ordinary customers. The distinction between a firm megawatt and a flexible megawatt — long an abstraction — is becoming a difference in price, in availability, and in who gets cut first. A hospital that can shape its own demand is on the right side of that line. A large inflexible load is on the wrong one.

The honest caveat

None of this argues that congestion is a permanent condition or that the grid cannot be built out; it argues that on the timeline of a hospital being designed now, the deliverability constraint is real, priced, and rising. Nor does reducing firm demand eliminate the need for the grid — a hospital remains a grid-connected building that draws power the vast majority of the time. The point is narrower and sturdier: in a system where moving power now costs billions and firm capacity is the scarce thing, the building that asks the grid for less — while generating its remainder as cleanly and efficiently as it can on-site — is both the cheaper building and the more resilient one. The $6 billion is the argument. The response is to need less of what it is pricing.

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U.S. ENERGY MARKETS

• PJM congestion hits ~$6B. Transmission congestion cost roughly $6 billion in 1H2026, up 43% year over year; real-time wholesale costs rose to ~$29.4B from ~$20.4B. The cost of moving power is escalating even where gas is cheap. (Utility Dive / PJM)

• Capacity stays short. PJM’s capacity auction again hit the $325/MW-day cap while falling ~6.8 GW short of its reliability target; its proposed Interim Resource Adequacy Service could curtail capacity-light large loads ahead of ordinary customers from 2027. (PJM)

• Texas load is real and record-setting. ERCOT hit 90,353 MW on August 20, even as speculative data-center load is screened after the governor’s August 3 verification directive. Real growth continues while speculative growth is filtered. (EIA STEO)

• Gas comfortable, diesel elevated. Henry Hub forecast near $3.44 (2026) with record ~3,985 Bcf storage into winter; South Central salt storage drawing down on summer power demand. Diesel forecast ~$4.80/gal in 2026, well above 2025, with Hormuz constraints persisting. (EIA STEO)

• Colorado settles Xcel at ~$157M. The Colorado PUC approved Xcel’s electric increase at about $157 million — down from a $356M request and below the $224.9M settlement — effective August 29, with commissioners flagging concern over utility capital outpacing inflation. (Colorado PUC / Xcel SEC filing)

Infrastructure implication: The through-line: electricity’s delivered cost is now driven by capital and congestion — substations, transmission, capacity — more than by the price of fuel. That is precisely why a hospital lifecycle model should never use today’s retail rate as its base assumption, and why reducing firm grid demand is a hedge against cost and a resilience measure at the same time.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

Beyond the U.S. energy-market story covered above, the region’s week was defined by electrification going operational and cybersecurity tightening into a hard procurement gate.

• All-electric goes live. UCI Health’s Irvine hospital is now operating as an all-electric acute-care facility, and El Camino Health’s ~$1 billion all-electric replacement in Los Gatos (340,000 sq ft, 122 single rooms, 12 ORs, targeted 2032) advances — moving electrification from demonstration to capital-development pathway. (HCO News / Becker’s)

• Adaptive reuse in the Congress city. In New Orleans — host of the October IFHE World Congress — Tulane launched a $500 million project to convert the long-vacant Charity Hospital into a one-million-square-foot biomedical research hub, targeted for 2029. (Regional reporting, 2026)

• Cybersecurity becomes a hard gate. The FDA is enforcing Section 524B with immediate “Refuse to Accept” holds for devices lacking a dynamic Software Bill of Materials covering transitive dependencies or a coordinated vulnerability-disclosure plan to patch within 30 to 90 days — with EU MDR aligning to the same lifecycle standard. (FDA CDRH)

Infrastructure implication: The region’s throughline is that “infrastructure” keeps widening: an all-electric hospital is now an operating fact rather than a thesis, a vacant landmark becomes research capacity through reuse, and a device’s software bill of materials is now a building-procurement gate. Each is a system the facility must design for, not a feature it can bolt on.

2. Spanish-Speaking Americas and the Caribbean

Regional chapters report a surge in retrofitting projects for aging urban infrastructure, with capital focused on seismic resilience and adapting HVAC to prolonged extreme heat. Facing grid instability and rising utility costs, private health networks are investing heavily in distributed solar paired with storage — shaving peaks and cutting reliance on imported diesel for backup. The region also anchors the runway to the first IFHE Latin American Regional Congress in Buenos Aires next April.

PROJECT SPOTLIGHT — São Vicente de Paulo Hospital — Brazil

A 681-bed hospital campus documented a retrofit combining medical-equipment efficiency with rooftop solar photovoltaics — submitted to the IFHE awards program as a worked example of decarbonizing an existing, occupied acute-care facility rather than a new build.

Source: IFHE Awards submission, 2026

Infrastructure implication: The hard problem in healthcare decarbonization is the existing estate, not the new hospital — most of the buildings that will operate in 2050 already stand. A sourced retrofit case that pairs equipment efficiency with on-site generation is exactly the transferable evidence the field needs.

3. Europe and the Middle East

European systems are operating under the revised Energy Performance of Buildings Directive, which pushes public buildings toward zero emissions on an accelerated timetable, while WHO’s European office, after record summer heat, has triggered a wave of chiller-plant retrofits prioritizing grid-independent cooling — a notable shift from the historical focus on winter heating resilience. On governance, IFHE-EU completed its own standing orders and established financial autonomy under IFHE’s Swiss framework, and set its next European Congress for Baden, Switzerland, May 12–14, 2027.

Infrastructure implication: Europe’s pairing of an accelerated zero-emissions mandate with a sudden turn toward cooling resilience captures the whole tension of the moment: decarbonize faster, and stay operable through heat that the old designs never anticipated. The grid-independent chiller plant — cooling that survives when the grid does not — is where those two imperatives meet.

4. Africa

Across the continent, microgrid energy-storage systems — solar paired with heavy battery capacity and smart controllers — are accelerating as the primary alternative to diesel-only backup, which remains exposed to fuel-price and supply-chain volatility. Procurement is standardizing around durable, low-energy medical equipment designed for off-grid and weak-grid environments, so that critical care continues when main power fails.

PROJECT SPOTLIGHT — Kigutu — Village Health Works, Burundi

The Kigutu solar microgrid documents continuous power across operating theatres, neonatal and maternity care, emergency services, laboratory, radiology, wards, medicine refrigeration, sterilization, water supply, and communications — with instantaneous battery support removing the interruption that patients previously experienced while generators started. Recognized through the IFHE awards program.

Source: IFHE Awards submission, 2026

Infrastructure implication: This is engineering as a clinical-enabling platform: in a low-resource setting, the difference between a generator’s start-up gap and instantaneous battery support is measured in patient safety. It is among the clearest demonstrations anywhere that resilience, decarbonization, and continuity of care are one design problem.

5. Asia-Pacific

Rapid healthcare expansion continues across Southeast Asia to meet growing demand, with capital deployed toward specialized tropical-disease research and high-acuity oncology hubs. On the engineering side, regional ministries are localizing international frameworks such as ASHRAE 170 and 90.1 into local codes, with particular focus on extreme-efficiency dehumidification and cooling that can hold stringent infection-control conditions in hot, humid climates without breaking the energy budget. Japan continues to anchor the region’s benchmarking, and will deliver a country presentation at the New Orleans Congress.

Infrastructure implication: The Asia-Pacific problem — infection-grade air control in tropical heat and humidity at an affordable energy cost — is a preview of a challenge that warming will push into more temperate regions. The dehumidification and cooling efficiency being worked out there is likely to travel.

IFHE GLOBAL CONNECTION

New Orleans comes into focus

The 29th IFHE World Congress, October 17–20 in New Orleans, is moving from promotion to detailed delivery. Hosted through AMFP — the United States IFHE member organization — and co-located with the Healthcare Design Conference + Expo, the current program describes roughly thirty IFHE sessions spanning infrastructure and trust, standardization and flexibility, distributed care, future-ready campuses, Latin American resilience, WHO Téchne and infection prevention, facility security, equipment as infrastructure, modern operating rooms, AI and integration, a Japanese country presentation, the International Building Awards, and a hospital tour, alongside shared keynotes, an IFHE Pavilion, and continuing-education credit. Member associations should be confirming delegations and travel now.

Governance ahead of the Congress

An Extraordinary Council Meeting is set for October 9, held virtually, to confirm the Executive Committee election and to consider revised Statutes and Standing Orders, ahead of the in-person Council meeting on October 17. A-members are reminded that Annual Membership Reports are due — and, structured consistently, those reports could become far more than administrative paperwork: a standing, federation-wide picture of national activity, projects, codes, and needs that the federation has never had in one place.

Awards as a knowledge base

This year’s IFHE International Building Award and Global Carbon Challenge submissions are moving toward Congress presentation, and the entry set — from the Arthur J.E. Child Comprehensive Cancer Centre to the Kigutu solar microgrid in Burundi to the São Vicente de Paulo retrofit in Brazil — is best treated not as a judging packet but as a reusable evidence base: case studies, benchmarks, and a global project atlas the whole membership can learn from. Separately, IFHE-EU’s completed governance reset, and its 2027 European Congress in Baden, offer a working model of regional autonomy under common federation governance that the Americas, Africa, and Asia-Pacific regions may find instructive.

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IFHE GLOBAL EVENTS CALENDAR

September 2026

• September — IFHE monthly webinar (see IFHE.info for schedule)

• September 20–22 — CHES National Conference, St. John’s, Newfoundland (+ Canadian Healthcare Construction Course, Sept 23–24)

• September 30–October 1 — Healthcare Engineering Conference, Gelsenkirchen, Germany (FKT)

October 2026

• October 9 — IFHE Extraordinary Council Meeting (virtual) (ifhe.info)

• October 13–14 — Healthcare Estates 2026, IHEEM (UK, external)

• October 17–20 — 29th IFHE World Congress, New Orleans, co-located with Healthcare Design Conference + Expo (hcdexpo.com/ifhe2026)

November 2026 and beyond

• November 12–13 — NZIHE International Conference, Auckland

• November 16–18 — IHEA National Symposium, Fremantle, Western Australia

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

• May 12–14, 2027 — IFHE-EU European Congress, Baden, Switzerland

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

If this resonated, consider restacking it — it helps another engineer or facility person find the Pulse.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 24 • Week Ending August 23, 2026 • Walt Vernon

FROM THE FIELD — PAPER ENGINEERING LION, PART 13

A running account of engineering a hospital energy system in real time

This will be, I think, my next-to-last Paper Lion episode for this particular project.

When I started, I think I said that we had been given the mission to explore a range of options for our UCH design. The project is moving very fast, much faster than most projects. Our deadline was yesterday. We did it.

But, for this week, I am going to hold you in suspense pending a couple of finishing-touches issues. But we did it. One of my Mazzetti colleagues told me that she never thought we could do it. I always knew that we could. But today, I want to talk about a few other issues that we have been dealing with in the same project.

I have written in the past about the Kaiser Small Hospital, Big Idea Competition. This initiative was undertaken when Kaiser was trying to rethink the model of delivering healthcare. Their thesis, at the time, was that they had figured out how to optimize care in a 200-bed community hospital with all the needed ancillary support. But they were thinking that maybe the future was not more 200-bed hospitals, but, obviously, small hospitals. So Kaiser issued a worldwide competition. I no longer remember all the details, but I think they had something like 435 entries from designers all over the world.

At the time, all of the Mazzetti principals were trying to strategize: should we try to team with a lot of architects? Should we team with only one? What was our best chance? People who know me won’t be surprised that I rejected the idea of trying to get onto somebody else’s team. Instead, I created ten entries for Mazzetti. For each, I used a different theme. And I went out and recruited architects to be on OUR team.

What was unique about that project was that the one of our ten entries that was named a finalist was focused on sustainability. Of course, we had to build so much more into it, and it was a fascinating experience on so many levels. But what was most special about it was that it was an opportunity to bring together all of the great ideas that we had been developing, and experimenting with, inside Mazzetti. And, a special nod to the brilliant designers at Perkins + Will, especially Robin Guenther and Michael Bardin, who were the perfect teammates and architects for the project.

In so many projects, the momentum of codes, of a schedule, of budgets, and most of all, the way we always do it, kills creativity. I have heard that it takes something like 14 years for innovation to move from the benchtop to the bedside in healthcare. I think, for healthcare buildings, it can be much, much more.

So SHBI was a chance to build a virtual hospital that brought together all of the creativity we had developed, and to focus it into a single vision for what could be. The promise of the competition was that the winner would be given the opportunity to actually build the envisioned design, so it was particularly exciting.

We did win, though it was a tie. Interestingly, we tied with a computer programming company, in a way. I well remember some of my Kaiser friends who were part of the effort celebrating the fact that it was not an architect, but an engineering company and a software company, that won. But neither of us was given the chance to build that hospital; Kaiser decided to go a different direction strategically.

I always remembered that project, and, as long as I have been at Mazzetti, I have thought about how we might try to make THAT vision the template we worked from. So often, I see designers more or less repeat what they have done over and over before. I heard one of my hospital facility friends describe our industry as a cut-and-paste industry.

There is reason for this, of course. Budgets are tight. Schedules are tight. Clients want what they know. Innovation creates risk and is often more difficult to implement. Often it takes more time and more money and certainly more work than just doing the same thing over and over. Doing something new is not a good business model. And yet it is the model I have always tried to follow, because I always know that we can, in fact, do better. And I have always felt that we owe it to each other, and to those who come after us, to find those better ways.

So SHBI never came to fruition.

After our Big Room meeting yesterday, we celebrated having done it, with a beer at a local pub. One of the younger Mazzetti engineers mused that, at the beginning of our UCH project, I had challenged the team to make this project, in essence, SHBI: The Next Generation. That is, rather than starting with the last project we did and projecting its successes forward, why not start with the idea that we will incorporate every advancement and good idea we have into an expression of who, in some sense, we hope to be. She was amazed, she said, because this project has become exactly that.

We talked about how interesting it was, as engineers, to be part of a team that is so open to new ideas. Here, for the record, is what “better” actually looks like on this project — a number of the things we are considering, or have already brought into the project scope. I should say plainly: we did not invent all of these. Many we learned from others, generous enough to share what they had figured out — as our friends at Providence shared theirs. That is rather the point.

• Heat recovery chillers (more or less a standard of care these days);

• Phase-change material for supplemental heating and cooling;

• Thanks to our pioneering friends at Providence, especially Geoff Glass, eliminating the need for a piped nitrous oxide system, at significant savings;

• Use of the new demand factors in the NEC for medical equipment, and its likely impact on overall electrical system sizing;

• Use of the new sizing criteria in the NEC, and its likely impact on electrical system sizing;

• Use of the new microgrid elements of the NEC, and possible application to distributed energy generation and storage;

• Exploring the possibility of a hydrogen fuel cell demonstration;

• An all-electric kitchen;

• All-electric sterilization;

• All-electric humidification;

• Eliminating hot water at handwash sinks;

• Eliminating isolated power systems;

• Considering the use of wireless light switches;

• A system for monitoring and reporting the status of large medical equipment, to reduce its energy consumption;

• Vacuum plumbing;

• Dynamic Gas Scavenging System (DGSS) valves;

• Air quality monitors for infection prevention;

• Ventilation setbacks;

• A wide range of greywater strategies, though probably not rainwater harvesting, due to Colorado water-rights law.

It has been a while since I have been part of a hospital design team. It has really been fun to work with this group, and to see the excitement of people thinking about how to truly be better. I wrote before about the CEO of this hospital. In our kickoff meeting, he challenged us, saying he wanted this project to be a legacy.

It looks like it will.

And one more, rather personal, reflection. I remember, often during SHBI, having to really push the team. Sometimes they thought we were good enough, and I knew we could do better. In some ways, I recognized myself doing exactly the same, this time around. These brilliant engineers were so fun to work with, and so capable, and they are truly creating something that will, I think, be special for this owner, this community, and this world.

When my colleague reminded me that I had challenged this team to make this the best project we had all ever done, I realized that she heard that. When I think, now, about a legacy that I hope this project will leave, it is not a list of 19 cool ideas — though I hope that all designers steal them and use them everywhere possible; the world will be better for it. I hope that the legacy these folks carry will be that we can all do better than being a cut-and-paste industry. We can always be pushing the boundaries of what is possible, and what is better. We can always try to build teams with that collective spirit. And even when we think we have done it well, we can almost always do better.

Legacy.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. The grid problem now has a customer-side answer

Two developments this week, on opposite coasts, define the same emerging strategy. In New York, Con Edison said it expects to bring 28 additional substations into service by 2035 as heating, transportation, and building electrification drive load growth — a concrete reminder that the cost of electrifying a hospital is not just gas equipment traded for electric equipment, but generation, transmission, substations, feeders, and service capacity. In California, CAISO advanced a proposal that would let behind-the-meter batteries and other distributed resources be counted as real grid resources, with advocates estimating it could unlock more than two gigawatts of additional participation.

Sources: Utility Dive — ConEd 28 substations • CAISO DDEMI

Infrastructure implication: Read together, these say the grid constraint has a customer-side answer. New York shows how much physical infrastructure electrification demands; California is building the mechanism that lets a hospital’s own battery reduce that demand. The design objective is no longer simply “electrify the hospital.” It is: electrify it while minimizing the new firm grid infrastructure it requires — which improves economics, resilience, speed-to-power, and carbon at the same time.

2. Diesel snapped right back up

Any impression that diesel was easing has been erased. The EIA’s August 17 survey put on-highway diesel at $5.454 a gallon, up nearly 20 cents in a single week and about $1.74 above a year ago, with California over $6.75. Global inventories remain below the five-year minimum, and the near-term outlook still carries Strait of Hormuz transit risk. Last week’s dip was noise, not a trend. (EIA Gasoline & Diesel Update)

Infrastructure implication: Diesel volatility is now itself a design input. A facility whose emergency power depends on distillate should model a wide band — $4, $6, $8 a gallon, plus delivery scarcity — not a single figure, and should recognize that every hour a generator can avoid running carries rising economic value. It is the clearest argument yet for storage and non-combustion on-site generation that reduce fuel-logistics dependence.

3. Batteries are becoming ordinary infrastructure

U.S. battery capacity has grown at an average rate of roughly 70% a year over the last three years, according to the EIA — the point at which a technology stops being a special project and becomes standard infrastructure. Reinforcing that, Con Edison’s revised Bring-Your-Own-Battery demand-response tariff took effect August 14, and rising outage costs are steadily improving storage economics. (EIA)

Infrastructure implication: For healthcare, this should change procurement thinking. Battery pricing, controls architecture, fire protection, interconnection, and lifecycle replacement belong in standard campus master planning now, not in a specialty study. A resilience battery a hospital installs anyway can increasingly stack value — demand reduction, capacity, demand-response revenue — provided its state-of-charge reserve for emergencies is protected and not dispatched away for economics.

4. A hospital rebuilt above the flood

In Tennessee, Ballad Health broke ground on a $44 million replacement for Unicoi County Hospital — the facility destroyed by catastrophic flooding during Hurricane Helene two years ago. The replacement is being built roughly five feet above the 500-year floodplain, so it can keep operating through future extreme weather. (WGRV)

Infrastructure implication: This is climate adaptation made literal: a hospital rebuilt higher because the old one drowned. It belongs to the same lesson running through this year — design for the conditions the data now shows, not the ones the codes were written around — and it is the physical counterpart to the resilience arguments that fill the rest of this issue.

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THE 12-MINUTE DEEP DIVE

Electrify the Hospital — Without Building It a New Grid

The last two years of this newsletter have circled one idea: the electricity grid’s binding constraint is no longer how much power can be generated, but whether it can be delivered and timed. This week the story turned a corner, from diagnosing that constraint to answering it — and the answer lives on the customer’s side of the meter.

The bill for electrifying is bigger than the equipment

Start with what New York made concrete. Con Edison expects to add 28 substations by 2035, because electrification — heat pumps, electric vehicles, all-electric buildings — is driving load faster than the existing distribution system can carry it. For a hospital, this reframes the cost of electrification entirely. Replacing a gas boiler with a heat pump is the visible part. The invisible part is that the all-electric hospital may request materially more electrical service than the building it replaced, and that request ripples upstream into feeders, substations, and transmission that someone has to build and someone has to pay for. An electrification plan that budgets only for equipment has budgeted for the wrong thing.

And the timing of that upstream capacity is no longer guaranteed. Across the country, interconnection queues run five to seven years and large transformers carry lead times beyond 160 weeks. A hospital that assumes it can simply request more firm capacity, late in design, may find the capacity is available on paper and undeliverable on schedule. Firm grid capacity has become a scarce, slow, expensive thing — which changes what a smart building should ask of it.

The move: ask the grid for less

Here is the shift. If firm grid capacity is scarce and expensive, then reducing the amount of it a hospital must request is worth real money and real schedule — not someday, but at the moment the service is designed. A 15-megawatt all-electric hospital that can hold its firm winter demand to 11 megawatts, using thermal storage, heat recovery, and flexible heating equipment, may avoid triggering a service upgrade, a substation contribution, or a multi-year wait. The reduction is not merely an energy-bill saving. It is a capacity and schedule asset.

This is why the tools that shift and store energy are being repriced. Evaluated only against time-of-use arbitrage, a battery or a chilled-water tank looks like a modest hedge. Evaluated against the cost and delay of the grid infrastructure it lets a hospital avoid, the same asset looks entirely different. California’s move to let behind-the-meter batteries count as grid resources, and Con Edison’s Bring-Your-Own-Battery tariff, are early versions of the market catching up to that logic: the customer’s own equipment, properly recognized, can reduce the infrastructure the utility would otherwise have to build. New York is demonstrating the size of the electrification bill; California is building the mechanism to shrink it.

Thermal storage deserves a seat at this table

One point gets missed in the enthusiasm for batteries: electrical storage is not the only way to reduce firm megawatts, and often not the best. For a hospital, chilled-water or phase-change thermal storage can shift several megawatts of cooling or heating load, provide longer duration than a battery of comparable cost, and carry lower fire and lifecycle complexity. Whenever utility capacity is the binding constraint, thermal storage should be screened side by side with batteries, not treated as an afterthought. The goal is not to install a particular technology; it is to reduce the firm capacity the building asks the grid to guarantee, by whatever combination does it best.

A hierarchy, not a slogan

None of this argues against electrification. The building must be all-electric; anything else locks in decades of combustion. The argument is about how to source and shape the electricity so that an all-electric hospital does not simply transfer its problem onto a strained grid. The order of operations matters: efficiency first, then heat recovery, then reducing firm megawatts through storage and flexible load, then appropriate on-site generation for resilience, then clean procurement for the remainder, with renewable energy certificates last. Certificates have their place, but they cannot reduce a substation requirement, shorten an interconnection queue, lower a demand charge, or keep the lights on in an outage. Physical demand management comes first; attributes follow.

Put it on the basis-of-design sheet as its own line, next to connected load and emergency-system load: required firm utility capacity. Then compare the options — twenty megawatts of firm service, versus fifteen firm plus five of storage, versus twelve firm plus eight of flexible and on-site capacity — on cost, energization date, reliability, lifecycle, and carbon. That comparison now deserves the same design attention as transformer voltage or generator topology. The objective, stated plainly: do not just electrify the hospital. Electrify it while asking the grid for as little new infrastructure as possible. Done well, that single discipline improves economics, resilience, speed-to-power, and decarbonization at once.

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U.S. ENERGY MARKETS

• Diesel back near records. On-highway diesel rose to $5.454/gal in the August 17 EIA survey — up ~20 cents in a week and ~$1.74 year over year, with California over $6.75. Global inventories remain below the five-year minimum. (EIA)

• Batteries scale ~70%/year. U.S. battery capacity has grown roughly 70% annually over three years, moving storage from special project to standard grid infrastructure — with new state procurement mandates and factory investment reinforcing the trend. (EIA)

• Gas cushion is thinning. Working gas reached 3,169 Bcf as of August 14 — 6.2% above the five-year average but only 0.9% above last year — and the weekly injection was just 16 Bcf as summer demand ate into the surplus. Henry Hub is forecast near $3.44 in 2026, but today’s cheap gas is a near-term scenario, not a 20-year assumption. (EIA)

• PG&E rate pressure compounds. PG&E’s 2027 general rate case requests $16.637 billion, an 8% increase, with 6.1% escalation sought for each of 2028–30; the Public Advocates Office estimates outside proceedings could push average bills ~16% higher in 2027 and ~30% by 2030. Its five-year capital program runs to about $73 billion. (Utility Dive)

• Colorado confirms it’s capital, not commodity. Xcel’s Colorado electric case settled near a $225 million base increase, but the strategic number is its $60 billion 2026–30 investment program — transmission, generation, storage, and wildfire mitigation — the real driver of rate escalation. (Utility Dive)

• Planned capacity isn’t delivered capacity. Xcel asked the Colorado Supreme Court to intervene in a land-rights dispute blocking interconnection of two nearly complete wind projects totaling more than a gigawatt — a reminder that generation which is physically finished can still be stranded by easements and permitting. (Utility Dive)

Infrastructure implication: The through-line: rate escalation is increasingly driven by system capital — substations, transmission, wildfire hardening — not by the price of energy. That is precisely why a hospital lifecycle model should never use today’s retail rate as its base assumption, and why reducing firm grid demand is now a hedge against cost as much as a resilience measure.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

The U.S. grid and rate story dominates and is covered above. Three developments round out the region.

• Clinical evidence for energy setbacks. Cleveland Clinic researchers reported that reducing air-change rates in unoccupied operating rooms produced substantial energy savings with no observed association with higher surgical-site infection, mortality, or ICU admission — the clinical counterpart to the recent ASHRAE 90.1 addendum permitting unoccupied OR setbacks. The code lever and the safety evidence have now arrived together. (Cleveland Clinic)

• Cyber recovery as infrastructure. A UC San Diego project demonstrated a rapidly deployable “hospital IT system in a box” — satellite connectivity, private 5G, servers, and essential clinical apps — that restored digital operations for a 20-bed emergency department in 42 minutes in a ransomware-recovery test. It reframes cyber recovery as an infrastructure-resilience problem alongside power and water. (UC San Diego)

• Generative AI becomes a device question. The FDA published a discussion paper seeking feedback on regulating generative-AI-enabled medical devices — models that change after purchase, run in the cloud, and drift — which for hospitals is simultaneously a biomedical, IT, procurement, and risk-governance problem. (FDA)

Infrastructure implication: Taken together, the region’s week says the boundary of “infrastructure” keeps expanding: an unoccupied-OR setback is now an evidence-based energy strategy, cyber recovery is a resilience system, and a generative-AI model is becoming a piece of regulated clinical equipment the building must support and secure.

2. Spanish-Speaking Americas and the Caribbean

Brazil hosted the region’s marquee event as ABDEH’s XI Brazilian Congress for the Development of the Hospital Building concluded in Brasília, under the theme of healthcare infrastructure for the future — convergences between technology, sustainability, and longevity. Its final sessions ranged across hospital-building resilience, Brazil’s first palliative-care hospital, revised ICU minimum standards, and healthcare-asset management, and it deepened IFHE’s Americas relationships ahead of the first IFHE Latin American Regional Congress in Buenos Aires next April.

PROJECT SPOTLIGHT — Direct-Drive Solar Cold Chain

Across rural clinics in the Colombian Andes and Brazilian Amazon, procurement continues to standardize around direct-drive solar refrigerators that store cooling in phase-change ice-lining rather than chemical batteries, holding vaccine temperatures through multi-day outages without the maintenance burden of battery banks.

Source: Regional engineering reporting, 2026

Infrastructure implication: Storing the cooling itself rather than the electricity to make it removes the most failure-prone component of a rural electrification project — the same principle, at clinic scale, that makes thermal storage attractive in a large hospital.

3. Europe and the Middle East

European engineering societies continued their turn from heat response toward heat-resilient design, with WHO’s European office emphasizing grid-independent chiller-plant operation to prevent the cascading clinical and IT failures that overheating triggers. The United Kingdom’s New Hospital Programme advanced its “Hospital 2.0” standardization effort, with 11 standardized hospital-scheme partnerships — an approach worth watching for whether design standardization preserves enough local flexibility for site-specific resilience.

PROJECT SPOTLIGHT — The “Waterless” Central Utility Plant

Interest continues to grow in closed-loop, air-cooled central plants that eliminate cooling towers to achieve net-zero water for HVAC. The design trades a modest amount of efficiency for independence from municipal water and the associated Legionella-management burden — a trade increasingly attractive as drought and waterborne-pathogen risk rise together.

Source: Facilities engineering reporting, 2026

Infrastructure implication: Where thermal storage can shift the cooling load, an air-cooled plant can also cut the water dependency — two different routes to the same resilience goal of a hospital that keeps cooling even when a utility, electric or water, falls short.

4. Africa

Africa produced two stories at opposite ends of scale this week, and together they capture the continent’s dual reality. At the national level, Kenya’s Ministry of Health announced a roughly KES 29 billion program to build 13 new county referral hospitals and ten specialized maternal-and-newborn facilities, financed through a blend of government, development-partner, and private capital tied to universal health coverage. At the facility level, the lesson remains that financing structure, not hardware, decides whether electrification lasts.

• Kenya’s private facilities go solar. In parallel with the public buildout, a private-sector program is installing solar across 780 healthcare facilities using lease-to-own and power-purchase financing that requires no upfront capital, with installation running September through December and an expected 40–60% cut in electricity costs. (Business Daily Africa)

PROJECT SPOTLIGHT — Liberia — Bong Mines Hospital

Bong Mines Hospital dedicated a new solar-powered water system alongside an incinerator, linking reliable water, waste management, and infection prevention in a single low-resource resilience upgrade — a reminder that at many facilities, water and waste are the infrastructure that most directly determines whether care can continue.

Source: Liberia Ministry of Health, August 2026

Infrastructure implication: Where a billion-dollar hospital worries about firm megawatts, a rural facility’s resilience often turns on whether it has clean water and safe waste handling at all. Both are infrastructure problems; only the scale differs.

5. Asia-Pacific

Australia posted an unusually deep capital pipeline. New South Wales approved the roughly A$2 billion Bankstown Hospital — the state’s largest-ever public-hospital investment — and appointed a contractor under an Early Contractor Involvement model, bringing construction expertise in before the design is frozen to de-risk constructability, commissioning, and utility sizing. Further projects at Manning, Redcliffe, Bundaberg, and Mandurah round out the pipeline. Japan, meanwhile, continued to set the region’s performance benchmark, with HEAJ site visits to high-efficiency facilities including the ZEB-Ready Odawara medical center.

Infrastructure implication: The Early Contractor Involvement model at Bankstown is quietly important: bringing the builder in before design freeze is one of the few structural fixes for the constructability and commissioning failures that so often undermine a hospital’s energy performance in practice. It is a procurement answer to a technical problem — exactly the kind of cross-disciplinary move healthcare infrastructure needs more of.

IFHE GLOBAL CONNECTION

A governance milestone ahead of New Orleans

IFHE has called an Extraordinary Council Meeting, to be held virtually on October 9, to confirm the Executive Committee election and to consider revised Statutes and Standing Orders, in preparation for the in-person Council meeting at the World Congress. It is a housekeeping-and-governance milestone of the kind that keeps an international federation healthy, and it sets the stage for New Orleans. Member associations are reminded that annual membership reports are due, and that delegate registration and visa arrangements deserve attention now.

Measured performance, and the archive

With the August webinar on hospital energy performance now concluded — anchored by Cortellucci Vaughan Hospital and its roughly 90 kBtu/sf performance in a cold climate — the most useful next step is to turn a single event into durable knowledge: a short technical summary of actual-versus-design performance, and a challenge worth adopting federation-wide, namely that every new hospital ought to be able to disclose its measured energy use three years after opening. IFHE’s webinar archive, now well over a hundred sessions, remains a professional-development library best organized around the problems members face rather than by date.

Brazil, Congress, and the Carbon Challenge

ABDEH’s XI Congress in Brasília has concluded, deepening IFHE’s Americas engagement. Ahead lies the 29th IFHE World Congress, October 17–20 in New Orleans, hosted through AMFP and co-located with the Healthcare Design Conference + Expo. And IFHE’s Global Carbon Challenge returns for 2026, recognizing facilities that achieve measured reductions in energy use and carbon intensity — a program whose past winners have spanned hospitals and non-hospital facilities across several countries. Members planning to enter should begin assembling their measured data now.

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A personal note — and an apology to my friends in the IFHE Latin America region

I owe the region a word. I was to attend the ABDEH meeting in Brasília, and I had planned for it all year, cancelling other commitments so I could be there. The road to it was already an adventure — a passport too old to travel on, then a ten-year visa that turned out to be tied to that old passport, and, as I set out on the bus from Hanover to Boston, still no visa in hand and an airline telling me I could not board without it. Literally as we pulled into Boston, the email arrived from Brazil; a very kind airline attendant printed it from her own account and sent me on my way. I was so relieved. I was to be part of the opening session, to speak the next day on global energy and climate developments and how our members can be positive actors in them, to record a podcast, and to join the in-person meeting of the IFHE Latin America region.

Then, in Newark, I learned the plane to São Paulo had a mechanical problem and was cancelled. I could not have reached Brasília until the small hours of the morning I was to speak. So, with real sadness, I had to call my friend Fábio and tell him I would not make it. With his usual grace — he is, among other things, a patient and gentle coach as I try to learn Portuguese — he told me not to worry, that they would be fine, and that there would be more chances. I am looking forward to them.

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IFHE GLOBAL EVENTS CALENDAR

August–September 2026

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway

• September 2 — IHEA Queensland Regional Professional Development Day, Cairns Hospital

• September 20–22 — CHES National Conference, St. John’s, Newfoundland (+ Canadian Healthcare Construction Course, Sept 23–24)

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria

• September 30–October 1 — Healthcare Engineering Conference, Gelsenkirchen, Germany (FKT)

October 2026

• October 9 — IFHE Extraordinary Council Meeting (virtual) (ifhe.info)

• October 13–14 — Healthcare Estates 2026, IHEEM (UK, external)

• October 17–20 — 29th IFHE World Congress, New Orleans, co-located with Healthcare Design Conference + Expo (hcdexpo.com/ifhe2026)

November 2026 and beyond

• November 12–13 — NZIHE International Conference, Auckland

• November 16–18 — IHEA National Symposium, Fremantle, Western Australia

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

My wife and I just finished reading Roots – great book in so many ways. But I miss it, and I’ve been looking for the next thing. Last night, in an airport (mourning the fact that my flight to Brazil was cancelled so I could not follow through on my commitment of support for the IFHE chapters gathering there), I stumbled on the book, Franklin’s Stove. I had heard of this book, and the reviews had intrigued me. So, I picked it up, and started to read. It immediately thrilled me. It is the story of a great inventor (in my mind, my son is named at least partly for Benjamin Franklin) and his investigations of an engineering problem in what we would call today HVAC – how to more efficiently, more cleanly, heat indoor spaces. (Imagine the relief I felt when the person who is now my wife told me she kind of likes nerds.)

