Kaiser Ontario Medical Center - batteries and fuel cells in lower right corner -

HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Week of June 14, 2026 • Issue No. 14

LDES for Healthcare Summit — 29 Days Away

Monday, July 13 | Salt Lake City | University of Utah, S.J. Quinney College of Law

The U.S. LDES Consortium is sunsetting this year. Before it closes, we are hosting the first and only summit dedicated entirely to long-duration energy storage for healthcare. National Lab scientists from Sandia, Argonne, NREL, Idaho National Lab, and Oak Ridge. 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. Free for healthcare facility owners. CEUs provided.

This knowledge will not be assembled in one room again.

Register here: LDES for Healthcare Summit on Eventbrite

From the Field

Paper (Engineering) Lion — Week 3

This week was a combination of waiting . . . of pushback . . . and of steady progress in the fictional hospital we are designing.

During an all-hands meeting this week, we showed the team images of the Kaiser Ontario microgrid and explained how it works. The fact that this system is up and running — real solar, real batteries, real islanding — energized the room. Suddenly the ideas we are exploring did not feel theoretical. When people can see the thing working, it changes the conversation.

As noted in our first week, one issue we know we are going to have is the way that the local permitting authorities will enforce the new provisions of the 2026 National Electrical Codes. In some ways, there should be no trepidation. A couple of years ago, our Code Making Panel spent an extraordinary amount of time poring over these new ideas, trying to be very certain that they were clear, and that they accomplished what we intended.

Recall that in our old paradigm, there was an infinite, reliable, inexpensive electrical utility. That utility would almost always provide all of the power to the hospital. It would also get some of its energy in the form of natural gas, and, when the infinite electrical utility would fail, one or more diesel generators would fire up and assume the load.

What the NEC now permits is a collection of on-site energy generation and storage assets, and they can provide as much of the facility power as needed, anytime. We are working hard to make that idea manifest on this project. When we reached out to the town, their staff first wanted to make certain that we knew what questions we were going to ask. So, two weeks ago, at project kickoff, we reached out. This week, we heard back, and they are asking a revealing question. They asked us to “please clarify whether the design includes any required diesel generator connection or equivalent provision for the life safety and critical portions of the Essential Electrical System under the adopted 2026 NEC and applicable NFPA requirements.” This is a revealing comment, as it shows that the town is thinking in the old paradigm; there must be a diesel generator or equivalent provision. In fact, we propose to have fuel cells on both sides of the transfer switches, and not on just one. That is a hard concept to grasp.

There are so many questions we are going to need to tackle, to see whether this is going to work. One of the most important has to do with the requirements of the serving electrical utility. For this imaginary project, we know that both the utility and the municipal water utilities are saying that they are going to charge fees to extend their lines to this particular site. We also now know that the natural gas utility is not interested in funding a plant on the site. Interestingly, they can supply either bundled or unbundled natural gas and transmission service. We will need to be thinking about our preferred procurement strategy, and how that will impact the economics and reliability of the system. The electrical utility is unable to meet with us for another couple of weeks, so we are going to have to move forward with modeling of systems with nothing other than their published rates. I am eager to meet with them, and start to fill in the dots for what might be possible.

It is worth noting that I am an electrical engineer, and so the Paper Lion has focused on the electrical systems. But on the HVAC side, the team is also working through a range of system options, all aimed at making the hospital all-electric with a historically low energy use intensity. The thermal and electrical strategies interact with each other in important ways, and both must be resolved together.

A big question we are going to need to ask ourselves is how to size the various system elements. Here, we are going to be constrained by space, and by dollars, both capital and expense. We will also need to meet with the local air quality management district to identify any potential restrictions, but I expect no issues — fuel cells produce CO₂ but their criteria pollutant emissions are vastly lower than diesel or boilers.

And so, the issue is going to come down to dollars, in large measure. We had an initial meeting to explore financial feasibility, and we agreed that we are going to need to outline one or more system possibilities with a lower cost, and an operating expense, and then work to design a strategy that can make them real.

One issue, then, is to establish a baseline against which to measure. This is not as easy as it might appear. In our story, the pre construction contractor did a market survey of recently constructed hospitals, and has been carrying a budget based on that. However, they have also recently solicited informal estimates from trade partners – and they are all higher than the established budget. This is likely because the data center industry is attracting builders and talent, with higher fees and higher wages. This is going to make even achieving a baseline a challenge, and we are pondering whether we will create a baseline that meets the too low budget, or that meets the owners standards, or some other method. This is obviously a key question, as the baseline is going to have the defining impact on what our capital difference is going to be.

This fictional project will also help form the basis for an ACHA white paper I am co-authoring on how to design a decarbonized hospital.

We are now in the maelstrom!

— Walt Vernon

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IFHE Global Scan

U.S. Energy Markets

FERC end-of-June action: less than 3 weeks away. FERC committed to acting by end of June on large-load interconnection (RM26-4-000). DOE directed FERC to take jurisdiction over loads >20 MW — a historic shift from state/local authority. NARUC opposing. Holland & Knight: action “could have important implications for data center developers, large industrial customers, utilities and transmission providers.” FirstEnergy separately asked FERC to require data centers to pay for transmission costs using a gas-pipeline-style cost-allocation approach. For hospitals: the rules written this month define interconnection economics for a decade. Holland & Knight

EIA June STEO: Hormuz still closed, 11M b/d shut in. Strait not expected to reopen until Q3 2026; pre-conflict traffic not returning until early 2027. Brent forecast $105/bbl. Wholesale gasoline prices forecast up ~50% in 2026. U.S. power use headed to another record in 2026 AND 2027. Despite truce talks, the structural disruption persists. EIA STEO

