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Semantics-driven Design through Geo and Building Information Modelling for Energy-efficient Buildings Integrated in Mixed-use Healthcare Districts

Final Report Summary - STREAMER (Semantics-driven Design through Geo and Building Information Modelling for Energy-efficient Buildings Integrated in Mixed-use Healthcare Districts)

Executive Summary:
Both in terms of societal as well as environmental impact, the healthcare buildings sector plays a key role as the world faces demographic and climate changes. Ageing population aged over 60 years will be nearly tripled, leading to major increase in the number of potential patients. This phenomenon places the healthcare building sector among the top EU priorities; it plays a key role for a sustainable community. However, their energy use and carbon emission are among the highest of all building types. In order to cope with the energy, financial, political, societal and environmental crises, all healthcare districts in Europe are seeking to substantially reduce their energy consumption and carbon emission by 30-50%. Therefore, they are planning new energy-efficient building projects as well was energy-efficiency retrofitting of the existing buildings. There is a strong need of a breakthrough in designing energy-efficiency buildings integrated in the healthcare districts.
STREAMER is an industry-driven collaborative research project on Energy-efficient Buildings (EeB) with cases of mixed-use healthcare districts that aims to reduce the energy use and carbon emission of new and retrofitted buildings in healthcare districts in the EU by 50% in the next 10 years. Such districts are the best real examples of neighborhood with integrated energy system consisting of mixed building types (i.e. hospitals and clinics; offices and retails; laboratories and sport facilities). The main objects are:
- To substantially optimize the energy-efficient design of both new and retrofitted buildings in the healthcare districts.
- To provide the multidisciplinary design teams with advanced design tools by improving the open interoperability between the Building Information Modelling (BIM) and Geographical Information System (GIS) in a Sematic Web (SW) environment, and by enabling model-based analysis of the energy performance.
- To effectively manage information flow, knowledge integration, communication and design-making in the participatory semantics driven design process according to the principles of the Integrated Project Delivery (IPD).
The STREAMER results will be validated in 4 projects involving Implementers Communities. The outcome will be used to extend the standardization in EeB design and operation, open BIM-GIS (IFC-CityGML), and Integrated Project Delivery (IPD).
Project Context and Objectives:
Both in terms of societal as well as environmental impact, the healthcare buildings sector plays a key role as the world faces demographic and climate changes. Ageing population aged over 60 years will be nearly tripled, leading to major increase in the number of potential patients. This phenomenon places the healthcare building sector among the top EU priorities; it plays a key role for a sustainable community. However, their energy use and carbon emission are among the highest of all building types. In order to cope with the energy, financial, political, societal and environmental crises, all healthcare districts in Europe are seeking to substantially reduce their energy consumption and carbon emission by 30-50%. Therefore, they are planning new energy-efficient building projects as well was energy-efficiency retrofitting of the existing buildings. There is a strong need of a breakthrough in designing energy-efficiency buildings integrated in the healthcare districts.
STREAMER is an industry-driven collaborative research project on Energy-efficient Buildings (EeB) with cases of mixed-use healthcare districts that aims to reduce the energy use and carbon emission of new and retrofitted buildings in healthcare districts in the EU by 50% in the next 10 years. Such districts are the best real examples of neighborhood with integrated energy system consisting of mixed building types (i.e. hospitals and clinics; offices and retails; laboratories and sport facilities). The main objects are:
- To substantially optimize the energy-efficient design of both new and retrofitted buildings in the healthcare districts.
- To provide the multidisciplinary design teams with advanced design tools by improving the open interoperability between the Building Information Modelling (BIM) and Geographical Information System (GIS) in a Sematic Web (SW) environment, and by enabling model-based analysis of the energy performance.
- To effectively manage information flow, knowledge integration, communication and design-making in the participatory semantics driven design process according to the principles of the Integrated Project Delivery (IPD).
The STREAMER results will be validated in 4 projects involving Implementers Communities. The outcome will be used to extend the standardization in EeB design and operation, open BIM-GIS (IFC-CityGML), and Integrated Project Delivery (IPD).
The main concepts to achieve these objectives are:
a. Functional and technical optimisation of the spatial layout and the building envelope directly related to innovative services and building operations within the healthcare districts and surrounding areas.
b. Cost-effective optimisation of the MEP and HVAC systems in the buildings, taking into account the inter-dependencies between medical equipment, building components and energy systems. STREAMER will solve the most crucial design failures that cause transmission / efficiency loss between equipment and buildings during operation, especially when modern equipment is installed in existing building or energy systems. Optimisation will be done regarding the interconnections between medical equipment and MEP/HVAC systems, through product modelling in relation with Building Information Modelling (BIM) and Geo Information Systems (GIS) as well as through process modelling to feed Building Management Systems (BMS).
c. Optimal interaction between the building’s and neighbourhood’s energy systems in the healthcare district and surrounding areas (e.g. smart grid, smart use of district heating/cooling and energy generation).

Project Results:
The STREAMER scientific results have been published in peer-reviewed journal articles and in conference papers. The list from Deliverable D8.6 is represented below in a categorized way.
2.1.1 Design methodology
The overall approach that has emerged from the work on STREAMER. The initial scientific analyses addressed the importance of focusing on early design, later publications elaborate the semantic label approach as a basis for the design methodology. Also, the implications for tools that are to be used are published.
• Sebastian, R., Böhms, H.M. Bonsma, P., van den Helm, P.W. (2014). Semantic BIM and GIS Modelling for Energy-Efficient Buildings Integrated in a Healthcare District in ISPRS Proceedings; 8th 3DGeoInfo Conference. Vol. II-2/W1, 27 – 30 November 2013, Istanbul, Turkey
• Sleiman, H. A., Hempel S., Traversari R., Bruinenberg, S. (2017). An Assisted Workflow for the Early Design of Nearly Zero Energy Buildings, MDPI AG Journal Energies, 10(7), 993, Multidisciplinary Digital Publishing Institute
• Benner, J.; Häfele, K.H.; Bonsma, P.; Bourdeau, M.; Soubra, S.; Sleiman, H.; Robert, S. (2014). Interoperable tools for designing energy-efficient buildings in healthcare districts in Proceedings of ECPPM - eWork and eBusiness in Architecture, Engineering and Construction,17-19 September 2014, CRC Press, the Netherlands
• Traversari, A.A.L. Den Hoed, M., Di Giulio, R., & Bomhof, F.W. (2017). Towards Sustainability through Energy Efficient Buildings‘ Design: Semantic Labels, the International Journal Entrepreneurship And Sustainability Issues, Vol.4 Number 3, pp. 243-256;
• Traversari, A.A.L. (2016). Semantic Labels for Energy Efficient Building Design enabling Early Design evaluation in the International Journal Entrepreneurship and Sustainability Issues