It is also the story of changing human interactions with their changing climate. At the time, the issue of the day was the Little Ice Age, and the need to escape from open, smoky, wood-burning fireplaces. The perception that forests were not infinite was on their minds, but they accelerated the Industrial Revolution’s technological paradigm of burning things to release useful energy. They were both figuring out how to live through their climate change challenges even as they accelerated ours. And, as the author says in her introduction, “If the stoves were hypotheses about inventing a way out of a climate crisis, their story shows that surviving climate change is not just a technical problem; there is no magic bullet. Climate change is a social and political problem, one with a much bigger history.”

Our work today is another chapter in that bigger history, and I look forward to reading the book, learning the lessons, and trying to do better.

This week, two important policy events that are part of that story.

I serve on Code Making Panel 15 of NFPA 70, the National Electrical Code. My old friend and mentor, Hugh Nash, first helped me obtain a seat on this important committee. A couple of cycles ago, we created the idea of a “healthcare microgrid.” The idea was that, like so much else in the world of healthcare buildings, a microgrid that serves a healthcare building is not the same as a microgrid that served other kinds of buildings. The reasons are clear. Most buildings are designed to evacuate people on the occurrence of some emergency or other. Hospitals, and, increasingly, outpatient buildings (as we are able to move more and more intensive procedures out of the hospital) require a different ethic; that of defending in place. So, rather than having enough energy on site to allow orderly evacuation, the healthcare building must have sufficient resources to enable continued operation for a reasonable time. The idea is that we must be orderly in the way we shut down procedures; we must continue to care for the people too sick to move; we must provide a safe haven for the community when all else fails. The hospital is in so many ways, a sacred kind of space. And so, its energy systems must be different and must ensure this continued service.

In previous versions of the NEC, and its cousin, NFPA 99, the Health Care Code, we are largely silent on the requirements for a healthcare microgrid. We note simply that it is one way to supply power to the Essential Electrical System. As I have worked with design teams at Mazzetti on Kaiser Richmond, Kaiser Ontario, Valley Children’s Hospital, Village Health Works, and now, UCHealth, some of the things that are important to ensuring microgrid effectiveness are becoming increasingly apparent. But also apparent, are some new opportunities created by this new concept for providing energy for these critical buildings.

What I find is that the idea of these opportunities are really quite as foreign to the current design and construction community as the idea of burning coal was to Franklin’s contemporaries. Helping people make the conceptual leap to what is possible, from what is totally outside their experience, is a very difficult proposition. One, I fear, I will lose. At least in this round. Right now, we are struggling with the somewhat arcane distinction between what is a performance requirement, and therefore the purview of NFPA 99, and what is an installation requirement, and therefore the purview of NFPA 70. This chapter of the story will evolve over the next several weeks. Stay tuned.

The other interesting happening was the acceptance, by the ASHRAE 189.3 committee, for the issuance of proposed Chapter 12, for that document. I have written before about ASHRAE 189.3. It is the healthcare section of the International Green Construction Code.

Our new chapter does two important things.

First, th4e chapter is doing what we are now doing for UCHealth. Historically, engineering has looked at energy systems somewhat in silos – thermal and ventilation systems; water, sewage and gas systems; and electrical systems. Thus, the norms and the standards for resilience are isolated from one another by both practice, expertise, and regulations. It became clear to me years ago that this paradigm forced us into suboptimal solutions. I actually give credit for this idea to my friend Travis English from Kaiser Permanente, who asked me once why a microgrid could not also include thermal energy storage.

Why indeed?

What 189.3 does, is to start a very early answer to Travis’ question. Historically, our solution to resilience needs has been – more diesel generators, or more diesel or propane fuel stored on site to generate needed electricity or heat. We have relied on trucks from outside to bring us more oxygen and other medical gasses. We have relied to other trucks to take away our massive waste streams. The answer that SHBI, and the Shark Tank (SHBI II), and the healthcare microgrid, and UCH, and now ASHRAE 189.3 start to answer is, how can we better build resilience into our buildings – and, do it in a way that does not make our climate worse. The essence of the chapter is a requirement to derive at least 25% of the on-site energy resilience systems from non-combustion sources, including thermal storage, ability to operate using passive forces, ability to flex with weather and generate on site. It does recognize fuel cells using methane as a bridging strategy – the debate now underway at UCH. It is trying to force us to think about building resilience and decarbonization in new ways, in integrated ways, and in ways that much more creative than just another diesel.

The second thing it does, and this is qualitatively quite different, is to create requirements for resilience. My old friend Robin Guenther worked on a commission after the Hurricane Sandy disaster. She told me that one of the things that happened was that, because we have pushed so much care outside of the hospital, we created inadvertent resilience problems. The example I wont forget – the dialysis centers after Sandy did not have resilience built into their infrastructure. And so, after the hurricane, many many people were deprived of needed dialysis services. Where else could they go? They went, desperate, to the now overloaded hospitals. Remember, too, the nursing homes in Florida after hurricanes or Texas, during the freeze.

So, the 189.3 chapter suggests some resilience requirements for some hospital and some non-hospital buildings. It suggests ways that we can prepare for the increasingly frequent, and increasingly ferocious severe weather events that we are experiencing during our chapter of the changing climate. These measures are targeted at helping to keep people out of overloaded hospitals during disasters, by keeping open the dialysis and other critical facilities. It also takes lessons from Phoenix Arizona and other places and encourages the creation of places of heat- and freeze-refuges, to help people to withstand temperature extremes they cannot otherwise escape; and, thus, stay out of the heat. All of this is predicated on risk assessments that the particular facility can conduct, as required by FGI.

Not many jurisdictions have yet adopted the IGCC. I am sure that some people will not like the idea of requiring even more of our beleaguered healthcare system.

As I have written before, we, in America, seem to not value the idea of investing in social services. Instead, we make our healthcare system the de facto social safety net, by thrusting upon it all of the collected miseries we otherwise refuse to fund.

There is no magic bullet. “Climate change is a social and political problem, one with a much bigger history.”

Let us write our chapter well.

These documents will be out for public comment soon.

Help.

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 23 • Week Ending August 16, 2026 • Walt Vernon

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FROM THE FIELD — PAPER ENGINEERING LION, PART 12

A running account of engineering a hospital energy system in real time

This has been an interesting week, in the life of the UCH project!

I.

I will start with what may seem a side issue, but today, is not; WATER.

A week ago, in our Big Room meeting, the permit fees for a water connection for the project were discussed. I won’t disclose the numbers, but suffice it to say that they are huge.

This makes sense of course; this part of Colorado is essentially a high desert. And, if you follow the news, you will have heard about the fact that the western US is in the midst of the worst drought in at least the last 1200 years. The states that depend on the Colorado and Rio Grande rivers for water are facing drastic cuts in water, and this is causing tremendous problems. Last year was among the driest and warmest for snowpack Colorado has recorded. We have no choice but to adapt; the drought is here, and this building must survive it. But every clinician knows that treating the symptom while ignoring the cause is how you lose a patient. Adaptation is the ICU; mitigation is prevention and the first principle of medicine applies to infrastructure too: it is better, and far cheaper, to prevent the disease than to treat it forever. If the conditions we are now designing around are being driven, even in part, by what we build and how we power it and the evidence for that is strong then those of us who shape the built environment are not only victims of this change. We are also, unavoidably, among its causes. Which means we are also among its cures. I do not find that discouraging. It is the most hopeful fact in the whole picture: the same hands that helped make the problem can help unmake it.

The reason this is significant for the UCH project is that a conventional design, and some of our potential strategies (we are now down to a code minimum and three alternatives) consume a lot of water. Because Colorado is dry, it’s a highly energy efficient solution to use evaporative cooling when we need cooling. But its also highly water INefficient.

And so, this week, we are studying the impact of water consumption of the options still in play, and how implementing them would change the economics of the project. Interestingly, in this particular locale, the fees to connect to the water system are enormous. But, once you are connected, the fees to actually take water from the system are quite low. That first part makes sense to me, but not the latter part.

At any rate, one of the solutions we are pursuing is to use a phase change material, as I discussed in previous posts, to serve as a thermal battery and thus, provide needed thermal peaking, both heat and cold. (This reminds me of a joke told to me many years ago by an old mechanical engineer about a thermos; it keeps things hot, and it keeps things cold; how does it know?) This particular option does not rely on evaporation, and so, it is highly attractive from a water consumption – and permitting – perspective. It has not been done, so far as we can tell, in a hospital, but the physics are simple, and it has been done in other locations. This particular option is high on our list.

A second option we launched with respect to water this week was reuse. We had previously determined that municipal reclaimed water was too expensive to bring to the site, so we have shifted to other potential strategies. We are looking at three, basically. 1. Could we collect rainwater, and store it for irrigation and other non-potable purposes? 2. Could we capture and process some of the greywater from the site, and use it for irrigation and other non-potable purposes? 3. As a minimum, can we afford to install piping for a future extension of the municipal reclaimed water to the site?

The jury is still out on all three, but they are likely cost prohibitive, even if they can save us a lot on initial permitting fees. Our economics for necessities like water are just too inexpensive, despite looming supply challenges. And, we have bumped against a new regulation we had not anticipated – water rights. To try to summarize decades of water use law, Colorado is a prior appropriation state. That means that, if someone has rights to water downstream, nobody upstream (including people trying to collect rainwater or greywater) has the right to hold onto that water and thus deprive the downstream off-takers. Colorado has been gradually evolving this legal structure in ways that are way too complex to detail here, but, if we determine that it might be economically feasible to use either rainwater capture or greywater reuse, we will then need to untangle this Gordian knot for this location.

That’s really interesting. I have always thought that dealing with on-site energy for hospitals was a complicated connection of technology, regulation, project finance, and procurement finance, but now I realize that so too, is water.

II.

A second set of developments faces us with respect to the energy systems, and this one concerns the regulatory environment.

The 2026 National Electrical Code includes a number of important changes from 2023. One of the biggest is the sizing requirements for the switchgear and feeders for what we used to call the “normal” side of the distribution system. Setting aside for today, the issue of normal vs emergency nomenclature, the issue was that, for the emergency sources, we could size the system based on historical data and prudent demand factors. The truth is, the NEC calculations, if followed all the way to the apex of the source to the building, result in hospital source requirements that are significantly – 300% - 400% - too large for the loads they must serve. We fixed this problem a long time ago for the diesel generators, but not for other elements of the system. NEC 2026 finally starts to chip away at this problem, and now, the sources and switchgear on the other side of the transfer switch can be sized similarly – historical data and prudent demand factors.

The problem is, what does the phrase “historical data and prudent demand factors” mean? We have been fortunate to work with the State of California on exactly this issue for several years, now with respect to the on-site sources. Our strategy has been to collect the actual peak demand from similar hospitals, and to use reasonable assumptions to factor in such issues as shelled space, intensity of services, census, etc. and to derive a set of peak demand numbers. We can then use this and a reasonable safety factor to estimate the peak demand load for a similar new hospital.

This has worked for on-site sources, but we had not tried it for the off-site sources or total loads, and we had not tried it in Colorado. So far as I know, nobody has done either, before.

And this week, we were able to meet with the city plan checkers and agree to this methodology for this project. This will be a big savings in terms of both cost and space for this hospital, no matter which option we eventually select.

And, note, it should also be a similar savings in both cost and space for all hospitals who are able to use the 2026 NEC across the country. That is why the NEC did it, and I hope it will help the industry. It will mean a small savings in the cost of healthcare, and a small savings in embodied energy of the building. It is a win across the board.

III.

I have written before about the amount of on-site energy storage required by a hospital. It turns out, this is another devilishly complex regulatory question, and this week, I think I have unlocked it. I will save that, though, for a future post, as we need to talk about EUI.

IV.

The biggest problem we ran into this week was the EUI calculation.

Let me start with a bit of a sidestep.

In January 2025, the State of Colorado issued a Microgrid Roadmap. I just found this, this week. It’s a really interesting document; a product of the Colorado Resiliency Office, the Colorado Energy Office. Its an excellent document, developed in the wake of the increasing number of climate-related extreme weather events in the state. The goals for the roadmap are to improve grid resilience and reliability for individual customers and communities, to deliver and manage electricity, to provide infrastructure where additional distribution infrastructure is impractical, and to allow independent operation of communities, neighborhoods, our buildings – especially critical facilities – disconnected from the grids.

One of our options – the microgrid with fuel cells, meets these needs exactly. Indeed, the Colorado Roadmap identifies a number of barriers to the development of this needed infrastructure, and suggests a wide range of strategies to overcome them. It urges the various legislators and regulators to collaborate to remove these barriers. Our Broomfield microgrid has resolved them all.

But, the Roadmap failed to take into account another barrier, that may be the most difficult of all.

A hospital is a critical facility. As such, its needs for electricity during a grid outage is significant. Even if we could figure out the intermittency problem, the amount of space required to provide this energy from solar would be impractically immense. And, even with the best, most compact electrical batteries, the space and expense for a system sufficient to serve a hospital is equally impractically immense. Renewable hydrogen is unavailable in sufficient quantities today, and virtually impossible to transport or store. Renewable hydrogen is a hope for the future, and maybe improved electrical batteries, as well, but today, none of these solutions can be the primary fuel for a hospital microgrid.

As I wrote before, our microgrid is currently planned to use natural gas through highly efficient fuel cells. This microgrid will eliminate very dirty diesel generators. It will eliminate natural gas combustion boilers. It will have lower emissions than the grid today has. It will be much more efficient than a system that uses the electrical utility – with unused heat from electricity generation and transmission losses and combustion of natural gas for heat. It will have much better impacts on local air quality than the combination of continuously operating natural gas boilers and consuming electricity from the grid. It serves as a bridge towards a future emission-less generation source. It meets all of the goals for these most critical of facilities expressed in the State of Colorado Microgrid Roadmap. Our design manages to overcome all of the obstacles raised by the report.

Our microgrid is the perfect solution.

Except.

The Colorado energy code has strict (and getting stricter) requirements for energy efficiency. Energy codes inherently target the energy consumption of a building, irrespective of the source of that energy. The intention is to drive down how much the building consumes, even as other regulations drive down the emissions from sources of energy.

The problem for our Broomfield microgrid is that the way the energy codes define energy consumption of the building ignores, for utility-derived electricity, the emissions for that energy. But, for a building that uses the very microgrid prescribed by Colorado’s own Roadmap, but that must, due to considerations noted above consume natural gas to generate electricity, that natural gas has to be counted in the EUI. That natural gas, though better than the alternative system, fails to meet the energy codes, as now understood.

This is obviously a conflict between state policies, and obviously a problem for this project.

At this point, the jury is out. We are communicating with the City and the State officials, to see if there is a way out of the conundrum.

For years, I have been working on the National Electrical Codes, to enable hospital microgrids, just as envisioned by the Governor’s roadmap. For years, I have been working on the CMS reimbursement issues, the refueling issues, the economic issues, the local air quality issues, even the seismic issues in California.

Today, there is a new policy hurdle. No idea where we will end up. Stay tuned.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. An operating room that can’t stay cool is not an operating room

This summer produced the clearest evidence yet that heat is not only a public-health problem but a clinical-capacity problem. Freedom-of-information data from 33 NHS trusts in England showed average July ward temperatures of 31.9°C — well above NHS England’s 28°C guidance — with one Greater Manchester trust recording 41.8°C, and surgeries cancelled when operating-theatre cooling failed. In France, an assessment attributes roughly 6,000 excess deaths to the June heatwave, and the government ordered some 30,000 air conditioners for hospitals and aged-care facilities.

Massachusetts, meanwhile, became the second U.S. state to appoint a statewide heat-resilience officer, whose remit explicitly names health centers and the electric grid — a sign that heat adaptation is starting to be institutionalized the way climate and cybersecurity offices were before it.

Sources: The Guardian — NHS ward-temperature data • Mass.gov — Heat Resilience Officer

Infrastructure implication: Capacity planning counts staffed beds, operating rooms, imaging, and workforce — but an operating room that cannot hold temperature is functionally no longer an operating room, an MRI past its environmental limit is unavailable capacity, and a pharmacy that cannot keep medication cool has lost capability. Climate adaptation belongs in clinical-capacity planning, not only in the sustainability plan. And portable air-conditioning is emergency mitigation, not resilience — it draws peak power precisely when the grid is most stressed.

2. Electricity demand sets new records — two years running

The EIA now projects U.S. electricity consumption rising from a record 4,195 billion kilowatt-hours in 2025 to 4,268 billion in 2026 and 4,391 billion in 2027 — the third straight year of upward-revised forecasts, driven substantially by AI data centers and electrification. The constraint increasingly is not generation but delivery: interconnection queues of five to seven years, and transformer lead times now exceeding 160 weeks. (EIA via Yahoo Finance)

Infrastructure implication: Hospitals are being urged to electrify — heating, kitchens, sterilization, boiler replacement, EV charging — at the same moment utilities confront data-center growth, transformer shortages, and transmission limits. The marginal hospital electrical load is becoming both more expensive and harder to serve. Electrical infrastructure — main transformers, medium-voltage switchgear, large breakers — has to become an early-procurement package, identified in design development, not left to construction-document bidding, or it will jeopardize the opening date.

3. Virginia shows how the cost lands

Dominion Energy’s Virginia system is a concrete illustration. Its fuel costs are projected to rise from roughly $2.31 billion in 2021 to $4.35 billion by mid-2027, as it leans increasingly on wholesale-market purchases — expected to supply about 23% of its power by 2027 — with data-center growth the central driver. Residential bills are projected to rise materially. (Belfer Center, Harvard)

Infrastructure implication: A twenty-five-year hospital financial model built on “current rate times a fixed escalation” is now a modeling error. It should be tested against at least four cases: conventional escalation; a capacity-constrained grid; a rate-structure change that adds demand, standby, fixed, or coincident-peak charges; and the value of on-site resources. The rate structure can matter more than the average cents per kilowatt-hour.

4. Diesel sets a record

The diesel crack spread — the margin a refinery earns turning crude into diesel, and the standard gauge of whether refining or crude is the bottleneck — hit a record high on August 13, closing near $100 a barrel, with global inventories below the five-year minimum and the fuel materially disrupted in three of four major regions. Strikingly, Brent crude has fallen roughly 26% from its April peak even as diesel margins set records — crude down, diesel up. (ZeroHedge / Bloomberg)

Infrastructure implication: The divergence is the point: the crude price is now an unreliable predictor of what delivered fuel actually costs. For any facility whose emergency power depends on distillate, that is a widening and structural exposure — seven U.S. refinery closures since 2019 removed capacity that does not return quickly — and it is the backdrop against which the fuel-cell-versus-diesel question in this issue’s field notes gets decided.

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THE 12-MINUTE DEEP DIVE

All-Electric Is Settled. The Hard Part Is Where the Electrons Come From.

Let us dispense with the debate that is still consuming too much of this industry’s attention. Every new building — hospitals emphatically included — must be all-electric. Not mostly. Not eventually. All-electric, now. The reason is simple and unforgiving: any combustion equipment installed in the building today — a gas kitchen, a gas-fired sterilizer, gas humidification, a gas boiler for heat — bakes in decades of future combustion. That is carbon lock-in, and it is a decision that outlives everyone who signs off on it. Once the pipe is in the wall and the equipment is on the roof, the building is committed to burning fuel for its entire service life, no matter how clean the grid around it becomes. The only way to let a building decarbonize as its energy supply decarbonizes is to build it all-electric from the start. There is no other choice, and pretending there is one wastes time we do not have.

So the interesting question was never “electric or combustion?” That is settled. The interesting question — the one that actually takes engineering — is where the electrons come from.

Why the building still needs its own sources

A hospital cannot go dark. That single fact means an all-electric hospital cannot simply plug into the utility and trust it, because this year has made vivid what happens to a grid under stress: records broken two years running, interconnection queues of five to seven years, transformer lead times past 160 weeks, and, in several regions, a marginal generator — the plant that runs to serve the next increment of demand — that is getting more carbon-intensive, not less, as data centers drive new gas generation and delay coal retirements. An all-electric building on that grid has solved the lock-in problem and inherited a sourcing problem. It needs its own on-site generation for resilience, and it needs the electrons it makes and buys to be as clean as they can be.

“Cleanest possible” is a three-part test

The phrase that matters is “the cleanest sources possible” — and “possible” is doing real work. It is not emissions alone. A source that is clean but uneconomic is not possible; it will not get built, or it will bankrupt the operating budget of a hospital already under margin pressure. A source that is clean today but has no path forward is not possible either, because it strands the facility on a dead-end technology. Possible means clean across three dimensions at once: economics, emissions, and a path to future decarbonization. A source has to pass all three.

This is exactly why on-site fuel cells are the right choice today, and why they are so often misunderstood. A fuel cell does not combust anything. It is an electrochemical process — it consumes methane but never burns it — which is a categorical difference from every combustion-based on-site option: diesel gensets, gas turbines, reciprocating engines. Because there is no flame, there is no combustion emission profile: dramatically lower criteria pollutants, far better local air quality at the fence line, and lower carbon than burning the same fuel. That is the emissions case and the economics case. But the decisive advantage is the third test. The same fuel cell can run on hydrogen. It has a path. A combustion turbine burns fuel and always will; a fuel cell can consume methane now and clean hydrogen later, with no stranded asset in between. Today’s natural-gas fuel cell is therefore a bridge — cleaner than combustion now, and convertible to zero-carbon when clean hydrogen is available. It is honest to say plainly that a gas-fed fuel cell still has a carbon output today; what makes it the right bridge is that it is the only on-site technology with a credible route to eliminating that output entirely. That hydrogen future is not hypothetical from where I sit — the design work for hospital hydrogen fuel cells is already being done.

Then the off-site remainder — also the cleanest available

On-site generation, backed by batteries for peaking, carries the bulk of the load and the resilience burden. What remains — a smaller quantity now — comes from off-site, and the same principle governs it: the lowest-emission stream available. Where distributed-access arrangements allow it, that increasingly means buying clean power directly in the spot market rather than accepting an undifferentiated utility blend. Where it does not, renewable energy certificates are the instrument. Either way the off-site piece is chosen, not defaulted into, and it is chosen for carbon.

Why this is hard — and why it is engineering

If “where do the electrons come from” is the question, the “how” is the main driver of the answer, and the how is a moving target on four axes at once. It is technology — fuel cells, batteries, hydrogen, storage chemistries all advancing. It is regulation — energy codes, interconnection rules, tariffs, emissions accounting, all shifting under the project. It is project finance — what pencils, what is bankable, what a margin-pressured health system can actually fund. And it is energy procurement — spot access, RECs, fuel contracts, all with their own evolving economics. Get the balance right and you have an all-electric hospital drawing the cleanest achievable electrons from the best available mix of on-site and off-site sources, with a path to zero. Get any one of the four wrong and the whole thing falters. This is why hospital energy is not a slogan and not a checkbox. “Electrify everything” is the easy, settled part. Sourcing the cleanest possible electrons through a four-way landscape that never stops moving is the actual work — and it is the work that decides whether a building that is all-electric on paper is actually clean, resilient, and affordable in practice.

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U.S. ENERGY MARKETS

• Records, two years running. EIA projects U.S. electricity consumption at 4,268 billion kWh in 2026 and 4,391 billion in 2027, after a record 4,195 billion in 2025 — the third straight upward-revised forecast, led by data centers and electrification. (EIA / Yahoo Finance)

• Delivery, not generation, is the bottleneck. Interconnection queues run five to seven years; transformer lead times now exceed 160 weeks and prices keep rising. Electrical infrastructure has become an early-procurement item, not a construction-phase one. (Belfer Center, Harvard)

• Diesel at a record. The diesel crack spread hit a record near $100/bbl on August 13; global inventories are below the five-year minimum. Brent fell ~26% from its April peak even as diesel margins set records — crude is no longer a reliable predictor of delivered fuel cost. (ZeroHedge / Bloomberg)

• The marginal grid is getting dirtier in places. Utilities have postponed the retirement of 15 coal plants — which emitted nearly 65 million tonnes of greenhouse gases in 2023 — and more than 100 GW of new gas capacity has been announced, most expected online before 2030, as data-center demand reshapes generation planning. This is not a reason to hesitate on electrification, but a reason the electron-sourcing strategy matters. (EESI)

• Coal retirements keep slipping. Of 8 GW of coal capacity expected to retire in 2025, only 2.6 GW actually did, after federal emergency orders extended plant operations — and the same pressure is shaping 2026, with several large coal units’ shutdowns postponed. (EIA)

Infrastructure implication: The common thread: electricity’s cost and carbon are both becoming local, hourly, and structural rather than national and average. All-electric is the settled design; the real work is sourcing the cleanest achievable electrons — on-site generation for resilience plus the lowest-emission off-site supply available — against the specific utility system a building sits on.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

Beyond the U.S. grid story covered above, several policy, code, and capital developments stand out this period.

• A billion-dollar all-electric hospital advances. El Camino Health submitted its application to replace its Los Gatos hospital with a 344,000-square-foot, all-electric acute-care campus — 122 private rooms, 12 ORs, an expanded ED — targeting completion in 2032. It is a marker of how quickly all-electric has become the design default for major new hospitals in clean-grid states. (El Camino Health)

• New York funds the harder path. NYSERDA’s Empire Building Challenge: Hospitals program is making more than $20 million available — up to $5 million per hospital, capped at 75% of project cost — for deep-electrification and efficiency retrofits of existing hospital buildings, with applications due September 15. (NYSERDA)

• A code lever for hospital energy. ASHRAE published Addendum bh to Standard 90.1, now folded into the 2025 edition and aligned with Standard 170-2025, requiring unoccupied setbacks — reduced ventilation or adjusted temperature — in high air-change spaces such as operating rooms when they are not in use. Ventilation dominates hospital HVAC load, so this is more consequential for energy than it sounds. (HFM Magazine)

• Cybersecurity becomes a procurement gate. The 2026 Medical Device Cybersecurity Index found that 56% of healthcare organizations have rejected a device during procurement over cybersecurity concerns — up from 46% a year earlier — and 35% will not consider a device without a Software Bill of Materials. As hospital building and clinical systems grow more connected, controls governance is becoming part of resilience. (RunSafe Security Index)

Infrastructure implication: Two things that actually move healthcare decarbonization — a defensible technical lever and a way to pay for it — advanced together this month, in the ASHRAE setback provision and New York’s financing pool. And the cybersecurity gate is a reminder that an all-electric, heavily instrumented hospital is also a larger cyber-physical attack surface: the question of which building and clinical systems fail if the network drops belongs in the same resilience exercise as loss of power or water.

2. Spanish-Speaking Americas and the Caribbean

The region’s marquee event is the XI Brazilian Congress for the Development of the Hospital Building (XI CBDEH), hosted by ABDEH in Brasília from August 19, with a program spanning resilience, regenerative architecture, carbon reduction, planetary health, and healthcare infrastructure adaptation — unusually well aligned with IFHE’s strategic agenda, and a strong opportunity to deepen the federation’s Americas relationships ahead of the first IFHE Latin American Regional Congress in Buenos Aires next April.

PROJECT SPOTLIGHT — Direct-Drive Solar Cold Chain

Across rural clinics in the Colombian Andes and Brazilian Amazon, procurement continues to standardize around direct-drive solar refrigerators that store cooling in phase-change ice-lining rather than in chemical batteries, holding vaccine temperatures through multi-day outages without the maintenance burden of battery banks.

Source: Regional engineering reporting, 2026

Infrastructure implication: Storing the cooling itself, rather than the electricity to make it, removes the most failure-prone component of a rural electrification project — a design principle that generalizes well beyond the cold chain to any critical load in a maintenance-constrained setting.

3. Europe and the Middle East

Europe’s heat delivered the region’s defining story, and this year it moved decisively from public-health framing to infrastructure-operability framing. The English NHS ward-temperature data and the French excess-death toll are covered above; alongside them, WHO’s European office issued technical guidance emphasizing cooling-system resilience and grid-independent operation for chiller plants, to prevent the cascading clinical and IT failures that overheating triggers. Massachusetts, separately, appointed one of the first U.S. state heat-resilience officers — a sign that heat adaptation is beginning to be institutionalized the way climate and cybersecurity offices were before it.

Infrastructure implication: The throughline from London to Lyon to Boston is that heat resilience is becoming a named, staffed, funded function rather than a line in a sustainability report. For hospitals, the actionable version is unglamorous: envelope, shading, chilled-water plant renewal, thermal storage, and passive survivability — the measures that keep a building operable when both the temperature and the grid are against you.

4. Africa

The African story this month is financing structure as much as technology. Sweden’s development agency and the Clinton Health Access Initiative continue to build a blended-finance model designed to fund not just installation but long-term operation across South Africa, Eswatini, Kenya, and Malawi — addressing the reason previous electrification efforts failed, since only about half of sub-Saharan hospitals have reliable power. And in Kenya, a large private-sector program is taking that logic to scale. (Clinton Health Access Initiative)

PROJECT SPOTLIGHT — Kenya — 780-Facility Hospital Solar Program

A Kenyan program is moving to install solar power across 780 private healthcare facilities, using energy audits followed by lease-to-own or power-purchase financing that requires no upfront capital from the facility, with systems installed between September and December and monitored remotely, before expanding to a further 716 facilities in 2027. Officials expect facility electricity costs to fall 40 to 60 percent. A survey found 97% of the facilities rely on the grid utility and 76% back up with diesel rather than solar.

Source: Business Daily Africa, August 2026

Infrastructure implication: The design lesson is in the financing, not the panels: a no-upfront-cost structure with remote performance monitoring is what lets margin-constrained facilities adopt at scale — the same “who can actually pay for it” question that governs decarbonization everywhere, answered here with a model built to travel.

5. Asia-Pacific

Japan continues to set the regional benchmark for measured hospital performance, a fitting companion to this month’s IFHE webinar on the modeled-versus-actual energy gap: the new building at the Odawara Municipal General Medical Center, a 406-bed regional and disaster hospital, achieved ZEB Ready certification with a building energy index of 0.43 by attacking outdoor-air loads, recovering waste heat, and right-sizing HVAC. Australia’s IHEA remains highly active on regional resilience, with a Queensland professional-development day at Cairns Hospital, and New Zealand’s NZIHE international conference approaches in November.

Infrastructure implication: Odawara’s 0.43 index is the empirical rebuttal to the idea that new hospitals must consume two to three times as much: a major disaster hospital in a demanding climate reached that level through discipline, not exotic technology. It deserves to be a global benchmark — an Asian counterpart to Cortellucci Vaughan, and an argument that measured performance, disclosed after opening, should become the norm.

IFHE GLOBAL CONNECTION

The webinar happened — now make it an asset

IFHE’s August 12–13 webinar, “Why Are So Many New Hospitals So Energy Inefficient?”, has now taken place, featuring Cortellucci Vaughan Hospital and its roughly 90 kBtu/sf performance in a cold climate. The opportunity now is to convert a one-time event into durable institutional knowledge: post the recording, extract a short technical summary of the actual-versus-design performance, and set it against the benchmark — typical acute-care hospitals at 200 to 300 kBtu/sf, high-performers under 150, Cortellucci near 90. It also poses a question worth turning into an IFHE initiative: why can’t every new hospital disclose its measured energy use three years after opening? Measured, published performance is how the modeled-versus-actual gap finally closes.

More broadly, IFHE’s webinar archive — now well over a hundred sessions spanning hospital energy, decarbonization, geothermal, glazing, refrigerants, and water — is a standing professional-development library, best organized around the problems members actually face rather than left as a chronological list. Could not attend live? The archive is the point, not the footnote.

WHO, WASH, and the standards work

WHO released a new Water, Sanitation and Hygiene strategy covering 2026 through 2035, foregrounding aging infrastructure, climate resilience, and — notably — water, sanitation and hygiene in health-care facilities, which is one of the five domains of the ATACH healthcare-facility standards effort that IFHE is helping lead. The convergence is not accidental: water, energy, cooling, and resilience are increasingly one integrated problem, and the international frameworks are beginning to treat them that way. (World Health Organization)

IFHE’s working-group contributions to the climate-resilience and sustainability standards continue, and calls for volunteers and source materials remain open at volunteers@ifhe.info.

Brazil and New Orleans

The XI CBDEH Congress in Brasília (August 19–22) anchors the IFHE Americas calendar this month, with a keynote on global climate and energy trends and the healthcare response. Looking ahead, an IFHE Extraordinary Council Meeting is set for October 9, and the 29th IFHE World Congress runs October 17–20 in New Orleans, hosted through AMFP and co-located with the Healthcare Design Conference + Expo — positioned as the largest joint healthcare-engineering and design gathering to date. Member associations should be confirming delegations, Council representation, and visa letters now.

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IFHE GLOBAL EVENTS CALENDAR

August 2026

• August 19–22 — ABDEH XI CBDEH Brazilian Congress, Brasília (IFHE keynote August 20) (abdeh.org.br)

• August 21 — California Energy Commission SB 48 comment window (energy.ca.gov)

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway

September 2026

• September 2 — IHEA Queensland Regional Professional Development Day, Cairns Hospital (ihea.org.au)

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria

• September 24 — Future of Health Activators speaker session (IFHE/WHO standards)

October 2026

• October 9 — IFHE Extraordinary Council Meeting (ifhe.info)

• October 17–20 — 29th IFHE World Congress, New Orleans (hosted through AMFP), co-located with Healthcare Design Conference + Expo (hcdexpo.com/ifhe2026)

November 2026

• November 12–13 — NZIHE International Conference, Auckland (nzihe.co.nz)

• November 16–18 — IHEA National Symposium, Fremantle, Western Australia

2027

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

A couple of weeks ago, I wrote about the near-completion of ASHRAE Research Project RP1816. This project continues a long line of work I have been doing, both internally, and with various grants and National Labs regarding the Energy Consumption of Medical Equipment in general, and Large Medical Equipment in particular.

Today, I want to pose a question to everyone; What happens when the space containing a piece of medical equipment gets warmer than manufacturer specifications? Is that even a thing?

Let me give you some context.

RP 1816 found – as had many previous studies (see Note below) - that the nameplate data on medical equipment almost always significantly overstates the actual energy consumed by the equipment. And, because energy in must equate to energy out, the heat rejection information similarly significantly overstates the actual heat generation.

As a consequence, the new ASHRAE Handbook will include new suggestions for demand factors that are applied to individual units, and diversity factors that can be applied on top of that for systems that serve multiple pieces of equipment.

Notwithstanding this growing body of evidence, and notwithstanding this pending peer-reviewed research project, with probably the most extensive statistical analysis available for anything like this kind of situation, and notwithstanding the fact that these tables will be in the forthcoming ASHRAE Handbook, I have heard reluctance from some HVAC designers to use this guidance.

The reluctance takes this form. “The manufacturers have a number. If I don’t use that number, my system might be undersized. If my system is undersized, the room might get too warm. If the room gets too warm, the equipment might malfunction. If the equipment malfunctions, it might give bad diagnosis. If the equipment gives bad diagnosis, something bad might happen to a patient. If something bad happens to a patient, then something bad will happen to me and my company.”