Combustion risk shifting from fuel price to permitting. EPA finalized combustion-turbine NSPS amendments January 2026 with new NOx requirements. California tightening boiler/engine oversight. New York hospital air permits showing NOx RACT pressure. Methane leaks from boilers may be 100x greater than estimated (The Chemical Engineer). The strategic question is no longer “Can I buy fuel?” but “Can I permit, test, and run combustion equipment the way I used to?” The Chemical Engineer / EPA

ERCOT data centers still failing voltage tests. Reuters (June 5): four groups of large power users abruptly disconnected during voltage-disturbance testing. Each group could trigger 5,000+ MW of demand tripping. 26 such events documented since 2023. ERCOT approved tougher interconnection criteria. Sempra/Oncor: $7B+ Texas transmission for ~16 GW additional demand. GV Wire / Reuters

PJM expedited interconnection track approved by FERC. Effective July 31, up to 10 large projects/year, ~10 months to interconnection agreements. Faster path for shovel-ready generation. PJM 2027/2028 auction shortfall attributed to “unprecedented surge in data center load.” NYISO warns of narrow summer reliability margin. Utility Dive

Record 86 GW new U.S. utility-scale generation planned in 2026. Solar at 51%, battery storage at 28% of additions. 9.7 GWh new storage in Q1 2026 — quarterly record. Storage increasingly financeable for healthcare campuses facing outage risk, demand charges, or generator-runtime constraints. EIA / Reuters

NERC: evening-hour risk specifically flagged. Solar output declining while load stays high. Tilts resilience value toward batteries, dispatchable CHP, thermal storage, and demand response. “Improved but not carefree.” NERC

English-Speaking Americas

All-Electric Hospitals

Kaiser San Francisco: 300+ bed all-electric replacement hospital filed. 623,000–760,900 sf, 14-story, Anza Vista neighborhood. Construction 2028, completion ~2033. Perkins & Will design. Kaiser’s all-electric pipeline now includes Richmond (operational), Ontario (microgrid operational), San Jose, Sacramento, Sunnyside (Oregon), and San Francisco. This is a documented corporate capital delivery strategy, not a series of one-off projects. SF YIMBY

Codes & Standards

FGI 2026: guidelines becoming enforceable code. Expanded infection-control requirements add higher ventilation rates, negative pressure rooms, and flexible isolation capacity — driving HVAC demand upward. Regulatory convergence: CMS + NFPA + FGI + ESG integrating into unified facility governance. FGI

NFPA 72: cybersecurity requirements for fire alarm systems. Connects to NFPA 99 cyber chapter for 2027 and the Fox Tempest disruption from Issue 11. Fire systems are now part of the cyber-physical governance conversation. NFPA

Energy & Resilience

Texas healthcare pilot: carbon AND cost reductions verified (24x7, June 2026). Minus 2 Degrees tracked seven Texas emergency care facilities from baseline through 2024–2026. Average emissions fell ~130 tonnes CO₂e per facility, with some exceeding 60% reduction. 65,530 kWh saved, $8,553 in electricity costs, $12,000 in procurement, $4,000 in supply optimization. Nationwide scaling could save $187M annually and cut 793,000 tonnes CO₂e. 24x7 Magazine

Healthcare energy efficiency plateau. HCO News: hospitals have exhausted most operational improvements. Remaining savings require capital infrastructure: envelope, HVAC replacement, electrification + storage. Multi-decade capital planning, not incremental retrofits. HCO News

Capital Projects

JPS Health (Texas): $1.5B new hospital. Mega-project signal. Becker’s

Dana-Farber: 300-bed cancer hospital (Boston). Major academic medical center expansion. Dana-Farber

Henry Ford: $2.2B expansion (Detroit). System-level modernization. Henry Ford Health

Canada

Canadian circular economy pilot: 1,550+ tCO₂e avoided (GTHA). Reusable surgical gowns, hybrid instruments, Scope 3 accounting. Physical redesign of sterilization and storage infrastructure required. CCGHC

Spanish-Speaking Americas

Chile: code updates requiring prolonged renewable islanding. Health ministries mandating acute-care hospitals maintain critical operations via renewable microgrids without diesel refueling. Autonomous voltage/frequency formation required. Industry analysis

Chile: National Cancer Institute MEP/BIM in seismic zone. Complex oncological center integrating massive imaging equipment with building isolation systems for post-earthquake continuity. Industry analysis

Brazil Paraná: nine new hospitals announced. Decentralized buildout across multiple cities including Nova Esperança (38-bed, R$18.1M), plus facilities in Bituruna, Foz do Iguaçu, Cascavel, and others. Government of Paraná

Europe

UK: first fully electric healthcare ESTATE announced. Equans presentation at Decarbonising NHS Conference (June 9): Oriel eye hospital London (2027), West Middlesex all-electric diagnostic centre (2028), Pontefract hospital PFI full retrofit (2028). Combine electrification, thermal storage, solar, and BESS. Portfolio approach, not one-off projects. Equans

NHS England: 68% carbon reduction achieved. On track for 2032 internal target. However, NHS Wales emissions UP 20% since 2018/19. Divergence within the UK system shows uneven execution. Tomorrow.City

UK: £74M clean-energy upgrades for public buildings including hospitals. Solar, heat pumps, batteries, lighting. Plus Great British Energy putting rooftop solar on 200 hospitals. UK Government

Germany: 65% renewable-heating requirement binding June 30 — THIS MONTH. Cities over 100,000 population. Hospital central-plant replacement decisions face stronger pressure toward renewable or hybrid solutions. German Government