2.1.2 GIS for energy simulation
Even though the list of technological results does not have a lot of GIS-oriented entries, some considerable work has been done on the usage of GIS in relation to energy issues. This mainly involved the extension of existing standards (D6.3). The papers also address other aspects (noise, emergency management) and deal with the question which level of detail is relevant when including IFC (separated buildings) in GIS (districts) models.
• Haefele, K.H. Casper, E., Kaden R. (2014). OGC Standard CityGML Opens Up New Applications in Energy Simulation in Journal of the National Institute of Building Science, December 2014, Vol. 2, No. 6, pp.30-32
• Nouvel, R.; Kaden, R.; Bahu, J.M.; Kaempf, J.; Cipriano, P.; Lauster, M.; Benner, J.; Munoz, E.; Tournaire, O.; Casper, E. (2015). Genesis of the CityGML energy ADE in Proceedings of CISBAT Future Buildings & Districts Sustainability from Nano to Urban scale, Vol. 2, September 9-11, 2015, pp.931-936 Ecole Polytechnique Federale de Lausane (EPFL), Switzerland
• Haitz D., Geiger A. (2015). Konvertierung von CityGML-Gebäudemodellen in gbXML für energetische Betrachtungen in Forum Bauinformatik 27, pp. 28-36. 21-23 September 2015, Wichmann, Germany
• Nouvel R., Bahu J.-M. Kaden, R., Kaempf, J., Cipriano P, Haefele, K.H. (2015). Development of the CityGML Application Domain Extension – Energy for Urban Energy Simulation in Proceedings of 14th Conference of International Building Performance Simulation Association IBPSA. 7-9 December 2015, pp.559-564. Hyderabad, India
• Benner, J, Geiger, A., Häfele, K.H. (2016). Virtual 3D City Model Support for Energy Demand Simulations on City Level – The CityGML Energy Extension. REAL CORP 2016. 21st International Conference on Urban Planning, Regional Development and Information Society, Hamburg, 22-24 June 2016, pp.777-786 CORP, Schwechat
• Geiger, A., Benner, J., Haefele, K.H. (2014). Generalization of 3D IFC Building Models in 3D Geoinformation Science, 11-13 November 2014,pp. 19-35, Springer

2.1.3 Case study descriptions, hospital-specific
Specifically the Italian and Dutch case studies have been reported in scientific publications. These reports provide the background for the practical application of other scientific results.
• E. Iadanza, B. Turillazzi, F. Terzaghi, L. Marzi, A. Giuntini, R. Sebastian (2014). The STREAMER European project. Case study: Careggi hospital in Florence” in Lacković, I. and Vasic, D. (Eds.), 6th European Conference of the International Federation for Medical and Biological Engineering – IFMBE Proceedings 45 - MBEC 2014, 7-11 September 2014, Dubrovnik, Croatia, Springer International Publishing, Switzerland, pp. 649-652, DOI: 10.1007/978-3-319-11128-5_162
• Marzi, L. (2014). Tools and methods for the management of healthcare real estate assets: The experience of the multidisciplinary laboratory of the Careggi University Hospital in TECHNE Journal of Technology for Architecture and Environment: Florence, Italy, pp.241-249 Firenze University Press
• Koster, M., Van Nederpelt, S., Sebastian R. Schippers-Trifan, O. (2015). STREAMER Semantic BIM design approach for hospitals: research case of Rijnstate Hospital in Arnhem, the Netherlands in Sustainable Places Conference Proceedings, September 2015, pp.121-129 Savona, Italy, Sigma Orionis;
• Marzi, L., Di Giulio, R., Turillazzi B., Terzaghi, F., Giuntini, A. (2016). Integration of BIM-GIS systems for energy-efficient hospital buildings. The Streamer research and the case study of the Careggi Polyclinic (Florence); in Italian Society of Science, Technology and Engineering or Architecture (ISTeA): Back to 4.0 Rethinking the Digital Construction Industry, 30 June -1 July 2016, Naples, IT

2.1.4 Hospital design
Implications for hospital design and hospital campus design have been described in a couple of scientific publications. These are mainly related to results of work package 1 (D1.1 D1.2 D1.5).
• Di Giulio, R., De Hoogh, S., Turillazzi, B., Quentin, C., Sebastian, R. (2014). Hospital campus design related with EeB challenges in Mahdavi, A., Martens, B. and Scherer, R. (Eds.), ECPPM 2014 – eWorks and eBusiness in Architecture, Engineering and Construction”, Proceedings of the 10th European Conference on Product & Process Modelling, Vienna 17-19 September 2014, eeBDM Workshop, CRC Press/Balkema - Taylor & Francis Group,London, UK, pp. 907–915.
• Di Giulio, R., Turillazzi, B., Marzi, L., Pitzianti, S. (2017). Integrated BIM-GIS based design for high energy efficiency hospital buildings in TECHNE Journal of Technology for Architecture and Environment, Vol.13 pp.243-255 Firenze University Press, DOI: 10.13128/Techne-19728

2.1.5 Early design configurator
The principles of the Early Design Configurator that has come up as one of the main enabling innovations of the STREAMER project has been described two papers.
• Hempel, S., Benner, J., Haefele, K.H. (2015). Generating Early Design Alternatives based on formalized requirements and geospatial data in Proceedings of the 32nd International Conference of CIB W78, pp.255-264 27-29 October 2015, Eindhoven, the Netherlands
• Hempel, S.; Benner, J.; Geiger, A, Haefele, K. H. (2016). STREAMER Early Design Configurator- a Tool for Automatic Layout Generation in Hájek, P., Tywoniak, J., Lupíšek, A. and Sojková, K. (Eds.), CESB16 Proceedings 22- 24 June 2016, Prague, Czech Republic, pp. 221-222.