All of the data and analysis show this argument to be misguided. But, I understand the fear and the logic. I also understand the impacts of significantly oversized HVAC systems all over the country (world?) wasting energy, capital, and carbon that hurts us all. The caution is logical but it isn’t free.

I have talked to some hospital owners to see if they have ever experienced an overheating piece of medical equipment. They report that the HVAC systems are so oversized that this is never even close to being an issue for them. As their building systems age, they are going back in to rightsize their HVAC systems to the actual loads, as opposed to whatever their well intentioned, but surely cautious designers, designed to.

I wonder, does anybody out there have an experience, one way or another, with a piece of medical equipment in a room that is warm, and whether it generates bad results?

If you have any insight into this question at all, please let me know.

And, thank you as always.

NOTE; I’m compiling a bibliography of this literature; if you want it when its done, let me know.

(The above photo was the initial three month schedule we envisioned to help UC get to the right answer for system selection. Note that the top two items had to do with codes and utilities. Getting irons in the fire early).

HEALTH INFRASTRUCTURE PULSE

FROM THE FIELD — PAPER ENGINEERING LION, PART 11

A running account of engineering a hospital energy system in real time

When I was a young engineer, the company I worked for designed a lot of HCA hospitals. They were beginning to expand their repertoire, and to design hospitals for other owners. In those days, we were designing hospitals all over the US. I think I had worked on hospitals in about 7 states during my first five or so years as a young electrical engineer. During those years, one important lesson I learned was that no two places ever had the same codes. That company had a very structured process for working with local codes officials to determine the model codes and the local amendments, as well as any particular interpretations of those codes. This was always the fundamental first step of working in a new location.

And so, when we started Broomfield, I tried to do exactly that. We had a similar process for working effectively with relevant utility companies, as they also always have their own idiosyncrasies. And so, when we started this project, we reached out to the utility companies, as I have mentioned, as well as the local codes authorities. I have talked a lot about our utility work, and this week we heard from both the natural gas and the electric utilities that they needed at least another four weeks each to determine how they would bring service to the site, and what that might cost. And, we have two weeks remaining to determine our preferred system. So, we are forced to estimate these costs, which is a huge potential issue. And yet, we probably have no choice.

I remember my old boss and mentor, Mr. Hugh Nash. Hugh would always tell me, “Walt, you have to get your irons in the fire early.” That was advice I absorbed completely, and that I try to live up to with every project. It is advice that I hope others will learn and similarly absorb and use to their advantage.

A second issue has to do with the State of Colorado Energy Code and Building Performance Standard.

Both of these codes have prescriptive limits for the maximum energy that can be consumed on site. The BPS permits either an Energy Use Intensity (EUI) or a Greenhouse Gas calculation. The BPS has limits that apply to all buildings through 2029, and another limit on buildings operating after 2030. Though we plan to be complete before 2030, we are obviously aiming at that particular target.

Both of these documents have specific limits for a hospital and for a medical office building. The limits for a medical office building are, lets say, unrealistic for the kind of medical office building we will create for this site. It appears that the regulations are focused on something that is more like a primary care service with low intensity procedures. In fact, this MOB will house significantly higher-intensity clinical functions than that. It is manifestly not the kind of Medical Office Building that was envisioned by the well meaning people who created this particular regulation. And so, like our early city irons, we are now in touch with the Colorado Energy Office, to try to work through the right way to get this done.

These limits are extremely important for at least one of the options we are narrowing in on. At this point, we are really down to what we are thinking of as a code minimum system, which consists of heat recovery chillers, and supplemental thermal needs from boilers and cooling towers. Our first option changes the supplemental thermal strategy to include a borefield that will treat the earth as a battery. The second option uses phase change material for supplemental thermal needs. The final option uses heat recovered from on-site electricity generation through fuel cells, as I have discussed in past posts. This one is particularly interesting in this way, as the energy codes require us to include the natural gas that we use to generate electricity and heat to be counted towards the total EUI and GHGs for the project.

This is an interesting policy dilemma.

First, we know that using fuel cells on site to generate both electricity and heat is going to be more efficient than using any fuel off-site and transmitting it through the grid and then through the local distribution system. We also know that the grid cannot be modified and expanded enough to meet the current increases in demand from a number of forces. The people designing the grid all talk about how dire the need is to develop more on-site generation and storage, in order to help the system as a whole to have sufficient capacity in a sufficient timeframe to meet all of the needs of all of the people, especially at a cost to rate-payers that is reasonable.

So, as a society, we have competing directions. And, as it happens, if we count the natural gas as part of our EUI or GHGs, we get close to the limits, depending on how we end up setting the MOB limits. Ideally, we would like to not get too close to the limits, in order to give margin of error to the hospital.

So, when we talk to the state COE, we need to work on both points; how can we use rational numbers for an MOB, and how can we help the grid by developing on site efficient generation (and eliminate diesel generators and most of the boiler combustion in the process) while still meeting the intent of the Energy and Building Performance Codes to protect the health of the global commons. Finding pragmatic technical and financial solutions that thread these needles is difficult enough. Finding ones that also meet regulatory needs can be even more challenging.

I have worked for many years in developing codes and standards. I have worked for many years with enforcement authorities around the country and around the world. I know that, by and large, these are good, hard-working, reasonable people trying to do a difficult job (just like most engineers!) I have learned that – getting your irons in the fire early – and working with them in honest, transparent, problem-solving ways can usually yield a good result for a project.

I often tell people now, that to be an engineer is to be much more than a technically adept person. To be a good engineer now is to be an expert in regulation, an expert in energy procurement, an expert in project finance, and an expert in technologies. Only by finding the sweet spot between all of these can you give the owner the project they need. And, as difficult as it is to be able to find this sweet spot, it is even more difficult now because all four of these areas are shifting all of the time.

During our preparation for last week’s Big Room meeting, one of my colleagues dropped a bomb in our internal room. He had found the GHG requirements in the BPS regulation. He discovered that it was going to be a problem for us to meet that, though we probably could meet the EUI. This threw me into quite a state, I have to tell you. We are coming down to the wire, and I was really kicking myself that I had not found this before. I could not sleep that night, thinking through various options for managing this new challenge.

The next day, in the Big Room, we mentioned the challenge and one of the UC team spoke up to remind us that the BPS did not require compliance with both the EUI and the GHGs, it required compliance with the EUI, and, if we can’t meet that, we can try a GHG performance standard. When our UC teammate told us this, I suddenly remembered that we had had exactly this same discussion a few weeks before, and had come to the same conclusion. I realized that this solution was still feasible, and that we could continue to the finish line.

It pays to get your irons in the fire early. It also pays to remember, and to apply, what you learn!

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THE 5-MINUTE EXECUTIVE BRIEFING

1. Texas stopped saying yes — and that should get every hospital’s attention

Texas this week moved from debating the risk of very large new electricity loads to actively pausing and auditing them. Governor Abbott directed ERCOT and the Public Utility Commission to halt approvals for new data-center grid connections while the state reviews roughly 474 gigawatts of proposed demand — more than five times the state’s record peak, with about 90% of it tied to data centers. The point is not that all of it would ever be built. The point is the opposite: planners can no longer tell the credible projects from speculative queue positions early enough to commit generation, transmission, and equipment without risking stranded costs.

There is a financial edge to this, too. Reporting this week noted that hundreds of millions of dollars in grid-connection deposits are now caught in uncertainty, with pending rules that could increase the nonrefundable share. That turns interconnection from a scheduling question into a balance-sheet question.

Infrastructure implication: A hospital is not a speculative data center — it is an essential community service with stable, long-term load. But utilities may still import large-load risk controls into the tariffs and interconnection practices that govern hospitals, laboratories, and major campus expansions. “Speed to power” is becoming conditional on proving the load is real. For any significant new project, the capacity question now belongs before schematic design, not late in it — and reducing requested firm import through on-site generation or storage may carry schedule value on top of the usual demand-cost savings.

2. Meanwhile, California is throwing electricity away

The mirror image appeared on the West Coast. California curtailed roughly 4.5 million megawatt-hours of wind and solar in the first half of 2026 — already more than in all of 2025 — and in April discarded about 18% of its grid-scale wind and solar output. In one part of the country, planners fear there is not enough capacity in the critical hours. In another, vast quantities of near-zero-cost clean energy are being thrown away because generation timing, transmission, load shape, and storage are not aligned.

Infrastructure implication: These are two faces of one problem: the grid cannot use energy it cannot move or time-shift. For a hospital, that reframes storage and flexible load from a narrow cost-arbitrage play into a way of capturing energy the grid is otherwise wasting — and it undercuts the habit of judging an all-electric strategy against the grid’s annual-average carbon number. When a load runs now changes both its cost and its emissions.

3. Heat, power, and water failed together — again, and more clearly

Europe’s heat made the compounding visible. Italy placed all 27 cities in its heat-surveillance network under red alert; Slovakia reached 42.2°C. Then the second-order effects arrived: low flows on the Danube forced Slovakia’s largest hydro plant to shut seven of its eight turbines, and cut Hungary’s only nuclear station to roughly 10% of output because its cooling water comes from the same drought-starved river. Hungary asked industry and households to cut evening demand. South Korea, in the same window, recorded 42.5°C — its hottest in 122 years.

Infrastructure implication: The design scenario is no longer “the utility fails.” It is record heat, reduced water, strained generation, and regional curtailment arriving together, while the hospital itself absorbs a heat-driven patient surge. Cooling towers are the Danube dependency in miniature. Every major hospital should be able to answer, quantitatively: if municipal water were restricted during the hottest week of the year, what happens to the central plant? If no one can answer that, the resilience assessment is not yet complete.

4. Rates keep climbing while wholesale energy looks calm

EIA data put average U.S. electricity revenue at 13.83 cents per kilowatt-hour in May 2026, up 5.3% year over year, with increases across all four end-use sectors. Wholesale energy, by contrast, is forecast slightly lower this summer on cheaper gas. The gap is the whole story: the cost pressure is migrating into capacity, transmission, congestion, and distribution — and into who is made to pay for a grid being rebuilt for enormous new loads.

Infrastructure implication: A single “electricity escalation” number is now a modeling error. The components move separately, and a utility can change the economics of a fuel cell, a battery, or a CHP plant through a standby or demand-charge revision without ever touching the commodity price. Long-term hospital models should test at least four cases: inflation-like escalation, a utility-specific forecast, sustained real increases, and a rate-structure shock.

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THE 12-MINUTE DEEP DIVE

The Grid Can’t Use What It Can’t Move

Two stories broke this week that look like opposites. In Texas, the grid operator effectively stopped accepting new large loads, because it cannot build capacity fast enough to serve them. In California, the grid threw away more clean energy in six months than in all of the prior year, because it cannot move or time that energy to where and when it is needed. Scarcity in one place, surplus in the other. They are not opposites. They are the same problem seen from two sides, and together they carry the most important planning lesson of the year for anyone building or running a hospital.

The Texas side: capacity you cannot assume

For most of the history of hospital construction, utility capacity was a coordination item, not a question. A major new facility could obtain service if it gave the utility enough lead time and paid the required extension costs. Texas has just demonstrated how fragile that assumption has become. Faced with 474 gigawatts of proposed load — five times its record peak — the state stopped approving new data-center connections and began auditing which projects are real. The deeper issue is not the total; it is that the grid can no longer distinguish a genuine commitment from a speculative queue position in time to build the generation and transmission that serving it would require.

The federal backdrop is the same. In June, FERC directed all six regional grid operators to justify or reform how they connect large loads — defined as demand above 20 megawatts — with the twin goals of speeding interconnection and protecting existing ratepayers. Most single hospitals fall below that threshold, but the reforms reach them anyway, because they rewrite the fundamentals: cost causation, queue credibility, the treatment of co-located on-site generation, and the line between firm and flexible service. When the rules for the largest customers change, the practices that govern the rest tend to follow.

The California side: energy you cannot time

Now turn the picture over. California’s problem is not too little energy; it is too much at the wrong moment. Roughly 4.5 million megawatt-hours of wind and solar curtailed in half a year is not a shortage — it is abundance the system cannot absorb, because the sun produces most strongly when demand is moderate, and the transmission and storage needed to carry that surplus into the evening peak are not yet in place. More than 40% of the state’s existing utility-scale solar is now paired with batteries, and 93% of the planned solar pipeline includes storage, precisely because the industry has understood that generation without the means to move or time it is generation wasted.

Put the two sides together and the lesson resolves. The grid’s constraint is no longer simply how much power can be produced. It is whether that power can be delivered to a given point, and shifted to a given hour. Scarcity and curtailment are both failures of deliverability and timing — and both point a hospital toward the same set of tools.

What this means for a hospital

If the binding constraint is deliverability and timing, then the assets that address it are the ones that let a facility move its own demand and supply its own power. Storage — electrochemical and thermal — lets a hospital consume energy when the grid has too much and lean on its own reserves when the grid has too little. Flexible load lets it shift consumption without cutting into patient care: chilled-water production, thermal-storage charging, heat-pump sequencing, battery charging, and selected plant loads can all be moved across hours in ways that a surgery or an intensive-care unit cannot. On-site generation lets it reduce the firm capacity it must ask the grid to guarantee in the first place.

This is why the framing of storage has to change. Evaluated only against time-of-use arbitrage, a battery or a thermal store looks like a modest hedge on the energy bill. Evaluated against this week’s reality, it becomes something larger: a way to capture curtailed energy that is briefly almost free, to shrink the firm grid service a hospital must request in a constrained interconnection queue, and to keep operating through the compound events that are arriving more often. The same asset answers the Texas problem and the California problem at once.

It also changes how a hospital should model its own decisions. An all-electric strategy judged against the grid’s annual-average carbon intensity misses the point that curtailment makes vivid: the hour a load runs determines both its cost and its emissions. The honest analysis is hourly, not annual. Owners weighing major electrification or storage decisions should be asking for 8,760-hour models — one value for every hour of the year — not a single blended number that hides exactly the timing the grid now cares about most.

The quieter point underneath

There is a strategic shift buried in all of this. For a century, the hospital’s relationship to the grid was simple and one-directional: the utility delivered power, and an emergency generator stood by in case it stopped. That model still describes the life-safety requirement, but it no longer describes the economic and resilience reality. A hospital that can store energy, shift load, generate on-site, and ride through a compound event is no longer just a building connected to a utility. It is becoming a managed piece of critical infrastructure in its own right — one that the grid increasingly needs as much as the hospital needs the grid. The institutions that understand that early, and design for it before the schematic is set, will be the ones still able to build affordably when capacity is scarce and rules are tightening. The ones that wait will find, as Texas just showed, that the door can close while you are still deciding whether to walk through it.

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U.S. ENERGY MARKETS

• Texas pauses large-load approvals. ERCOT and the PUC halted new data-center grid connections to audit ~474 GW of proposed load — 5x the state’s record peak, ~90% data centers. Grid deposits worth hundreds of millions are now caught in rule uncertainty, with the nonrefundable share potentially rising.

• California curtailment surges. ~4.5 million MWh of wind and solar curtailed in H1 2026, already more than all of 2025; ~18% of grid-scale wind and solar discarded in April. Over 40% of existing utility-scale solar is now battery-paired; 93% of the planned pipeline includes storage.

• FERC large-load reform is the backdrop. June 18 FERC orders directed all six RTOs to justify or reform large-load tariffs (loads above 20 MW), targeting faster interconnection while protecting reliability and existing ratepayers — reshaping cost causation and firm-versus-flexible service for institutional customers too.

• PJM scarcity holds as the benchmark. The 2028–29 capacity auction cleared at the $325/MW-day cap and still fell ~6.8 GW short of the reliability requirement. PJM expects roughly 70 GW of new very-large-customer demand by 2038.

• Rates up, wholesale calm. EIA: average revenue 13.83¢/kWh in May 2026, +5.3% year over year across all four sectors — even as wholesale energy is forecast slightly lower this summer on cheaper gas. The cost is migrating into capacity, transmission, and congestion.

• Gas abundant; delivered cost is the variable. Working gas reached 3,117 Bcf for the week ending July 31; May dry production ~110.3 Bcf/day, the highest May on record. But power-sector gas demand is forecast to hit a record in 2027 — abundant supply, rising dependence — and delivered hospital cost still turns on pipeline, basis, and firm-service charges.

• Storage as core infrastructure. Q1 2026 set a first-quarter record at 9.7 GWh installed, up 32% year over year. Sodium-ion is worth watching for 2029–2032 procurement horizons — abundant materials and favorable fire characteristics, though still far smaller than lithium-ion.

Infrastructure implication: The through-line across every item: the grid’s limit is increasingly deliverability and timing, not raw generation. That is why a single escalation rate misleads, and why storage, flexible load, and on-site generation are moving from sustainability options to capacity and schedule strategies.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

The U.S. grid story dominates and is covered above. On the codes front, work continued in NFPA 70 CMP-15’s Task Group on Article 517, which governs healthcare electrical systems and shapes how microgrids, alternate sources, and essential-system architecture are actually implemented. A quieter but important theme also surfaced at the ASHE conference: building-system cybersecurity. As connected controls, smart-building systems, and energy-as-a-service arrangements spread, the cyber-physical attack surface of a hospital’s infrastructure grows with them — and controls governance is becoming as much a part of resilience as mechanical and electrical redundancy.

Infrastructure implication: The lesson of the cybersecurity thread is that a hospital’s energy and controls systems can no longer be designed as if the network were incidental. The question — which building and clinical systems fail if the network disappears for 24 hours? — belongs in the same resilience exercise as loss of power or water.

2. Spanish-Speaking Americas and the Caribbean

The region’s marquee event is the XI Brazilian Congress for the Development of the Hospital Building (XI CBDEH), hosted by ABDEH in Brasília on August 19–21, with a program that bridges climate resilience, regenerative design, clinical-equipment planning, fire safety, and investment, and speakers from across the Americas. It is one of the strongest current opportunities to deepen IFHE’s Americas relationships ahead of the first-ever IFHE Latin American Regional Congress in Buenos Aires next April. Elsewhere, direct-drive solar vaccine refrigerators — using internal phase-change ice-lining rather than chemical batteries — are standardizing across rural clinics in the Colombian Andes and Brazilian Amazon.

PROJECT SPOTLIGHT — Direct-Drive Solar Cold Chain

Rural clinics across the Colombian Andes and Brazilian Amazon are standardizing procurement around direct-drive solar refrigerators that store cooling in phase-change ice-lining rather than in chemical batteries, holding vaccine temperatures through multi-day grid outages without the maintenance and replacement burden of lead-acid or lithium-ion cells.

Source: Regional engineering reporting, August 2026

Infrastructure implication: In remote, high-heat settings the maintenance overhead of battery banks is often what defeats an electrification project. Storing the cooling itself, rather than the electricity to make it, removes the most failure-prone component — a design principle with wide application beyond cold chains.

3. Europe and the Middle East

The heat drove the region’s infrastructure story, and its lesson was compounding: the same drought that strained hospital cooling also crippled the power and water systems those hospitals depend on. In response, engineering societies are moving from disaster response toward proactive code development — including early work on “thermal drift” modeling, which asks how long a building can remain survivable without active cooling, and predictive dynamic façade shading that deploys before a heat peak rather than after. In Germany, FKT published a pointed argument that hospitals should stop asking whether renewables, heat pumps, and batteries can work and start asking how fast they can be deployed to free up money for higher-priority care.

PROJECT SPOTLIGHT — The “Waterless” Central Utility Plant

A major Southwest U.S. health system broke ground on a greenfield hospital built around a closed-loop, air-cooled central utility plant — eliminating cooling towers entirely to achieve net-zero water for HVAC. The design trades a modest amount of energy efficiency for independence from municipal water and the associated Legionella-management burden, a trade increasingly attractive in drought-exposed regions.

Source: Facilities reporting, August 2026

Infrastructure implication: The European heat showed cooling towers as a water dependency in miniature. An air-cooled plant answers that vulnerability directly — at an energy cost that, against the risk of losing cooling entirely during a water restriction, may be well worth paying where water is scarce.

4. Africa

SAFHE continues to anchor African healthcare-engineering participation, and the region’s defining theme remains the pairing of clean generation with the financing and maintenance structures that make it last. Development partners are increasingly explicit that the failure point of past electrification was not the panels but the absence of funded operations and maintenance — and new equipment-donation intake rules across several ministries now require multi-year local parts supply and technician training before hardware is accepted.

PROJECT SPOTLIGHT — Sida–CHAI Health-Facility Solar Initiative

A partnership between the Swedish International Development Cooperation Agency and the Clinton Health Access Initiative is electrifying thousands of health facilities across South Africa, Eswatini, Kenya, and Malawi. Its financing model is designed explicitly to fix the reason previous solar efforts failed: insufficient funding for long-term system maintenance rather than insufficient capital for installation.

Source: CHAI, 2026

Infrastructure implication: Across sub-Saharan Africa only about half of hospitals have reliable electricity, and roughly 15% of facilities have none. The decisive variable is rarely the technology — it is whether the capital structure funds operations and maintenance for the life of the system, not just the installation. That is the same financing-decides-who-can-build lesson that governs decarbonization everywhere, in its starkest form.

5. Asia-Pacific

Japan produced the region’s standout, and a natural companion to this week’s IFHE webinar on hospital energy performance. HEAJ reports that the new building at the Odawara Municipal General Medical Center — a 406-bed regional and disaster hospital — achieved ZEB Ready certification with a building energy index of 0.43, an exceptionally strong result for a major acute-care facility, by reducing outdoor-air loads, maximizing waste-heat recovery, and right-sizing HVAC. Nearby, the new 801-bed Hyogo College of Medicine Hospital placed its clinical functions on the second floor and above as a deliberate flood-resilience measure against the adjacent river. Australia’s IHEA, meanwhile, continues to lead on integrating the spatial and thermal demands of clinical AI into hospital design.

Infrastructure implication: Odawara’s 0.43 index is the empirical answer to the webinar’s provocation: if a large disaster hospital in Japan can reach that level of measured performance, the gap between what new hospitals are designed to consume and what they actually consume is a matter of discipline, not physics. It deserves a global audience — an Asian counterpart to Cortellucci Vaughan.

IFHE GLOBAL CONNECTION

IFHE is helping WHO write the rules

The most significant development for the federation this period is the launch of a WHO-led effort, under the Alliance for Transformative Action on Climate and Health (ATACH), to create the first global standards for climate-resilient, environmentally safe, and sustainable healthcare facilities. The standards are being organized around five domains — governance, facility management, water and sanitation, the built environment, and supply chain — and are meant to be globally applicable while remaining practical for countries at very different levels of resource. IFHE has been asked to lead two of the three working groups delivering this work, and to bring the technical expertise and volunteer capacity of its members to bear.

This matters because most healthcare-sustainability frameworks today are built around reporting — measuring emissions and making commitments. This effort moves toward facility-level performance standards, the kind that eventually shape design criteria, operations, water and waste systems, and international accreditation expectations. It is a rare chance for operational healthcare-engineering knowledge to shape an international framework from the inside. Calls for volunteers and for materials — standards, case studies, and examples from around the world — are going out now; members who wish to take part can write to volunteers@ifhe.info.

Register now: the August 12–13 webinar

IFHE’s webinar “Why Are So Many New Hospitals So Energy Inefficient?” runs August 12–13 in two globally timed sessions, featuring Cortellucci Vaughan Hospital — which operates at roughly 90 kBtu/sf in a cold climate — with Ian Jarvis and Amandeep Deol of Climate Challenge Network. HEAJ and IHEA are already amplifying it through their national channels, HEAJ with Japanese-language caption guidance. It is a session for owners, CFOs, and capital-planning leaders as much as for engineers. And for those who cannot attend live, IFHE’s webinar archive now holds a full 2026 series — electrified kitchens, decarbonization, geothermal, high-performance glazing, refrigerant management — that stands as a professional-development library for chapter meetings and staff education.

Brazil, awards, and New Orleans

The XI CBDEH Congress in Brasília (August 19–21), hosted by ABDEH, is the season’s major IFHE Americas gathering, with a keynote on global climate and energy trends and the healthcare response. AMFP, the U.S. member organization, has opened its inaugural national awards through August 31, with recognition to come around the New Orleans Congress. That Congress — the 29th IFHE World Congress, October 17–20, co-located for the first time with the Healthcare Design Conference + Expo — is now close enough that the practical work is delegations, Council representation, and visa letters. Member associations should be confirming named delegates and using the national conferences between now and October as recruitment venues.

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IFHE GLOBAL EVENTS CALENDAR

August 2026

• August 12–13 — IFHE webinar: “Why Are So Many New Hospitals So Energy Inefficient?” (Cortellucci Vaughan; Jarvis and Deol)

• August 19–21 — ABDEH XI CBDEH Brazilian Congress, Brasília (IFHE keynote August 20)

• August 31 — AMFP inaugural national awards close; California Energy Commission SB 48 comment window

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway

September 2026

• September 14 — CMS CLIA comment deadline (laboratory preparedness, biosafety, cybersecurity)

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria

• September 24 — Future of Health Activators speaker session (IFHE/WHO standards, accreditation case studies)

• September 30–October 1 — Healthcare Engineering Conference, Gelsenkirchen, Germany

October 2026

• October 13–14 — Healthcare Estates 2026, IHEEM (UK, external)

• October 17–20 — 29th IFHE World Congress, New Orleans (hosted through AMFP), co-located with Healthcare Design Conference + Expo

November 2026

• November 16–18 — IHEA National Symposium, Fremantle, Western Australia

2027

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

WHO created its Alliance for Transformative Action on Climate and Health (ATACH) program following the COP 26 meetings in 2021. During COP 26, the participating countries made health commitments, and ATACH brought together 70 countries to collaborate, develop and share tools, identify financing, and accelerate implementation. The mission of ATACH is to:

· Build climate-resilient health systems

· Decarbonize healthcare operations

· Integrate health considerations into climate planning

· Mobilize financing and technical assistance

· Share knowledge and best practices globally

Today, 107 countries, including 25 countries where IFHE has chapters, have joined ATACH. To advance their goals, ATACH is launching a two-year process to create a set of standards to help all members, and any country, to achieve these goals.

For many years, IFHE has been an NGO in official relations with the WHO. Part of our agreed upon workplan is that IFHE will support WHO in the development of standards, For years I have served as IFHE’s Focal Point for our work with WHO — the designated liaison between the two organizations — after years of working with WHO on these same kinds of issues. It is out of these long relationships that they asked us to help lead this effort. Accordingly, we are now leading two of the three WHO ATACH Working Groups who are focused on delivering these much needed standards. IFHE is very proud to be able to bring to bear the collective expertise of the IFHE members to this important project.

This work will include rigorous literature review, collection of relevant standards from countries around the world, and case studies. As we do this work, one thing we will do is to provide access to collected materials to the IFHE community. Our hope is that this sharing of knowledge will help the IFHE membership to support this global effort to protect both the communities we serve from the increasing health catastrophe that is climate change, and the global community by doing our part to bend that climate curve.

I am hoping that the brain trust that is the IFHE will join together to support this effort. We will be issuing calls for volunteers, and materials. We will also be reaching out to our strategic partners, and our corporate members.

If you have an interest in helping with this effort please be in touch with me or with IFHE at volunteers@ifhe.info.

Thank you all, for being part of the solution.

A note on the image above. The United States is an IFHE member country through AMFP, so American members will take part in this work regardless of the federal government's standing with WHO. The US also remains listed as an ATACH member even as it has withdrawn from the WHO — an ambiguity I've left visible here rather than resolve, because it captures something real about this moment. I've also marked, in a third color, the countries where IFHE has a member chapter but which have not joined ATACH. Part of our work is to encourage those chapters to help bring their countries into the alliance.

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 21 • Week Ending August 2, 2026 • Walt Vernon

FROM THE FIELD — PAPER ENGINEERING LION, PART 10

A running account of engineering a hospital energy system in real time

This week, we have been narrowing in on as many of the assumptions as we can.

When we kicked off the project, we started by generating a white board project plan. I identified then, that we needed to ensure that we started talking to the utilities and the codes officials fast. I knew they would take a long time to resolve, and that they would be critical to our final outcome. We reached out to them literally the next day. Today, we are still waiting on all of them. For now, we are going to have make decisions without final numbers and decisions from them.

Our other big uncertainty is the first cost of our various options. When we started this work, Mortenson gave us a due date for a final decision that was just about the time that we are bringing trade partners on board. Mortenson was worried that the trade partners would not have time nor expertise to price the options we were studying. Accordingly, we hired a well known developer of microgrids. By virtue of their experience, they have much better data an expertise with which to give us estimates. And, we were able to get them started sooner than we will our Trade partners, even if they had the expertise.

Of course, that aspiration did not work well with the fact that the engineering team is still working through a lot of details regarding each system option. Since some of this has not been done before, some of the assumptions are taking significant time and effort. That makes it very hard for the microgrid developer to know what to estimate, and we have had to really work hard to be sure enough of a scope, and to define it well enough to help them to help us. On Friday, we had two extensive meetings with them, and I think we have it done well enough for this purpose.

Of course, there is also the issue that the estimates they are giving us are only estimates. Once we get the Trade Partners on board, we have no idea how they will react to the estimates. We will obviously need some kind of process to figure out how we will reconcile our conceptual estimates with the Trade Partners, once they come on board.

There is also the issue we don’t exactly know how the decision will be made. As I wrote a few weeks ago, the project is over budget, and there is need for some kind of capital adjustment. Also, the systems we are proposing are not within the previously established budget, because that one was based on previous projects, all of which used traditional engineering strategies. This one is qualitatively different (in fact, some of the old assumptions will not longer work with new Colorado energy and Building Performance Codes). So, the budget struggle is real, and understandable, at least in this instance. But, because there are significant financial benefits from the strategies we are suggesting, it opens the door to thinking about them in a different financial way. UCH is open to other financing strategies, and we are going to need to move this decision path to closure sooner than later. My hope is, the financial advantages of long term investing in new strategies will help UC for years to come.

I want to do a deep dive, now, into an important issue that has arisen. This is one I have struggled with for many years, ever since first wondering how we could use fuel cells to replace diesel generators.

That first incarnation came during the Kaiser Permanente Small Hospital Big Idea Competition. In that international competition, KP sought, from any designer in the world, a concept for a small hospital that would transcend traditional thinking. At the time, I submitted ten entries, each with a different theme. My Mazzetti partners thought I was insane, and they scrambled to get on other architectural teams. In the end, one of my entries, with Perkins + Will and my old beloved friend Robin Guenther was the co-winner. And it envisioned using fuel cells all the time, rather than diesel generators some of the time.

At the time, an unappreciated part of the entry was a regulatory agenda. We identified that the things we wanted to do were not 100% permitted at that time. And, looking at the adoption schedules of various model codes, we showed how we would change the codes to enable this kind of system. Since that time, this has been one of the things I have been working on. It has proved far more complex and difficult than I then imagined, but it is happening.

At the time, we identified three big issues that needed resolution before the solution could work. First, we needed to get CMS to permit the system. CMS enforces the 2012 edition of NFPA 101, and all referenced codes. Even now, 15 years later, we are still being forced to use these old codes. The problem was, the changes we have now made in NFPA 99 and 70 and even 110 are in codes that are newer. So, I was able to work with CMS to get their categorical waiver, permitting the use of the newer codes for the purpose of permitting these healthcare microgrids. This was a huge advance.

The second big issue has been seismic certification. In California, we must have all elements of the Essential Electrical System, including its on-site generation sources, certified to be able to withstand an earthquake, and still perform their duties. We are inching forward on this one, but we are not there yet. Fortunately, Colorado (and most other states) do not have these requirements, so I can sidestep this one, for this project.

The final hurdle is the issue of fuel storage. California requires that a hospital have 72 hours of on site fuel storage. It is unambiguous. So far as I can tell, no other state has such an unambiguous requirement. I have not fully researched this, but cursory research says there are no such requirements. There are, however, many requirements that a hospital have a plan for emergency operations.

But first, lets reflect on what this 72-hour or 96-hour requirement means.

For decades, the mental model that we in healthcare have lived with is that we have an infinite, inexpensive, reliable electrical utility. And, in case it fails, we turn on a diesel generator and use it for some of our loads. The entire premise of this model is that the diesel is protecting us against – loss of the electrical service.

In this way, the diesel generator is basically an insurance policy. Being an insurance policy, maybe its worth thinking about alternatives in the context of insurance against failure.

And now a reflection. Statistics for the reliability of a typical electrical utility is something like an average of 11 hours of outage in a year. (https://www.eia.gov/todayinenergy/detail.php?id=66744). There is no reliability data for natural gas utilities. About the best data we have is from an NREL study in 2019. (https://www.nrel.gov/docs/fy19osti/72509.pdf). This study found that natural gas utilities are approximately 100 times more reliable than electrical utilities in general. So, what if we used natural gas for our insurance against an electrical utility failure? In that case, do we need on-site fuel?

The main issue is that what we are then insuring against is the failure of BOTH the electrical utility AND the natural gas utility. The NREL study does note that common mode failures – a failure of both utilities at the same time – are possible, if unlikely.

The microgrid strategy relies on the natural gas utility. So, I did research into simultaneous failure of both the electrical utility and the natural gas utility in Broomfield, in Colorado, and in the US.

For the Broomfield area, I found one clearly documented regional event in the past ten years involving overlapping loss or shutdown of both electricity and natural gas: the December 2021 Marshall Fire. It affected Superior, Louisville, and portions of Boulder and Broomfield. Natural gas was intentionally shut off for public safety on December 30, 2021, and restoration and individual relighting continued through approximately January 4. Electric restoration was substantially complete earlier, although the hardest-hit properties remained unavailable. This outage did not affect the Broomfield site, but it could have. I found no other simultaneous electrical and natural gas failure in the state of Colorado.

The national record confirms that common-mode failure is real but rare. Winter Storm Uri in February 2021 produced massive electric outages and natural-gas production, processing, transportation, and local-distribution failures. Electric outages lasted as long as four days for some customers. FERC/NERC found that electric losses contributed to gas failures and gas failures contributed to electric-generation losses.

Winter Storm Elliott in December 2022 heavily stressed both systems and caused widespread electric outages, but major local gas-system collapse was narrowly avoided. FERC/NERC concluded that New York City likely would have lost gas service had temperatures remained low longer; emergency LNG support preserved pressure. Elliott should therefore be treated as a near miss, not an observed simultaneous customer outage.

The January 2024 and January 2025 Arctic events stressed both systems but caused no major joint failure or system-operator electric load shedding. These events show that extreme weather does not normally produce common-mode failure when preparation, fuel supply, and coordination work properly.

Based on the publicly available information reviewed to date, simultaneous interruption of both utility electricity and natural gas appears to be substantially less frequent than electric outages alone. Note that public sources do not necessarily provide a comprehensive, geographically joined database of electric and gas outages, so this review should be treated as a document-event search rather than a complete statistical survey.