Catalonia: €2.4B twin hospital mega-campuses elevated to “general interest.” Hospital Clínic–University of Barcelona Health Campus (300,000 m², €1.7B) and Girona Health Campus (175,000 m², €740M). Government tied declaration to faster urban and energy processing. Two of Europe’s biggest healthcare infrastructure pipelines. Hospital Clínic Barcelona

Ireland HSE Pathfinder Decarbonisation Programme. Actual procurement activity for hospital decarbonization and geothermal exploration. Real procurement, not strategy documents. HSE

IHEEM: “Preparing NHS estates for low-carbon heat” (Health Estate Journal). Backlog maintenance and infrastructure readiness as gating factors for decarbonization delivery. Health Estate Journal

European Healthcare Design Congress: June 15–17 — THIS WEEK. “Agile not fragile.” Modular surge-ready infrastructure, AI and digital twins. EHD

Africa

Gavi $28M HFSE: completing THIS MONTH. 1,277 facilities across Zambia, Ethiopia, Pakistan, Uganda. Largest coordinated health facility solarization ever. Gavi

South Africa Western Cape: “once in a generation” tertiary rebuild. Tygerberg Hospital redevelopment + Metro East (Belhar) + Metro West (Klipfontein). 550-bed regional hospital at R4.6B. Western Cape Government

Madagascar: 500 rural health centers electrified (World Bank LEAD). Scaling as basic infrastructure, not pilot philanthropy. World Bank

Liberia: New Redemption Hospital solar unit. Solar alongside new hospital and imaging/education facilities. Replacing diesel dependence. World Bank / Direct Relief

CHAI/Sweden: electrifying health facilities in South Africa, Eswatini, Malawi, Kenya. Multi-country program. CHAI

Asia / Pacific

Singapore: Eastern General Hospital ~1,400 beds, opening from 2029. Bedok North campus. Plus Sengkang (+140 beds 2026), Changi (+160 beds 2027), SGH Elective Care Centre (+300 beds 2027). Massive APAC capacity signal. MOH Singapore

India: Azim Premji Foundation 1,000-bed hospital, Bengaluru. ₹1,000 crore, 10 acres near NIMHANS. Private-philanthropic tertiary care at scale. Business Standard

South Korea + Singapore: liquid cooling for medical AI. Hospitals retrofitting server rooms for extreme AI workloads. Sudden spikes in localized power density forcing electrical upgrades within existing footprints. Industry analysis

Australia: Metro North Health 100% ZEV passenger vehicles by 2026. Staged charging rollout. Gold Coast Health charging at Robina Hospital. Metro North Health

China: first commercial brain-computer interface device approved. For quadriplegia from cervical spinal cord injury. Neurotechnology milestone with future rehab-suite implications. Reuters

IFHE Global Connection

IFHE Building Award: submissions due July 1 — 17 DAYS. New healthcare facilities and major renovations. Presentations at October World Congress. IFHE

IFHE Carbon Challenge: submissions due July 31. Carbon performance benchmarking. IFHE

AEIH–SEDISA collaboration agreement (Spain, June 8). Hospital engineering society and health management society formalized cooperation. Cross-disciplinary governance model other IFHE countries could replicate. AEIH

AFIB 30th Journées: October 7–9, Rennes. “Reinventing the profession for a sustainable future.” BM d’Or awards. AFIB

Grundfos welcomed as IFHE affiliate partner. New corporate partnership. IFHE

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

IFHE Global Events Calendar

JUNE (THIS WEEK AND NEXT)

Jun 15–17: European Healthcare Design Congress, London. europeanhealthcaredesign.eu

Jun 16–17: ÖVKT Forum Krankenhaustechnik, Vienna

Jun 16–18: Africa Health ExCon. africahealthexcon.com

Jun 17: CHES Canadian Healthcare Construction Course. ches.org

Jun 19: NZIHE conference presentation submission deadline. nzihe.org.nz

Jun 23: FKT: Sector coupling — CHP + heat pumps + renewables. fkt.de

Jun 24: FDA READI-Home Innovation Challenge webinar

Jun 24–25: 2nd Healthcare Facility Design & Build Summit (Innovatrix). innovatrix.eu

Jun 25: WHO ATACH High-Level Strategic Meeting, Paris. who.int

Jun 30: Germany: 65% renewable-heating requirement takes effect (cities >100k)

Jun 30: U.S. 30C charging-infrastructure tax credit expires

JULY

Jul 1: IFHE Building Award submissions deadline. ifhe.info

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 on Eventbrite

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

Jul 15: IHEA: Built to Withstand — Multi-Hazard Resilience (Australia)

Jul 23: FKT: Waste management in healthcare (Germany). fkt.de

Jul 30: IHEA QLD: Intelligent Infrastructure in Healthcare Facilities, Brisbane. ihea.org.au

Jul 31: IFHE Carbon Challenge submissions deadline. ifhe.info

AUGUST–OCTOBER

Aug 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Aug 3–4: AHA Health Care Construction Workshop

Aug 3–14: IHEEM Healthcare Facility Planning Course (online)

Aug 19–21: ABDEH XI CBDEH 2026, Brazil. abdeh.org.br

Aug 20–21: IHEEM Health Facility Briefing

Sep 15: CHES IPAC Webinar: Flexible Endoscope Basics

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference — Resiliens i sundhedsvæsenet (Denmark)

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: hcdexpo.com

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

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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Where Healthcare Infrastructure Meets the Climate Imperative

Week of June 7, 2026 • Issue No. 13

LDES for Healthcare Summit

Monday, July 13 | Salt Lake City | University of Utah, S.J. Quinney College of Law

On July 13, the day before the U.S. Long Duration Energy Storage Consortium’s final annual meeting, we are hosting the first — and only — summit dedicated entirely to long-duration energy storage for healthcare.