2.1.6 Summary and conclusion
Main scientific results that have been published address the overall methodology (including the semantic labels approach) and the background for the most prominent technological results (the Early Design Configurator). Implications for designing hospitals are published, just as the results of case studies where the scientific insights have been validated. A separate category of scientific results deals with the BIM-GIS interaction.
Comparing the published scientific results with the exploitable results (as outlined in D10.11 the PUDF), it can also be concluded that some scientific results have not made it to technological and commercially exploitable results (like the BIM-GIS interaction). Other exploitable results are not based on published scientific results. The reason for this is that the STREAMER project has been set up as a very application-oriented project (for instance, no universities are involved in the consortium), so it cannot be expected that a one-to-one relation exists between published scientific results and commercially exploitable results.

2.2 Technological results
The technological project results fall into two categories: methodologies and tools. Methodologies can come in many forms: it may be a step-by-step approach to reach a result, describe guidelines or templates, or can contain an overview or database of design options including a description of how to use it. A tool is generally a piece of software that has functionality to perform tasks. In many cases, a tool has to be used as part of a methodology.
The whole project has generated many different results; insights were formulated, partial results were created that have to be integrated with other tools in order to become useful in other contexts. Most project results were described in the formal and contractually agreed deliverables. This section gives a summary of the main results, focusing on those results that can and will be exploited by the project partners, and that jointly give an overview of the STREAMER approach.
Some tools and methods can be used independently, others are only meaningful when used together with other tools or methods.
2.2.1 Overview
The below table gives a quick overview of the STREAMER technological results, the main dependencies, and the STREAMER partner that is exploiting that result. Only exploitable results are listed.
• Decision support tool:
o Short description: Tool to help design teams evaluate design alternatives. This tool is the ‘end station’ for many other tools, where outputs are brought together.
o Works with : PLM solutions, Early Design Configurator, Semantic labels methodology, Energy intermediate tool, TNO Energy Calculation tool, MEP/EeB selection,
o Owner: DMO
o Short description: To verify that the content of the IFC file is according to specification, in other words: that it contains the right information
o Works with: In principle all other tools
o Owener: AEC3
• PLM solutions
o Short description: Document management, version control, access control and other ‘managerial’ tasks that are needed in a BIM workflow.
o Works with: Energy intermediate tool (integrated) All other tools (through API)
o Owner: CST
• Early Design Configurator
o Short description: A tool that can automatically generate floorplan layouts based on a Program of Requirements and Design Rules
o Works with: Semantic Labels methodology, Database of design rules
o Owner: DMO
• Semantic labels methodology
o Short description: One of the methodological basics of STREAMER, a way to categorize rooms and MEP/EeB systems in an early design phase
o Works with: Design Decision Support Tool, Early Design Configurator, Database of Design Rules, Energy Intermediate tool, TNO Energy Calculation Tool
o Owner: TNO
• Database of requirements for hospital rooms
o Short description: A set of ‘standard’ requirements for hospital rooms, to increase the speed of developing a Program of Requirements
o Works with: Early Design Configurator
o Owner: RNS
• Database of design rules
o Short description: A set of design rules that capture designers knowledge and expresses them in computable form, based on the Semantic Labels
o Works with: Semantic Label methodology, Early Design Configurator, Rule-based checking toolkit
o Owner: DJG
• Rule-based checking toolkit
o Short description: A tool that can evaluate a design (stored in an IFC file) against the design rules
o Works with: Database of design rules, Semantic Label methodology
o Owner: CEA
• Energy Intermediate tools
o Short description: A tool that can attach default information (based on the semantic labels) to an IFC file so that the trnSYS energy tool can calculate energy demand for the design
o Works with: PLM solutions, MEP/EeB Selection tool, Semantic Label Methodology, Design Decision Support tool
o Owner: CST
• TNO Energy Calculation Tool
o Short description: A tool that can directly calculate energy demand for a design, based on an IFC file containing semantic labels. Based on ISO 16798-1
o Works with: Semantic Label Methodology, Design Decision Support tool
o Owner: TNO
• MEP/EeB Selection tool
o Short description: A tool to assist designers in creating zones in a design (rooms having the same MEP or EeB characteristics) and can attach an MEP or EeB label category to those rooms, for subsequent energy calculations.
o Works with: Energy Intermediate Tool, Semantic Label Methodology
o Owner: CST
• Energy mapping viewer
o Short description: A method, working with an existing tool, to help analyse energy supply and demand in a larger area
o Works with: -
o Owner: DWA
The process that ties the majority of these tools together has been outlined in the attached document nr 1 .
The numbers indicate results that can be demonstrated jointly:
1. Database of requirements (including adapted tool for PoR management)
2. Early Design Configurator
3. BIMQ requirements management
4. MEP/EeB selection tool
5. TECT energy calculation
6. Design decision-support and lifecycle validation tool
7. Rule-based checking toolkit
(The PLM tool was not yet advanced enough to support the whole demonstration.)
Other results provide background or support (like, the methodologies) or can be applied separately (like, QGIS).
2.2.2 Tool: Design decision-support and lifecycle validation tool
The Decision Support tool helps design teams to evaluate different design alternatives. The tool reads information from many different sources and can perform multi-criteria analysis against a set of STREAMER Key Performance Indicators, addressing energy efficiency, total cost of ownership, and quality.
The tool contains a user-configurable dashboard that enables the selection of different KPIs. It also contains extensive viewing capabilities to study the different design alternatives in more detail. See attachment nr 2 and 3.
The tool integrates information from all other STREAMER tools. It can read building designs in the IFC standard format, including information that has been added by energy simulation tools. Financial information (Life Cycle Costing) is calculated based on key figures. The tool is designed in such a way that other relevant information that can be included in a BIM, such as operational quality or safety, can also be included in the definition of Key Performance Indicators.