But, I ask you, how many electrical outages have you experienced in your career? And how many simultaneous electric AND GAS outages? With a microgrid that offers supply from both an electrical utility and a natural gas utility, we need only insure against the exceedingly rare situation in which both are lost.

Given that, how would an insurance underwriter assess the odds and what mitigation might be appropriate?

Lets start with CMS. CMS requires a Medicare-participating hospital to establish an all-hazards emergency plan, and to implement emergency and standby power systems based on that plan. It does not, however, prescribe a fixed quantity of stored fuel.

CMS’s 2023 categorical waiver is especially important. It permits qualifying healthcare facilities to use sources other than conventional generators or batteries—including fuel cells, solar, wind and energy storage—as part of a healthcare microgrid system, if the system complies with the 2021 NFPA 99, the 2023 NFPA 70 and their associated references. What is critical here is that both of these documents require “Sufficient reliability to provide effective facility operation consistent with the facility emergency operations plan.” https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-states/categorical-waiver-health-care-microgrid-systems-hcmss?utm_source=chatgpt.com

The Joint Commission (TJC) is the accrediting body that surveys hospitals on behalf of CMS, against its own accreditation standards and, where applicable, the CMS Conditions of Participation and incorporated NFPA requirements. It is TJC that expresses the operational planning framework most explicitly, in its Emergency Management standard NPG.03.02.06. The specific language is as follows:

“NPG.03.02.06

The hospital has a plan for managing resources and assets during an emergency or disaster incident.

Note: The hospital considers its prioritized hazards identified as part of its hazard vulnerability analysis when developing a plan for resources and assets.

Element(s) of Performance for NPG.03.02.06

1. The hospital’s plan for managing its resources and assets describes in writing the actions the hospital will take to sustain the needs of the hospital for up to 96 hours based on calculations of current resource consumptions.

Note 1: Hospitals are not required to remain fully functional for 96 hours or stockpile 96 hours’ worth of supplies.

Note 2: The 96-hour time frame provides a framework for hospitals to evaluate their capability to be self-sufficient for at least 96 hours. For example, if a hospital loses electricity and has backup generators, the emergency response plan for resources and assets establishes how much fuel is on hand and how long those generator can be operated before determining next steps. The plan may also address conservation of resources and assets, such as rationing existing resources, canceling noncritical procedures, or redirecting resources.”

There is no requirement for storing 96 hours of fuel on site. Or 72, or any amounts. Simply a requirement to be self-sufficient for at least 96 hours.

On the maintenance side, TJC’s publicly available guidance confirms that hospital emergency-power inspection and maintenance requirements draw from NFPA 110; its current public FAQ expressly references the 2010 edition of NFPA 110 for emergency-power-system maintenance. Joint Commission. I have not found a publicly available TJC standard or FAQ imposing an independent universal requirement for 72 or 96 hours. But, I have reached out to TJC’s team to talk through appropriate strategies for this new paradigm. Jim Grana spoke at the recent LDES for Healthcare Summit, and he talked about the need for engineers, owners, and TJC to work together to find good answers.

We are under the 2026 NEC for this project. But, the CMS Categorical Waiver only recognizes 2023. 2023 first permits a healthcare microgrid to serve the Essential Electrical System microgrid “with sufficient reliability to provide effective facility operation consistent with the facility emergency operations plan.” (517.30(B)(5)). NFPA 70 requires no amount of on-site fuel storage.

2026 made a number of important clarifications, but nothing that affects this particular question.

NFPA 99 2021 says a hospital must be served by a Type 10, Class X, Level 1 on-site source for the Essential Electrical system. Type 10 means the system must be on within ten seconds. Level 1 refers to the consequences of failure of the system.

Class X is undefined by 99, but the NFPA Handbook for 99 says that “NFPA 99 requires all health care emergency power systems (EPSSs) to be Class X, which means that the run-time capacity is not defined in NFPA 110 but needs to be specified by the facility in collaboration with the authority having jurisdiction. The run time will vary for each facility and will depend on many factures [sic], including the ability to receive new fuel and environmental conditions (e.g snow or flooding potential).

In Colorado, the Authority having jurisdiction is the Colorado Department of Public Health and the Environment (CDPHE). CDPHE’s CMS-based guidance uses this language: “Facilities maintaining an onsite fuel source must have plan for keeping the emergency power system operational during the emergency.” The guidance does not say the entire anticipated emergency duration must be physically stored on site. https://cdphe.colorado.gov/emergency-preparedness-guidance-critical-access-hospitals-cahs?utm_source=chatgpt.com”

In our case, our particular fuel cell choice will not run on propane or diesel fuel; only on methane or hydrogen. I will write another time about hydrogen for hospitals, but suffice it to say our only real options are to store natural gas in some form.

A few years ago, Kaiser did a mini “rerun” of SHBI, in a project they called the Shark Tank. In that project, two engineering firms, the two who had tied in the SHBI I project were asked to envision what a zero carbon hospital would look like. Again, we used the fuel cell architecture, and this time, we were determined to figure out the best way to supply on site natural gas fuel.

For UCH, I dusted off that work, and refreshed it. Working with a number of fuel vendors, including some recommended by the fuel cell company we are working with, for many reasons, we have settled on a strategy of using a mobile truck containing Liquid Natural Gas as our on-site source. For our project, one such trailer will neatly provide about 93 hours of capacity at full load for the fuel cells; about 117 hours of capacity for the ESS loads only, and, if we were to shed the MOB (a reasonable strategy if we were in an event where both the electrical utility and the natural gas utility were down), we would have about 167 hours of capacity. I don’t know that we need that much, I don’t know that the codes will require it, but I know that I will sleep better at night if the hospital is so designed. And these are full-load numbers; in reality we never run at full load, so the real durations are longer still. To the extent duration ever becomes the binding question, the design includes a second, empty trailer bay and a standing contract for refills as needed. That is exactly the resupply logic that Class X contemplates: the run time is not a fixed number of stored hours but a facility-specific plan that accounts for the ability to receive new fuel.

I could go on an on with what I have learned about CNG, LNG, propane storage, etc. Suffice it to say, I think we have enough now to be able to help the UCH team make a reasoned decision as to the right path forward.

Two and a half weeks to go.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. The price signal maxed out — and the grid still came up short

PJM’s capacity auction for 2028–29 cleared at the $325 per megawatt-day cap across the entire region, and even at that ceiling the market fell roughly 6.8 gigawatts short of its reliability requirement — a larger deficiency than the prior auction. This is the sharpest possible statement of where the grid is: the price signal is at its maximum, and the resources are still not there.

Infrastructure implication: Higher capacity prices improve project economics, but they cannot conjure turbines, transmission, interconnection approvals, or permits on the timeline the load is growing. For a hospital, this is the argument for treating on-site generation as a capacity and schedule asset, not only an energy-cost measure — and for treating any flexible megawatt it can shed at the peak as a resource with real value.

2. Heat pushed a normally power-rich grid into emergency operations

On July 26, the Department of Energy issued an emergency order covering the Southwest Power Pool, which serves about 20 million people across all or part of seventeen states, authorizing it to call on backup and otherwise-unavailable generation as a last step before rotating outages. During the event, wind generation fell to roughly 7% of SPP output, coal and gas together supplied about 80%, and prices topped $500 per megawatt-hour in constrained locations — running roughly five times higher near the Nebraska–Iowa border than in the southern part of the system. SPP is normally a net exporter.

Infrastructure implication: When a wind-rich net exporter needs federal emergency authority to get through a heat wave, the lesson is not about one region — it is that neighboring grids cannot help when they are all under the same heat dome at once. Annual-average electricity prices are now an inadequate basis for evaluating storage, thermal flexibility, or on-site generation. The exposure lives in a handful of constrained hours, and that is exactly what resilience assets are priced against.

3. A hospital can have power and still be unable to operate

Reports from the United Kingdom this summer describe hospitals delaying or cancelling MRI scans, blood tests, procedures, and surgery because buildings and temperature-sensitive equipment could not be kept adequately cool during the heat. Many older facilities lack comprehensive cooling, and the World Health Organization’s European office has now tied extreme heat explicitly to hospital cooling, power, IT, water, and staff safety, with Europe warming at roughly twice the global average.

Infrastructure implication: This is the shift in how heat resilience has to be understood. The failure mode is not loss of power — the grid can stay energized while the building loses the ability to operate safely, because cooling capacity, heat rejection, electrical capacity, or equipment tolerance runs out. Every hospital should model a compound scenario: temperature above the original design condition, full occupancy, one major chiller unavailable, possible grid curtailment, smoke limiting outdoor-air strategies, and constrained water — then identify which clinical services fail first.

4. Rising rates land on hospital budgets no matter what they build

EIA data for May 2026 showed average U.S. revenue per kilowatt-hour up 5.3% year over year, with increases in 44 states and the District of Columbia — Ohio and Illinois each up around 22%, Hawaii around 31%. Utility capital plans now run to roughly $1.4 trillion through 2030, and in PJM, transmission congestion alone cost participants about $1.8 billion in May and June. Meanwhile natural gas stayed soft, with Henry Hub settling near $2.75 per MMBtu at the end of July, down about 16% on the month.

Infrastructure implication: A health system with no capital project still pays for the grid’s rebuild through its rates. And the soft gas price is a trap for planning: low Henry Hub is not low delivered cost once pipeline, distribution, firm-capacity, balancing, and basis charges are added. Fuel-price risk is not one variable — the commodity and the delivered cost move separately, and the exposure sits downstream of the wellhead.

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THE 12-MINUTE DEEP DIVE

Three Kinds of Reliability — and Why Hospitals Keep Confusing Them

The events of this week reward a distinction that hospital energy planning too often blurs. When a health system says it wants a “reliable” energy supply, it usually means three different things at once, and they call for three different investments. Pulling them apart is the clearest way to understand what the grid is telling us.

Reliability one: will the utility service stay on?

The first kind of reliability is the one everyone thinks of — how often, and for how long, the utility interrupts service. The historical answer in the United States is reassuring on average: something on the order of a few hours of outage per year for a typical customer. This is the risk the emergency generator was invented to cover, and against this risk alone, a diesel generator with a fuel tank is a reasonable answer.

But averages conceal the tail. This week’s SPP emergency and PJM’s capacity shortfall are not about the average year. They are about the specific, correlated hours when heat drives demand up, drives some generation offline, and prevents neighbors from helping because they are all stressed at once. Utility reliability, in other words, is getting less predictable in exactly the hours a hospital can least afford it.

Reliability two: will the on-site system actually work?

The second kind of reliability is entirely internal: when the utility fails, do the on-site systems start, transfer load, carry what they are required to carry, and keep running? This is the domain of the essential electrical system, of transfer switches and paralleling gear and fuel quality and testing regimes. It has nothing to do with the grid and everything to do with engineering discipline and maintenance.

It is also where a subtle temptation has entered. As grid emergencies multiply, some large facilities — data centers among them — have begun running their backup generators to support the grid through demand-response arrangements. For a hospital, that possibility deserves real caution. Before a facility values its emergency generators as a grid resource, it must confirm that the air permit allows non-emergency operation, that market and utility rules permit participation, that the machines can parallel or transfer safely, that fuel remains reserved for an actual outage, that added run hours are reflected in maintenance intervals, and that none of it compromises accreditation or the emergency operations plan. The emergency generator exists for reliability two; renting it to the grid can quietly undermine exactly that.

Reliability three: is there enough energy in the region at all?

The third kind of reliability is the newest, and the one this week put in the foreground: energy-supply adequacy — whether sufficient utility and on-site resources exist during a regional shortage. This is what PJM’s 6.8-gigawatt shortfall is about. It is not that the wires failed or that a generator would not start. It is that the region, in aggregate, may not have enough deliverable capacity when everyone needs it at once.

Against this third risk, the traditional model has no answer. A diesel generator sized to carry the life-safety and critical branches for a few hours does nothing to address a region that is structurally short of capacity for a decade. What addresses it is a facility that can reduce its draw on the grid at the coincident peak, generate meaningfully on-site, store energy across hours, and — where it makes sense — operate through stressed conditions rather than simply riding out a brief outage.

Why the distinction changes the investment

Kept separate, these three reliabilities point to different things. Utility reliability is addressed by backup. On-site reliability is addressed by engineering and maintenance. Energy-supply adequacy is addressed by flexibility, storage, and on-site generation that can carry real load for real durations. The mistake is to buy the first — a bigger diesel plant — and imagine it has answered the third.

And this is where the economics have quietly shifted. A recent analysis in Scientific Reports, modeling a hospital solar-battery-diesel microgrid with the national laboratory’s REopt tool, found net-present-cost savings of 9 to 14% against grid-only operation — and that adding the resilience constraints cost only 0.4 to 2.4% beyond the financially optimal system. Resilience, on those numbers, is close to a design variable rather than an insurance premium. The honesty of the study is what makes it useful: the same model still leaned on diesel at high critical-load levels and in poor solar conditions, and the result depends on site, tariff, and cost assumptions. It does not prove every hospital microgrid is nearly free. It proves resilience is worth modeling as an economic variable rather than assuming it as a cost.

The part that decides who can actually act

There is a fourth thing, and it is not a kind of reliability — it is the thing that determines whether any of the first three get funded. The hospitals most exposed to rising rates and regional scarcity are frequently the least able to self-fund the capital-intensive systems that would protect them, running as they are on thin margins under reimbursement pressure. The technologies exist. The projects exist. The financial structures exist — third-party ownership, power-purchase arrangements that keep the asset off the balance sheet, capital stacks that blend tax-credit transfer with grants and utility incentives, and, increasingly, no-upfront-cost structures like the recently reported medical-center solar installation delivered with its roof upgrade at no capital outlay. What determines whether a margin-pressured hospital captures the hedge is rarely the engineering. It is whether someone can assemble the financing to fit that specific institution. That assembly is not a commodity service; it is the difference between an idea that is sound and a project that gets built.

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U.S. ENERGY MARKETS

• PJM short at the price cap. The 2028–29 capacity auction cleared at the $325/MW-day cap region-wide and still fell ~6.8 GW short of the reliability requirement — a larger deficiency than the prior auction.

• SPP emergency order, 17 states. DOE authorized the Southwest Power Pool (July 26) to dispatch idle and backup generation as heat, weak wind (~7% of output), and constrained imports pushed it toward rotating outages. Prices topped $500/MWh in constrained spots, ~5x the southern system.

• Retail rates climbing broadly. EIA May 2026: average revenue per kWh up 5.3% year over year, higher in 44 states and DC. Ohio and Illinois ~+22%; Hawaii ~+31%.

• Congestion as a cost of its own. PJM transmission congestion cost participants ~$1.8 billion in May–June alone — delivering power can now rival the cost of producing it.

• Gas soft, delivered cost is not. Henry Hub settled ~$2.75/MMBtu on July 31, down ~16% on the month. But delivered cost still carries pipeline, distribution, firm-capacity, balancing, basis, and marketer charges — low commodity price is not low delivered cost.

• Cost allocation is the live fight. FERC has moved on large-load integration; states are weighing tariffs that require very large new loads to bear dedicated interconnection costs, minimum commitments, and exit fees. Hospitals are longstanding essential customers, not speculative new loads.

Infrastructure implication: For any hospital in PJM, SPP, or another high-cost jurisdiction, a single “electricity escalation” number is now a modeling error. Commodity energy, capacity, transmission, distribution, congestion, riders, and standby service move separately — the total bill can rise sharply while wholesale energy looks flat.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

The U.S. grid story dominates and is covered above. On the operations side, two quieter items deserve attention because they are immediately actionable. A reported steam-trap maintenance program at Northwell Health is producing substantial savings with short payback and measurable carbon reductions — a reminder that on large legacy estates, unglamorous steam optimization can deliver faster, cheaper decarbonization than any headline electrification project. And a separately reported medical-center solar installation, roughly 300 kW with a roof upgrade included, was delivered at no upfront capital cost; the financing and roof-integration structure is more transferable than the project’s size.

Infrastructure implication: The two together make a point worth holding onto: the highest-value moves are not always the largest. A steam-trap program funded from the operating budget and a solar array funded with no capital outlay are both available to margin-pressured systems that cannot write a large check — which is most of them.

PROJECT SPOTLIGHT — Northwell Health Steam-Trap Program

A reported proactive steam-trap maintenance program across Northwell Health’s estate is generating substantial energy savings with a short payback period and measurable carbon reductions. Steam optimization is less visible than electrification but can deliver rapid, practical reductions across large legacy hospital campuses, where failed traps quietly waste energy year-round.

Source: Healthcare Facilities Today, July 2026

Infrastructure implication: Steam-trap failure is invisible until someone measures it, and the fix is operating-budget scale, not capital-campaign scale. For any system with a central steam plant, a documented trap-testing program is among the fastest-payback carbon and cost measures available — and it needs no financing structure at all.

2. Spanish-Speaking Americas and the Caribbean

Direct member reporting remains the right instrument for this region, and the activity is real. Rural solar-plus-storage microgrids continue to spread across Brazil and Colombia to protect vaccine cold chains independent of fragile national grids, and Latin American engineering societies are pursuing regional variances in global HVAC standards to reflect sustained humidity and natural-ventilation strategies. The scientific-congress calendar building toward the first-ever IFHE Latin American Regional Congress in Buenos Aires in April 2027 continues to fill.

PROJECT SPOTLIGHT — Caribbean Hospital Renewable Microgrid

A major Caribbean hospital is deploying a 1 MW / 5 MWh microgrid built around a custom energy-storage system, intended to run the facility on renewable energy and hold power through the outages that severe weather routinely imposes. It sits alongside broader regional work, including a Jamaican risk-and-resilience assessment that mapped roughly 1,700 critical facilities into clusters that could be served by microgrids, paired with local training on interconnection and storm-hardening.

Source: Regional project reporting, 2026

Infrastructure implication: In island and hurricane-exposed systems, the microgrid is not an efficiency upgrade — it is the difference between a hospital that operates through a storm and one that does not. The Jamaican facility-mapping approach is worth borrowing anywhere hazard exposure varies sharply across a national estate: prioritize by criticality and exposure before designing individual systems.

3. Europe and the Middle East

The heat is the region’s defining infrastructure story. In Bordeaux, the Bordeaux-Mérignac weather station recorded six days at or above 40°C in 2026 — more than in the entire 105-year period from 1920 through 2025 combined, when only five such days occurred, and reached before August even began. Weeks after the heat, wildfire smoke reached the edges of the metropolitan area. One European city, in one summer, experienced record heat and then wildfire smoke: the two design conditions arriving together, not in separate decades. Across the UK and France, active cooling systems were overwhelmed, and IHEEM and Germany’s FKT organized emergency symposiums on chiller failures and voltage drops.

Infrastructure implication: Bordeaux is one station, and it illustrates a pattern documented far more broadly. The planning lesson is compounding: heat now arrives with smoke and air-quality collapse, so the cooling design and the smoke-readiness design are the same problem, evaluated together. A hospital that solves for heat by opening to more outdoor air, and for smoke by closing to it, has two control strategies pointing in opposite directions — which is a decision to make in advance, not during the event.

PROJECT SPOTLIGHT — University Hospital Lewisham Geothermal

University Hospital Lewisham in the UK is advancing a major ground-source heat-pump project, positioned as a test case for deep decarbonization of legacy hospital stock — the older, hard-to-retrofit building type that struggled most in the July heat.

Source: Facilities reporting, July 2026

Infrastructure implication: Geothermal heat sinks decouple a hospital’s heating and cooling from extreme ambient air temperature — precisely the vulnerability that failed when air-source and conventional systems hit their rejection limits. Legacy-stock retrofits are where the hardest and most valuable lessons will be learned.

4. Africa

SAFHE’s 2026 conference program is live under the theme “Synergy in Action,” and the organization continues to anchor African healthcare-engineering participation. The infrastructure story this week is concrete: utilities and development partners are pairing solar and storage with the specific clinical loads that fail first when the grid does.

PROJECT SPOTLIGHT — Eskom / Mafikeng Provincial Hospital Microgrid

Eskom’s Development Foundation handed over a renewable-energy microgrid at Mafikeng Provincial Hospital in South Africa: a 200 kW solar PV system coupled with a 400 kWh battery storage system and integrated through a central microgrid controller. Eskom described the system as sufficient to meet the hospital’s requirements and noted it directly addresses outages driven by cable theft while reducing the facility’s reliance on diesel backup.

Source: SAnews, July 2026

Infrastructure implication: Where grid failure comes not only from capacity but from cable theft and physical insecurity, on-site solar-plus-storage does double duty — it hedges both the outage and the vulnerability that causes it. The pairing of a utility foundation with a public hospital is also a financing model worth watching across the region.

5. Asia-Pacific

Japan’s summer energy stress — record spot electricity prices driven by heat, high LNG import costs, and a weak yen — continues to make the case that fuel-price exposure running through imported LNG is its own distinct risk. HEAJ is mobilizing Japanese participation for New Orleans. In Australia, IHEA is convening on the spatial and power-density demands of integrating data centers into hospital footprints for on-site AI — the large-load question arriving inside the building envelope — while continuing to lead on the coordination of seismic, heat, and sea-level resilience.

Infrastructure implication: The data-center-in-the-hospital question is the week’s large-load story at a different scale: the same computational load competing with hospitals for grid capacity is now moving onto hospital campuses, bringing server-room cooling, uninterruptible-power, and fiber demands with it. Regions treating seismic, heat, and sea-level resilience as one coordinated design problem, rather than three, will have the most transferable expertise to offer the federation.

IFHE GLOBAL CONNECTION

Register now: the August 12–13 webinar

IFHE’s next webinar, presented by Mazzetti, is “Why Are So Many New Hospitals So Energy Inefficient?” — a look at Cortellucci Vaughan Hospital, which operates at roughly 90 kBtu/sf in a cold climate, with Ian Jarvis and Amandeep Deol of Climate Challenge Network. It runs in two sessions timed for worldwide participation: Session 1 on August 12 (8:00 a.m. PDT / 11:00 a.m. EDT / 4:00 p.m. BST / 5:00 p.m. CEST / 5:00 p.m. SAST / 8:30 p.m. IST), and Session 2 rolling into August 13 for Asia-Pacific (9:00 a.m. JST / 9:30 a.m. ACST / 12:00 p.m. NZST). Registration is open, and national organizations should circulate both options.

The program’s value is that it reframes the measured-versus-modeled performance gap as a question of accountability, not just efficient equipment — which makes it a session for owners, CFOs, and capital-planning leaders as much as for engineers and commissioning providers. Members should also remember that IFHE’s webinar archive now holds more than 150 sessions, including this year’s on refrigerant management, high-performance glazing, geothermal, and decarbonization. Could not attend live? The archive is a standing professional-development resource for chapter meetings and staff education.

The Building Award and Cut the Carbs

The 2026 International Building Award and the companion Global Carbon Challenge — “Cut the Carbs” — have reached their submission deadlines, with recognition to come at the New Orleans Congress. Members with strong projects should stay engaged: even beyond this cycle, a well-populated award program gives the federation a documented, comparable, global cross-section of contemporary healthcare design, engineering, and decarbonization, and the Carbon Challenge portfolio can be assembled in under ten minutes for the next round.

Venezuela

Following the recent earthquake, IFHE continues to work through contacts on the WHO emergency-response team to find how the federation can be useful. The honest picture is that the team is stretched — managing an Ebola response at the same time, disasters on top of disasters. We are not going to overstate what has been arranged; we are staying in the conversation and will report specifics when there are specifics to report. The recent inter-regional resilient-hospitals dialogue convened by WHO, PAHO, and CDRI is a reminder of how much of this work runs through exactly these channels.

New Orleans

The 29th IFHE World Congress runs October 17–20 in New Orleans, hosted through AMFP — the U.S. member organization — and co-located with the Healthcare Design Conference + Expo. With the agenda published, the practical priorities are now registrations, delegations, visa and invitation-letter needs, Council participation, and bilateral meetings. The concentrated owner networks within AMFP’s chapters — North Texas alone reports 50 healthcare-provider members across 11 health systems — are a natural recruiting base. The Congress is most valuable when it produces working relationships and a 2027 agenda, not only an event.

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IFHE GLOBAL EVENTS CALENDAR

August 2026

• August 2–5 — ASHE Health Care Facilities Innovation Conference, Minneapolis (external; New Orleans recruitment opportunity)

• August 4 — WHO / PAHO / CDRI Inter-Regional Resilient Hospitals Dialogue

• August 6 — NHS England national healthcare portering standards webinar (IHEEM, external)

• August 12–13 — IFHE webinar: “Why Are So Many New Hospitals So Energy Inefficient?” (Cortellucci Vaughan; Jarvis and Deol, presented by Mazzetti)

• August 19–22 — ABDEH XI Brazilian Congress, Brasília

• August 21 — California Energy Commission SB 48 comments due

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway

September 2026

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria

• September 30–October 1 — Healthcare Engineering Conference, Gelsenkirchen, Germany

October 2026

• October 13–14 — Healthcare Estates 2026, IHEEM (UK, external)

• October 17–20 — 29th IFHE World Congress, New Orleans (hosted through AMFP), co-located with Healthcare Design Conference + Expo

November 2026

• November 16–18 — IHEA Symposium WA 2026, Fremantle, Western Australia

2027

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 20 • Week Ending July 25, 2026 • Walt Vernon

FROM THE FIELD — PAPER ENGINEERING LION, PART 9

A running account of engineering a hospital energy system in real time

I.

Another exciting Broomfield week. What will I do when it’s all decided and life gets back to normal? One thing I have noticed is that projects like this help me identify the real questions being faced by real owners, and then dig for answers — answers I think are likely to be helpful for everyone.

First, excellent news: we have avoided the dreaded Transmission Study threatened by the United Power team. Our load estimates for the hospital — not including the on-site generation — are low enough that we will not trigger this study. Everyone on the team breathed a sigh of relief. Me especially. I note, though, that hospitals can be considered large loads in many instances, and large loads create this interconnection anxiety. I have heard about projects in New York that cannot proceed because the electric utility does not have capacity for interconnection.

II. The carbon emissions of fuel cells

For a number of years I have advised healthcare clients not to build traditional cogeneration systems. My argument has been that these things generate significant emissions, and as the grid gets more renewable, the cogeneration unit is likely to become a stranded asset from a carbon perspective, even if it works well financially.

So my colleagues at Mazzetti rightly challenged me when I suggested we use fuel cells in lieu of diesel generators — for exactly the same reason. Once installed, the fuel cells, providing seductively attractive financial returns, will continue to produce carbon even as the grid may get cleaner. I ask my colleagues all the time: how can we responsibly build any combustion, knowing what we all know about the realities of the climate crisis?

At the Big Room meeting two weeks ago, the owner made it clear that everything other than cost was nice, but the non-negotiables for healthcare are reliable energy and lowest cost. All the rest is nice, but not on the non-negotiables menu. And yet, while the urgency of now is always uppermost, we cannot fail to consider the long-term implications of our decisions. As my friend Don Berwick hypothesized his grandchildren would someday ask: “Papa, where were you?”

In this case, the fuel-cells-instead-of-diesels strategy is going to cost some up-front capital, but the ongoing electricity savings are too attractive to ignore. We are going to eliminate a second electrical service and a set of paralleled diesel generators in favor of the fuel cells. With the fuel-cell microgrid, the cost of a second electrical service is much less necessary.

But the fuel cell still consumes natural gas. While it does not burn the gas, it does reform it to obtain hydrogen, and therefore produces a substantial quantity of carbon dioxide. On a per-kWh basis the fuel cell generates far less than a diesel generator — but the diesel only runs occasionally, while the fuel cells, to obtain their economic benefit, run all the time. The fuel cells are cleaner than the grid today. But United Power tells us they will be 80% renewable by 2030 and 100% renewable by 2040. If they achieve this (and I am curious at what cost to customers), then they will be lower-emission than the fuel cells.

So it is a fair question: what about the stranded carbon asset? As one of my colleagues asked, how is it different from a traditional cogeneration solution? We have developed four answers. None is perfect, but together they are, I think, sufficient — and instructive for the industry.

a. The fuel cells can be driven by renewable natural gas. I have written about this before and I don’t love it: RNG tends to be expensive, and there is an availability challenge, especially if everyone tried to do it.

b. The fuel cells can be driven, in various concentrations, by hydrogen. In fact the fuel cells already operate on hydrogen — it’s just that they make their own today, from methane. It is possible now to feed a blend of pure hydrogen and methane to the fuel cell, greatly reducing its carbon output, and in the future we may have hydrogen fuel cells available to us. There are so many issues — round-trip efficiency, cost, embodied carbon in the hydrogen, transport and storage. I am hoping for a clean-hydrogen future, and soon. But as my colleagues remind me, hope is not a strategy.

c. We can provide carbon capture on the fuel cells. This may be our best strategy in the short run. Again there are expenses and logistical issues — getting rid of the collected carbon dioxide — but it can be done.

d. We can change the sequence of operations. At some future date, when the grid crosses the line of carbon content, the fuel cells could be turned off, operating only on loss of utility power. They would become more or less what the diesel engine is now — an expensive insurance policy. But an expensive insurance policy that is remarkably lower in CO2 than a diesel engine.

There is also a second perspective. Fuel cells have much lower emissions of the other pollutants common to combustion. On Wednesday night, before our Big Room meeting, I woke at 2 a.m. and could not sleep, so I researched this. What I found: fuel cells produce significantly less of the non-carbon emissions, even running 24×7×365, than a similar-sized diesel plant produces even if the diesels run only eight hours a year. That is astounding, and it speaks both to how dirty the diesels are and how clean the fuel cells are.

This is good news for the fuel-cell argument. The catch: the amount of non-carbon pollutants in either case is so small that it is really just noise in the system — far fewer emissions than, for example, the cars that come onto the property to drop off patients and visitors. So the real non-financial issue is not these local pollutants; it is the carbon. (Remembering that, like the starfish thrown back into the sea, the local emissions do matter to those who experience them.)

III. Investment Tax Credits

One issue we are working through is the Investment Tax Credits and how they fit the fuel-cell strategy. The tax credits are one lever that helps, for the next few years, to make these projects more financially attractive.

Most readers are familiar with the Direct Pay provisions of the fuel-cell and battery incentives that remain after the One Big Beautiful Bill rescinded so much of the previous Inflation Reduction Act. The problem is that the credits carry requirements. They include a 30% base credit and two 10% adders. The first adder comes from domestic content; many manufacturers have adapted, and finding fuel cells or batteries that meet it is not too difficult.

The harder one is the Energy Communities adder. An Energy Community is an area meeting one of three statutory criteria: a qualifying brownfield site; a statistical area with significant historical fossil-fuel employment or tax revenue and unemployment at or above the national average; or a census tract (or adjoining tract) where a coal mine has closed or a coal-fired unit has retired. The purpose is to encourage investment in communities affected by the transition away from fossil fuels. Broomfield qualifies, so we will earn the additional 10%.

Having said that, I told the UCH team about Valley Children’s Hospital. There we started with an Energy Community designation — but because of a change in the local employment rate, it lost the designation before we could complete the project. For purely demographic and regulatory reasons, having nothing to do with the project under construction, VCH lost this 10%. Welcome to tax law.

IV. Medical equipment procurement

Another topic worth pointing out. In an earlier post I described the research we are concluding on energy consumption and its implications for large medical equipment. In the Big Room we divide into clusters working on similar issues, and I somewhat randomly joined one that turned out to be the Fit-Out Cluster — the people who get all the equipment into the building and working in time for opening, with trained, equipped staff. This is not a trivial task; the medical equipment must arrive months before opening so it can be calibrated and certified.

We were talking about how they will select their equipment, and I asked to be involved. I almost fell out of my chair — in all my years in this business I have never really thought about being involved in medical-equipment procurement (Mazzetti has a superb team for exactly this service). But I remembered the sections in our paper about better procurement, and I asked whether, for energy purposes, I could help. They were thrilled.

In particular I want to build a system that facilitates staff operation of equipment to get it into the lowest appropriate power state. Some manufacturers already facilitate this. I am separately working with another health system that has a number of outpatient CTs they want to better control. The energy penalty for waste here is double — we waste energy operating equipment that provides no use, and then use even more energy to remove the heat it generates. Ideally we can create something scalable, to help all of healthcare push down wasted energy. A benefit to all. That, after all, is the goal.

We are going to get this done.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. Heat is now a hospital-operability problem — on four continents at once

Within a single week, four regions hit the same wall. MISO declared an emergency energy alert across the Midwest and South. ERCOT set a record demand of roughly 87 GW in the Texas heat. Japan’s day-ahead spot electricity reached its highest level since early 2023 as 40°C heat, record LNG import costs, and a four-decade-low yen converged. And across the UK and France, active cooling systems were overwhelmed as ambient temperatures pushed past 40°C — condenser rejection limits and grid brownouts, not equipment failures in the ordinary sense.

The WHO European office has now made the framing explicit: extreme heat is a facility-continuity problem, tying it directly to hospital cooling, power, IT, water, and staff safety, and Europe is warming at roughly twice the global average. This moves heat out of the public-health department and into facilities, capital planning, and emergency management.

Infrastructure implication: Cooling has become mission-critical infrastructure, and it fails in company — heat arrives with grid stress, water stress, and patient surge at the same time. Resilience assessments built around “loss of normal power” miss the actual event. The scenario to design against is a hot day, a grid interruption, reduced water, and a full census, all together.

2. The diesel shock is structural, not a spike

U.S. refiner margins set records through mid-July. The 3-2-1 crack spread — the margin a refinery earns turning three barrels of crude into two of gasoline and one of diesel, and the standard gauge of whether refining or crude is the bottleneck — closed at a record near $70 per barrel, with the diesel crack above $91. The reason it beat even the 2022 peak is not only the war: seven U.S. refinery closures since 2019 removed roughly 1.2 million barrels per day of capacity, and global closures plus war damage cut output an estimated 4.5 million barrels per day in the second quarter. Refineries are running near 96% of capacity and still cannot rebuild distillate inventories.

Infrastructure implication: A war-driven price spike reverses when the shooting stops. Lost refining capacity does not come back quickly. That makes distillate-dependent emergency power an exposed position for longer than a spike would imply — and it is the backdrop against which the fuel-cell-versus-diesel question in this issue’s field notes gets decided.

3. The grid buildout is landing on hospital bills — whether or not they build anything

U.S. utilities requested $18.6 billion in rate increases in the first half of 2026, including a record $9.2 billion in the second quarter alone, up 26% year over year. Investor-owned utility capital plans now reach roughly $1.4 trillion through 2030. In the PJM region, transmission congestion cost market participants about $1.8 billion in May and June alone, and the latest capacity auction cleared at its price cap with reserves still below target.

Infrastructure implication: A health system with no capital project still pays for the grid’s expansion through its rates. That reframes on-site generation: it is a hedge against the rate pass-through, not only against outages. The full argument is in this issue’s Deep Dive.