The U.S. LDES Consortium is a three-year program that brought together scientists from across the National Laboratories to advance the science, policy, and markets for long-duration storage. The Consortium is sunsetting this year. The expertise assembled in this room will not be gathered again.

Here is what the day looks like.

In the morning, you will hear from the scientists who are inventing these technologies. Sandia National Laboratories’ Luke McLaughlin and Henk Laubscher will provide a comprehensive overview of LDES technologies relevant to healthcare. Will McNamara, Director of the U.S. LDES Consortium, will frame the grid forces that are reshaping healthcare’s energy exposure. And we will work through the codes, standards, and accreditation issues — including a presentation with James Grana of The Joint Commission — that determine whether and how hospitals can deploy these systems.

Before lunch, Chris Searles of CGS Associates and Curtis Ashton of American Power Systems will address battery safety in healthcare — the risks, the standards, and the practical implications. Then Rame Hemstreet, retired from Kaiser Permanente, will walk through the Kaiser microgrid installations that helped prove the concept.

Over a hosted networking lunch, Chad Beebe of ASHE will join a featured conversation on the evolving agenda for healthcare infrastructure.

In the afternoon, you will hear from the people who are financing, building, and operating these systems. Patrick Balducci of Argonne National Laboratory, Jeffrey Gifford of the National Laboratory of the Rockies, and Jon Utech of Mazzetti will present on economic models and financing. Then Ratan Milevoj of Valley Children’s Hospital, Eric Berzon, retired VP and Assistant Treasurer of Kaiser Permanente, and Paul Lacourciere of CE Law Group — the attorney structuring the Phase 2 transaction — will present the VCH case study, believed to be the largest hospital battery system in the world.

Rebecca Barney of NREL, Dustin Smith of Mazzetti, and Kevin Koubek of Yale New Haven Health will present on thermal energy storage applications, including the Wellstar Paulding geothermal heat pump system and the Northwell Mather TES project.

Sara Rossi of Direct Relief, Sandra Begay (retired, Sandia’s Indian Energy Program), and Michael Jensen, CEO of UNHS Montezuma Creek, will present on safety-net and tribal healthcare resilience. Jonathan Lewis of Klickitat Valley Health and Zhiwen Ma of the National Laboratory of the Rockies will cover hydrogen energy storage. And the day will close with commissioning, operations, and workforce development — with presenters from Idaho National Laboratory and Oak Ridge National Laboratory.

This is a one-time event. The Consortium is closing. This knowledge — from the scientists who developed it, the hospital owners who deployed it, the code officials who regulate it, and the financial experts who figured out how to pay for it — will not be assembled in one room again.

The Summit is free for healthcare facility owners and operators. A small registration fee applies to others to help cover costs. CEUs will be provided.

Register here: LDES for Healthcare Summit on Eventbrite

From the Field

Paper (Engineering) Lion — Week 2

For our fictional hospital this has been a busy week!

The engineering team has been working hard to develop an energy model for the first, smaller, incarnation of the demand side for the hospital. This will be critical to allow us to better model different combinations of on-site energy systems, for energy, carbon, space, and financial viability.

At the same time, there is always pressure to obtain site planning permits from the local city. And, there is always pressure to test the budget. Most owners create a budget based on the costs of recent, similar projects. Recent, similar projects do not usually include the future-focused strategies we want to explore. This creates obvious dilemmas. The estimators are going to want better information on the systems we might propose, and, since the starting point for the budget is these more traditional designs, we have to articulate what the traditional design might look like. This takes time away from the analysis we would rather be doing, but it’s critical for the project performance, and it provides us with a good baseline against which to measure our suggested enhancements when we are able to get that far.

One thing the fictional design will be doing is poring over whatever owner standards the hospital has. As noted last week, it is highly likely that the owner standards will require things like two electrical services. Two services will have big implications for the space and budget requirements, and the design team is going to want to help the owner to see advantages of modifying these standards to, for instance, eliminate this second service. But, it will help the later business case that the owner includes this second service in its baseline budget and space allocation. Eliminating this, as well as some or all of the diesel plant will help very much to pay for the alternatives we will want to consider.

The fictional team has also been in touch with the city, to talk with them about the new editions of the National Electrical Code, and how they will interpret them. This is a critical element of the project, as it will have major implications for the sizing of the electrical system.

Critically, NEC 2026 includes the following language for the utility:

“(B) Capacity of Systems. Systems shall have the capacity and rating to meet the maximum actual demand likely to be produced by the connected load on the system. Demand calculations for sizing of the systems shall be based on one or more of the following: (1) Prudent demand factors and historic data (2) Connected loads (3) Feeder calculations”

This language mimics the language that was already in the code for the on-site energy generation storage, and it allows an engineer to actually engineer. Traditional methods of sizing services always resulted in systems that were significantly oversized. This new provision is critically important for all-electric buildings. Think about it; if the traditional sizing methods result in systems that are systematically larger than the loads they will serve, and if we then add MORE loads to them because we are shifting them off of natural gas, that shift will result in even more oversized systems, chewing up capital and space. With this new language, engineers can design all-electric systems that may even be LESS capital and space than our traditional systems, because they are actually engineered. A critical development in the codes.