2.2.3 Tool: BIMQ requirements management and mvdXML-based model checking
The STREAMER workflow is a typical example of Architecture, Engineering & Construction (AEC) design processes that require collaboration of different domains. Data exchange between different tools is enabled by the use of Building Information Modelling (BIM) and open standards, namely IFC and the BIM collaboration Format BCF ( An increasingly important aspect of BIM-based projects is quality control of shared BIM models. Following the layered model checking approach proposed in STREAMER (see Deliverable 5.2) a set of tools have been developed to (1) specify and manage BIM data requirements, also know as Level of Development (LOD) and Level of Information (LOI), and (2) automatically check BIM-IFC files against those requirements based on the open mvdXML format. The principle workflow is shown in the separate document nr 4, where both steps shown as BIMQ Guide (blue box) and BIM Validation (orange box) shall support the creation of the BIM model (yellow box).
The BIMQ Guide (see spate document nr 5) was developed by the partner AEC3 ( and is a web-based solution used to capture Exchange Information Requirements (EIR, see also ISO 19650-1) within the STREAMER workflow (early design of hospitals). The tool itself is very flexible and can be used from simple requirement configurations based on predefined specifications to full complexity starting from scratch including the needs to provide technical details such as the mapping of end-user requirements to the BIM-IFC data structure. Exchange Information Requirements are linked with processes and basically identify what data is needed (in BIMQ described as data concepts like the STREAMER PoR Labels that are attached to an object type like room) and who is responsible to deliver that data. Accordingly, the BIMQ Guide follows the Information Delivery Manual (IDM) and Model View Definition (MVD) methodology from buildingSMART and fits to international standards. A screenshot of BIMQ with a typical requirements table is shown in Figure 2. The tree structure in the first column defines data requirements by linking properties to object types, like for instance information about Accessibility for Rooms. Further information like code, description or units maybe assigned to these elements in order to provide further details. Ownership and responsibility of information is given in a separate column, as well as mapping details to IFC or other data structures. Finally, the MAN settings in the last columns are linked with processes like for instance the Early Design Configuration. They enable to configure information needs that they vary between projects or used tools.
Based on such requirements table it is very simple to make project specific adjustments, for instance if data requirements of used tools change over time or a new type of hospital must be supported. For example if a specific label (property) is not relevant anymore or the list of room type options shall be reduced it can be adjusted by few clicks in the user interface. Next to this a new set of PDF reports and mvdXML-based checking specifications ( can be exported by the tool and used for further data quality control.
A prototype implementation for mvdXML-based model checking has been developed as a plug-in for the xBIM IFC viewer ( The implementation is mainly designed to allow individual stakeholders to independently verify the conformity of received and produced BIM-IFC models against the agreed exchange requirements and concept roots in a user friendly visual 3D environment as shown in separate document nr 6.
To enable a complete collaboration workflow between stakeholders of the established IDM processes the MVD user interface component has been designed to allow the interactive analysis of models according to arbitrary combinations of exchange requirements, concept roots and IFC classes, the UI allows immediate feedback on the validation status of selected elements as well as whole models; this filtering strategy also helps to improve the responsiveness of the application which can become relevant if thousands of requirements need to be checked for large IFC models. Visual color coding styles have been developed to allow rapid traffic-light model inspection in the 3D viewer of passing and failing requirements.
Furthermore, validation reports in the BIM collaboration format (BCF) can be generated to give detailed feedback about identified issues. Thus, it allows stakeholders to exchange communication threads on the result of validation tests across different BIM platforms while retaining complete reference of the involved IDM, MVD and IFC background.

2.2.4 Tool: PLM solutions integrated with BIM & GIS
PLM, or Product Lifecycle Management, is the glue between all the different tools and data. All the documentation, models, computation results are stored on the server, accessible at any time by any actor and will be visible through any solution that will implement the PLM API. One of the main advantage of combining PLM and BIM is that PLM solution supports validation processes. Each kind of document can be integrated into a completely customizable circuit. Only PLM administrators can have access to such processes definition.
The PLM tool is based on existing software that has been enhanced in a number of ways:
• An API has been defined that enables other tools (specifically the STREAMER tools) to directly access the PLM functionality
• A possibility to work with the BIM Collaboration Format has been included. BCF enables the tracking of changes to designs.
Integration with the eveBIM tool (of CSTB) is tight. Various plugins allow for the usage of BCF connected to IFC files. See separate document nr 7 and 8.

2.2.5 Tool: Early Design Configurator (Configurator of parametric design solutions)
The Early Design Configurator has emerged to become one of the most prominent results of STREAMER. The tool is based on the observation that in early design, usually choices are made that cannot be easily changes later on, but which have a considerable impact on the building’s performance – notably energy efficiency, but other aspects as well. Usually, an experienced architect can make an early design that is expected to fit the customer’s requirements. However, making such a design is costly; only one variety is usually made. The Early Design Configurator automates this process to a high degree. Thereby, it is easy to create multiple designs that can be evaluated and compared.
The Early Design Configurator takes inputs from three sources:
• The Program of Requirements identifying the customer’s requirements: how many rooms, how large, which characteristics. This PoR is enhanced with the STREAMER Semantic Labels: these provide a shorthand way to quickly identify the main characteristics of rooms, even when more detailed specifications are not yet available.
• The building’s outer shell (the form), and any restrictions in the floor plan. The size of the building is usually already defined (otherwise, the designer first has to make a choice for this) for instance in a refurbishment scenario. Also, some rooms, corridors, stairs, elevators or other elements are fixed and cannot be changed.
• Design rules that have encapsulated the architect’s knowledge. These design rules are expressed using the STREAMER semantic labels and may contain specific experiences, wishes or principles. For instance, a rule can state that the distance between specific rooms may not be more than a maximum, or that some rooms should be on the same floor, or near to the elevator, or that office rooms and patient rooms should not be mixed.
Based on these inputs, the EDC starts making designs automatically. A design should fulfill the outer shell and fixed room restrictions as a hard condition, and makes succesive new design variants that fulfill the PoR and the design rules increasingly well. The algorithm used for this optimization is known as „Evolutionary Programming“, a techique from the field of Artificial Intelligence that optimizes a solution by continuously “trying“ different designs. See separate document nr 9
Defining the building outer shell, and fixed rooms. See separate document nr 10.
The optimizer at work. The colors indicate how ‘satisfied‘ the algorithm is.
Design variants can be created by re-running the algorithm with adjusted preferences in design rules (which rule should take precedence).

2.2.6 Method: Semantic labels design methodology
The Semantic Labeling approach is one of the methodological core concepts introduced by STREAMER. In short, the semantic labels fill the gap between the (often very coarse) requirements and characteristics used in early design stages on one hand, and the much more detailed specifications that are usually only known in much later design stages. This makes it possible to evaluate a design in the early design stage.
The semantic labels provide characteristics of the major components of the hospital, grouped in more or less ‘standard’ categories. The STREAMER tools are then able to ‘reason’ with these categories, for instance the Design Rules make heavy use of these. Also, two tools use the Semantic Labels for initial estimation of energy demand.
Using the semantic labels in the so-called ‘assisted workflow’ (making use of additional information and tooling) leads to better information in early design stages, where the impact of design choices is usually high.
Semantic labels are defined for Access and Security (to identify rooms that are public, or restricted access), for Comfort class (in terms of noise, temperature and light), Construction (minimum dimensions), Equipment (being able to support specialized equipment), Hygienic class (very high for operating theatres, for instance) and User profile (office hours, 24/7). See separate document nr 11.