4. An IFHE webinar takes on the performance gap

On August 12–13, IFHE hosts “Why Are So Many New Hospitals So Energy Inefficient?” — a look at Cortellucci Vaughan Hospital, operating at roughly 90 kBtu/sf in a cold climate, with Ian Jarvis and Amandeep Deol of Climate Challenge Network. The subject is the persistent gap between modeled and actual hospital energy use. Registration is open, and both sessions are timed for worldwide participation.

Infrastructure implication: Efficient systems are increasingly available, yet many new hospitals consume far more than their designs predicted. The webinar is less an efficient-building case study than a challenge to conventional planning, modeling, commissioning, and operational accountability.

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THE 12-MINUTE DEEP DIVE

The Grid Is Getting More Expensive. Hospitals Will Pay Either Way.

There is a version of the electricity-cost story that treats it as someone else’s problem — a data-center problem, a utility problem, a regulatory fight playing out in dockets a hospital never reads. That version is wrong, and this issue is a good moment to say why, because the numbers that arrived this month make the through-line unusually clear.

The cost is real, and it is structural

Start with what utilities are asking for. U.S. utilities requested $18.6 billion in rate increases in the first half of 2026, including a record $9.2 billion in the second quarter — 26% more than the same quarter a year earlier, affecting more than 56 million customer accounts. The largest filings are not obscure: roughly $1.2 billion from Oncor in Texas, about $1.5 billion combined from Dominion in Virginia, an 18% residential increase sought by Eversource in Connecticut.

Behind the rate cases sits a capital cycle of a scale the sector has not seen in a generation. Investor-owned utilities plan to invest on the order of $1.4 trillion through 2030, and the cost of the things that buildout requires — turbines, transformers, transmission, construction labor — is itself rising. Lazard’s latest work puts the increase in construction cost above 10% across every generation type in a single year, with combined-cycle gas at a fifteen-year high and gas-turbine deliveries now quoted into the 2030s. Electricity prices rose 4% in June year over year, outpacing inflation.

The important word is structural. Fuel prices rise and fall; capital additions enter the rate base and stay for decades. When a utility spends to serve new load, that spending is recovered from customers over the life of the asset — which means the buildout being driven today by data centers and electrification is a cost that will sit on bills long after this year’s headlines fade.

Why it lands on hospitals specifically

Here is the part that is easy to miss. A hospital does not have to build anything, connect anything, or expand anything to pay for this. It pays through its rates, like every other customer, for a grid being rebuilt largely to serve loads it has nothing to do with.

The clearest illustration is PJM, the market serving roughly 67 million people across Pennsylvania, New Jersey, Maryland, Virginia, Ohio, and the District of Columbia — major healthcare markets all. PJM’s transmission congestion cost market participants about $1.8 billion in May and June alone. Its most recent capacity auction cleared at the price cap while reserves stayed below target. Congestion is now creating situations where the cost of delivering electricity can rival the cost of producing it — a cost that flows through to every bill in the region.

So the question of who pays becomes the whole question. And this month produced the precedent that shows it is genuinely in play: in North Carolina, Duke Energy Carolinas reached a settlement cutting a proposed residential increase from roughly 18% to about 9.5% — and agreed to examine a separate large-load tariff for customers such as data centers. That is the hinge. Regulators are beginning to separate whether grid investment is needed from which class of customer should pay for it. The federal Ratepayer Protection Act now moving through Congress would push in the same direction, though notably it was narrowed to cover data centers specifically.

For candor’s sake, the picture is not one-sided. One empirical study found that data-center growth was associated with slightly lower average retail rates from 2015 through 2024, as growing sales spread fixed costs over more kilowatt-hours — and its authors caution that supply constraints could now reverse that. That caution is the point. The conditions that made new load benign are precisely the ones that no longer hold.

On-site generation as a hedge — and what the code still assumes

If rising rates are structural, then on-site generation stops being only a resilience play or a sustainability gesture and becomes a hedge against a cost the hospital cannot otherwise control. And the economics are more favorable than the reputation suggests. A recent analysis in Scientific Reports, modeling a hospital solar-battery-diesel microgrid with the national laboratory’s REopt tool, found net-present-cost savings of 9 to 14% against grid-only operation — and, strikingly, that adding the resilience constraints cost only 0.4 to 2.4% beyond the financially optimal system. Resilience, on those numbers, is close to free: a design variable, not an insurance premium.

The honesty of that study is what makes it useful. The same model still leaned on diesel at high critical-load levels and in poor solar conditions, and its results depend on site, tariff, and technology-cost assumptions. It does not prove every hospital microgrid is nearly free. It proves that resilience is worth modeling as an economic variable rather than assuming it as a premium.

And it runs into the obstacle every honest version of this argument has to face: the code still assumes on-site fuel. NFPA 99 is read by many to require an on-site fuel supply capable of sustaining the essential system for the full required duration. For a fuel cell running on pipeline natural gas, that is a genuine problem — a pipeline is not on-site fuel. Liquefied natural gas means cryogenic storage; compressed gas is impractical on volume; propane is a different fuel entirely. This is the gap between what the technology can do and what the code was written to expect — codes built for a generator-and-a-fuel-tank world, being asked to govern microgrids. Closing that gap is the work of the standards committees, and it is why the reframing underway in the National Electrical Code — from an “alternate source” to sufficient on-site power with sufficient reliability — matters so much.

The part that determines who can actually do it

Which brings the argument to its real conclusion. The technologies exist. The projects exist. The financial structures exist. What determines whether a given hospital can act is rarely the engineering — it is whether the financing fits an institution running on thin margins under reimbursement pressure. The hospitals most exposed to rising rates are frequently the least able to self-fund the capital-intensive hedge that would protect them.

That gap is bridgeable, and bridging it is a discipline of its own: third-party ownership and power-purchase arrangements that keep the asset off the balance sheet; capital stacks that blend tax-credit transfer, grants, philanthropy, and utility incentives; the prepaid structures that make projects work in low-resource settings. The Investment Tax Credit, with its domestic-content and energy-community adders, is one lever — as this issue’s field notes show, a real one, and a fickle one. Assembling these into something a hospital CFO will sign is not a commodity service. It is the difference between an idea that is technically sound and a project that actually gets built.

That is the honest shape of the moment. Rising rates make on-site generation increasingly valuable. The code has not yet caught up to the technology. And the financing structure decides who captures the hedge and who simply pays the pass-through. The first is a diagnosis anyone can read in the WSJ. The last is where the actual work lives.

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U.S. ENERGY MARKETS

• Rate requests at record levels. $18.6B in utility rate increases requested in H1 2026, including a record $9.2B in Q2 — up 26% year over year, affecting 56M+ accounts. Named filings: Oncor ~$1.2B (TX), Dominion ~$1.5B (VA), Eversource seeking ~18% residential (CT).

• PJM congestion $1.8B in two months. Transmission congestion cost PJM participants ~$1.8B in May–June. The 2028–29 capacity auction cleared at the $325/MW-day cap with reserves below target. Delivering power now can cost as much as producing it.

• The Duke precedent. Duke Energy Carolinas settled to cut a proposed ~18% residential increase to ~9.5% and to examine a separate large-load tariff — regulators separating whether investment is needed from which class pays.

• Construction costs up across the board. Lazard reports power-plant construction costs up 10%+ in a year for gas, solar, and wind alike; combined-cycle gas at a 15-year high; gas-turbine deliveries quoted into the 2030s.

• Refining, not crude, is the bottleneck. 3-2-1 crack spread closed near a record $70/bbl; diesel crack above $91. Seven U.S. refinery closures since 2019 removed ~1.2M bpd; global output down ~4.5M bpd in Q2. Physical crude approached $110 even as futures wobbled on talks — volatility, not resolution.

• Gas comfortable, for now. Working gas 3,056 Bcf as of July 17; April dry production ~110.9 Bcf/day, the highest April on record. Ample supply reduces — but does not remove — price risk from LNG exports, pipeline limits, and weather.

• Storage keeps its footing. Q1 2026 was the strongest first quarter on record for U.S. storage, ~9.7 GWh installed, +32% year over year. Storage retained the clean-electricity investment tax credit without the early termination applied to some wind and solar.

Infrastructure implication: For any hospital in PJM — or any high-cost jurisdiction — a single “electricity escalation” number is now a modeling error. Commodity energy, capacity, transmission, distribution, riders, demand charges, and standby service are moving separately, and the total bill can rise sharply while wholesale energy looks flat.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

The grid-cost story dominates the U.S. picture and is covered in this issue’s Deep Dive and Energy Markets sections. On the codes front, FGI has confirmed its 2026 Codes and Handbooks for fall release, splitting baseline consensus minimums from companion best-practice guidance — with notable additions for incident command centers, mobile-unit infrastructure, discharge waiting facilities, and behavioral-health design. Resilience is being written into the spatial program, not left to the emergency-management binder.

ASHE reported record participation in its Energy to Care program — 70 Sustainability Champions across 13 organizations, 328 Sustained Performance awards, and every one of the 140 Energy to Care Award winners demonstrating at least a 10% EUI reduction over one year or 15% over two, with more than 4,900 facilities participating over the program’s life. Having helped start that program in its early days, I find the scale it has reached genuinely moving: energy reduction in healthcare is now mainstream practice, not a boutique initiative. In Canada, CHES has issued a call for white papers on moving hospitals off natural-gas heating in sub-zero climates without sacrificing winter peak resilience — the cold-climate mirror of the fuel-cell question.

PROJECT SPOTLIGHT — Norton Audubon Hospital Thermal Storage

Norton Audubon Hospital’s ice-storage system reduced first-year energy costs by roughly $278,000 and has contributed to nearly $4 million in cumulative savings from energy measures since 2016. Thermal storage shifts cooling load off the peak without the fire-code complexity of large indoor lithium-ion installations, and can carry cooling through short interruptions when integrated properly.

Source: Reported facility data, 2026

Infrastructure implication: Cooling is a major and partly shiftable hospital load, which makes thermal storage one of the few resilience measures that also reduces peak-demand charges. The design lesson is timing: chilled-water or ice storage should be evaluated at concept design, before the central plant is sized — not bolted on afterward.

2. Spanish-Speaking Americas and the Caribbean

Direct member reporting remains the right instrument for this region — public-site scanning undercounts it — but the current activity is real. Rural solar-plus-storage microgrids continue to spread across Brazil and Colombia to protect vaccine cold chains independent of fragile national grids, and Latin American engineering societies are petitioning for regional variances in global HVAC standards to account for sustained humidity and natural ventilation in non-critical zones. The Border Health Innovation Summit convenes in El Paso in August, bringing AADAIH members and Mexican delegates together on cross-border supply-chain resilience.

PROJECT SPOTLIGHT — Caribbean Hospital Renewable Microgrid

A major Caribbean hospital is deploying a 1 MW / 5 MWh microgrid built around a custom energy-storage system, intended to run the facility on renewable energy and hold power through the outages that severe weather routinely imposes. The project sits alongside broader regional work — including a Jamaican risk-and-resilience assessment that mapped roughly 1,700 critical facilities into clusters that could be served by microgrids, paired with local training on interconnection and storm-hardening.

Source: Regional project reporting, 2026

Infrastructure implication: In island and hurricane-exposed systems, the microgrid is not an efficiency upgrade — it is the difference between a hospital that operates through a storm and one that does not. The Jamaican facility-mapping approach is worth borrowing: prioritize by hazard exposure and criticality before designing individual systems.

3. Europe and the Middle East

The mid-July heatwave produced the region’s defining infrastructure story: active cooling systems overwhelmed across the UK and France as temperatures pushed past 40°C, driving a pivot toward what engineers are calling passive survivability — dynamic solar shading, phase-change materials in building envelopes, and geothermal heat sinks that bypass extreme ambient air temperatures. IHEEM and Germany’s FKT organized emergency symposiums on chiller failures and voltage drops. The WHO European office has formalized the framing, tying extreme heat to hospital cooling, power, water, and staff continuity, and reporting heat-vulnerability assessments underway in Armenia, Georgia, Kazakhstan, Poland, and Ukraine.

On the policy side, EU health ministries are under pressure to move procurement away from price-only models toward frameworks that weigh carbon lifecycle and durability. In an unusual signal of how far the resilience conversation has traveled, Slovakia has classified two hospital projects partly as defence spending, citing their potential dual-use role — a reminder that hospitals are increasingly recognized as national-resilience infrastructure, even where the reclassification outruns the actual protective design.

PROJECT SPOTLIGHT — University Hospital Lewisham Geothermal

University Hospital Lewisham in the UK is advancing a major ground-source heat-pump project, positioned as a test case for deep decarbonization of legacy hospital stock — exactly the older, hard-to-retrofit building type that struggled most in the July heat.

Source: Facilities reporting, July 2026

Infrastructure implication: Geothermal heat sinks decouple a hospital’s heating and cooling from extreme ambient air temperature — which, in a week when air-source and conventional systems hit their rejection limits, is precisely the vulnerability that failed. Legacy-stock retrofits are where the hardest and most valuable lessons will be learned.

4. Africa

SAFHE’s 2026 conference program is live under the theme “Synergy in Action,” and the organization continues to anchor African healthcare-engineering participation, expanding training on off-grid solar maintenance and water-system resilience across Sub-Saharan Africa. The biomedical-engineering story is the one to watch: the African Development Bank committed roughly $33.6 million to the second phase of Rwanda’s Centre of Excellence for Biomedical Engineering and e-Health, aiming to localize production of rehabilitation robotics and device testing and to decouple African health systems from vulnerable global supply chains.

PROJECT SPOTLIGHT — Rwanda Centre of Excellence for Biomedical Engineering

The African Development Bank’s ~$33.6 million commitment to Phase II of Rwanda’s CEBE targets local capacity to produce and test advanced medical devices — rehabilitation robotics among them. Separately, ECOWAS and WAHO delivered roughly $3.4 million to The Gambia for mobile emergency-response vehicles, dialysis infrastructure, and biomedical diagnostic capacity.

Source: AfDB project reporting, July 2026

Infrastructure implication: In many African systems, building infrastructure and clinical equipment cannot be planned or maintained as separate disciplines — and equipment donated without maintenance, parts, and trained technicians becomes a stranded asset. Localizing device production and testing addresses the root of that problem rather than its symptom.

5. Asia-Pacific

Japan’s energy shock is the region’s headline — record spot electricity prices driven by the convergence of extreme heat, record LNG import costs, and a four-decade-low yen, with more heat forecast into early August. HEAJ is actively mobilizing Japanese participation for New Orleans. Elsewhere, HEAJ and New Zealand’s NZIHE are leading code initiatives that address seismic resilience and sea-level rise together for coastal facilities, and Australia’s IHEA is convening on a newer question: the spatial and power-density demands of integrating data centers into hospital footprints to support on-site AI.

Infrastructure implication: The data-center-in-the-hospital question is the large-load story arriving inside the building envelope. The same computational load that competes with hospitals for grid capacity is now moving onto hospital campuses — with the server-room cooling, uninterruptible-power, and fiber demands that follow. The regions treating seismic, heat, and sea-level resilience as one coordinated design problem, rather than three, will have the most transferable expertise to offer the federation.

IFHE GLOBAL CONNECTION

Building Award and Cut the Carbs — deadline July 31

The 2026 International Building Award closes this week, on July 31, with recognition at the New Orleans Congress. As of late July the submission pool stood at six — two from Canada, two from Brazil, one from the United States, and one from Burundi — which is both an opportunity and a prompt. A well-populated cycle gives the federation a documented, comparable, global cross-section of contemporary healthcare design, engineering, and decarbonization. Members should be reminded that major renovations are eligible, and that the companion Global Carbon Challenge — “Cut the Carbs” — can take a facility portfolio in under ten minutes. The goal for both is at least one submission from every member association, and broad participation rather than a single showcase project.

That a Burundi submission sits in this year’s pool is worth pausing on: it is exactly the kind of high-impact, low-resource healthcare-engineering story the federation should be elevating.

The August webinar

Registration is open for “Why Are So Many New Hospitals So Energy Inefficient?” on August 12–13, featuring Cortellucci Vaughan Hospital and Ian Jarvis and Amandeep Deol of Climate Challenge Network. Both sessions are timed for worldwide participation. Member organizations should circulate it through their national channels — it speaks directly to owners, facility managers, engineers, commissioning providers, and capital-planning teams, and it reframes the measured-versus-modeled performance gap as a question of accountability, not just efficient equipment.

A note worth repeating: IFHE’s webinar library now holds more than 150 resources, including this year’s sessions on refrigerant management, high-performance glazing, geothermal, and decarbonization. Could not attend live? The archive is a standing professional-development resource for chapter meetings and staff education, not a set of expired notices.

Venezuela

Following the recent earthquake, IFHE continues to work through contacts on the WHO emergency-response team to find how the federation can be useful. The honest picture is that the team is stretched thin — managing an Ebola response at the same time — disasters on top of disasters. We are not going to overstate what has been arranged; we are staying in the conversation, and we will report specifics when there are specifics to report. The August 4 inter-regional resilient-hospitals dialogue convened by WHO, PAHO, and CDRI is a reminder of how much of this work runs through exactly these channels.

New Orleans

The 29th IFHE World Congress runs October 17–20 in New Orleans, hosted through AMFP — the U.S. member organization — and co-located with the Healthcare Design Conference + Expo. Member associations should be confirming delegations and Council representation now, and international delegates who need invitation letters for visa processing should begin early. Delegations are already mobilizing across the federation; the Congress is most valuable when it produces working relationships and a 2027 agenda, not only an event.

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IFHE GLOBAL EVENTS CALENDAR

July 2026

• July 31 — IFHE International Building Award and Cut the Carbs submission deadline

August 2026

• August 2–5 — ASHE Health Care Facilities Innovation Conference, Minneapolis

• August 4 — WHO / PAHO / CDRI Inter-Regional Resilient Hospitals Dialogue

• August 12–13 — IFHE webinar: “Why Are So Many New Hospitals So Energy Inefficient?” (Cortellucci Vaughan; Jarvis and Deol, Climate Challenge Network)

• August 15 — IFHE Building Award evaluation forms due

• August 19–22 — ABDEH XI Brazilian Congress, Brasília

• August 21 — California Energy Commission SB 48 comments due

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway

September 2026

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria

• September 30–October 1 — Healthcare Engineering Conference, Gelsenkirchen, Germany

October 2026

• October 17–20 — 29th IFHE World Congress, New Orleans (hosted through AMFP), co-located with Healthcare Design Conference + Expo

November 2026

• November 16–18 — IHEA Symposium WA 2026, Fremantle, Western Australia

2027

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires (with AADAIH 40th anniversary)

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees.

The Health Infrastructure Pulse is published weekly.

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© 2026

I love my community in Santa Fe. I have gotten involved in sustainability organizations there. Today, I was reminded that New Mexico, Colorado, Montana, the Western US is suffering from the worst snow drought on record. Indeed, we know that we are now in the worst drought in at least the last 1200 years. The State of Texas, the largest producer of fossil fuels, is negotiating to get New Mexico to reduce its water consumption, so Texans can have more.

A couple of weeks ago, I had dinner with some friends who have relocated to Santa Fe from Texas. Knowing that I regularly volunteer to perform poll watching for elections, my friends asked me, in frustration with what is going on in our world, what they can do to help. I have another friend who told me recently that he admired my philosophy of life. He told me “you don’t seem to get overwhelmed by what is going on, you just constantly find new ways to get involved, and make a positive difference.” I guess that’s my best advice.

This week, Donald Trump threatened to increase tariffs on Canada because of increasing wildfires there. At the same time, he has reduced funding to US agencies who work on preventing wildfires here.

This week, President Trump demanded that the Federal Government stop funding the US National Academies of Science, Engineering, and Medicine, the Nation’s, and the world’s most influential scientific organizations, because science does not align with his views.

What we can each do is to engage. We can engage and support people and organizations who are committed to science and integrity and human flourishing. People and organizations where we can contribute, and where we can make positive contributions. Institutions like, in fact, the National Academies. Institutions and like the International Federation of Healthcare Engineering.

Today, I am privileged to work with the National Academy of Medicine on its Action Collaborative to Decarbonize the Health Sector. Together with Don Berwick and Eric Berzon, I drafted the white paper that helped to launch that effort. I am well-acquainted with the people of NAM; people of immense integrity, and commitment to science, and to the good of humanity. They consistently, despite political pressure, live according to the Einstein mantra engraved in the concrete outside the building – “The right to search for truth implies also a duty; one must not conceal any part of what one has recognized to be true.”

Getting involved with organizations like this, supporting their work, is one way to react to our current realities and to continue walking forward in the cause of science and humanity.

I would also point to the work of the International Federation of Healthcare Engineering. This humble organization, bringing together the people from around the world who plan, design, construct, and operate the health system infrastructure of the world. During the Covid Crisis, we supported the nations of the world, through the World Health Organization, as a help desk of experts, consulting to any country, any organization who needed Covid help.

IFHE has also expressed its commitment to the imperative to address the crisis in climate and health.

Indeed, the current Cut the Carbs Awards Program is an effort from IFHE to celebrate the achievements in climate impact from its members.

A couple of years ago, I did a walking tour through Canyon de Chelly, among the holiest of places in the Navajo nation. Our guide was a 70-year old woman, who had grown up in the Canyon. As we walked, she told us stories of living in the canyon, and climbing the walls to get to the school bus every day. She told us that, when she was a little girl, sometimes, walking behind her mother, she would get so tired. She would cry and complain about how tired and sore she was. “Just keep walking,” her mom would say. “you can do it.”

Just keep walking.

A couple of years ago, we started the process of supporting the application for a grant to VCH for what we are now conceptualizing as their Phase 2 of the microgrid – the vastly expanded Battery Plant.

At the time, under a different Federal Administration, the idea was to pair funding from the California Energy Commission with funding from the US Department of Energy, to demonstrate the value to healthcare of Long Duration Energy Storage. As part of the project, Sandia National Labs partnered with us, to provide various analysis and evaluation services.

And thus, was I introduced to the US Consortium on Long Duration Energy Storage. I went to their first Annual Meeting in 2024, and I remember thinking – there are 400 PhDs here - and me. It was so impressive what they were doing, all in service to helping companies in the US to advance the science, policy, and economics of this critical technology. I was advising my young engineers at the time, misquoting Mr. McGuire in The Graduate– “Just one word. Are you listening? - Plastics Batteries!”

I got involved in several of the Consortium’s Tiger Teams, as they called them, and immersed myself into battery technology. In addition to our work at VCH, Kaiser Ontario, Kaiser Richmond, and Village Health Works in Burundi, I began to think about how batteries can be used in healthcare, and how these use cases would intersect with then national model codes, especially NFPA 70 and NFPA 99.

As a result of all of that, several things are happening now that open yet more new doors for healthcare entities:

1. ASHRAE 189.3 is about to launch, for public comment, a proposed addendum for low-carbon on-site energy resilience systems. This will be paradigm changing.

2. I have submitted a Public Input to the 2029 edition of the National Electrical Code, to better define the requirements for a healthcare microgrid. Critically, that proposal contemplates a major upgrade to the way we conceptualize the application of on-site energy storage capacity for healthcare.

3. I am working with a team at ASHRAE to convene a very different kind of standard. Most current standards look through one lens –Electricity, heat, cooling– at needs for on-site energy storage for resilience. In truth, the best opportunities are found as the synergies of these systems. Accordingly, I have proposed to develop a multi-entity standard that would bring togetherall of the relevant organizations to align around a standard that will be less prescriptive, and less siloed.

Sadly, because federal support for economic competitiveness in this critical industry has apparently been swept into the category of “waste, fraud, and abuse,” the Consortium’s funding ends this year. Last week, the Consortium held itsfinal annual meeting. And I was able to arrange to have a special LDES for Healthcare Summit the day before the official Annual Meeting.

It was an incredible day, bringing together the regulators, the standard writers, finance experts, ASHE, and many of the top researchers on this topic from the National Labs. I had been thinking that this was a conversation that needed to happen. Before, when I would hear the laboratory experts talk, I could see they did not really understand the realities of people who need these technologies. When I talked with healthcare people, I could tell they did not yet understand the potential benefits of these emerging technologies. When I talked with regulators, I could see their anxiety over how they were supposed to regulate these things that were so new to them.

Bringing all of us together created the space for conversations that would not otherwise have happened. I hope it also created connections and relationships that will endure.

Critically, we heard from the pioneers willing to go first– Kaiser, who now has more than 100 microgrids of various configurations in its facilities; Valley Children’s Hospital, who is currently building what will be the largest LDES installation for a hospital in the world; CellCube who used EAAS contracts to deploy systems for economic benefit; Direct Relief and the Navajo Nation, who are showing how these technologies benefit smaller healthcare buildings through economic and resilience lenses; and Klikitat Valley Health, who have shown how to integrate hydrogen storage and generation into a modern healthcare facility.

Perhaps the most striking lesson was that several of the most ambitious examples came not from wealthy urban academic medical centers, but from rural and essential hospitals. That should not surprise us. These are often the places where grid weakness, fuel logistics, limited redundancy, and the human consequences of failure are most acute. Resilience is not an amenity there. It is part of maintaining access to care.

I am proud that Mazzetti, together with CellCube and EOS provided funding for the event. Because Mazzetti is a Benefit Corporation, we will provide in some format, not completely clear to me now, recordings of the many excellent sessions.

The technologies exist. The projects exist. The financial structures exist. The remaining barriers are largely institutional: codes written for another era, organizations working in silos, and a persistent assumption that healthcare resilience must look the way it always has.

Don’t say it can’t be done.

from; LDES for Healthcare Summit, 7/13/2026, Salt Lake City, Utah

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Issue No. 19 • Week Ending July 18, 2026 • Walt Vernon

FROM THE FIELD

On Monday, I stood in front of a room in Salt Lake City and gave a talk with a title I had been turning over for months: “Codes Opened the Door, Nobody Has Walked Through It Yet.”

The argument was simple. The permission to build resilient, low-carbon, on-site energy systems in American hospitals already exists. NFPA 99-2021 recognizes sources beyond generators and batteries, including health care microgrid systems. CMS has a categorical waiver that gives facilities a federal pathway to use them. The National Electrical Code has been quietly moving away from the language of an “alternate source” toward something more honest: enough on-site power, with enough reliability, to keep the essential system running. That is a performance question, not a prescriptive one, and it is a different question than the one most of us were trained to answer.

The door is open. Almost nobody has walked through it.

This week made the cost of not walking through it a great deal more concrete.

“We are not saying there is a utility and a diesel. We are saying you must have enough on-site power, with enough reliability, to ensure continuous operation of the essential system.”

— The reframing underway in NEC Article 517

On Thursday, U.S. refiner margins set a record for the third consecutive session. The 3-2-1 crack spread closed at $69.66 per barrel. The diesel crack settled above $91 per barrel, also a record. Retail diesel topped $5 a gallon. Russia has banned most diesel exports after months of drone strikes on its refineries. Roughly thirty Middle Eastern refineries have been damaged or destroyed. Distillate inventories sit about 11 percent below their five-year seasonal average even after a weekly build, with U.S. refineries running at 96.2 percent of capacity.

Refineries are running nearly flat out, and inventories are still below normal. This is not a crude problem that will resolve when the shooting stops. As JPMorgan’s head of commodities research put it this week, the shock has become a refining story rather than simply a crude supply story.

Which brings me to a hospital in Burundi.

Village Health Works sits in Kigutu, and its Phase I microgrid is complete. For years the calculus there was brutally simple: diesel was expensive, hard to get, and sometimes only available through channels no institution wants to depend on. When global diesel prices spike, a hospital in rural Burundi does not experience a line item on a budget. It experiences the question of whether the generator runs tonight.

The solar array at VHW is not an environmental gesture; it’s a hedge, and its what we can afford. And hedges work — we have the receipts. Kaiser’s microgrid portfolio absorbed the energy price shock following the invasion of Ukraine without a cost increase. That is what a hedge does. It converts a variable you cannot control into one you can.

I have been carrying one image for a long time on this subject. My first visit to Haiti — the visit that eventually became the Sextant Foundation — took me to Hôpital Sacré Coeur in Milot, after the earthquake. There was no electricity in the town. None. Except at the hospital, where the diesel generators ran. I stood there and watched the unmanaged exhaust drift across the fence into the elementary school next door, where I could hear the children singing.

And I knew that, between words, they were also breathing.

We can do better now. We have the technology, we have the code pathway, and as of this week we have a fuel market that is making the argument for us. What we do not yet have is the number of facilities that have actually walked through the door.

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PAPER ENGINEERING LION — PART 8

A running account of engineering a hospital energy system in real time

This week was a bit quiet.

For one thing, we hosted the LDES for Healthcare Summit on Monday, followed by the actual LDES Consortium final Annual meeting, a VHW Board meeting, and the American College of Healthcare Architecture Summer Leadership Summit, which just ended today. I will write more on the LDES mid-week. Lots to consider there. One great thing is that Mortenson, our UCH general contractor, sent some of their team to the meeting, at which they were able to get a crash course on what this new paradigm includes, including conversations with Chad Beebe of ASHE, and Jim Grana from the Joint Commission. It will be so helpful for UCH that the team is getting educated.

For UCHealth, we put together our workplan to get answers to the UCH team, at least in a preliminary way, by our next Big Room meeting next week. Our emphasis this week is nailing down the assumptions we will be using.

Our team is working hard, but we have a number of people working in different directions. One thing I noticed is ensuring that everyone is using the same assumptions, to ensure more effective consolidation of data from across efforts. In particular, the design keeps moving, as the planning team works on how large and just where the various elements of the building are going to be. We discovered that the changing square footage was creating different, uncoordinated modeling from our team. So, we aligned around a fixed set of assumptions, knowing that (a) any deviations at this point are likely noise in the system, and (b) we can true up details later, as these decisions get made.

We needed to hone in on a preferred battery chemistry (which is not a trivial exercise), nail down system sizing, nail down fuel cells versus linear generators (fuel cells, more on that another time), and nail down which fuel cell, noting the huge demand from the massive data center orders.

UC does not currently use an Energy Procurement consultant, so I brought one in to our team, to help us think through likely energy costs in the future for this project. As one simple example, the costs for natural gas to feed on-site fuel cell generation are likely not the same as the costs to combust for thermal energy under a conventional design. Ensuring we are using the right cost data is critical.

A similarly critical decision is the escalation of pricing. As the US excursion into Iran has shown, (and paraphrasing the great Yogi Berra) predicting energy prices is hard; especially for the future. One thing we do know is that the market for energy is global, and just because we produce a lot here, it does not follow that we will be able to buy it at a low cost. Since we are aggressively selling US energy to others overseas, and as supply in the rest of the world is affected by various global events, costs are going up.

And, at the same time, electrical costs are very local. In general, especially with rising electrical demand (demand in this country is skyrocketing for the first time in decades), electrical costs are likely to increase more than natural gas prices. This is because the electrical grid needs to be rebuilt, piling those costs on top of the costs of actually generating the electricity. So, escalation in Broomfield is not the same as some national average, which is what I see many of our competitors using for across the board calculations. Estimating the escalation is an art as much as a science, and we have gone to extensive efforts to do so. Obviously, illuminating these numbers with a range, based on a sensitivity analysis is equally critical.

I think our team was a bit disappointed in our Big Room meeting last week. We were very excited about creating a Choosing by Advantages table, showing the range of system options we are considering, versus a range of factors, including impact on EUI, carbon emissions, local air quality, resilience, space, and of course, capital cost and ongoing operational costs. As we presented this information last week, the owner was very clear that all of the other factors were nice. But UC has to be able to afford to provide healthcare. What is going to matter are capital cost and operational savings. This is exactly what I hear from every healthcare clients I work with. This is something I talked about in the LDES conference. In healthcare energy, there are two non-negotiables; healthcare needs reliable energy, and lowest possible cost. Sustainability is nice, but it is not one of the non-negotiables.

While this reality may have been a bit disappointing to some on my team, I also think its helpful and, ideally, not discouraging. I have made a career of finding ways to make what is better also meet these non-negotiables. That is what engineering should be. If it were easy, anybody could do it. Because it isn’t, we will.

To speed up the project, we got the bill from the utility for the application fees, and we just paid it, to avoid any red tape from the large UC entity to get them set up as a vendor. Similarly, we were given the go-ahead to bring on board a developer of microgrids to help us with more accurate costs. We must have this information if we are to have a chance at accurate cost projections. We have some plug numbers we are using, and they are probably in the ballpark, and we are working with some vendors of fuel cells to nail down some of the costs, but there is no substitute for opinions from someone who has done it.

We are also exploring the issues raised last week on utility interconnection timing, including a Transmission study.

Right now, we are pushing many people to try to pull together the data we need, so we can provide usable information when we meet next week.

We are going to get this done.

Remember Deo’s determination.

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THE 5-MINUTE EXECUTIVE BRIEFING

1. Diesel resilience just got repriced — and it is a refining problem, not an oil problem

U.S. refiner margins hit record highs for three consecutive sessions this week. The 3-2-1 crack spread — the standard benchmark for refiner profitability — closed Thursday at $69.66 per barrel, a record. The diesel crack settled above $91 per barrel, also a record. AAA showed retail diesel crossing $5 per gallon on Thursday for the first time in three weeks, while EIA’s national average retail diesel price rose 21.8 cents to $4.796 per gallon as of July 13, $1.038 higher than a year earlier.

The drivers are stacked: Russia halted most diesel exports amid a domestic fuel crisis worsened by sustained drone strikes on its refineries; renewed Strait of Hormuz tensions; Chinese limits on fuel exports; and roughly thirty Middle Eastern refineries damaged or destroyed during the conflict. U.S. fuel exports have hit record highs as international buyers compete for supply, which has pulled domestic stockpiles down.

Two details matter more than the headline price. First, EIA reported distillate inventories rose 4.6 million barrels for the week ending July 10 and are still about 11 percent below the five-year average — with refinery runs at 96.2 percent of capacity. The prior week saw distillate fall 5.0 million barrels when analysts had expected a 900,000-barrel build, a 5.9 million barrel miss against expectations. Second, and more important for how hospitals should think about this: the constraint is refining capacity, not crude availability.

Source: Reuters, July 16, 2026

Infrastructure implication: A hospital cannot hedge a refining bottleneck by watching oil prices. Emergency fuel budgets, resupply contracts, generator testing costs, and 72- and 96-hour storage strategies were all priced against an assumption of available, affordable distillate. That assumption is now the exposed position. This is also the moment to revisit a question the code has never seriously asked: how much on-site fuel is the right amount, given that required storage duration rests on a refueling assumption that a constrained distillate market may not honor.

2. Gas is soft while diesel spikes — the divergence is the story

EIA reported working gas in storage at 3,024 Bcf as of July 10, up 41 Bcf week over week and 181 Bcf above the five-year average, with natural gas prices sliding to a two-month low on higher output and ample storage. Distillate sits roughly 11 percent below its five-year average. One fuel is comfortable; the other is not.