The team will have also reached out to the various energy companies who will be serving this site. The energy companies will have wanted authorization from the owner to talk to the engineers. In this case, let’s posit that the gas company has given their tariff information to the design team, as well as plans for future increases. The gas company will have been asked for plans for fuel mix, in the future, in response to decarbonization plans, as well as price increases and reliability data. In some jurisdictions, a utility provided natural gas service might be seen as a reliable source of fuel, meaning that it could take the place of on-site storage systems. In most jurisdictions, this will not be true, and on-site fuel storage will need to be considered, if the site moves away from diesel fuel and towards fuel cells.

Similar to the electrical plan reviewer, our fictional electrical utility company is moving slower than the project, and needs time to set up a meeting. This will be another critical piece of context for the overall project, and the team will need to be pushing this along as fast as possible.

In our fictional case, we will assume that the hospital has no energy procurement strategy, and has traditionally just purchased bundled service from the various utility providers. That creates tremendous opportunities to consider different ways to procure the energy, opening up a range of potential financing structures. We will want to bring in energy procurement expertise. In the old days, it used to be possible to design technology, energy procurement, project finance strategies in silos, because all of them were fixed. Today, there are choices in each of these areas of endeavor, and all of them are changing. To do the job right, they must be considered together, as a whole. Our fictional team will attempt to do just this.

Because Mazzetti is currently finishing up our ASHRAE/University of California Research project on the energy consumption of Large Medical Equipment, we will try to bring the fruits of that work to this project. Accordingly, we will be talking to the client’s medical equipment planners and GPO, to think through how this might be done. Similarly, we will want to begin initial conversations with the internal food service people on the topic of electric kitchens. Many healthcare organizations still prefer gas kitchens, despite the huge advantages of all-electric kitchens.

Other questions on our minds. The fuel cell company we have worked with for many years on many hospitals has become so busy they are no longer responding to phone calls. What to do? The temptation is to move to linear generators, but is this wise? Are they ready for prime time? So many questions.

Our Paper Engineering Lion is a mass of moving pieces, and our fictional hospital design team will need to work on all of them to help this owner create the Legacy Building they are after.

Now, back to work!

— Walt Vernon

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IFHE Global Scan

U.S. Energy Markets

Diesel dropped to $5.35/gal (June 1). Down from $5.60 in mid-May as Brent crude fell below $100/bbl on US-Iran truce hopes. But California remains at $7.40/gal. The Strait of Hormuz ceasefire has “largely held” since April 8, but a long-term peace agreement has not been achieved. South Africa is seeing diesel relief but governments restoring fuel taxes. India hiked diesel prices twice in one week. The structural risk has eased but not disappeared. EIA / Rigzone

FERC large-load interconnection: end of June deadline. The jurisdictional stakes are now fully visible. DOE has directed FERC to take jurisdiction over large-load interconnection (>20 MW) — a historic shift from state/local authority. NARUC is opposing. The American Bar Association published a detailed analysis of the “jurisdictional collision.” PJM is being used as a template. The rules being written this month will define hospital interconnection economics for the next decade. FERC / ABA / Snell & Wilmer

ERCOT: data centers failing voltage-disturbance tests (June 5). Reuters reports ERCOT identified reliability risks after large data-center and crypto projects failed voltage tests. Houston Chronicle reports ERCOT approved tougher interconnection criteria. This is the Texas version of the PJM story — data center load is now causing documented reliability failures in a second major grid region. Hospitals in Texas are downstream of these events. Reuters / GV Wire

Solar-plus-storage accelerating due to gas turbine delays (June 3). Reuters reports long waits for gas turbines are pushing developers toward solar+storage as faster and cheaper near-term solutions. For healthcare campuses, this strengthens the case for phased resilient-power strategies rather than waiting for a single-technology answer. Reuters / Utility Dive

Healthcare energy efficiency plateau emerging. HCO News reports hospitals have exhausted most operational efficiency improvements. Remaining savings require capital infrastructure: building envelope, HVAC replacement, electrification + storage. The shift from operational optimization to capital infrastructure transformation aligns with multi-decade planning, not incremental retrofits. HCO News

Healthcare utility costs still rising fastest of any sector. EnergyCAP’s 2026 survey: 88% of hospital respondents reported utility budget increases — higher than any other sector. 71% prioritized improving forecast accuracy. Residential electricity prices up 5% in 2026 (EIA), with East Coast regions seeing 5–7% annual growth. EnergyCAP / EIA

English-Speaking Americas

All-Electric Hospitals

Kaiser Permanente: new all-electric hospital filed for San Francisco. San Francisco Chronicle and SFGATE report Kaiser has filed plans for a 623,000–760,900 sf, 300+ bed all-electric replacement hospital in the Anza Vista neighborhood. Construction targeted 2028, completion ~2033. This extends Kaiser’s all-electric pipeline to at least five hospitals: Richmond (operational), Ontario (microgrid operational), San Jose, Sacramento, Sunnyside (Oregon), and now San Francisco. This is no longer a project-by-project story — it is a documented corporate capital delivery strategy. SF YIMBY / The Real Deal

BC Cancer Centre / New Surrey Hospital: fully electric MEP. Salas O’Brien providing MEP design for one of the first fully electric hospitals in British Columbia. Proves that fully electric systems can support heavy clinical loads including cancer treatment. Salas O’Brien

San Marcos Medical Center: 1.75 MW Bloom Energy fuel cell array. Full island-mode capability within a microgrid-ready central utility plant. Guarantees 100% independent operation during grid disruptions. Bloom Energy

Codes & Standards

FGI 2026: guidelines becoming enforceable code. The Facility Guidelines Institute’s 2026 edition converts from advisory guidelines to formal code language with enforceable requirements. Design flexibility is reduced; engineering decisions become codified expectations. Expanded infection-control requirements add higher ventilation rates, negative pressure rooms, and flexible isolation capacity — driving HVAC demand upward and counteracting efficiency gains. FGI / Copilot analysis

ASHRAE Guideline 43 + ASHRAE 1864/TRP. Guideline 43 fills the gap between ASHRAE 170 design standards and day-to-day operations. The 1864 research project is aligning Standards 170, 62.1, and 241 to reconcile IAQ, infection control, and energy efficiency. IAQ and energy are now fully coupled. ASHRAE / EHE Inc.