2.2.7 Method: Database of requirements for hospital rooms
When working on the pilot projects, it has become apparent that requirements gathering is a time-consuming process. In some cases, requirements are based on regulations, sometimes on former experiences, or sometimes just because it was best practice at the time.
STREAMER Partner RNS has identified that a lot of time can be won by using a standard list of requirements that are relevant in a hospital setting, as is already in use in Sweden. They started to explore if such standards can be developed for use in (at least) the Netherlands, thus leading the way in this field. Eventually such a list may be handed over to an emerging group of collaborating hospital facility managers. The databases of SE and NL may then serve as examples for wider European uptake.
The advantage of such a databas is that it captures expert knowledge, reduces time consuming data collection for requirements, and reduce risk for development of projects as requirements are commonly accepted and proved to be sufficient. Additionally, employees of hospitals will have lesser need for adaptation when employed in another hospital because of standardization. In operation theatres, this can reduce risks in wayfinding for a surgeon for example.

2.2.8 Method: Database of design rules
The Design Rules are used in the Early Design Configurator and the Rule-based checking toolkit. Design rules are meant to capture experience and knowledge in a way that can be ‘calculated‘ by computer programs.
A design rule works upon the rooms in the Program of Requirements and its associated characteristics. For instance, using a design rule it is possible to specify that patient rooms and offices should not be mixed. Or, that a preparation room should be close to a surgery room.
The database of design rules thus captures expert knowledge, and as such it is complementary to the other STREAMER result ‘database of requirements’.
Examples of these design rules are:
• Functional area with (name equals “Admission”) must be contained in the lowest story;
• Functional area with (name equals “MedicalArchive”) must be contained in the highest story;
• functional area with (name equals “LowCareWard”) must be clustered horizontally and vertically;
• Traveling distance between space with (name equals “PatientRoom”) and space with (name equals “NursingStation”) is less than 20.0 m;
• Space with (HygienicClass equals “H5”) must be clustered horizontally and vertically;
The design rules are meant to be readable by humans, while at the same time easily interpretable by computers.

2.2.9 Tool: Rule-based checking toolkit
The rule-based checking toolkit uses the Database of Design Rules to verify that a design is still valid. During the design, the designers may have made changes to the output of the Early Design Configurator that may violate some rules. The Early Design Configurator creates an automatic design that is as much as possible according to the Design Rules, but subsequently it may be needed to adapt the design manually. Maybe because of the choice of MEP systems, maybe because of other considerations that were not included in the design rules.

This tool is complemented with another tool which enables editing the set of design rules. This editor is rather basic; it helps the user to formulate design rules that are syntactically correct, but it does not have an extensive Graphical User Interface, since it is expected that the information will be entered by IT specialists and will not be updated very frequently.

2.2.10 Tool: Energy intermediate tool (eveBIM-TRNSYS)
A special tool has been developed in order to enable two existing tools (eveBIM, a viewer, and trnSYS, an energy calculation tool) to make use of the STREAMER labels. See separate document nr 12.
2.2.11 Tool: TNO Energy Calculation Tool (TECT)
In order to evaluate the energy performance of buildings, a tool has been created that is exactly based on the relativel recently defined standard EN ISO 16798-1. The tool that has been used for STREAMER makes explicit use of the Semantic Labels. The tool calculates the energy demand for each room and for each hour in a year, and it takes as inputs:
• The IFC file that contains the design of the building, also containing the STREAMER Semantic labels for each room so that default values can be used;
• A configuration file, also containing default values for spaces and façade;
• Climate conditions as defined by EN ISO 16798-1.
The energy demand information is written back into the IFC file, and the information can be read and evaluated in the Decision Support Tool.

2.2.12 Tool: MEP / EeB selection
One major result of the STREAMER project is to be able to assess a design in an early phase, when normally not much information is yet available. This is especially true for MEP (Mechanical, Electrical and Plumbing) systems, that have a huge impact on the energy performance of a building, but which are usually taken into consideration in relatively late design stages.
One piece of information that STREAMER has added in early design stages, is a Semantic Label for each room, which gives basic information on the way this room will be used. This label already indicates a first way to make the choice for MEP systems smaller: some MEP systems are simply incompatible with the future usage of rooms. For instance, radiators (for heating) are usually not allowed in surgical theatres because they cannot be cleaned satisfactorily. The same goes for natural ventilation (opening the window).
When making a design, it is usually very beneficial to group rooms that share the same MEP system and/or EeB (façade) technology. The tool that is used for this is the MEP / EeB Selector. The tool enables the user to view the building design (visualizing the IFC file), to identify zones that share common choices for permissible MEP / EeB technologies and to (manually) make a choice for the MEP / EeB type in that zone. See separate document r 13 and 14.
Both for EeB and MEP systems, the STREAMER project has defined labels as well. These labels enable the energy calculation tools to make much more educated guesses (using default or standard values) with respect to energy characteristics of rooms, MEP and Façade technologies.
The tool is based on the open source eveBIM tool.

2.2.13 Tool and method: energy mapping viewer (QGIS)
A method has been developed, working with an existing tool (QGIS) which is intended to enhance the workflow around using the tool in situations where various energy sources or users are present in a larger area.
It is possible to view characteristics of a neighbourhood without having to interview people or companies. This means the decision field can be narrowed beforehand. As an extra bonus, lower governments such as provinces or municipalities are in need of this kind of data visualization to be able to make decisions regarding the energy transition. Usually these actors have GIS data but do not combine them themselves for analyses.
Buildings sorted by typology and energy demand. See separate document nr 15.
The method follows a step-by-step approach in which publicly available (open) data is used, along with GIS and BIM information, and where energy supply, energy demand and energy transportation opportunities are compared, in order to be able to select a number of combinations that can then be analysed in cost-benefit scenarios, also taking into account other (non-technical) parameters.