Infrastructure implication: For facilities weighing dual-fuel strategies, thermal electrification, or CHP economics, the two fuels are no longer moving together. Any resilience model that treats “fossil fuel price risk” as a single variable is now mismodeling the problem. The exposure is specific, and it sits on the distillate side — which is precisely where emergency power lives.

3. MISO emergency alert shows what a thin reserve margin costs

MISO issued an emergency energy alert on July 15 across parts of the Midwest and South, driven by generation outages combined with extreme heat. Wholesale prices reportedly spiked above $900/MWh in Michigan and held around $600/MWh in several other states.

Infrastructure implication: Average energy prices remain manageable; that is not the risk. The risk is the shape of the tail. A facility exposed to real-time or peak-indexed pricing, or one relying on the grid to be there during a heat event, is exposed to those hours specifically. Resilience assets and load flexibility are priced against the tail, not the average — which is the argument facility teams usually lose in front of a CFO who is looking at an annual average.

4. New York moratorium and FERC cost allocation put hospitals in the large-load queue

New York imposed a one-year moratorium on new large data centers of 50 MW or more while it develops a standardized environmental review, citing electricity costs, water use, and community impacts. Organized opposition to data center expansion is spreading, with demonstrations planned in at least 125 locations. Meanwhile FERC is working through co-located large-load and transmission cost-allocation questions, pushing RTOs and ISOs toward arrangements where large new loads pay their share of system upgrades. Delaware is considering a large load tariff classifying facilities at 25 MW and above; large load tariffs are proliferating as states take a more active role.

Infrastructure implication: This is the sleeper story for healthcare. A hospital campus adding electrification capacity enters the same interconnection queue, and increasingly the same cost-allocation regime, as a hyperscale data center. Behind-the-meter, non-exporting resources start to look less like a sustainability preference and more like schedule insurance — a way to avoid a queue whose timelines are set by loads far larger than yours.

5. Cyber resilience is now a 30-day infrastructure planning benchmark

The Joint Commission and AHA launched the second phase of their Cyber Resilience Readiness program in July, adding advisory services and a certification pathway to the self-assessment introduced in May. The program is built around sustaining safe clinical operations during cyber-related technology outages of 30 days or longer. The FBI’s most recent Internet Crime Report identified healthcare and public health as the most frequently targeted sectors in 2025, with 642 incidents including 460 ransomware attacks.

Source: Joint Commission, July 2026

Infrastructure implication: A 30-day outage benchmark is not an IT specification. It is a fuel resupply question, a water management question, a generator runtime question, and a controls question. Larger organizations are being advised to bring biomedical engineering and facilities into the core assessment team alongside IT and clinical leadership. That is the correct instinct, and it is the same convergence showing up in FDA device cybersecurity expectations.

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THE 12-MINUTE DEEP DIVE

I. The End of Cheap Diesel Resilience

For as long as most of us have been designing hospitals, the emergency power question has had a settled answer. You size the generators, you size the tank, you test monthly, and you assume the fuel truck comes. Every element of that answer rests on a market condition, not an engineering principle: distillate has been cheap, abundant, and deliverable.

This week that condition visibly failed. Not permanently, and not everywhere — but visibly, and in a way that is instructive about where the real exposure sits.

The mechanism matters more than the price

It would be easy to file this under “oil prices are up because of the war” and wait for reversion. That reading misses what happened. Crude has continued moving through the Strait of Hormuz in meaningful volumes. The bottleneck is refining. Russia banned most diesel exports to manage a domestic fuel crisis after sustained drone strikes on its refining infrastructure. Roughly thirty Middle Eastern refineries were damaged or destroyed. China limited fuel exports. What remains of global refining capacity is running hard — U.S. refineries at 96.2 percent — and still cannot rebuild distillate inventories, which sit about 11 percent below the five-year average.

The volatility profile is instructive. EIA’s on-highway diesel price actually fell from $5.350 on June 1 to $4.578 by July 6 before the July 8 wholesale shock sent it back above $5. This is not a slow escalation a budget can absorb through a fuel adjustment clause. It is a market that can move a dollar in either direction inside a few weeks, on news a hospital has no visibility into and no influence over.

What this changes for the essential electrical system

Consider what the code actually assumes. Required on-site fuel storage duration is calculated against an expectation of refueling. That expectation is doing enormous quiet work. It presumes a functioning distribution network, a supplier with allocated product, delivery priority for a critical facility, and a price the operating budget can absorb. During a regional emergency — the exact scenario the storage requirement exists to address — every one of those presumptions is under stress simultaneously, and now they are under stress in a market where the product itself is scarce.

This cuts in two directions, and both deserve attention. Facilities may find their required storage duration is inadequate to the actual resupply risk. They may also find, on close analysis, that the code’s prescriptive storage requirement is poorly matched to their real operating profile — too much fuel sitting too long, with degradation and polishing costs, when the underlying question was never “how many gallons” but “how many hours of assured operation.” Those are different questions. Only one of them has a fuel-independent answer.

The hedge argument, with evidence

The strongest case for on-site renewable generation and storage in this environment is not carbon. It is variance reduction. A hospital that has displaced a meaningful share of generator runtime with solar and batteries has converted an uncontrollable input cost into a fixed capital cost with a known service profile.

Kaiser’s microgrid portfolio provides the demonstration. Through the energy price disruption following the invasion of Ukraine, those facilities did not absorb a cost increase. That is not a projection or a model. That is what happened.

Village Health Works in Burundi makes the same argument at the opposite end of the resource spectrum. Phase I of the microgrid is complete, Phase II is planned, and the strategic direction includes electrifying equipment currently dependent on charcoal harvested from surrounding rainforest. When global distillate markets tighten, a rural Burundian hospital does not negotiate a fuel adjustment. It rations. The solar array is the difference between operating and not operating — which is the same thing it is for an American hospital, just with the margin of safety stripped away so you can see the mechanism clearly.

What to do about it in the next ninety days

• Update the emergency fuel assumption. Update resupply contracts, delivery priority terms, and generator operating cost models against current market conditions rather than last year’s.

• Separate the storage question from the duration question. Ask how many hours of assured essential-system operation you actually need, then ask what mix of stored fuel, stored energy, and on-site generation delivers it most reliably.

• Model battery-supported generator downsizing. Batteries can reduce low-load generator runtime, which is where fuel burn is least efficient and maintenance cost accrues fastest.

• Stop adding diesel capacity by default. On new projects, make the diesel-only baseline justify itself against a hybrid alternative rather than the reverse.

• Check fuel quality management. Larger inventories held longer for security reasons create contamination and degradation exposure that the security rationale does not eliminate.

II. Medical Device Cybersecurity Is a Facilities Capital Problem

Two independent developments converged this month, and the convergence is the signal.

FDA’s updated medical device cybersecurity guidance emphasizes secure device architecture, quality system integration, software bills of materials, lifecycle support, and postmarket risk management. Separately, the Joint Commission and AHA moved their Cyber Resilience Readiness program into a second phase with advisory services and a certification pathway, organized around sustaining clinical operations through outages of 30 days or longer.

Read together, they establish something that the traditional org chart is badly positioned to handle: cybersecurity expectations now have capital plan consequences, and continuity expectations now have infrastructure consequences.

The replacement cascade

Legacy connected devices frequently cannot meet current expectations without extensive upgrades — patchability, authentication, defined end-of-support dates, documented software bills of materials. For some equipment, remediation will cost more than replacement and still leave residual risk. Which means the device retirement schedule is no longer driven purely by clinical utility or accounting life. It is driven partly by security supportability.

And replacing equipment is a facilities event. New power requirements. UPS or isolated power. Data outlets and wireless capacity. Cooling. Structural support. Shielding. Medical gas changes. Room renovation. A device replacement roadmap driven by cybersecurity considerations, if it is not integrated with the facility capital plan, will surface as a series of unbudgeted infrastructure surprises.

The 30-day question

The Cyber Resilience Readiness benchmark deserves specific attention from facilities leadership, because a 30-day continuity requirement is not primarily an IT problem. Over thirty days: fuel gets resupplied, or does not. Water management programs continue documented sampling, or lapse. Building automation systems that lost network connectivity get operated manually, or drift. Ventilation pressure relationships get monitored by someone walking the building with an instrument.

Guidance on assembling the assessment team suggests larger organizations add biomedical engineering, facilities, IT security, clinical leadership, and legal. In practice, the facilities contribution to a 30-day continuity plan may be the difference between a plan and a binder.

III. Wildfire Smoke as a Design Condition

Smoke is currently affecting multiple regions, and the research picture has hardened. Outdoor smoke penetrates buildings readily, leaves persistent indoor contamination that can continue off-gassing after the visible plume has passed, and carries risk across respiratory, cardiovascular, neurological, immune, reproductive, and cancer pathways — particularly when the fuel includes structures, vehicles, metals, and plastics rather than vegetation alone.

ASHRAE Guideline 44 provides a framework for protecting occupants through design, operation, filtration, and smoke-readiness planning. The implementation problem is that a hospital cannot simply increase filtration and declare the matter closed.

The filter media problem

Research indicates that some electrostatically charged filter media lose smoke-removal performance rapidly in service, while mechanical media retain performance but impose increasing pressure drop as they load. A nominal MERV rating alone does not predict real wildfire smoke performance. The practical questions are whether existing air handlers can tolerate the pressure drop of the filtration a smoke event actually requires, whether outdoor air and economizer sequences can be safely overridden, and whether replacement filter inventory exists on site when a regional event begins and the supply chain is serving everyone at once.

Where the conflicts are

Smoke mode, infection control ventilation requirements, energy conservation sequences, and thermal comfort will conflict during an event. ASHRAE Guideline 43’s framework for a written ventilation management plan is the right vehicle for resolving those conflicts in advance, with predetermined priorities and named approval authority — because the middle of a smoke event is a poor time to discover that two control sequences and one accreditation requirement point in different directions.

• Identify the outdoor air intakes and infiltration pathways that dominate during smoke events — loading docks and ambulance bays are frequently the largest and least controlled.

• Verify fan capacity against the pressure drop of smoke-event filtration before the event, not during.

• Establish PM2.5 monitoring rather than relying on filter ratings as a proxy for indoor conditions.

• Write the smoke mode sequence, assign the authority to invoke it, and rehearse it.

IV. Water Management: The Binder Is Not the Program

An Upper East Side Legionnaires’ outbreak has sickened more than sixty people, and reporting identified widespread cooling tower testing and reporting violations across New York City. New rules now require monthly rather than quarterly testing, with escalating penalties.

The immediate story is local. The lesson is not. This is a governance and accountability failure at least as much as a water treatment failure. The relevant questions for any health system are uncomfortable in their simplicity: Who owns the cooling tower inventory? Is it complete? Who is named as responsible? What is the laboratory turnaround, and what happens between sample and result? What are the corrective action thresholds, who is authorized to act on them, and what is the escalation path when a contractor does not perform? Does senior management see anything other than a compliance attestation?

CDC recommends comprehensive water management programs, and both Joint Commission and CMS frameworks lean heavily on ASHRAE Standard 188 as the reference. The existence of a program document satisfies the citation. It does not satisfy the risk.

A further complication is arriving from the climate side: UK healthcare estate reporting warns that water shortages and changing source water temperatures may create new Legionella risk. Conservation measures that reduce flow without accounting for stagnation, residence time, and temperature can degrade water safety while improving a sustainability metric. Lower consumption is not automatically safer water.

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U.S. ENERGY MARKETS

• Refining margins at record highs. The 3-2-1 crack spread closed at $69.66/bbl Thursday, a third consecutive record session. Diesel crack above $91/bbl, also a record. Gasoline crack near $59/bbl, a level last seen in June 2022.

• Distillate inventories below normal despite a build. Up 4.6 million barrels for the week ending July 10, still roughly 11 percent under the five-year average, with refinery runs at 96.2 percent of capacity.

• Natural gas comfortable. Working gas in storage at 3,024 Bcf as of July 10, up 41 Bcf week over week and 181 Bcf above the five-year average; prices at a two-month low on higher output.

• MISO emergency energy alert, July 15. Generation outages plus extreme heat across parts of the Midwest and South; wholesale prices reportedly above $900/MWh in Michigan, near $600/MWh in several states.

• Lazard cost reversal. Utility-scale solar remains the cheapest new-build generation in the U.S., but costs rose 18 percent year over year, while new combined-cycle gas sits at a 15-year high. The “everything is getting cheaper” narrative no longer holds.

• Record buildout still projected. EIA indicates the U.S. could add 86 GW of utility-scale generation in 2026, including 43.4 GW solar and 24.3 GW battery storage, with battery additions concentrated in Texas, California, and Arizona.

• Large-load cost allocation accelerating. New York’s one-year moratorium on data centers of 50 MW or more; FERC pressing RTOs and ISOs on cost responsibility; Delaware weighing a large load tariff at the 25 MW threshold.

Infrastructure implication: Behind-the-meter, non-exporting resources are becoming attractive for reasons that have little to do with energy arbitrage. The value is in resilience, peak management, insulation from local volatility, and — increasingly — avoiding an interconnection queue whose timelines are being set by loads an order of magnitude larger than a hospital campus.

IFHE GLOBAL SCAN

Five regions, seven lanes: construction and capital projects; codes, standards and accreditation; energy and utilities; energy storage; air and water; biomedical and clinical engineering; waste and circularity.

1. English-Speaking Americas

Construction and capital projects

Structural construction is underway on New York State’s Wadsworth Center public health laboratory complex in Albany, an approximately $1.7 billion project consolidating five existing laboratories and employing nearly 800 people, targeted for completion in 2030. The program emphasizes adaptability, energy efficiency, and future public health readiness — which in practice means high-containment ventilation and redundancy, substantial emergency power and process loads, specialized exhaust and pressure relationships, and heat recovery opportunities constrained by contamination control.

In San Antonio, University Health approved roughly $90 million to expand two hospitals before their scheduled 2027 openings — 60 inpatient rooms and 16 exam rooms at Palo Alto, 20 inpatient rooms and eight exam rooms at Retama — relying on modular expansion concepts to add capacity without delaying opening. Separately, city leaders are seeking federal support for land acquisition for a proposed 1.4-million-square-foot VA complex.

Harris Health’s LBJ campus expansion continues to advance the John M. O’Quinn Hospital alongside a new central utility plant. The 2026 HFM construction survey found 23 percent of respondents expect to build a central energy plant within three years, with 11 percent already constructing one — well above prior-year levels.

Infrastructure implication: Two patterns are worth naming. Demand assumptions are moving faster than project delivery timelines, which puts a premium on designs that can add beds, diagnostic capacity, electrical distribution, medical gas, and cooling without major disruption. And central plants are increasingly appearing as strategic capital projects in their own right rather than as invisible enabling work.

Community impact as project risk

A $670 million expansion at Memorial Regional Hospital in Hollywood, Florida is generating complaints regarding noise, vibration, property damage, and acquisition practices in the adjacent neighborhood.

Infrastructure implication: Community engagement is frequently treated as an entitlement exercise that concludes at approval. Construction logistics, vibration, haul routes, dust, and multi-year disruption can become reputational and legal exposure well after entitlements are secured. Measurable vibration, noise, dust, traffic, and complaint-response protocols increasingly belong in project controls rather than in the public affairs function.

Codes, standards, and accreditation

FGI has moved from the longstanding “Guidelines” framing to 2026 FGI Codes and separate FGI Handbooks, with Codes presented as minimum requirements supporting compliance and safety and Handbooks carrying commentary and best practice. Areas receiving increased attention include mobile units connected to host facilities and discharge lounges.

Infrastructure implication: For an international audience, this repackaging is genuinely useful: it draws a clearer line between what is mandatory in U.S. practice and what is advisory, which has long been a source of confusion for members reading American standards from abroad. The underlying trend it reflects — healthcare infrastructure designed as a distributed care platform with explicit throughput functions rather than a static inpatient asset — is one most IFHE member countries are navigating in some form.

ASHE is drawing attention to ANSI/ASHRAE/ASHE Standard 170-2025, which includes updates from the 2021 edition. Guideline 43 continues to gain traction as the framework for a written ventilation management plan. The CMS categorical waiver permitting emergency power sources authorized under NFPA 99-2021, including health care microgrid systems, remains in force — and remains substantially underused.

Energy and storage

ASHE announced 70 facilities as 2026 Energy to Care Sustainability Champions on July 13, with 328 facilities receiving Sustained Performance Awards and 140 receiving Energy to Care Awards for meaningful EUI reduction.

The LDES for Healthcare Summit convened in Salt Lake City on July 13, followed by the final annual meeting of the U.S. Long Duration Energy Storage Consortium. The Summit’s recurring theme was that the remaining obstacles to long-duration storage in healthcare are organizational, financial, and regulatory rather than technical — governance, ownership structures, financing, code acceptance. A notable side effect: general contractors and construction managers attended and received direct exposure to code and accreditation authorities, including ASHE and Joint Commission representatives, on what an alternate essential-power architecture actually requires.

Infrastructure implication: Two things follow. The Consortium’s wind-down removes a convening body that has been useful in connecting national laboratory capability to healthcare applications, and it is not obvious what replaces that function. And the contractor education point deserves emphasis: a design team can specify a microgrid, but if the general contractor, the commissioning agent, and the AHJ are encountering the architecture for the first time during construction, the schedule risk is substantial. Bringing builders into the code conversation early is cheap. Discovering the gap at inspection is not.

New research in Scientific Reports models hospital microgrids with coordinated multi-node battery placement, PV, and medical load prioritization under outage scenarios, using a load hierarchy across ICU, OR, imaging, and pharmacy based on Value of Lost Load. Coordinated multi-node placement reduced Energy Not Supplied by 55–63 percent versus baseline configurations while maintaining at least 95 percent supply to life-critical loads across most stochastic outage cases.

Source: Scientific Reports, January 2026

Infrastructure implication: The practical takeaway is the load hierarchy, not the optimization method. “Critical load” is not a single number. It varies with outage duration, patient census, weather, clinical acuity, and available staffing. Treating it as a fixed nameplate figure is how essential electrical systems get sized for a scenario that never actually occurs.

PROJECT SPOTLIGHT — NextNRG California Healthcare Microgrids

NextNRG has begun pre-construction on two California healthcare microgrid projects — Sunnyside Nursing Center in Torrance and Topanga Terrace in Canoga Park — with engineering, permitting, and project planning underway as both move toward commercial operation. The projects are notable less for scale than for facility type: skilled nursing and residential care settings, where extended outages carry acute clinical risk and where microgrid deployment has been rarer than in acute care.

Source: GlobeNewswire, July 7, 2026

Infrastructure implication: Post-acute and residential care facilities carry many of the same continuity obligations as hospitals with a fraction of the engineering staff and capital access. If microgrid economics are becoming workable at this scale, the addressable population of facilities is considerably larger than the acute care sector alone.

2. Spanish-Speaking Americas and the Caribbean

A correction is in order, and it is worth stating plainly because it says something about how infrastructure intelligence gets gathered. Public-source scanning of this region returns very little, which is easily mistaken for low activity. It is not. Direct correspondence with member associations shows the Spanish-speaking Americas may currently be the most coordinated IFHE region in terms of scientific agenda and cross-border cooperation. The gap was in the scanning, not in the region.

Regional scientific calendar

ABDEH hosts the XI Brazilian Congress in Brasília, August 19–22, focused on technology, sustainability, and facility longevity. Colombia held the VII National Meeting of Hospital Architecture and Engineering in Cartagena in early July under the theme “360 Design,” with the XV Colombian Congress scheduled for Bogotá in September. Costa Rica is planning a regional congress in October under the theme “Spaces that Heal,” and Chile follows in November with a program centered on mental health and neuroarchitecture. Associations in Argentina, Brazil, and Venezuela are showing increasing cross-country cooperation, and the IFHE Americas region has submitted its first budget for the use of IFHE-provided funds.

Infrastructure implication: Two observations. First, the thematic range here — neuroarchitecture, healing environments, facility longevity — is broader than the energy-and-resilience frame that dominates North American and European programs, and the federation would benefit from that breadth traveling in both directions. Second, this level of activity building toward the first-ever IFHE Latin American Regional Congress in Buenos Aires in April 2027 suggests the regional congress will arrive with momentum behind it rather than having to create it.

Venezuela

Following the recent earthquake in Venezuela, IFHE has been in direct contact with the president of AVAIMS, the federation’s Venezuelan member association, and has extended the full support of the IFHE community. Details on healthcare facility impact are still being established, and the Pulse will report specifics when they are confirmed rather than estimate them now.

Infrastructure implication: Federation membership is easy to treat as a directory listing. It is worth more than that when a member association is operating in the aftermath of a seismic event and can reach a global network of healthcare engineers directly. Whatever technical assistance eventually proves useful, the first thing that matters is that the call gets answered.

Persistent regional priorities remain hurricane and seismic resilience, grid reliability, diesel dependence, water security, medical equipment maintenance, oxygen supply, and waste treatment. IFHE is also working to establish contact with PAHO, which has not yet responded.

PROJECT SPOTLIGHT — Solar and Storage at Ten Cuban Hospitals

With support from the Japanese government and JICA, ten Cuban hospitals — four in Havana and six across other provinces — will receive photovoltaic systems, batteries, and supporting equipment to maintain continuity of medical services during power outages. The work is led by Cuba’s Ministry of Public Health with UNDP, the Ministry of Energy and Mines, Unión Eléctrica, and local authorities. Systems are being sized to each hospital according to critical energy demand, building characteristics, and urban location. The program is expected to benefit approximately 2.6 million patients and 27,500 healthcare workers. JICA and Cuba are also collaborating on hospital digitalization for diagnostic imaging and on grid stabilization and renewable integration on Isla de la Juventud.

Source: POWER Magazine, July 1, 2026

Infrastructure implication: Note the design premise: systems sized to critical energy demand rather than to whole-building load. That is the same performance question the NEC is moving toward — how much on-site power, with what reliability, for which loads — arrived at independently under severe resource constraint. Cuba is an IFHE prospective-member country, and this is a well-documented, currently deploying program of direct regional relevance.

3. Europe and the Middle East

European healthcare design conversations continue to center on accelerating project delivery — modular construction, standardized designs, digital planning tools — while preserving adaptability and long-term resilience. The binding constraint in much of the region is not capital but the elapsed time from concept through approval, procurement, completion, and operational readiness.

Recent European reporting placed average EU diesel around €1.94 per liter with wide country-to-country variation. European diesel refining margins exceeded $60 per barrel this month following Russia’s export halt, with buyers in Brazil, Africa, and Turkey competing for replacement barrels from India, the Middle East, and the U.S. Gulf.

Infrastructure implication: European hospitals face the diesel exposure described in this issue’s Deep Dive alongside a policy environment moving against combustion. That combination narrows the window during which diesel-default emergency power remains a comfortable choice.

Michigan published a hospital-focused guide explaining air quality permitting requirements for common hospital equipment including boilers, emergency generators, and sterilizers. The relevance extends well beyond one state: hospitals frequently discover late that a new generator, boiler, CHP plant, fuel cell, or sterilizer triggers permitting, emissions testing, recordkeeping, or operational limits. Air permitting belongs in early concept evaluation, not final design.

On the Middle East, no major verified new hospital engineering development surfaced in this cycle. Persistent regional issues remain extreme heat, cooling demand, water and desalination dependency, energy resilience, and high-acuity megaproject delivery.

PROJECT SPOTLIGHT — ÖVKT Annual Meeting and European Congress Mobilization

Austria’s ÖVKT held Forum Krankenhaustechnik 2026 — Bau & Betrieb in Vienna on June 16–17, and its annual meeting is scheduled for September 22–24, 2026. The association’s calendar also directs members toward the IFHE World Congress in New Orleans. Austria is among the more visibly active member bodies in 2026 programming, alongside SAFHE’s Cape Town conference and open call for abstracts under the theme “Synergy in Action,” and HEAJ Japan’s July notice promoting the New Orleans Call for Presentations for the Facility, Project & Asset Management Track.

Source: Member association calendars, July 2026

Infrastructure implication: Three member bodies on three continents are actively mobilizing delegations for New Orleans. The Congress is the federation’s principal 2026 convening and the logical organizing point for awards, regional engagement, and technical exchange — but its value depends on what it produces afterward: working relationships, recorded educational material, and a 2027 agenda.

4. Africa

Africa Health ExCon reporting continues to emphasize new hospitals, modernization, digital systems, modular construction, and integrated healthcare planning. Ongoing programs across the continent continue to combine oxygen generation, solar power, medical gas piping, and biomedical technician training as a single integrated system rather than as separate disciplines.

Nigeria’s Rural Electrification Agency published a tender for the supply, delivery, installation, commissioning, and operations and maintenance of 32 solar power systems for healthcare facilities and schools across three regions, initiated by ECOWAS under the World Bank-backed Regional Off-Grid Electricity Access Project.

Source: pv magazine, June 5, 2026

Context for scale: in Sub-Saharan Africa roughly 15 percent of health facilities have no electricity access — approximately 25,000 facilities — and health facilities without electricity are associated with 39 percent lower patient foot traffic than those with reliable power. Global donor commitments now target solarization of more than 98,000 health facilities.

Source: WRI, January 2026

Infrastructure implication: The 39 percent foot traffic differential deserves more attention than it gets. Electrification is usually justified on service quality and equipment function. This suggests it also determines whether patients present at all — which makes power a determinant of utilization, not merely of clinical capability. Note also the operations and maintenance scope in the Nigerian tender: the field has learned that installation without a maintenance model produces a solar array that stops working.

PROJECT SPOTLIGHT — Gavi Health Facility Solar Electrification — Completion Window

Gavi’s Health Facility Solar Electrification programme committed approximately US$28 million to deploy 5–8 kWp photovoltaic systems and cold chain equipment across 1,277 health facilities in Zambia, Ethiopia, Pakistan, and Uganda, with completion targeted for June 2026 and an estimated 25 million people in the catchment areas. Zambia inaugurated the first solar clinic under the programme, with 250 clinics in scope; Uganda is fitting 250 Health Centres III with solar installations, implemented by UNICEF with the Ministry of Health and WHO. The programme was structured as a learning agenda under Gavi’s Cold Chain Equipment Optimisation Platform, testing whether cold-chain solarization can scale to full facility electrification and unlock co-investment and long-term government maintenance support.

Source: Gavi and UN Uganda

Infrastructure implication: The programme’s completion window has now arrived, which makes its stated learning agenda immediately relevant: whether co-investment and sustained government maintenance funding actually materialized is the question that determines whether the model scales. For IFHE and for organizations working in low-resource settings, the maintenance and financing findings will matter considerably more than the installation count.

5. Asia-Pacific

India continues substantial capacity expansion. Maharashtra announced redevelopment of Ulhasnagar Central Hospital into a 500-bed multispecialty facility, alongside plans to expand ESIC hospital capacity. The Indian market continues to combine very large capacity needs with modernization, affordability, energy reliability, water constraints, and biomedical equipment requirements simultaneously.

Australia remains among the most visibly active member bodies. IHEA held its National Conference on the Gold Coast in March, focused on managing health infrastructure risk across innovation, people, process, and technology, and is promoting the IHEA Symposium WA 2026 in Fremantle, November 16–18, under the theme “Collaboration by Design: Advancing Healthcare Together,” with abstract submissions open. Healthcare expansion in Queensland continues alongside workforce growth.

Japan’s HEAJ posted a July notice promoting the New Orleans congress and specifically calling attention to the Call for Presentations for the Facility, Project & Asset Management Track — a clear signal of active mobilization for October.

Regional expertise in disaster resilience, seismic design, extreme weather response, and high-density hospital development remains among the most exportable knowledge in the federation, and modular deployment as a post-disaster resilience strategy continues to develop in Indonesia and the Philippines.

Infrastructure implication: The Asia-Pacific membership holds capability the rest of the federation needs — particularly on seismic and disaster resilience — and a structured knowledge exchange would move value in both directions. Fremantle in November sits after New Orleans in the calendar, which makes it a natural venue for carrying Congress outcomes forward rather than restarting the conversation.

IFHE GLOBAL CONNECTION

Three items warrant immediate attention from the federation and its members.

Awards — International Building Award deadline July 31

Less than two weeks remain for submissions to the 2026 International Building Award, covering new healthcare buildings and major renovations. Both awards will be presented at the New Orleans Congress: the New Buildings Award and “Cut the Carbs,” the federation’s decarbonization recognition. The stated goal is at least one hospital submission from every member association.

The deadline is the visible object; the opportunity is larger. A well-populated award cycle assembles a global portfolio of contemporary healthcare design, engineering, resilience, and decarbonization examples the federation can use well beyond the Congress — as webinar material, Digest articles, and project profiles, including for entries that do not win. Members should be reminded that major renovations are eligible, not only new construction, and that projects demonstrating measurable engineering and operational achievement are actively encouraged.

Infrastructure implication: A submission from every member association would produce something the federation does not currently have: a documented, comparable, global cross-section of what healthcare decarbonization and resilience actually look like in practice, across every income level and climate zone in the membership. That database is arguably worth more than the awards themselves.

29th IFHE World Congress — New Orleans, October 17–20

The Congress is co-located with the Healthcare Design Conference + Expo, with registration open. Delegations are mobilizing: HEAJ is promoting the Call for Presentations to Japanese members, ÖVKT is directing Austrian members to the event, and SAFHE and IHEA are running parallel national programs. A presidential work plan tracking delegation status by member country, visa and travel barriers, regional group meetings, prospective member meetings, sponsor participation, and post-Congress publication commitments would convert a well-attended event into a durable program.

The Americas region and the education library

The IFHE Americas presence remains thin relative to the region’s potential, and this week’s Latin America scan gap illustrates the cost. Near-term priorities: formalize the regional steering group, identify one cross-border technical project, develop Spanish-language webinar capacity, and engage pending and prospective organizations — the Cuban hospital solarization program in this issue is a concrete example of exactly the kind of work the region should be documenting and sharing.

IHEEM

The Institute of Healthcare Engineering and Estate Management has formally notified IFHE of its departure from the federation.

We are sorry to see them go. IHEEM has been a substantial presence in international healthcare engineering for a long time, and the federation is smaller without them. We wish them well, and we hope that in time — like the prodigal son — we will have the opportunity to welcome them home.

IHEEM’s own program continues, and this newsletter will keep listing it, because the work remains relevant to healthcare engineers regardless of federation affiliation. Healthcare Estates 2026 runs October 13–14, and a new Scotland Regional Conference is scheduled for November 10–11.

Webinars and committee volunteers

The monthly webinar series launched in January runs on the second Wednesday of each month, deliberately scheduled at both 12 noon and 12 midnight GMT so that members across every time zone can attend a live session rather than only a recording. The 2026 program has covered decarbonization, geothermal HVAC, high-performance glazing, refrigerants, and electrified kitchens.

The 2026 workplan is actively recruiting volunteers for five standing committees: Strategic Partners, Communications, Educational Opportunities, Website Development, and Awards. Members interested in contributing to the federation’s program between congresses should reach out through their national association.

The webinar library remains one of the most practical vehicles for continuous member value between congresses, particularly for engineers in countries with constrained travel budgets. Tagging by infrastructure type, country or climate, new construction versus existing facility, biomedical engineering, energy, water, waste, resilience, codes, and language would make it genuinely navigable.

Strategic partnerships

Work continues to strengthen relationships with the World Health Organization, ASHRAE, the International Hospital Federation, and Health Care Without Harm. Efforts to establish contact with PAHO are ongoing; the organization has not yet responded, which is worth noting given the volume of regional activity described in this issue’s Spanish-speaking Americas section and the obvious complementarity between PAHO’s resilient hospitals work and the federation’s technical membership.

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IFHE GLOBAL EVENTS CALENDAR

July 2026

• July 31 — IFHE International Building Award, submission deadline

August 2026

• August 2–5 — ASHE Health Care Facilities Innovation Conference, Minneapolis. Program emphasis on 2026 FGI Codes, 2027 NFPA 101 updates, Joint Commission survey changes, battery safety, energy right-sizing, and cybersecurity.

• August 5 — NAM Climate Collaborative feedback due

• August 19–22 — ABDEH XI Brazilian Congress, Brasília — technology, sustainability, and facility longevity

• August 21 — California Energy Commission SB 48 building performance standards, comments due (workshop July 29)

• August 31–September 2 — FSTL Annual Conference, Trondheim, Norway — “Security and Preparedness” within a total defence framework

September 2026

• September — XV Colombian Congress, Bogotá

• September — Denmark national congress

• September 22–24 — ÖVKT Annual Conference, Pörtschach, Austria — “Safe Operation of Healthcare Facilities”

• September 30–October 1 — 7th Hospital Technology Trade Fair and Healthcare Engineering Conference, Gelsenkirchen, Germany — AI in hospitals, digital twins, emergency preparedness

October 2026

• October — Costa Rica regional congress — “Spaces that Heal”

• October 13–14 — Healthcare Estates 2026, IHEEM (UK). Listed for member reference; IHEEM has departed the federation.

• October 17–20 — 29th IFHE World Congress, New Orleans, co-located with Healthcare Design Conference + Expo

November 2026

• November — Chile regional congress — mental health and neuroarchitecture

• November — Italy national congress

• November 10–11 — IHEEM Scotland Regional Conference (see note above)

• November 16–18 — IHEA Symposium WA 2026, Fremantle, Western Australia — “Collaboration by Design”

2027

• April 26–30, 2027 — IFHE Latin American Regional Congress, Buenos Aires, co-located with AADAIH 40th anniversary. First IFHE regional congress in Latin America.

• April 27, 2027 — HEAJ event, Japan

ABOUT

Walt Vernon is CEO of Mazzetti, an employee-owned benefit corporation focused on healthcare and climate engineering, and President of the International Federation of Healthcare Engineering. He founded the Sextant Foundation, a 501(c)(3) advancing clean energy for low-resourced health facilities internationally. He holds degrees in electrical engineering, business, law, and energy law, and helped write the National Electrical Code provisions that enable hospital microgrids. He serves on NFPA 70 CMP-15, NFPA 99, and ASHRAE 189.3 committees, and on the Leadership Team of the U.S. Long Duration Energy Storage Consortium.

The Health Infrastructure Pulse is published weekly.

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© 2026 Walt Vernon / Health Infrastructure Pulse. All rights reserved.

Many years ago, I remember being in a car on my way to some client or other, when I received a phone call that would, in some ways, change my life.

“Hello” the voice said. “My name is Deo Niyizonkiza. I’m building a world class hospital in Burundi, and I need your help.”

I remember thinking “Wow. I thought these guys were all from Nigeria, and they did their scams using email.”

But something stopped me from hanging up. Deo went on to talk about people I knew from WHO who had recommended me to him, and I began to believe. He mentioned a book that Tracy Kidder had written about him, and I looked him up on Amazon. Finally convinced, I listened more.

A few weeks later, Deo was going to be in the Bay Area. I wanted to meet him in person, so I agreed to pick him up at his hotel in Burlingame and take him to the bus station. I remember having no idea who I would meet, but as we talked, I fell in love with this human being, and his vision. I asked him where he would go once he got on the bus I was taking him to, and he told me he was going to Napa. I made quick mental calculations, and asked him if I could just take him, and save him the money for a bus ticket.