Loma Linda University Health: $7.5M hazardous waste penalty (June 4). Illegal disposal of hazardous waste and medical records. A compliance signal: waste infrastructure failures carry real financial consequences. San Bernardino Sun

Energy & Resilience

Canadian Coalition for Green Health Care: circular economy pilot completed. 1,550+ tCO₂e avoided in the Greater Toronto and Hamilton Area through reusable surgical gowns, hybrid instruments, and Scope 3 accounting. Supply chain decarbonization now requires physical redesign of sterilization, sorting, and storage infrastructure. CCGHC

NACHC/DOE: up to $57M for FQHC solar microgrids (Southeast). Up to 70% of system cost covered, combinable with IRA direct pay. Scaling the community health center microgrid model. NACHC / DOE OCED

Spanish-Speaking Americas

Chile: code updates requiring prolonged renewable islanding. Regional health ministries updating facility codes to require acute-care hospitals to maintain critical operations via renewable microgrids for extended periods without diesel refueling. Engineers must deploy BESS and microgrid controllers capable of autonomous voltage and frequency formation (island mode). Industry analysis

Brazil/Peru: Amazonian clinics pairing solar with LEO satellites. Standardized deployment of solar-plus-storage microgrids paired with Low Earth Orbit satellite terminals for isolated telehealth outposts. Continuous power + high-bandwidth real-time remote diagnostics. Industry analysis

Europe

Royal Shrewsbury Hospital: £16.2M energy investment (BBC). Solar panels, heat pumps, £1M/year savings, 3,000 tonnes CO₂ annually. Another NHS trust executing at scale through the Public Sector Decarbonisation Scheme. BBC / SaTH NHS Trust

Nottingham £34.8M still generating coverage (4th week). LABM Weekly (June 1) and others continue covering the UK’s last coal-heated hospital story. Media attention confirms this as one of the most significant NHS infrastructure stories of the year. LABM Weekly

Copenhagen: Mary Elizabeth’s Hospital opening June 2026. Pediatric facility referenced by Siemens Healthineers for low-dose imaging workflows and integrated children’s hospital design. Siemens Healthineers

European Healthcare Design Congress: June 15–17, London. QEII Centre. “Agile not fragile.” Modular surge-ready infrastructure, AI and digital twins for climate adaptation. EHD

Decarbonising the NHS 2026 Conference: June 9, London. 250+ heads of sustainability, facilities, and estates from NHS trusts and ICBs. Second annual event. HIL

Africa

Gavi $28M HFSE program: completing THIS MONTH. 1,277 health facilities across Zambia, Ethiopia, Pakistan, and Uganda. 25 million people in catchment areas. If confirmed, the largest coordinated health facility solarization program ever completed. The financing model addresses the primary reason previous solar efforts failed: insufficient maintenance funding. Gavi / UNICEF

Morocco: blended ESG finance for smart hospital deployment. Sovereign wealth + DFIs + private equity co-financing ahead of GITEX FUTURE HEALTH AFRICA 2026. National-scale smart hospital construction, not isolated pilots. Industry analysis

Pan-African water safety: Legionella risk in solar thermal systems. Updated guidance on maintaining safe domestic hot water temperatures in solar-thermal systems to prevent Legionella amplification. Engineers must implement automated thermal flushing and secondary disinfection. Connects to ASHRAE 189.3 water resilience work. Infection control networks

Africa Health ExCon: June 16–18. Innovation and health-system scaling. Convening signal for the region. Africa Health ExCon

Asia / Pacific

South Korea + Singapore: liquid cooling retrofits for medical AI compute. Hospitals retrofitting server rooms with high-density containment and liquid cooling for extreme AI workloads. Sudden spikes in localized power density forcing electrical distribution upgrades within existing footprints. A new infrastructure challenge that didn’t exist two years ago. Industry analysis

India: 100 MW solar across 25,000 health facilities. IKEA Foundation and Selco Foundation financing installation across 12 states. India is the world’s 7th largest healthcare carbon emitter. Blended finance proving low-carbon healthcare is both a climate strategy and a public health intervention. Selco Foundation

WHO ATACH High-Level Strategic Meeting: June 25, Paris. Climate-resilient healthcare facilities on national health-system agendas. Keeps resilience tied to delivery-system planning rather than optional sustainability. WHO

IFHE Global Connection

IFHE June 10 webinar: Healthcare Decarbonization & Design — happening this week. Troy Savage, Mazzetti. Covers IFHE Global Carbon Challenge + 2026 International Building Award entry guidance. Two sessions for global time zones. Register

IFHE Building Award 2026: submissions due July 1 — 24 days. Recognizing new healthcare facilities and major renovations. Sustainability, innovation, functionality, accessibility, patient-centered design. IFHE

IFHE Carbon Challenge: submissions due July 31. Carbon performance benchmarking. IFHE

Grundfos welcomed as IFHE affiliate partner. New corporate partnership supporting federation activities. IFHE