2.3 Documentation and background of results
The results outlined in the previous section are based on findings of the project that are reported in the formally agreed deliverables. In most cases, the foreground knowledge that has gone into the results, has been described in the deliverables; however, implementation-specific details are not always documented in these deliverables, either because of the very detailed nature or because they were further developed after submission of the deliverable report.
The tools are:
• Decision support tool based on D3.2 D3.5 D3.6
• BIM Q based on D5.1 D5.5
• PLM solutions based on D5.3 D5.4
• Early Design Configurator based on D1.6 D6.2. Note: Considerable update after submission of D6.2 was made based on feedback of design workshops.
• Semantic labels methodology based on D1.6 D2.5 D2.6. Note The rooms labels are in D1.6. The MEP/EeB labels in D2.5 and D2.6 respectively.
• Database of requirements for hospital rooms based on D1.6. Note: The approach for the database has been documented in D1.6. The content of the database has been further developed after that.
• Database of design rules based on D1.6 D6.1.
• Rule-based checking toolkit based on D1.6 D6.1
• Energy Intermediate tool based on D3.4.
• TNO Energy Calculation Tool based on D6.6. Note: This tool was created based on preliminary results from another project, but finalised in STREAMER, based on the assessments in D3.3 and D3.4. The tool is expected to operate according to the principles outlined in D6.6. However, the tool itself is not documented in a formal deliverable.
• MEP/EeB Selection tool based on D2.6. Note: Making use of the content in deliverables D2.1 D2.2 D2.3 D2.4
• Energy mapping viewer based on D2.7 D2.8.

2.4 Additional results
As can be concluded from the previous section, some results have not been foreseen in the scope of the STREAMER project, they were not included in the DoW and have thus not been reported in formal deliverables.
This section summarizes those results.

2.4.1 MEP/EeB Selection tool
During the development of the STREAMER design methodology it became apparent that choosing MEP and EeB technologies would have a large impact on the energy performance. It was thus needed to make this choice in early design stage as well. The EDC was able to ‘filter’ out some MEP/EeB technologies based on semantic labels, but the resulting design still contained too many options.
It was decided (during the GA in Karlsruhe, M42) to adopt the open source tool EVEBIM (partner CSTB has extensive knowledge about this tool) and to create MEP/EeB choice functionalities in this tool.

2.4.2 TNO Energy Calculation Tool
While working with the available energy calculation tools, it became apparent that including the Semantic Label information would be problematic (although not impossible; to a certain extent the interface to the trnSYS tool shows this). Also, it appeared that a new standard to calculate energy efficiency (EN/ISO 52016-1) became available and no available tool worked with that standard.
Partner TNO was already working on the energy standard, including a tool to make calculations based on BIM, so it was decided to make this tool (called TECT) compatible with STREAMER, by enabling it to read the Semantic Labels information. Also, it was included in the integration approach outlined in D6.6.

2.4.3 Comparison of energy calculation tools
While working with various energy calculation tools (SBEM, trnSYS, TECT, VABI), it was concluded that there is a huge variance in the way these tools operate. Thus, comparisons of energy efficiency cannot be made when different tools are used.
The differences between tools were so large and seemed so unpredictable that in order to analyse any uncertainty, it was decided to conduct a brief study into how these tools behave.
The outcomes have been reported in the document “Comparison of Energy Calculation Tools - A study conducted within the Streamer project to highlight differences in some energy performance calculation software”, written by Mikael Nutsos and Anton Clarholm of LOKUM.

2.5 Validation of the results
The results from the previous section have been validated in the pilot projects. This includes both the actual tools and the methods. Below you can see Tool and method / Validated in pilot / Summary and marjor shortcomings:
• Decision support tool / IT andFR / No specific shortcomings were identified. In general, the availability of specific key parameters for LCC calculation may of course be an issue in all applications outside NL (for which key figures are known).
• BIMQ/ - / The tool has not been validated in a pilot, but rather during development of all tools, testing the content of the exchanged information continuously.
• PLM solutions /-/ While parts of the PLM have been demonstrated in practice (in connection to STREAMER tools), the PLM itself has not been validated in practice.
• Early Design Configurator/ IT and FR and NL / The EDC has been used explicitly in IT and FR, where it has been used to do a ‘shadow engineering’. In the NL case, the EDC was not tested as part of the pilot; however, it was evaluated extensively during two interactive design sessions with the Implementers Community.
• IT, FR: EDC could not import (existing) IFC files., FR: Creating a precise outer shell shape; differing height of rooms in one storey; glazing ratio is fixed, NL: Creating the outer shell shape (greatly improved after 1st design session).
• Semantic labels methodology / UK and NL / The NL site has been used to extensively validate the content of the semantic labels, including actual monitoring of physical parameters. No specific shortcomings were identified (any issues have been resolved during the project period).
• Database of requirements for hospital rooms / NL andFR / The Program of Requirements methodology (including labels) has been developed in the NL case (so, no shortcomings from their side). It was re-used in the FR case. FR: structuring spaces like stairs and elevators were missing
• Database of design rules / NL and FR / The design rules have been tested through expert sessions with all pilot cases. The rules have been explicitly used in the FR case. FR: Import/export of design rules in EDC had problems (these were solved later); travelling distance rules needed; more precise clustering rules.
• Rule-based checking toolkit / FR / FR: no specific comments (however, see ‘database of design rules’
• Energy Intermediate tool / FR / The Energy Intermediate Tool was meant as a way to create an interface to ‘standard’ energy simulation tools. This was used explicitly in the FR case. In other pilots, the TECT was also used (which natively uses the STREAMER labels). FR: 2nd order space boundaries are needed for correct calculation, which were not present in the output of the EDC tool
• TNO Energy Calculation Tool / IT and FR / The TECT has been used in the IT and FR pilot projects. The real ‘validation’ has been done in the additional activity carried out by LOKUM, leading to the additional result ‘comparison of energy calculation tools’). IT, FR: not tested thoroughly because it became available at the end of the project
• MEP/EeB Selection tool / UK / UK: The tool itself was not validated, but the idea behind the EVEBIM update was tested
• Energy mapping viewer / NL and IT / The energy mapping method and viewer were developed by a Dutch partner, constantly testing their insights with the NL pilot project. Parts of the approach were also used in the IT case, but with other software. NL: The available datasets vary considerably across locations, which limit the full use of the tool/ methodology

Additional insights from the pilots with respect to results:
• The UK and IT pilot sites provided inputs to the ‘refurbishment scenarios’ especially when it came to defining requirements to the EDC that should be able to handle such scenarios.
• The UK pilot identified the need for ‘batch mode operation’ tools: tools that can be run without manual intervention in order to compare a larger number of design alternatives.
• The IT pilot has performed more in-depth analyses of energy simulation with different floorplan layouts and different choices for MEP/EeB technologies.
More extensive reporting on the outcomes of the four pilot projects can be found in deliverables D7.2 D7.4 D7.6 and D7.8 for the four projects, and D7.10 summarizing and comparing them.