And thus was born over a decade of service to Deo and to Village Health Works. That day, I remember saying something to him about having a new friend. “That’s good,” he said. “I need all the new friends I can get, because all of my old friends were killed during our civil war.”

I could tell so many stories about Deo, and the people I have been able to mobilize to help him, and who have been touched by his magic.

Right now, I am working with one of the large healthcare architects who is considering helping Deo with a master plan for the next phase of VHW. They are worried because they don’t see a good business plan, and they don’t see funding in hand for the project and they don’t see how it can work. I remember having exactly those feelings ten years ago.

Today, I was able to spend most of the day with a new collection of new friends. For years, the VHW Board has been meeting by video. I am so grateful for zoom, but you cannot get to really know people through zoom. Today, Deo brought us together in the home of Bill and Sharon Jacob, two of our founding Board members, for a retreat. Our purpose was to think deeply about what we, and so many others, have done, and where we will go next. We were able to have breakfast together, to celebrate this shining city on the hill, to weep with joy, to think deeply about what this organization means, to get to know one another more deeply, and to build a shared vision for what comes next. I developed a huge new respect for every one of these people, but most of all, for that singular human being, who brought us together.

Today, Deo shared with us a revised Vision, Values, and Mission Statement. We wrestled and word-smithed, and debated them, especially the Vision, and the Mission. Then, Deo put on the screen the values he hopes VHW will embody. There were five, and one was this:

“Uncompromising Commitment. We do whatever it takes, driving forward with grit and resilience to overcome logistical, financial, and geographic barriers.”

When I read that, I could feel it, and I could feel it at least because that is something I might have written. I felt it because I thought about the Board Members Deo talked about who left the Board because they had felt that the organization was moving too fast, with too few resources, in ways that were too few to succeed. And then the organization did succeed. I thought about the big architectural firm, who, not knowing Deo, was debating whether he was worth investing in. For the values, there were no discussions. Only thumbs up.

This one man with a dream to create a vision for what rural healthcare can mean in a world where rural communities are all too often left behind. This man who, like a Nigerian con man, roped me in. This man who really is creating a shining city on a hill.

Today, I am working with the WHO to try to create standards for health facilities for low and middle income countries. Today, I am working with Mass Design and others, on a project to improve conditions in health facilities through central Africa. Last year, I worked with UKAID on a project to help develop Nigerian health facility resilience standards. When I do this work, I carry VHW and Deo with me.

Deo will speak at the 2026 IFHE Congress in New Orleans. VHW has applied for the New Buildings Award, and, more important, based on its new microgrid that provides 95% of its energy through a solar and micro-hydro microgrid, the Cut the Carbs Award.

One of our fellow board members was talking about the fact that, when he wrote a check to VHW, he felt gratitude to be able to put some of his money to such a cause.

Amen.

If you want to learn more about Village Health Works, or support our mission: villagehealthworks.org

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Week of July 12, 2026 • Issue No. 18

LDES for Healthcare Summit — Happening today!

Today, July 13, the LDES for Healthcare Summit will convene at the University of Utah in Salt Lake City. Scientists from five National Laboratories. Hospital owners. ASHE. The Joint Commission. Case studies from Kaiser Permanente, Valley Children’s Hospital, Klickitat Valley Health, Direct Relief, and the Navajo Nation. The U.S. LDES Consortium’s final act before sunsetting.

A full recap is coming this week in a standalone mid-week essay.

From the Field

Paper (Engineering) Lion — Week 7

This week was another of our every two weeks Big Room Meeting. The cadence of these meetings is super helpful, as it gives us a focus for communication and decision making that is extremely helpful.

In the case of this microgrid, we are coming down to the wire. The project has a schedule driven by needs to recruit a healthcare workforce from scratch, and the need to provide better quality healthcare for this growing community. If we cannot align around an alternative to a conventional system in the next six weeks, we will have to default to an imperfect status quo solution that no longer serves the needs of a future-focused organization. I feel the responsibility heavily.

This week, we continued to refine our models. Our microgrid modelers are now working closely with the rate experts from United Power. We have brought on an Energy Procurement expert who we often work with – Carlos Lopez of ECOM Energy. Carlos is helping us to validate natural gas pricing, in particular, together with modeling natural gas futures, in ways we can rely on.

We still do not have first cost data from the utility. In the case of natural gas, we are going to assume it factors out of the equation. Either, we will buy natural gas to burn in boilers, or we will buy natural gas to convert in fuel cells. Either way, the fees to bring service to the site are likely to be similar, so we are factoring that out. United Power is another matter entirely. Here, we are debating the value of one service vs two – something I wrote about on Linked in a few months ago. The proposition is that, properly designed, the on-site generation resource plus one utility feed will be more reliable than two utility feeds and some diesels. Note that my pending proposal to NFPA 70 addresses precisely this question. More on that another day. The point is, we have to get those costs to present a reliable decision making.

Indeed, during the meeting this week, we discussed our Choosing by Advantages matrix. We noted that the CBA methodology typically addresses costs after considering everything else. The Owner’s Rep and the Owner noted that the other qualities might be nice, but at the end of the day, it was going to come down to costs. Every client I deal with has exactly the same imperatives; how do we get reliable energy? How do we do so at the best cost, with varying emphasis on capital investment versus operating expense.

In this case, people really woke up this week to the financing question. I had previously suggested that we needed a second track. It is great to explore technical solutions and figure out the optimal set of systems. But, then we have to figure out how to pay for them. It’s clear that this track is going to quickly accelerate now. That acceleration is so that we can achieve our six week milestone, but also because it could help our project budget.

In addition to being unable to get good cost data from the utility (fingers crossed on this one), we need to also get good construction cost data. We know that the project budget here was developed by looking at the costs for five similar hospitals completed in recent years. The problem is, those hospitals were built under different energy codes that were easier to meet. And, they did not take advantage of new provisions in the codes that, if used wisely, will drive down the capital investment. And, none of them used the kind of on-site generation system we are proposing. So, they are unreliable predictors for sure. And, we can’t get our Trade Partners on fast enough to do our six-week sprint. And, since these are new ways of designing systems, we are struggling to figure out who we can talk to, to help generate reliable numbers.

And so, in answer to all of these problems, I suggested that one potential financing strategy is to outsource the plant, altogether. The finance-build-operate model for infrastructure is increasingly common in healthcare. The essence of the idea is that the hospital can unencumber their balance sheet, trading for ongoing operational expense that will, in theory, be better than what they might have spent if they did the project themselves. There are many devils in these details, and I have no idea whether we will go that route. However, right now, we need good data. So, we are inviting such a party to the dance, to help our engineering analysis team with better estimates of first cost.

And shifting back to the utility cost estimates, is an interesting illustration of the real world challenges that often arise in a complex, fast-moving project like this one.

Like all good utilities, this one wants to get paid before it does anything. So, we submitted an application for service as fast as we could. United promised us fast turn-around on a bill for the application. We are still waiting. And, we have learned that it will take time for the University to set up a new payee in its system. So, to keep the project moving, we will pay the fees as soon as we get the bill, and then get reimbursed later. It is our job to help this owner get the best possible system, so we are doing what we have to do, to get it done.

I would also note another interesting aspect of this utility negotiation. When we first met with United, the advised us to submit three different applications; one for temporary power for construction (understandable, and the builder is on it), one for the first phase, and a third for the second phase. They represented that, if we were to submit for both phases of the project, it might be enough load to trigger what they called a Transmission Study. I don’t remember the details, but I remember hearing the word “years” included somewhere. That is a bit alarming for a lot of reasons. In this case, United Power is the local distribution network, but not the ultimate supplier of the power. They attach to what we all think of as the grid. And, we have all been hearing about the strains the grid is under these days with rapid load growth. These strains are showing up in the form of interconnection delays, and, yes, years. We followed their advice, and submitted for phase one only, but even that raises many questions. Can we still get all the capacity we need in phase one, even if we don’t need it all until phase two? We don’t want to have to redo this part of the infrastructure later. What will happen to the other buildings planned for the same parcel? Will they, like a game of musical chairs, suddenly trigger a Transmission study at some point? What about the hospital planned by another owner right across the street? What about other growth in the area? This is a question that got the ear of the project leadership, and we will be working through it as well.

Indeed, the fact that we are proposing to do on-site generation is exactly what the experts on grid design talk about all the time. (I often attend their meetings, and this is the solution most often mentioned to the time it takes to build out the grid).

And, there are other issues with having our own power plant that we are grappling with.

Colorado, and Broomfield, have pretty strict energy codes. They include, as one path, a prescriptive EUI target for various kinds of buildings. In addition, Colorado has a serious Building Performance Standard. It has limits for buildings operating now, and for buildings operating as of 2030. We are planning for a building to open in 2029. Technically, we could get the building permitted under the building code, and even under the current BPS. But, I would never forgive myself if we designed a building that would struggle to meet the 2030 rules. And so, 2030 rules are our target.

But here’s the thing. If we buy electricity from the grid, we do not need to worry about its fuel. For the purposes of the energy code, and the BPS, we are designing to site energy, not source energy. So, if we bring natural gas onto the site to generate electricity, we have to count it. If we buy electricity, we do not have to count the natural gas used to make it. That difference is significant in this case, but we think we can still meet the EUI targets.

The other thing on our minds is the carbon FUTURE of the system. I am inspired by my Mazzetti colleagues, all of whom, by now are younger than I am. They have raised the point that, just as we do not want to give the University a building they can’t legally operate in 2030 and beyond, so we also don’t want to give them a building that will continue to spew carbon dioxide into the air for decades. This is the very argument I use so often against cogeneration plants that combust natural gas. In both cases, the on-site generation today is better than the grid, but in both cases, the question is, what happens as the grid cleans up. In Broomfield, United Power expects to be zero carbon relatively quickly, and so, the carbon future of our solution must be considered.

I started the internal conversation by talking about hydrogen. The first purely hydrogen fuel cell for a hospital, with my engineering stamp on it, is now operating in Klickitat, Washington. This week, Governor Newsom in California signed a law allowing renewable hydrogen to be considered a clean fuel (see below). But the hydrogen future, as my colleagues pointed out, is uncertain at best.

So, we met with the vendor who we are talking to about this project to explore various options for carbon futures. We are under an NDA, so we cannot reveal much, but suffice it to say, there are ways to deal with the problem in both short- and long- terms. And, especially because we will capture the heat from the fuel cells and use it for the peaking energy we need, it will be a highly efficient system. The emissions numbers, today and in the future, look really good.

This week, we are building our workplan. While six weeks out is the absolute drop dead date, I am hoping we will be close enough to help them decide in four.

Well, three and a half now. Stay tuned.

— Walt Vernon

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IFHE Global Scan

U.S. Energy Markets

US-Iran MOU signed June 18 — Hormuz reopening. The biggest energy market structural change of the year. EIA July 7 STEO confirms: most crude production expected to return to pre-conflict levels by end of 2026. Shut-in production back online by Q1 2027. Brent averaged $85/bbl in June, down $22 from May and $32 from April peak. Forecast: $74/bbl Q3 2026, falling to $65/bbl in 2027. Global oil inventories shifting back to pre-conflict oversupply. EIA STEO July 7

Diesel: $4.57/gal (July 6). Down 18% from $5.60 peak in seven weeks. All five regions declining. EIA forecast: continued decline through Q3 as Hormuz traffic normalizes. Work Truck Online

FERC June 18 — generation adequacy reports due July 20 (8 days). Intervention deadline passed July 9. August 3: abeyance requests. August 17: 60-day RTO/ISO responses. September 16: answers due. FERC defined large load as >50 MW, >69 kV. Hospitals generally below this threshold but downstream effects on grid capacity, cost allocation, and tariff design affect everyone. RMI published detailed analysis of all six orders. FERC / RMI

PJM heat emergency July 3: $28,000/MWh price spike. Reserves crashed from 22 GW to 5 GW. Maximum Generation Alert issued. Critical threshold nearly breached. Hospitals in PJM territory experienced real-time capacity risk. Demand response, thermal storage, and battery protocols are not optional. Reuters

OBBBA: $700B–$1T in healthcare reimbursement cuts over 10 years. Hospitals face capital constraint precisely when infrastructure investment needs are highest. Systems designing new facilities must plan for lower operating margins and reduced access to capital. This accelerates the case for third-party financed infrastructure — exactly the strategy being explored at UCHealth Broomfield. Industry analysis

California AB 550 signed July 6: green hydrogen as renewable. Governor Newsom signed law recognizing green hydrogen-fired power as qualifying under state RPS. Strengthens the case for hydrogen fuel cells in hospital microgrids. Connects directly to Klickitat Valley Health (first purely hydrogen hospital fuel cell) and UCHealth’s carbon future analysis. Pleasanton Weekly / GasWorld

CARB: remote diesel monitoring guidance (July 3). All 35 California air districts can now require real-time monitoring of emergency standby diesel generators. San Joaquin Valley APCD — covering Madera County and Valley Children’s Hospital — included. CARB

California BPS: CEC published draft report (SB 48). Workshop July 29. Comment deadline August 21. Benchmarking data becoming an enforcement tool. Mazzetti did some of the first healthcare GHG reporting in California after AB 32 (2006). CEC

Henry Hub natural gas: $3.70/MMBtu in 2026, below $3.50 in 2027. Record U.S. production putting downward pressure on prices. Cheap gas near-term complicates the electrification argument but strengthens the “don’t lock in combustion” case for 20-year planning horizons. EIA STEO

English-Speaking Americas

Advocate Trinity: $300M replacement hospital, Chicago. Broke ground. 36 med-surg beds. Capital concentrated in targeted replacement. Becker’s

NYU Langone Huntington Academic Medical Center. Large campus with hospital + medical school. Major Northeast investment. NYU Langone

Hartford Hospital: $950M tower. Major Connecticut capital project. Hartford Healthcare

BayCare: $650M children’s hospital. Tampa Bay pediatric capacity. BayCare

Children’s Mercy: $1B+ expansion, Kansas City. System-level pediatric investment. Children’s Mercy

VA: $596M additional infrastructure FY2026 Q2. Utility systems, electrical upgrades, boiler plants. Federal healthcare infrastructure remains a substantial market. VA

CMS: Office of Health Technology Products established. Governing AI, interoperability, and digital health tools across federal programs. CMS

Chad Beebe appointed to battery-safety standard technical committee. ASHE now has a direct healthcare voice in battery safety standards development. ASHE

Colorado Regulation 28 BPS: 2030 targets confirmed. Directly relevant to UCHealth Broomfield. The 2030 rules are what the Paper Lion team is designing to meet. Colorado Energy Office

Spanish-Speaking Americas

Venezuela: PAHO $24M emergency appeal continues. 38 hospitals damaged. IFHE member AVAIMS coordinating. Sextant Foundation mobilizing resources. Donate: sextantfoundation.org/donate. Volunteer: volunteers@ifhe.info. PAHO

Europe

UK hospitals declared critical incidents during heatwave. East Surrey Hospital specifically named. Cooling, equipment, and IT systems failed. Internal temperatures exceeded safe clinical thresholds. Cooling is now a life-safety system, not a comfort system. Health Estate Journal: cooling moving from comfort to life-safety on hospital risk registers. Health Estate Journal / BBC

Europe heatwave: 3,700+ excess deaths. France announced €100M hospital cooling initiative including 30,000 air-conditioning units. Belgium and Netherlands also severely affected. Reuters / UN News

Croatia: €800M+ Osijek Hospital launched. National hospital complex consolidating services. Total Croatia News

Devon Partnership NHS: research facility under construction. UK project signal. Devon Partnership NHS

BEIPI report: “Building Safer Hospitals.” Infection prevention must enter governance, procurement, and design from the start — not consulted after designs are complete. AMR translated into ventilation, materials, and estate planning requirements. IHEEM

Africa

Rwanda Centre of Excellence for Biomedical Engineering Phase II. AfDB funding. 3D printing, rehabilitation robotics, localized device testing. Building African biomedical manufacturing capacity. AfDB

Solar microgrids surpassing legacy grid in developing regions. Healthcare facilities designing primary clinical power around renewable generation, bypassing traditional diesel. Industry analysis

Asia / Pacific

Australia: AU$2B Bankstown Hospital (NSW). Demolition and enabling works underway. One of APAC’s largest replacement programs. NSW Government

Queensland Gladstone Hospital: 51-bed modular expansion. Modular as permanent infrastructure, not interim. Prefabricated ward blocks. Queensland Health

IDC: 75% of APAC care providers deploying “agentic AI.” Autonomous agents in clinical workflows creating new computing, power, and cooling infrastructure demands. Healthcare IT News

IHEA Operating Theatre HVAC Efficiency Survey: open until July 30. Seeking global input on ACH, energy use, and IAQ in surgical environments. IHEA

IFHE Global Connection

LDES for Healthcare Summit completed July 13. Full recap coming mid-week. The U.S. LDES Consortium has officially sunset. LDES Summit

IFHE Building Award: submissions due July 31 — 19 DAYS. New healthcare facilities and major renovations. IFHE

IFHE Carbon Challenge: submissions due July 31 — 19 DAYS. Data validation August 15. Winners September 15. Awards at New Orleans Congress. IFHE

IFHE recruiting for IFHE-WHO team. Expert volunteers for climate-resilient/low-carbon healthcare facilities. Apply

ASHE webinar July 23: “What if Healthcare Infrastructure Were Treated Like a Patient in the ED?” Infrastructure as clinical diagnostic. ASHE

Venezuela earthquake: IFHE and Sextant mobilizing. Donate: sextantfoundation.org/donate. Volunteer: volunteers@ifhe.info. Sextant Foundation

IFHE President’s travel: August ABDEH Brasília, October Congress New Orleans, November Asia-Pacific tour.IFHE

https://www.ifhe.info/

IFHE Newsletter: check your spam folder. Monthly newsletter. Several email systems filtering incorrectly. Subscribe

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

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IFHE Global Events Calendar

JULY

Jul 20: FERC: RTO/ISO generation adequacy reports due

Jul 23: ASHE webinar: Infrastructure as Patient in the ED. ashe.org

Jul 23: FKT: Waste management in healthcare (Germany). fkt.de

Jul 24: CPS Energy San Antonio: battery/microgrid proposals due

Jul 29: CEC BPS Workshop (SB 48) — online. Comments due August 21.

Jul 30: IHEA QLD: Intelligent Infrastructure in Healthcare, Brisbane. ihea.org.au

Jul 30: IHEA Operating Theatre HVAC Efficiency Survey deadline. ihea.org.au

Jul 31: IFHE Building Award submissions deadline. ifhe.info

Jul 31: IFHE Carbon Challenge submissions deadline. ifhe.info

AUGUST

Aug 2–5: ASHE Health Care Facilities Innovation Conference, Minneapolis. ashe.org

Aug 3: FERC: abeyance request deadline

Aug 17: FERC: 60-day RTO/ISO response deadline

Aug 18–20: Joint Commission Physical Environment Base Camp

Aug 19–21: ABDEH XI CBDEH 2026, Brasília (IFHE President attending). abdeh.org.br

Aug 21: CEC BPS comment deadline (SB 48)

SEPTEMBER–OCTOBER

Sep 1: Joint Commission DMEPOS standalone accreditation effective

Sep 15: NYSERDA hospital energy proposals due

Sep 16: FERC: answers to RTO/ISO responses due

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Oct 7–9: AFIB 30th Journées, Rennes. afib.asso.fr

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register

NOVEMBER

Nov 10–11: IHEEM Scotland Conference. iheem.org.uk

Nov 12–13: NZIHE Conference, Auckland. nzihe.org.nz

Nov 16–18: IHEA National Symposium, Fremantle. ihea.org.au

2027

Apr 26–30: IFHE Latin American Regional Congress + AADAIH 40th, Buenos Aires

Apr 27: HEAJ 55th Conference, Japan

May 12–14: 12th IFHE-EU Congress, Switzerland

About the Author

Walt Vernon holds degrees in electrical engineering, business, law, and energy law. He is President of the International Federation of Healthcare Engineering, CEO and principal at Mazzetti—an employee-owned benefit corporation working to bend the climate curve—and founder of the Sextant Foundation, an NGO advancing clean energy systems for low-resourced health facilities worldwide. He helped write portions of the National Electric Code that opened the door to hospital microgrid systems, serves on the ASHRAE 189.3 committee and the ASHE Battery Safety Task Group, and is a member of the leadership team of the U.S. National Consortium on Long Duration Energy Storage.

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The California Energy Commission published its draft Building Energy Performance Strategy Report this week. If you own or operate a large building in California — including a hospital — this will affect you.

Senate Bill 48 directed the CEC to develop a strategy for using benchmarking data to track and manage the energy usage and greenhouse gas emissions of large covered buildings. The draft report recommends that the Legislature establish a statewide building performance standard program, and that the CEC administer it. This is not aspirational. It is a legislative mandate moving toward implementation.

I have been working with the CEC for twenty years. When California passed AB 32, the Global Warming Solutions Act of 2006, Mazzetti developed some of the first GHG inventories for healthcare organizations in the state. Nobody required us to do it. We did it because we knew it mattered.

Later, I worked with CEC staff on improvements to Title 24 energy regulations, extending them to hospitals. Through an administrative accident, the code had exempted hospitals altogether. Working together, we corrected the oversight, and I watched in admiration as the CEC staff collaborated with the healthcare industry to ease regulations into place that helped keep ongoing energy costs lower.

Since then, the CEC has funded Mazzetti’s pioneering healthcare microgrid projects — work that changed codes and permitted new design paradigms that the industry is just now beginning to adopt.

I know the people who helped prepare this report. I have worked with them. California is fortunate to have them.

Here is why this matters right now. On the UCHealth Broomfield project in Colorado, we are already designing under a state building performance standard. It changes how you think about the building from day one of the design process. Technically, the BPS is not a building code and so we could ignore it. But we cannot hand our client a building they can’t operate in compliance with the law. It is a powerful supplement to the building code. It reminds me of my friend Clark Reed at EPA who one day told the Green Guide that it was not good enough to DESIGN a building well, it had to also work. It ensures that the design and operations team work together to ensure that we will meet ALL of the requirements. For the money savings that will result, and for the health of the planet that supports us all.

California is about to do the same thing, at scale.

The CEC will host an online public workshop on Wednesday, July 29, to present the draft and answer questions. Written comments are due by Friday, August 21.

I will be there. If you operate healthcare facilities in California, you should be too.

Where Healthcare Infrastructure Meets the Climate Imperative

Week of July 5, 2026 • Issue No. 17

Venezuela Earthquake — Healthcare Infrastructure in Crisis

On June 24, two back-to-back earthquakes — magnitude 7.5 and 7.2 — struck northwestern Venezuela. The destruction has been catastrophic.

More than 2,295 people have been killed. Over 11,000 injured. Nearly 13,000 displaced. Thirty-eight hospitals have been damaged nationwide. Eight hospitals in Caracas were forced to close due to structural damage. Sixteen children died when a hospital collapsed in Catia La Mar.

At Vargas-IVSS hospital in La Guaira, 96 patients are crammed into a ward built for eight beds. Both ICU ventilators are offline from power failure. The blood bank holds 35 units. Only five of twenty-one assessed facilities are fully operational in the hardest-hit zones. Health workers are missing, including the official who coordinated maternal care across La Guaira. Venezuela’s health system entered this crisis already weakened, with hospitals facing shortages of up to 37% of essential medicines after years of underinvestment.

PAHO has launched a $24 million emergency appeal and is coordinating 39 Emergency Medical Teams from 33 countries. Eleven international field hospitals have been deployed.

Venezuela is a member of the International Federation of Healthcare Engineering through the Asociación Venezolana de Arquitectura e Ingeniería Médico Sanitaria (AVAIMS). I was finally able to reach our colleagues there this week. IFHE and the Sextant Foundation are both mobilizing resources to help. This is one of the things IFHE does. When healthcare infrastructure fails, our members are the people who understand how to assess the damage, stabilize the systems, and rebuild.

If you can donate: 100% of funds received through Sextant will go directly to support this work. I am making the first donation personally. Donate here and designate “Venezuela”: sextantfoundation.org/donate

If you can volunteer: We need assessment, reconstruction, and engineering expertise. If you are willing to go, email volunteers@ifhe.info.

We are coordinating with WHO and PAHO through IFHE’s official relations. More to come.

LDES for Healthcare Summit — 8 Days Away

Monday, July 13 | Salt Lake City | University of Utah, S.J. Quinney College of Law

This is the last issue before the Summit. If you have been considering attending, now is the time to register.

Scientists from five National Laboratories. Hospital owners who have deployed these systems. ASHE. The Joint Commission. Case studies from Kaiser Permanente, Valley Children’s Hospital, Klickitat Valley Health, Direct Relief, and the Navajo Nation. Economic models, battery safety, thermal storage, hydrogen, commissioning, and workforce development.

The day includes an opening reception, hosted networking lunch, and closing reception. CellCube is our program sponsor. Free for healthcare facility owners. CEUs provided.

The U.S. LDES Consortium is sunsetting this year. This knowledge will not be assembled in one room again.

Register: LDES for Healthcare Summit on Eventbrite

From the Field

Paper (Engineering) Lion — Week 6

Every project faces budget challenges at one point or another. Our UCH project is no exception.

This week, we are working on ways to reduce capital investment, while optimizing the design that will be forward-looking. In an overall cost reduction exercise we identified, in particular, the opportunity to eliminate a second electrical service. We have also daringly thrown onto the list the possibility of eliminating the diesel generators altogether for the project, in favor of our microgrid. On top of that, we are exploring ways to finance these parts of the project from something other than the capital allocated for the project. This is a complex analysis. We can’t just give back the second electrical service without also adding back the new microgrid, as tempting as that particular morsel is, in the search for cost reductions. Rather, we need to bundle the entire microgrid, including ongoing energy savings, into a single package that needs to be considered alongside the project finance for the building.

I have written before about my colleague Eric Berzon, who designed the various financing strategies that Kaiser used to become the first health system to achieve carbon neutrality. He, Robyn Helmlinger (Orrick), Kate Sherwood (ZeroEnergy) and I have submitted a paper to the National Academy of Medicine on the topic of how to finance healthcare decarbonization, largely structured around the techniques Eric developed at Kaiser. That paper is pending, but we are using exactly these techniques here. More on that as it develops in the future.

We have now submitted our permit application to United Power, and we will get the Xcel permit for gas to the site submitted next week. For the gas, we are able to buy bundled service from Xcel, or buy the commodity from a third party and transmission and distribution from Xcel. I will now start working with energy procurement consultants to think through the best combination. We are going to ultimately have to blend the energy procurement strategy, the project finance strategy, and the technical strategy into an overall strategy that best positions UCH for what every healthcare owner asks for – reliable energy; lowest and most predictable cost; and, if possible, sustainable. In this case, the ability to expand is also high on our priority list, which is why we are trying to anticipate where both energy markets and emission requirements will evolve. I note here, something I will pick up on in another part of this Pulse; new regulations on stationary diesels being enacted in the state of California through its Air Quality Management districts. The regulations are not going to stay static, and nor will the markets.

One thing we are looking at now, is the emissions of the different technologies available to us for a microgrid. We are looking at basically two technologies; fuel cells, and linear generators. Both have unique characteristics, and we are trying to sort out which will be better. Each comes with a blend of first cost, operating parameters, fuels they will take (which will matter for any on-site storage requirements), and importantly, emissions.

In general, the fuel cells are superior to the linear generators from an emissions perspective. All of them emit some amount of carbon. In general the fuel cells are 10-25% lower CO2 emissions, depending on operations and models. But because the fuel cells are not using combustion, they have much better emissions of other pollutants that matter – Nox, CO, PM, and VOCs. They are, however, still worse than the 80% renewable electricity that will theoretically be available from United Power in 2030.

So, the choice is going to be one that balances economics and resilience (fuel cells) versus lowest possible emissions (United Power and diesels that rarely run). My thesis for many years has been that the latter is likely the best answer, not only because of the economic and resilience needs of the facility, but also because of the possibility that we will evolve towards a green hydrogen future, in which case a hospital like this one, designed to use on-site fuel cells, will be perfectly set up to take advantage of that future. Someday, I will write more on the possible hydrogen future. I note that, when I helped write the ASHRAE Design Guide for Decarbonized Healthcare, I tried to put this material in, but hydrogen remains a controversial subject in some circles, so that “cutting room floor” material, I’ll bring back here soon!

In the meantime, we are working on ancillary issues. First, we are trying to figure out how to capture waste heat from any of these technologies in order to help with the peak heat issues I talked about last week. We are looking at how to supplement the basic technology (linear generator or fuel cell) with batteries to deal with the challenges of something that can be grid forming. We are looking at site implications for the project. We are trying to get the AHJs from the city to sit down with us to make certain they are reading the new NEC the same way we are. And, of course, those pesky economics.

PS: All of these strategies involve SOME form of Long Duration Energy Storage. The borefields to act as thermal batteries; diesel fuel for conventional storage; phase change materials for thermal energy storage; batteries for electrical peaks; propane or methane or hydrogen for fuel cells. I hope to see many friends and colleagues and yet to be friends in Salt Lake City next week for the LDES for healthcare summit. Join Us — It’s not too late We have worked hard to bring a special educational opportunity to the industry, to help to birth this new paradigm. Here is your one chance to see it whole; a kind of ultrasound, if you will, of the emerging new thing.

— Walt Vernon

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IFHE Global Scan

U.S. Energy Markets

FERC June 18 — countdown accelerating. July 9 (4 days): intervention deadline. July 20 (15 days): generation adequacy reports due from all six RTOs/ISOs. August 3: abeyance request deadline. August 17: 60-day response deadline. September 16: answers due. Commissioner Rosner’s four pillars: protecting consumers, reducing infrastructure costs, boosting efficiency, enhancing technologies. The battleground has moved to regional stakeholder processes. FERC official

PJM heat emergency July 3: reserves crashed from 22 GW to 5 GW. Maximum Generation Alert issued. Real-time prices spiked as high as $28,000/MWh. Critical threshold of 3.2 GW nearly breached. Hospitals in PJM territory experienced real-time capacity risk THIS WEEK. Demand response, thermal storage, battery storage, and load-shedding protocols are not optional. Reuters

CARB: remote monitoring guidance for stationary diesel engines (July 3). Formal guidance for all 35 California air districts on permitting remote monitoring and recordkeeping for emergency standby diesel generators. San Joaquin Valley APCD — which covers Madera County, home to Valley Children’s Hospital and the worst air quality in the nation — is one of the 35 districts that can now implement this. Every diesel generator in California just became more visible to regulators. CARB

Brent crude: ~$72/bbl — lowest since start of US-Iran conflict. China cutting diesel prices July 4. Hormuz tanker traffic continuing to resume. But EIA STEO still assumes strait not fully normalized until Q3. U.S. rig count rose for third consecutive week (580 rigs). Diesel price trend: $5.60 (mid-May) → $5.35 (June 1) → $5.06 (June 15) → $4.83 (June 22) → continuing decline. EIA / Reuters

VA: $596M additional infrastructure in FY2026 Q2. Utility systems, electrical upgrades, boiler plants, EHR-supporting modernization. Federal healthcare infrastructure remains a substantial growth market. VA

South Coast AQMD: diesel generator testing limited to 20–50 hours annually. Diesel is not freely dispatchable in air-quality-sensitive regions. Permit modifications may be needed for broader operation. Michigan EGLE also published a hospital-focused air quality guide covering boilers, generators, and sterilizers. SCAQMD / Michigan EGLE

English-Speaking Americas

University Health San Antonio: $90M expansion of two new hospitals before opening. Palo Alto (227 rooms) and Retama (167 rooms). Opening February and April 2027. Designing for expansion from the outset. Healthcare Design

Chapel Allerton Hospital (UK): £32M theatre block. Kier appointed. Two new operating theatres and support spaces. IHEEM / Health Estate Journal

CMS: Office of Health Technology Products established July 2026. Governing AI, interoperability, and digital health tools across federal programs. AI in clinical and operational workflows now faces defined federal review. CMS

Global healthcare construction pipeline: $715B, ~60% in execution. North America ~40% share. Fourteen U.S. projects over $500M advancing in 2026. GlobalData / Becker’s

Spanish-Speaking Americas

Venezuela: PAHO $24M emergency appeal (July 1). 38 hospitals damaged. 2,295+ dead. 11,267+ injured. Rapidly deployable modular infrastructure and off-grid power solutions needed to restore acute care capacity. See full details and donation link above. PAHO

Europe

Europe heatwave: 3,700+ excess deaths (France, Belgium, Netherlands). France announced €100M hospital cooling initiative including 30,000 air-conditioning units. Heat resilience is now a capital planning issue, not an emergency response. Reuters / UN News

Croatia: €800M+ Osijek Hospital launched. New national hospital complex consolidating services into large modern clinical campus. Total Croatia News

UK Ofgem: 16 LDES projects, ~7.6 GW. Pumped hydro, compressed air, lithium-ion, vanadium flow. 8–32 hour durations. Validates LDES as grid resilience infrastructure. Ofgem

Stoke Mandeville: fire door replacement across 40-acre campus. National Spinal Injuries Clinic and maternity ward. Practical life-safety and estate-risk signal. IHEEM

Africa

Ethiopia: maternal & pediatric infrastructure advancing. Concept-design planning for major maternal and pediatric healthcare projects associated with national health-system expansion. Enterprise signals

Solar microgrids surpassing legacy grid in developing regions. Healthcare facilities designing primary clinical power around renewable generation and energy management software, bypassing traditional diesel reliance. Industry analysis

Asia / Pacific

Australia: AU$2B Bankstown Hospital (NSW). Demolition and enabling works underway. One of APAC’s largest replacement hospital programs. NSW Government

Australia: Temora Hospital A$95M, completion 2028. Modern ED, flexible inpatient unit, perioperative suite, allied health, diagnostic imaging. NSW Health

Cambodia: National Pediatric Hospital $5.2M surgery building. Broke ground June 15, 2026. Specialized pediatric surgical capacity. Cambodia MOH

CPS Energy San Antonio: battery/microgrid procurement. Proposals due July 24. Utility-partnered microgrids may become models for hospitals that cannot carry all capital costs. CPS Energy

IFHE Global Connection

IFHE Power Shift webinar: July 10 — 3 DAYS. The Economics of Electrified Kitchens. Chef Christopher Galarza of Forward Dining Solutions and EcoChef. Hosted by Mazzetti. Electrification economics, induction vs. gas, ventilation, combustion health/safety, real-world case study. Register

IFHE Building Award: submissions due July 31. New healthcare facilities and major renovations. Presentations at October World Congress. IFHE

IFHE Carbon Challenge: submissions due July 31. Data validation August 15. Winners notified August 15. Final selection September 15. Awards at New Orleans Congress. IFHE

IFHE recruiting for IFHE-WHO team. Expert volunteers for climate-resilient/low-carbon healthcare facilities. Focus: thermal energy and energy generation/storage. Apply

IFHE President’s travel schedule. August: ABDEH XI CBDEH in Brasília. October: IFHE Congress in New Orleans. November: Asia-Pacific tour (South Korea, Indonesia, Thailand, New Zealand, Australia) plus outreach to lapsed members. IFHE

IFHE Latin American Regional Congress: April 26–30, 2027, Buenos Aires. First-ever IFHE regional congress in Latin America, co-located with AADAIH’s 40th anniversary. AADAIH

IFHE Newsletter: check your spam folder. Monthly newsletter. Several email systems filtering incorrectly. Check spam/junk if not receiving. Subscribe

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

✉ Subscribe to Health Infrastructure Pulse

IFHE Global Events Calendar

JULY

Jul 9: FERC intervention deadline — last day to participate in show-cause dockets

Jul 9: IHEA: Sunshine Hospital predictive maintenance (Australia). ihea.org.au

Jul 10: IFHE Webinar: Power Shift — Economics of Electrified Kitchens. Register

Jul 13: LDES for Healthcare Summit, Salt Lake City — FREE for hospital owners. Register

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

Jul 15: IHEA: Built to Withstand — Multi-Hazard Resilience (Australia)

Jul 20: FERC: RTO/ISO generation adequacy reports due

Jul 24: CPS Energy San Antonio: battery/microgrid proposals due

Jul 30: IHEA QLD: Intelligent Infrastructure in Healthcare, Brisbane. ihea.org.au

Jul 31: IFHE Building Award submissions deadline. ifhe.info

Jul 31: IFHE Carbon Challenge submissions deadline. ifhe.info

AUGUST

Aug 2–5: ASHE Health Care Facilities Innovation Conference, Minneapolis. ashe.org

Aug 3: FERC: abeyance request deadline

Aug 17: FERC: 60-day RTO/ISO response deadline

Aug 19–21: ABDEH XI CBDEH 2026, Brasília (IFHE President attending). abdeh.org.br

SEPTEMBER–OCTOBER

Sep 15: NYSERDA hospital energy proposals due

Sep 16: FERC: answers to RTO/ISO responses due

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Oct 7–9: AFIB 30th Journées, Rennes. afib.asso.fr

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register

NOVEMBER

Nov 12–13: NZIHE Conference, Auckland. nzihe.org.nz

Nov 16–18: IHEA National Symposium, Fremantle. ihea.org.au

Nov 27–28: HEAJ 55th Conference, Japan

2027

Apr 26–30: IFHE Latin American Regional Congress + AADAIH 40th Anniversary, Buenos Aires

May 12–14: 12th IFHE-EU Congress, Switzerland

About the Author

Walt Vernon holds degrees in electrical engineering, business, law, and energy law. He is President of the International Federation of Healthcare Engineering, CEO and principal at Mazzetti—an employee-owned benefit corporation working to bend the climate curve—and founder of the Sextant Foundation, an NGO advancing clean energy systems for low-resourced health facilities worldwide. He helped write portions of the National Electric Code that opened the door to hospital microgrid systems, serves on the ASHRAE 189.3 committee and the ASHE Battery Safety Task Group, and is a member of the leadership team of the U.S. National Consortium on Long Duration Energy Storage.