N₂O piping decommissioning trend continues. Healthcare systems globally documenting emissions reductions and safety improvements from decommissioning leaking centralized nitrous oxide systems. WFSA, UHS, ATACH, and IHEA all active. WFSA / IHEA

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

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IFHE Global Events Calendar

JUNE (THIS WEEK AND NEXT)

Jun 9: Decarbonising the NHS 2026 Conference, London. healthindustryleaders.com

Jun 9–10: SAFHE 2026, Cape Town. safhe.co.za

Jun 10: IFHE Webinar: Healthcare Decarbonization & Design (Troy Savage, Mazzetti). Register

Jun 10: CEC 2028 Energy Code policy discussions

Jun 15–17: European Healthcare Design Congress, London. europeanhealthcaredesign.eu

Jun 16–17: ÖVKT Forum Krankenhaustechnik, Vienna

Jun 16–18: Africa Health ExCon

Jun 17: CHES Canadian Healthcare Construction Course

Jun 19: NZIHE conference presentation submission deadline

Jun 23: FKT: Sector coupling — CHP + heat pumps + renewables. fkt.de

Jun 24: FDA READI-Home Innovation Challenge webinar

Jun 24–25: 2nd Healthcare Facility Design & Build Summit (Innovatrix). innovatrix.eu

Jun 25: WHO ATACH High-Level Strategic Meeting, Paris

JULY

Jul 1: IFHE Building Award submissions deadline

Jul 7: IHEEM Authorising Engineers Conference

Jul 9: IHEA: Sunshine Hospital predictive maintenance (Australia)

Jul 13: LDES for Healthcare Summit, Salt Lake City — FREE for hospital owners. Register on Eventbrite

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

Jul 15: IHEA: Built to Withstand — Multi-Hazard Resilience (Australia)

Jul 23: FKT: Waste management in healthcare (Germany)

Jul 30: IHEA: Intelligent Infrastructure in Healthcare Facilities (Australia)

Jul 31: IFHE Carbon Challenge submissions deadline

AUGUST–OCTOBER

Aug 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Aug 3–4: AHA Health Care Construction Workshop

Aug 19–21: ABDEH XI CBDEH 2026, Brazil. abdeh.org.br

Sep 15: CHES IPAC Webinar: Flexible Endoscope Basics

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference — Resiliens i sundhedsvæsenet (Denmark)

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

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

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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Week of June 1, 2026 • Issue No. 12

From the Field

Participative Engineering

For reasons I don’t really understand, one of my enduring memories is a little detail – the cover of a paperback book that was on my parents’ bookshelf. It had a white cover and it had a photo of the actor Alan Alda, kneeling in a Detroit Lions uniform. The book was called Paper Lion, and apparently, it had been made into a movie that starred Mr. Alda. I think it struck me because, as a young person, I was a fan of the TV Series Mash, in which Alan Alda was the primary character.

Recently, I came across the work of the author, George Plimpton. He practiced what was called participative journalism. The idea was that, rather than standing outside something, and trying to describe it, the journalist would instead find a way to participate in the event, in order to more deeply understand what was going on. Last week, I read Plimpton’s first book, Out of My League. In this book, Plimpton found himself on the pitcher’s mound in Yankee Stadium, pitching to the all-star team from each league.

As I have been thinking about the new possibilities that are emerging – new technologies, new financing strategies, new pressures, new energy procurement strategies, new regulatory pressures and opportunities – it occurs to me that one way to write about it would be a kind of participative journalism. That is, if a project were starting now, how would an engineer, a project team, approach it? This note will attempt to describe such an effort. It should not be seen as representing any project, necessarily, but the ways a project could be approached.

So, imagine a hospital being built somewhere in the Western US. It is a small hospital of an Academic Medical Center. It is going to be built at 120 beds, but with plans to expand, at some point in the future. The hospital CEO wants the project to be a Legacy. Let’s say, the project kicked off last week.

As a member of the engineering team, here are the things I am thinking about:

The owner almost certainly has design standards. My guess is that the standards reflect older ways of designing buildings. I am certain that the project will have first cost capital constraints, and so, one of the first things I want to do is to pore through the standards, and identify opportunities for savings through following newer, proven strategies. A great example of this would be to consider only a single electrical utility service instead of two, as I wrote about in a previous HIP.

One of the first things we need to do is to meet with the local utility company (or companies). We need to understand the ways that energy (electricity and natural gas) can be procured in the state. We need to understand the details of the utility pricing, available incentives, and likely evolution of the grid and its costs. I want to consider something like the utility provided plant as done by Dell Children’s Hospital. In our pretend case, there could even be multiple utility companies that could provide the same energy commodity to the site, and it is going to be imperative to meet with them as quickly as possible. In my experience, utility companies are notoriously slow, and this could take some time. I like to tell the story about the first time I did this kind of exercise, then as an apprentice, effectively, to an older engineer. When we were in the office the big sign up on the wall, printed on that long green and white folding computer paper with a daisy wheel printer – “This isn’t Burger King; We don’t do it your way.” I have now reached out to all of the companies, and we will have to see how fast they can react.

I am going to want to explore new systems allowed by the newest National Electrical Code. Let’s assume that this particular jurisdiction follows the current, 2023, NEC, but that they update their enforcement codes more or less as they are adopted. In that case, it is likely that we can fall under the 2026 edition, and the 2026 edition provides significant improvements to the microgrid possibilities for hospitals. Note that CMS currently operates under a Categorical Waiver that recognizes the 2023 edition, so, if I want to use the 2026, I may have to find a way to work with CMS again. In any event, it is highly likely the local plan reviewers will be unfamiliar with the new code provisions. So, the third big thing we must do is to meet with the local plan checkers to talk about how they will review the project, and how we can work together with them to implement these new ideas (I helped to write them, and my name appears in the book, so I am hoping this will have an impact).