Potential Impact:

3.1.1 General impacts
Hospitals like other public sector organisations have a responsibility to act as leaders in EeB area. The EU has adopted the Europe 2020 Strategy and the Action Plan for Energy Efficiency. If the EU nations are to meet the objective of reducing energy use and CO2 emissions, it cannot ignore the healthcare building sector. Healthcare buildings consume very considerable quantities of energy, and when we take into account the energy costs involved in transporting staff, patients, equipment and supplies around the various elements of a healthcare system, we see that this sector contributes significantly to Europe’s CO2 output.
The impact of STREAMER’s new design and management methodology will be at the centre of the green economy in the healthcare building sector. In average, an EU country spends nearly 10% of GDP on healthcare provision. This scale of economic activity, coupled with the relatively high energy intensity of healthcare operations, would suggest that the sector’s contribution to total CO2 pemissions in Europe is very significant. Given the current financial crash and its impact, the credit crisis and economic recession, next to the actual phenomenon of aging population, affordable healthcare has filled-up the top political and societal agendas in all EU countries

The quality of life of the citizens and SME workers will also improve accordingly. Direct involvement of the end-users and high quality communication plan will make possible the early planning of the construction activities, e.g. through fast-track and early “Site Plan” -considerations (constructability and coordination) will optimise the time SME workers spend at construction site, coordinate suppliers and subcontractors, improve logistics, etc. This will lead to a better safety for the citizens and SME workers. This will also avoid or significantly reduce the health impacts of psychological stress during a construction project.

Both in terms of societal as well as environmental impact, the healthcare building sector plays a key role as the world faces the demographic and climate changes. Ageing population puts a great demand on the healthcare facilities. By the year 2050, the world population aged over 60 years will be nearly tripled, from 700 million to 2 billion, leading to major increase in the number of potential patients. This phenomenon places the healthcare building sector at the front edge to make a better EU civil society. The planning, design, delivery and management of healthcare districts have a great influence in the delivery of healthcare services. The impacts of STREAMER will address all of the three aspects of sustainability:

People’ aspect represents the building occupants and the inhabitants in the surrounding areas. Their focus is on quality and function, in particular the services during the building operation period.
‘Planet’ reflects the society at large and the public clients, like hospital organizations and the local governments. STREAMER will assure EeB’s long-term environmental sustainability. ‘Profit’ addresses the benefit for the recipients of the healthcare services made possible by the financial added-values of energy efficient and low-carbon hospitals. ‘Profit’ also implies the fair commercial goals of large
companies and SMEs in EeB projects.

3.1.2 Specific impacts
In D10.10 the project’s specific societal impacts are outlined. A summary of these impacts is presented below.

1. Expected impact: Impacts outlined in the DoW: 50% reduction of energy consumption of healthcare districts in the next 10 years
Outcome Potentially even more than 50%, given the right available tools and technologies
2. Expected impact: Validated design decisions, taking into account the energy performance of buildings and Neighbourhoods
Outcome: Uptake of (parts of) the STREAMER approach is already showing results.
3. Expected impact: Fragmentation problems in design are resolved; continuity in information flows.
Outcome: Focus on early design optimization is well-received although no conclusive evidence can be presented yet.
4. Active participation of industrial partners; market competitiveness of SMEs
Outcome: Good interest in the Implementers Communities. The expected exploitation potential is disproportionally high for the SMEs (see D8.3)
5. Sustainable transformation of healthcare buildings and neighbourhoods in EU/
Outcome: European platforms like EUHPN receive STREAMER results well. National follow-up conferences are planned.
6. Contribution to EC EeB – PPP, Horizon 2020
Outcome: Active contribution to the EeB PPP, and follow up projects under H2020

Additional impacts:
• SMEs that participate in STREAMER have both profited commercially and scientifically (having been introduced to European research)
• Hospitals actively promoting usage of BIM in national platforms
• Spin-out company started that is (partially) exploiting STREAMER results
• Valorization of early scientific results to a commercially exploitable product
• Standardization outputs
• Implementers communities
Dissemination and stakeholder engagement is central to the success of STREAMER. Dissemination activities have been an essential and pervasive activity throughout the project’s life, and have been integrated within all its work packages.

The overall objective of the STREAMER dissemination strategy since the beginning of the project was to identify and reach as many stakeholders that will be involved within the STREAMER’s research activities in order to raise their awareness regarding the findings of the project and to encourage them to support and adopt the STREAMER’s solutions and recommendations regarding participatory design/ design optimisation. The intent here was to create an impact that will last beyond the end of the project by making the results of the research known to those who could benefit from them (i.e. identification of the issues, opportunities and challenges surrounding the participatory design within the healthcare sector). This would enable STREAMER to strengthen the research and knowledge base of stakeholders by facilitating the presentation of the work and results of STREAMER precisely and effectively to as wide a stakeholder audience as possible.