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Last Saturday, we delivered the final draft of ASHRAE Research Project 1816.

Years ago, Kaiser Permanente nominated me to serve on the committee for the Green Guide for Healthcare. That document, led by my dear friends Robin Guenther, Gail Vittori, and Tom Lent, was launched in the wake of the first versions of LEED, when a number of healthcare leaders, including KP, wanted to do something like LEED. However, LEED at the time was not well suited to hospitals or healthcare. There were many things that were impossible for hospitals from a regulatory standpoint, and many things a hospital could do that were not included in LEED. The GGHC created the first necessary bridge between the healthcare community, and more sustainable buildings.

One of the really intriguing aspects of that first (and subsequent) versions of the GGHC was the selection of low-energy medical equipment. As an electrical engineer responsible for designing the systems that powered this equipment, I had access to oodles of data on the NAMEPLATE information for equipment we were installing.

A few years later, I worked with Heather Burpee, of the University of Washington. Heather helped to manage the Targeting 100! Project, whose purpose was to help US hospitals find ways to achieve an EUI of 100. That work included the image shown above. As they were targeting a better EUI, you will see that all of the models hold the amount of energy consumed by medical equipment steady, the implication being there was no way to ever reduce it.

That was the problem I set out to solve. Before the Covid crisis, ASHRAE provided us with a grant to study the energy consumption of Large Medical Equipment. About the same time, the University of California had a similar question with respect to the energy consumption of MRIs, and they augmented the project with another tranche of funding.

Like everything else, Covid knocked us off track, and we were unable to get started on the project for a few years. Then, we struggled to find enough Gamma Cameras around the country to measure, and that slowed us down. Then, we struggled to get the data analyzed, as we lost our statistician. Then, were unable to find a manufacturer willing to work with us to pilot a Manufacturer’s Method of Test. Then, we hired Dr. Ehsan Mousavi, from Clemson to help us with statistical analysis. The team went through months of detailed Monte Carlo simulations, looking at every possible angle.

Finally, last Saturday, we delivered our final draft. I am sure it is not perfect, and it is now being reviewed by the Project Management committee. But, I think it is very important for the industry.

Here is what we found, and why it matters:

First, we need to think larger than just “Imaging Equipment.” The study was originally scoped to include Imaging Equipment. But, it included a number of modalities that were also treatment equipment.

We suggested a common vocabulary for operating states. Different entities (NFPA, ASHRAE, COCIR, EPA, every manufacturer) define the way their equipment works using a bewildering array of names that do not line up well from device to device, modality to modality. Our LBNL consultant, who had worked to develop the original Energy Star labels for consumer electronics, helped us to think through how to do this. We are hopeful that this vocabulary can become widely used by ASHRAE members and others to provide better data to buyers, and to allow for easier comparison between devices.

We suggested strategies for the healthcare procurement community. We know that nobody is going to pick an MRI just because it is the lowest energy. But, if all else is equal, we hope that the anticipated energy cost of a device over its life might matter, at least at the margins.

We suggested new ways to model the medical equipment in an energy model. Historically, energy modelers tend to use rules of thumb. Now, we have the data to project with confidence.

We suggested new demand factors and diversity factors for sizing HVAC equipment. We all know that equipment does not usually run at full nameplate load most of the time. But nobody has known what that meant in practice. Now, we do. Similarly, we all know that the equipment does not all operate simultaneously. But, we never knew how to estimate the impacts of that on system sizing. Now, we do.

We suggested new ways to think about the branch circuits, overcurrent protection devices, feeders, and power sources in electrical systems. The National Electrical Code has long had some factors that applied only to X-Ray Equipment. Now, for the first, time, we have enough data to provide much better guidance for design of these systems. For the 2029 National Electrical Code, we have submitted proposals to reflect this new data.

We suggested ways to operate the equipment, once installed, to minimize waste and to ensure lowest cost operation.

We have published some of the early analyses, using the Monte Carlo simulation, in other publications. We worked with researchers from DOE on their research including contributing to a paper they are publishing. We shared data between the teams, and helped them think about Energy Star for medical equipment.

None of these things by themselves will shrink Heather’s bar chart. But they can slow its growth. And in the battle to eliminate energy waste, to decarbonize healthcare, slowing the growth is where we start.

There are too many names of people who helped here to list them all. (And I may leave out someone, I hope not). Most of all, I want to thank ASHRAE and the University of California. It was your funding, and your patience, and your guidance and oversight that helped us get this done. I also want to thank the HVAC team inside Mazzetti. You gave us so many hours of brainstorming, and thinking and helping, to try to make sure this information could be used in ways that are valuable to the industry. I want to thank Bruce Nordman, now retired from LBNL, for invaluable early insight and methodological advice. I want to thank Dr. Mousavi, of Clemson University, whose patience with us non-statisticians, and whose brilliant analyses formed the basis of so much of our outcomes was so invaluable. I want to thank my long time friend and colleague, Jeff Rodriguez. Jeff performed all of our equipment readings all over the country; he has never met a challenge he could not overcome. I want to thank Te Qi, energy modeler extraordinaire; your brilliant analysis was so helpful at so many stages of this project. I especially want to thank Jacquelyn Tompkins and Charlie Ruschke of Mazzetti. These two young people stuck in there, when I am sure I frustrated them, telling them we could do better. They were also patient with me, and they never gave up. This team has done amazing work, and I think we all can be grateful to them.

I am not sure when the work will publish, but hopefully soon. Then, after decades of working on this, rather than retiring, I have new ideas. . . . .

Update (July 2, 2026): Another peer-reviewed publication using data from this research program has been published in Applied Energy — open access. The paper examines MRI energy consumption across 20 scanners in four U.S. healthcare facilities, confirming that nonproductive modes dominate scanner operating time and that clinical setting is a primary driver of energy use. You can find that one here: https://www.sciencedirect.com/science/article/pii/S030626192600944X.

Where Healthcare Infrastructure Meets the Climate Imperative

Week of June 28, 2026 • Issue No. 16

LDES for Healthcare Summit — 15 Days Away

Monday, July 13 | Salt Lake City | University of Utah

Scientists from five National Laboratories. Hospital owners who have deployed these systems. ASHE. The Joint Commission. Case studies from Kaiser Permanente, Valley Children’s Hospital, Klickitat Valley Health, Direct Relief, and the Navajo Nation. Economic models, battery safety, thermal storage, hydrogen, commissioning, and workforce. Free for healthcare facility owners. CEUs provided.

The U.S. LDES Consortium is sunsetting this year. This knowledge will not be assembled in one room again.

Register: LDES for Healthcare Summit on Eventbrite

From the Field

Paper Lion #5

This week was a big week for the UC Team.

First, I wish now that I could do this for the project as a whole. For people who have not been involved in a large planning, design, and construction effort such as this one, the experience is truly remarkable. There are so many aspects of a healthcare facility, and creating one has so many moving parts, all of which must be optimized, and all of which must intersect in a wonderful machine that will ultimately help skilled clinicians to take care of people. It has been a long time since I was involved at this level in a project like this, and it is quite exciting to take the field once more and to part of such a wonderful team.

I will pause here to repeat something that came out at the end of the meeting. The project, like all projects, faces a range of challenges. But the project leadership – Mike, who gave me permission to write about the project – and his UC team - has set a tone for the project that really inspires the entire team to step up, and to create something special together. I counted 50 people in this week’s Big Room. Mike had to leave the meeting early. Every meeting concludes with a Plus/Delta conversation, in which we talk about what is going well, and what we can do better. One person stood up and said that Mike’s leadership, and really, that of the entire UC team, were high on the list of Plus items, and that this leadership is getting the best out of us.

This week, the engineering team has made significant progress. Our design choices are firming up. We have been able to work with the team to think through the ways we will create a base case, and our first costs. We are rushing to get our Trade Partners on board, and we are going to try to use our selection process to try to test the two extremes of the wide range of strategies under consideration.

First, we are carefully studying thermal options. Recalling that this project is going to be phased, we have to conceptually design two iterations of each system – one for each phase. We are doing this so we can determine what must be done in Phase 1 to support Phase 2. Our base case is a very traditional hospital; a concept that I can tell gives everyone a sense of comfort; of familiarity. It will be just like the last hospital built, just like the hospitals being built by so many people. It will have steam boilers, chillers, two redundant electrical services, and a battery of diesel generators.

Our first change to this model is to replace the boilers and chillers with heat recovery chillers. The genius of this technology goes directly the one of the points of the ASHRAE Design Guide for Decarbonized Healthcare – usually, we have plenty of heat in a building. We use a lot of energy to get rid of that heat. Then, we must use more energy to create heat to put into other parts of the building. The first step in a decarbonized hospital is to stop this running in two different directions, and, instead, to move the heat from one space to another. Heat Recovery chillers are the way to do this. Importantly, this is an electrical piece of equipment, and it does not burn fossil fuels.

However, there are times in the year when heat recovery chillers can’t quite keep up – times when it is really cold inside, and times when it is really hot outside. So, we need strategies to provide supplemental heat and supplemental cooling for these peaks. The peaking problem is one of the problems that shows up over and over in engineering. Having enough of anything to meet the very rare peaks means that most of the time, we have too much, and we can’t spread the costs of doing something over a lot of use, but only over a tiny bit of use. Our first strategy will be to use conventional cooling towers and boilers to provide the peaking, supplemental heating or cooling. This system, while still using some amount of fossil fuels, consumes much less energy, emits much less carbon, and saves much more money. In operations. And we don’t have good first data. So, we are tantalizingly close to being able to test the feasibility of this idea, but not quite there.

Here, I want to talk a bit about our conversation in the Big Room. One of our young mechanical engineers presented our thinking. The Room was very engaged. The ideas were new to the people there, and they asked really insightful questions. The Mazzetti team were well prepared, and the conversation was deep, thorough, and fascinating. I was so impressed, especially, at the fact that the UC team includes a substantial representation from the Facility Operations Team, and we have, through the project, been able to engage with them. Finding good people to operate a hospital is hard enough as it is. Doing something new may require new skills. But the UC team is part of our conversation, and they are impressive in their willingness to think about new ways to do things. This, plus the fact that we also have our commissioning team on the project, to help navigate the transition from design to construction to operation, should help us to make certain this project not only has potential to work, but WILL work.

Our second option for supplemental thermal loads is to use boreholes. One big problem here is that we need more cooling than we need heating, over the course of a year. A second precept of the Decarbonization Design Guide is that you can more thermal energy not only spatially, but also temporally. That is, we can store it WHEN we don’t need it, and then use it at another time, when we do. The boreholes do this, as a form of Thermal Energy Storage. There are a number of challenges with this system due to the heating/cooling mismatch, and we have systems designed to work on both ends. Again, the economics look promising; but we still need good first cost estimates.

The final option for supplemental thermal loads is another kind of TES – phase change materials. During our meeting, an architect sitting next to me asked me what this means. When water changes into ice, it is called a phase change. When ice melts, it is a phase change. One of these (freezing) means you have to take heat away; the other (thawing) means you have to supply heat. A phase change material is just another material, chemically designed to have just this kind of phase change, but adding or removing heat. The interesting thing about phase change is that it maintains a constant temperature (put a thermometer on a piece of ice while it melts to test the idea). Thus, if we use phase change thermal energy, we can maintain a constant temperature which makes it much easier and more efficient for the heat recovery chiller.

Again, this system promises to provide much better energy consumption, carbon emissions, and operational cost savings. Importantly, these systems are so much simpler than the conventional, baseline system, it should greatly facilitate Maintenance and Operation. One thing that was really quite unique about the Phase Change TES is that it will use vastly less water than a conventional system would use. In a place like Colorado, in the midst of the worst drought in 1200 years, using less water matters.

During the meeting, we had the chance, finally, to talk with our electrical serving utility, United Power. I have to say, our experience here was equally superb. They brought a large team, with every aspect of the project expertise covered. Later, one person marveled to me that they have never before worked with a utility that was this helpful; often, its impossible to just get somebody to return a phone call. Key learnings here – getting the application for service in early is critical; applying in phases is critical - transmission upgrades may be required for larger loads, and we want to get the project moving. The utility is working to change its tariffs, and we need to deeply understand this, so we are skating to where the puck is going (or to be timely, running to where the soccer ball is heading). We will closely tie our energy and microgrid modelers to the experts from United Power, so that we are able to get the best possible data in order to make our best possible models.

Here, I want to talk a minute about microgrid modeling. We have been using a commercial modeling program for a number of years, that is widely reputed to be a good one. We have really liked it, and found it to be super useful. However, as a result of my work with the LDES Consortium on Long Duration Energy Storage, the scientists from Sandia trained our team on how to use their software, called ReOpt. I tell you this because this program is equally excellent. We have used this project to model the options using both programs, in order to test the details of each program. Importantly for the industry, the ReOpt tool is free. American taxpayers paid for it, and it is free; created to help people figure out how to best use LDES. It was really exciting to watch the Mazzetti Microgrid Modelers, who by now, are quite experienced and quite expert at this, to model the options. I have told many people that, after 40 years of doing electrical engineering, it’s interesting again. No longer are we just figuring out how big a diesel to specify; now we are doing real engineering. The engineering and modeling for this project show that the microgrid, using either fuel cells plus a battery, or linear generators, will work economically. They will allow us to take advantage of the new NEC provisions and replace the diesel generators. This will be a huge win for this community, which is highly sustainability focused.

There is much to still do. These results are preliminary. We do not have great first cost data, and we want to test the electrical rates with United. We are separately testing ideas around financing. But, because we are eliminating a second electrical service (electrical reliability here is 99.9996); because we are eliminating diesels; because we are eliminating chillers, cooling towers, and boilers; we have a chance, I think, to make this all work.

A lot of these ideas are new to many on the team. We have talked about site visits to see some of these systems in operation, and we will do that. But the upcoming LDES for Healthcare Summit on July 13 in Salt Lake City offers something that no site visit can: the chance to talk to healthcare people who have actually designed, financed, built, and operated these systems — all in one room, in one day. The team is sending a group. I cannot overstate how valuable it will be for our engineers to hear directly from the hospital owners, national lab scientists, and code officials who are living this work. If you are facing similar questions on your projects, I hope you will join us.

Many years ago, Kaiser Permanente launched a global competition to design the hospital of the future. They had 400 entries from the best architects from around the world. And one from an engineer. Mazzetti, and our architectural partner P+W went on to be one of the co-winners (it was a tie!) for the global competition. The promised prize was the chance to design and build the winning entry, but that never came to pass. Since that time, I have long tried to create an internal design standard that did not start with the last hospital we did and try to embellish it with a new idea or two. I have long tried to create an internal standard that represented the best of what we could do. And to build it. And now, I think we could.

— Walt Vernon

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ASHRAE 189.3: A New Chapter for Low-Carbon Healthcare Energy

I will spend this week at the ASHRAE Annual meeting.

When I first started attending ASHRAE meetings, I felt a bit like an intruder; I was an electrical engineer, after all, what business did I have at ASHRAE? (On that note, I started my University career as a Mechanical Engineer, but chemistry was too much for me, and math much more attractive; so today, I am a failed mechanical engineer and, I hope a reasonably decent electrical engineer).

One of the things I am working on is the ASHRAE 189.3 document. This is complicated, so let me try to explain it.

ASHRAE is in an agreement with the ICC to co-produce something called the International Green Construction Code, IGCC. Under this agreement, ASHRAE and their committees, produce the technical content. They call that content ASHRAE 189.1. The IGCC includes this content, and it applies to all buildings. IGCC is to help jurisdictions around the world who want a set of requirements appropriate for high-performance (sustainable) buildings.

But, healthcare buildings are different. Sometimes, things that are possible in an office building are inappropriate for a hospital. Sometimes, there are things that a hospital could do that could never be done in an office building. So, a number of years ago, ASHRAE formed 189.3. This document is a supplement to 189.1, and it tries to describe exceptions to 189.1, and add-ons to 189.1 that are unique to healthcare buildings.

Something that has bugged me for a long time is default use of diesel generators for our on-site energy generation needs. And, healthcare buildings have an inordinate need for on-site energy supply, in order to ensure continuous operation to support its life saving mission. So, every new building, especially as they become all-electric, automatically default to more diesels. More fossil fuels. More carbon. And every diesel that gets deployed today will sit there for decades putting more carbon into the air.

To their credit the ASHRAE Board has adopted a policy that every building built in 2030 and later should be zero carbon, and all existing buildings should be moving towards a 50% reduction in carbon. If zero is the baseline, a high performance building should do even better.

And while diesels are todays default, there are now technologies. 189.3 is therefore creating a new chapter focused on low carbon on site energy resilience systems. The general idea is that, when some code or other requires on-site redundancy for energy systems for healthcare, at least 25% of them should be zero carbon. The new chapter will be put to a vote on Monday, and, I hope, issued for public comment soon thereafter.

In some ways, a new chapter in a document that is an annex to a document that has not been too widely adopted is a small thing. But I contend that it is another bit of the stream of innovation that is helping healthcare buildings to meet their fundamental needs for inexpensive, reliable, and clean engineering systems.

I am working with ASHRAE this week on another, even more important effort. Today, health care in the US is among the most heavily regulated of industries. This manifests for sure with respect to what I will frame as on-site, resilience energy systems. That is, what are we required to do to ensure the ability to serve clinical needs when the building is forced to island.

Today, the designer of a hospital faces a bewildering array of requirements from NFPA, IEEE, TJC, ASHRAE, FGI, CMS, building codes, etc. The requirements are always prescriptive. They look at the different aspects of the needs in isolation of others. They often assume old technologies (e.g. diesel generators, boilers). They are rarely coordinated with each other.

What the world needs is a multi-organizational document, something like the IGCC, that can create a framework for these on-site energy systems. A great example is the UCH project. There, rather than providing diesel fuel for a boiler or a big diesel for electric heat, we are looking at the use of TES to provide necessary heat. And, no one solution will be perfect for every hospital for all kind of climactic, economic, and other reasons. One document can better articulate the opportunities for designing coordinated, optimized on-site energy systems.

This week, if things go the way we think they will, ASHRAE will launch such an effort.

Stay tuned.

Research Update: Energy Consumption of Large Medical Imaging Equipment

This week, Mazzetti delivered the final report for ASHRAE Research Project 1816 — a multi-year study, commissioned by ASHRAE and the University of California Office of the President, measuring the actual energy consumption and heat rejection of large medical imaging equipment including MRI, CT, PET/CT, and linear accelerators.

This matters because hospital engineers have been sizing HVAC and electrical systems for imaging suites based on nameplate data and rules of thumb — not measured performance. The result has been systematically oversized infrastructure, wasted capital, and inaccurate energy models. RP-1816 replaces assumptions with data.

The findings will change the ASHRAE Handbook. They were also the foundation for several public inputs Mazzetti filed to the National Electrical Code. And a sister publication expanding on the work has just been announced.

A deeper discussion of the research and its implications is coming in a future issue. For now: if you are designing, renovating, or planning a medical imaging suite, the way we have been sizing these systems is about to change.

IFHE Global Scan

U.S. Energy Markets

FERC June 18: details crystallizing — key deadlines confirmed. Five reform categories: transmission service processes, cost-shift prevention, co-location, electrically proximate loads, alternative transmission technologies. July 20: generation adequacy reports due. August 17: 60-day RTO/ISO response deadline. All five commissioners concurred. “The era of one national standard for data center interconnection is over before it began” — Mona Dajani, Cooley. Six regional answers on six different timelines. For hospitals: interconnection economics, cost allocation, and campus expansion planning are being restructured across every RTO/ISO territory. Utility Dive — 6 takeaways

Diesel: $4.83/gal (June 22). Down from $5.06 (June 15), $5.35 (June 1), $5.60 (mid-May). Accelerating decline as Hormuz tanker traffic resumes. Three Indian tankers cleared June 20. EIA wholesale forecast: $3.40/gal 2026, $2.98/gal 2027. But Strait not expected to fully normalize until Q3. EIA

ICF/Reuters: U.S. grid may need 445 GW of new capacity by 2030. Data centers, EVs, and electrified heating driving demand. Limited spare capacity beyond reliability needs. Texas and PJM under particular stress after 2027. For hospitals: grid capacity is now a project risk, not a routine assumption. Reuters / ICF

NYSERDA: $20M+ for hospital energy efficiency and electrification. Proposals due September 15, 2026. Funded through RGGI and 2025 Energy Efficiency and Building Electrification Order. NYSERDA

Europe June heatwave: power-price spikes and transformer failures. Heat-driven grid stress across multiple markets. Hospitals should revisit summer design days, cooling redundancy, thermal storage, and emergency-power runtime assumptions. Reuters

English-Speaking Americas

Projects

Grady Memorial (Atlanta): replacing offsite steam with onsite system. HCWH decarbonization cohort: 10% EUI reduction, $30M savings over 40-year plant life, 2,500 tCO₂e/year. Heat recovery chiller + solar under evaluation. HCWH

North Carolina “Beehive” mobile microgrids for disaster recovery. Towable solar+battery units deployed post-Hurricane Helene. Flexible resilience for temporary healthcare shelters and rural clinics during extended outages. NC DEQ

DOE: San Carlos Apache Hospital microgrid (Arizona). 500 kW BESS + 750 kW solar on tribal healthcare campus. Federal funding securing operational continuity for vulnerable rural health centers. DOE

CHRISTUS micro-hospital: New Braunfels, Texas ($28M). 35,000 sf, opening mid-2028. Emergency, inpatient, OR, imaging, recovery. Distributed access model in fast-growth markets. Becker’s

Atrium Health: first Atlanta hospital filed. MET Atlanta complex, 40-acre West End site. Filling Atlanta Medical Center closure gap. CON exemption pathway. Becker’s

UT Dell Medical: $750M gift for AI-enabled hospital + research campus. Co-location of care, computing, and research as standard model. UT Austin

Global healthcare construction pipeline: $715B, ~60% in execution. GlobalData Q1 2026. North America ~40% share. GlobalData

Spanish-Speaking Americas

Chile: Red Interclínica hospital acquisition. M&A driving facility consolidation. Engineers tasked with rapidly integrating legacy infrastructure into centralized digital and energy standards. Latin American Lawyer

IDB: targeting electricity losses in healthcare. Studying private management of public hospitals during crises. Growing mandate to cut electrical distribution losses in aging campuses. IDB

Europe

UK Ofgem: 16 LDES projects shortlisted, ~7.6 GW. Pumped hydro, compressed air, lithium-ion, vanadium flow. 8–32 hour durations. Validates LDES as grid resilience infrastructure, not just clean-energy support. Ofgem

EU/EIB: €10M grant for 10 Moldovan hospital retrofits. Total investment €72.4M. Targeting 40% energy reduction through thermal insulation, HVAC upgrades, and PV. Deep retrofit at scale. EIB

Ireland National Children’s Hospital: 160,000 m², 380 rooms. Major European mega-project. Cautionary case on governance, delivery risk, and complexity of consolidating national specialty services. Irish Government

New Zealand Dunedin Hospital: NZ$1.88B seismic rebuild. Base isolators, steel construction 2026, opening 2031. Resilience-focused design where seismic continuity is central. NZ Government

Africa

Sierra Leone: Paul E. Farmer Maternal Center opened February 2026. 166 beds, country’s first NICU. Partners In Health + Build Health International. Purpose-built maternal/neonatal infrastructure in a high-need setting. PIH

Zimbabwe Mater Dei Hospital: 750 kW solar hybrid commissioned. 1,300+ panels + battery. Reliable power for ICU and operating theatres. Shifting base loads away from diesel. UNESCO

Kenya MTRH: 2,000-bed multi-specialty hospital. Early 2027 completion. Major East Africa capacity expansion. Dawan Africa

Uganda Aga Khan University Hospital Kampala: 150→600 beds. Phased tertiary-care and academic medical infrastructure in East Africa. Aga Khan

Asia / Pacific

Hong Kong Kai Tak Hospital: 2,400 beds, phased opening October 2026. 500,000 m². One of the largest public hospital openings globally. Once-in-a-generation project for high-density urban hospital design. Hospital Authority

Australia Eurobodalla Regional Hospital: A$330M, exterior complete. Recruiting 160+ staff. First regional ICU. Consolidating Moruya and Batemans Bay services. Commissioning phase. NSW Health

Maldives: water-based batteries for island microgrids. Aqueous flow battery technology advancing for island healthcare resilience. Microgrid Knowledge

IFHE Global Connection

IFHE Building Award: submissions due July 1 — 3 DAYS. New healthcare facilities and major renovations. Presentations at October World Congress. IFHE

IFHE Carbon Challenge: submissions due July 31. 2023 baseline, 2025 performance year, 5%+ GHG reduction. Free tracking tool. IFHE

IFHE recruiting for IFHE-WHO team. Expert volunteers for climate-resilient/low-carbon healthcare facilities. Focus: thermal energy and energy generation/storage. Apply

IFHE President’s travel schedule. This fall, after the IFHE Congress in New Orleans, the President will visit all IFHE A-members in the Asia-Pacific Region, including South Korea, Indonesia, Thailand, New Zealand, and Australia, plus outreach to lapsed members. In August, the President will attend the ABDEH XI CBDEH in Brasília. IFHE

IFHE Latin American Regional Congress: April 26–30, 2027, Buenos Aires. First-ever IFHE regional congress in Latin America, co-located with AADAIH’s 40th anniversary. Scientific committee includes members from all Latin American national associations. AADAIH

IFHE Newsletter: check your spam folder. The IFHE publishes a monthly newsletter for members and the global healthcare engineering community. Several email systems are filtering it incorrectly. If you have subscribed and are not receiving it, please check your spam or junk folder. Subscribe at ifhe.info/newsletter

IFHE Global Events Calendar

JULY

Jul 1: IFHE Building Award submissions deadline. ifhe.info

Jul 1: Joint Commission Cyber Resilience + Outcomes-Driven certifications effective

Jul 7: IHEEM Authorising Engineers Conference. iheem.org.uk

Jul 9: IHEA: Sunshine Hospital predictive maintenance (Australia). ihea.org.au

Jul 13: LDES for Healthcare Summit, Salt Lake City — FREE for hospital owners. Register

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

Jul 20: FERC: RTO/ISO generation adequacy reports due

Jul 30: IHEA QLD: Intelligent Infrastructure in Healthcare, Brisbane. ihea.org.au

Jul 31: IFHE Carbon Challenge submissions deadline. ifhe.info

AUGUST

Aug 2–5: ASHE Health Care Facilities Innovation Conference, Minneapolis. ashe.org

Aug 17: FERC: 60-day RTO/ISO response deadline

Aug 19–21: ABDEH XI CBDEH 2026, Brasília (IFHE President attending). abdeh.org.br

SEPTEMBER–OCTOBER

Sep 15: NYSERDA hospital energy proposals due

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Oct 7–9: AFIB 30th Journées, Rennes. afib.asso.fr

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register

NOVEMBER

Nov 12–13: NZIHE Conference, Auckland. nzihe.org.nz

Nov 16–18: IHEA National Symposium, Fremantle. ihea.org.au

Nov 27–28: HEAJ 55th Conference, Japan

2027

Apr 26–30: IFHE Latin American Regional Congress + AADAIH 40th Anniversary, Buenos Aires

About the Author

Walt Vernon holds degrees in electrical engineering, business, law, and energy law. He is President of the International Federation of Healthcare Engineering, CEO and principal at Mazzetti—an employee-owned benefit corporation working to bend the climate curve—and founder of the Sextant Foundation, an NGO advancing clean energy systems for low-resourced health facilities worldwide. He helped write portions of the National Electric Code that opened the door to hospital microgrid systems, serves on the ASHRAE 189.3 committee and the ASHE Battery Safety Task Group, and is a member of the leadership team of the U.S. National Consortium on Long Duration Energy Storage.

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“It’s tough to make predictions, especially about the future.” Yogi Berra

I am not a person who remembers a lot of jokes, but one I remember (and which won’t render well here) is the question, “What is the secret to a good joke?” The joke is, as the listener is saying something like “I don’t know” the teller interrupts to say “timing.”

Through the years, I have run into this issue of timing thousands of times.
Today, I was talking to Ratan Milevoj at Valley Children’s Hospital. Ratan had hired me to help VCH to create an energy strategy, to help the hospital with concerns about reliability and expense. Over time, VCH agreed to an audacious undertaking – to build a microgrid, leveraging PV, Fuel Cells, and Batteries. The project has been challenging, as we are doing something that has literally never been done before (the Kaiser Ontario project was similar, but this one has unique advances from that one).

Ratan mentioned that, even for all of our challenges, our timing had worked out well. We have timed the project so that we will be able to secure the ITC credits. We are now living through the data center boom, and the resulting supply chain challenges. (Indeed, our go-to partner for fuel cells, who has always been there for us and for healthcare does not bother to return our phone calls anymore; they are so busy supplying data centers). Energy prices are increasing at a higher rate than we had projected when we started the project. If we had not started when we did, we would have lost all of these advantages.

And, when we talked, we reminisced. Early in the project, when we had been pondering opportunities for improving the energy vulnerability of the hospital, Ratan had asked me whether we should just wait, as solar panels were getting cheaper and better all the time. At the time, I suggested that (a) Yogi was right, and (b) we knew for sure that waiting would mean not taking advantage of the opportunities that we knew were available at that time.

Every client I work with worries about risk. Every client I work with wants to, at the same time, be at least somewhat innovative and future-focused. Many will repeat the line that they don’t want to be on the bleeding edge (too risky), but they do want to be on the leading edge. I have often responded (at least in private) that I wanted to be the scalpel; I wanted to be the catalyst that made things happen.

Often it is challenging. Often the outcomes can be uncertain. But more often, the outcomes are beneficial. And, each such innovation creates a platform on which the next innovation can occur. I am so grateful to Ratan, and the courage she and VCH showed to truly be innovators. I am grateful and humbled by the trust they placed in me to help them get it done. Ratan, and so many more like her, are the people that move us all forward.

And, to quote another futurist, “Here’s to the crazy ones. The misfits. The rebels. The troublemakers.”

Timing.

We interviewed for a project recently, in which I was able to participate. I don’t do a ton of project work these days, so it was kind of special for me to be able to help.

In the interview prompts, the owner asked us to address the way we would “do innovation” in the project. The question stayed with me afterward, because it implied a particular view of innovation. It implies a kind of answer, and an answer that I think is fundamentally wrong. The question implies a process of meetings, and sticky notes and ranking and cost benefit analysis, and a few minor issues surviving, and then like sea turtles rushing to sea and evading predators, maybe even evading the value engineering process!

This is how we tend to think about innovation IN a project. And, while this implied answer is partly right, it is also wrong.

I had a great response prepared, but we had so much to talk about that we did not get to it. So, I’ll share it here.

I have been thinking a lot these days about “innovation” and “thought leadership” and “change making.” Everyone I talk to these days says they are “thought leaders.” It feels more and more like Garrison Keillor’s Lake Woebegone, because we are all above average.

My answer for the interview was that innovation is not what you do. Rather, innovation is who you are.

I am reminded of the Chinese saying that you can never enter the same stream twice. And, in the same way, a client, with a project, can pick a person or a team who exhibits innovation. And, like the person stepping into the stream once, the client’s project can enter that stream, and even become part of it.

Indeed it was this line of thought that inspired me to write last week about timing, and Valley Children’s Hospital.

Last week, I talked about the Courage it took for VCH to enter, and to become part of that stream, when they had the chance to walk safely back to shore. And now, because they became part of that stream, they, and it, are becoming bigger and better.

That is why innovation is so difficult to institutionalize or to organize or to commercialize. Innovation is not a workshop. It is not a brainstorming session. It is not a process that can be turned on for a project. It is the product of imagination, courage, and persistence. Innovation is both who you are, and how you show up in the world.

More on both topics in future posts.

(Last Sunday, I did a short hike around Alpine Lake near Fairfax, California. I happened upon this stream, and it made me think about all of this).