More specifically, the sub-objectives and, at the same time the main dissemination activities performed, include the following:
• Elaborate the consortium’s strategy for dissemination activities and engaging stakeholders;
• Establish and maintain the project’s website; more information related to this aspect has been elaborated in D8.4 (M6);
• Establish an Implementers Community and engage the stakeholders throughout the course of the project in order to ensure that the results of the project are applicable and appropriate to stakeholders;
• Prepare and translate press releases and other materials for dissemination to the media and other stakeholders as many Member States as possible;
• Prepare scientific journal articles and conference presentations;
• Establish synergy relations with national and European initiatives and networks regarding the healthcare building sector (EuHPN; ECHAA; ECTP);
• Organize Design Workshops that would address the challenges and offer STREAMER solutions to healthcare centers managers and/or owners face during new construction or retrofitting projects;
• Prepare and organize training materials for hospitals and as input for university curriculum.
For this reason, the STREAMER partners have utilised during the project’s lifetime a project website, email lists, internal conferences, journal publications, policy papers, media communications and press releases, design workshops, external conference presentations, social networks, blogs and the telephone to contact individual stakeholders and involve them in the developments within STREAMER. These specific tools have been selected based on their appropriateness, their effectiveness and their reach. The dissemination plan and timelines have been closely aligned with the STREAMER deliverables and milestones.
The STREAMER dissemination strategy covered both internal and external communication and dissemination. For internal purposes, this dissemination strategy provided partners of STREAMER consortium with an effective and efficient blueprint to follow in disseminating the work and results of the project. Internal communication has been conducted via email, monthly teleconferences, periodic face-to-face meetings (around other workshops), shared documents (including administrative project documents, case study data and reports and publications) which were stored in the secured website SharePoint.
Effective dissemination usually results in the establishment of contacts and interconnection of networks – a legacy that often outlives the project. In this context, among the external objectives of the STREAMER’s dissemination strategy was the establishment of an Implementers Community that would act as an important vehicle to commit current and future stakeholders, connect researchers, practitioners and policy-makers, but which would also serve as prime and sound example of energy-efficient healthcare districts addressing both new developments and retrofitting projects in this sector. This established IC would facilitate the collaboration among different groups of stakeholders to enhance uptake of the project’s results and integration of different and diverse end-user knowledge.
The consortium, among which the 4 large hospitals involved in STREAMER (representing the initial IC members), have placed particular emphasis on facilitating this collaboration, establishing important links and closely integrating with other organisations carrying out similar or related research and analysis, or facing the same challenges. This integration and collaboration effort will not only strengthen the research and knowledge base for the research activities carried out in STREAMER, but also open up possibilities of enhancing future cooperation, as the STREAMER findings and solutions are based on realistic stakeholder contexts, interests and drivers. To this respect, the STREAMER dissemination strategy aimed from the beginning of the project to identify and establish contacts with other relevant projects, studies and initiatives, to increase awareness of the consortium’s work and research results, apprise them of STREAMER and enable the integration of the range of research activities about participatory design for healthcare building constructions in Europe and in the world at large.
Summary of dissemination activities
• 2013 / 2014: 2 conferences, 3 posters, 17 presentations, 1 press release/media briefing, 4 publications, 1 peer review publication, 4 articles, 1 workshop, 5 Other. In total 38.
• 2015 / 2016: 2 conferences, 0 posters, 16 presentations, 0 press release/media briefing, 5 publications, 9 peer review publications, 2 articles, 5 workshops, 7 Other. In total 46.
• 2017: 1 conference, 2 posters, 5 presentations, 1 press release/media briefing, 1 publication, 3 peer review publications, 0 articles, 3 workshops, 4 Other. In total 20.

Note that the absolute numbers for 2017 seem low, compared to the previous column. However, 2017 only contained 8 months, where 2015/2016 contained 24 months. This means that the intensity of dissemination activities in 2017 has been just as high (even higher) than the previous years.

3.3 Exploitation of results
As described in the DoW, immediate knowledge dissemination and valorisation towards the exploitation of the STREAMER’s results will take place in and through the Implementers Community. The flagship projects – the 4-large real project in the UK, the Netherlands, Italy and France- represent the important vehicle to commit current and future stakeholders.
Dissemination activities through the IC and using the flagship projects aim at harnessing enthusiats and enthusiasm, as well as connecting researchers, practitioners and policy-makers through formal and informal collaborative activities.
The IC in conjuction with the real demonstration projects has served- and will continue to do so beyond the projects duration- as prime and sound examples of energy-efficient healthcare districts, addressing both new construction and retrofitting. It will achieve widespread impact through joined-up thinking in policy making, strategic planning and participatory design practice.
The exploitation of results by the consortium is outlined in D8.3. A summary of the exploitation is presented below.
• The initial exploitation targets the directly addressable markets of the STREAMER partners (home countries).
• In most cases, the application area will be hospitals. The Implementers Communities in six countries (UK, IT, NL, FR, PL and SE) serve as the basis.
• Some partners indicated that other domains would be targeted as well.
• The positioning of STREAMER results has been analysed in clusters of results (tools) that can best be used jointly (see table below).

The results that are most relevant to be exploited jointly are clustered as follows:
• Decision support: KER #1: Design decision-support and lifecycle validation tool and KER #14 Energy intermediate tool and KER #16 TNO Energy Calculation Tool
• Energy calculation in early design: KER #8 Semantic labels design methodology and KER #14 Energy intermediate tool and KER #16 TNO Energy Calculation Tool
• Early design & variants: KER #4 Knowledge editor and KER #5 Early Design Configurator and KER #8 Semantic labels design methodology and KER #11 Database of Design Rules and KER #12 Rule-based checking toolkit
• PLM: KER #2 PLM solutions integrated with BIM & GIS
• Requirements: KER #10 Database of requirements for hospital rooms
• GIS energy mapping: KER #13 Energy mapping viewer
• Data validation: KER #15 BIMQ
In the PUDF (D10.11) some principles for future joint exploitation of these clusters of results are outlined.
The expected exploitation in quantitative terms (additional investments; expected extra turnover based on exploiting STREAMER results) amounts to a leverage factor of more than 2: the expected amount is more than 16M€, resulting from an EU grant of 8M€.

List of Websites:
The public STREAMER website was formally launched at the kick-off meeting in September 2013 together with the consortium internal website SharePoint. The address for the public website is: . Access to the restricted website can only be done by the consortium partners and EC officials through the public website by login in with personal credentials.
The content for both websites is continuously updated and extended during the project’s lifetime. The role and task distribution concerning the public website is described within the DoW. In short, the
content management is done by the project coordinator (TNO) with contribution from all consortium
partners. Partner MAE (WP8 leader) ensures the content is made available for the website by bundling this information (updates) and transfers that quarterly to TNO. TNO will subsequently provide the partner that hosts the website, DMO (T8.2 leader), with complete information. DMO is in charge of publishing the approved content on the website. Additional tasks of DMO is to give technical support and to make documents available for download both from the STREAMER public and secured SharePoint website (this is only possible by uploading materials on the DMO-server). DMO places the documents on the server and connects them with the link on the public website.
Regurlar updates of the public website have been scheduled and performed quarterly during the whole project duration.
Parts of the public website and the available publications/downloads will be used for local dissemination
(sometimes in English, sometimes in the national language) and will be among others made available via the company websites of the consortium partners.