Energy costs are rising with double digits. This particular community is highly attentive to environmental issues. They are in an area with close proximity to fossil fuel extraction sites, and they have installed ambient air quality monitoring devices out of concern. An all-electric, or almost all-electric hospital with energy (thermal and electrical) storage is something we must explore. Because the hospital wants to plan to expand, it is highly likely that the rules and codes that will be in place when they do will be much more strict in terms of emissions than what holds today. So, to enable them to be able to expand, we must do much more than simply leave room for another boiler; we need to produce a system that will be easy to expand in the face of changing energy markets and changing regulations. That implies an all-electric hospital with the lowest emission on-site energy plant (generation and storage) we can develop. A first task is to envision the list of potential systems that we might develop. This is complicated, as the interaction between thermal energy systems and electrical systems impact each other, and each could include a range of options. But, we need to develop the scenarios that we will model, and align around them so as to maximize benefit without expending inordinate time.

We will need to think about what the building is likely going to consume. This will be a key element against which to test our various technical options for feasibility. We should do these models at both the smaller, current size, as well as at the larger expanded size, so that our designs can anticipate needed growth at this phase.

Every project, by the time it gets to the engineers, has an assumption about cost. Probably, the cost is based on similar hospitals constructed recently in the area. Because all of these used conventional systems, they are apples and oranges to what we will try to do, and yet, that budget informs the business case for building the hospital, and it represents a serious constraint in our design. So, we need to explore the owner’s appetite for creative financing structures. As I have written in the past, I recently worked with a number of co-authors on a draft paper cataloguing the ingenious ways that this can be done. This work was inspired by my long partnership with Kaiser Permanente, and, in particular, with my friend Eric Berzon, who was the VP and Assistant Treasurer there. Eric is a financial genius, and I have learned so much from him. I will bring him into the conversation with the owner, and test their openness to various strategies we might pursue. This conversation will help to define the field of play.

The Western US is now in the worst drought in 1,200 years. (We don’t know, because the tree rings only go back that far, but it might be the worst ever). The region is water stressed in a serious way. Years ago, in my work on ASHRAE 189.3, we considered the risks of using various kinds of greywater in health facilities. ASHRAE sponsored a study of this topic, which Mazzetti helped to lead. We will try to tap into that work to see if there are ways we can use various sources of greywater in some instances to help reduce our pressure on this vital resource. I would point, here, to the work being done by our India office. In India, there are no municipal sewage systems, and hospitals must generally treat all water that enters the hospital, and all water that leaves it. It can be done.

There is a lot to do. As our participative story evolves, we will talk about all of these and more efforts, and thinking. I hope participative engineering can inspire, and provide a roadmap to others, because all of us can, and should, be doing this.

We are engineers; with all of the changes around us, now we really have the chance to do engineering.

— Walt Vernon

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IFHE Global Scan

U.S. Energy Markets

EU EPBD transposition deadline: May 29 — this week. The revised Energy Performance of Buildings Directive must be transposed into national law across all EU member states by May 29. This establishes zero-emission building standards, legally binding timelines to phase out fossil-fuel boilers, mandatory Building Automation and Control Systems (BACS) for non-residential buildings, and whole-life carbon assessments for new hospital construction. Fossil fuel heating subsidies already ended January 1, 2025. New public buildings must meet zero-emission standards by January 1, 2028; all new buildings by January 1, 2030. National building renovation plans are due December 31, 2026. For European hospitals, this is not aspirational — it is a regulatory cliff with massive capital planning implications. The 16% worst-performing non-residential buildings must be renovated by 2030, and 26% by 2033. European Commission

FERC large-load interconnection action imminent (June deadline). FERC committed to acting by June on the large-load ANOPR (RM26-4-000) after reviewing 3,500+ pages of public comments. The December 2025 PJM co-location order already established that data centers must pay their fair share and cannot avoid transmission costs through behind-the-meter netting. The June action may establish nationwide rules for large-load interconnection — directly affecting hospital microgrids, campus expansion, and energy procurement strategy. CAISO has separately recommended $6.7 billion in transmission projects across 38 proposals, signaling that California hospitals must treat interconnection and transmission planning as major capital-risk factors. FERC

Diesel: $5.596/gal nationally, $7.22/gal in California. Down from the $5.80 April peak but still $2.06 above year-ago levels. Asian refinery cuts tied to the Iran conflict continue threatening 1–2 million b/d of middle-distillate supply. Diesel affects emergency generator budgets, construction costs, waste hauling, ambulance fleets, and long-duration outage planning. California’s $7.22 price is compounded by the nation’s strictest air-quality permitting, generator runtime constraints, and emissions compliance requirements. EIA / Rigzone

Healthcare utility costs rising fastest of any sector (EnergyCAP 2026). In EnergyCAP’s 2026 State of Utilities survey, 88% of hospital and clinic respondents reported utility budget increases — higher than any other sector. 71% prioritized improving budget and forecast accuracy. Energy is becoming financially visible enough to demand executive-level forecasting, not just facilities management. This is the data that belongs in every CFO presentation. EnergyCAP

English-Speaking Americas

All-Electric Hospitals: The Wave Is Here

UCI Health Irvine: 144-bed all-electric acute-care hospital (opened December 2025). Seven-story facility with a 24-hour emergency department. UCI describes it as “the nation’s first all-electric acute-care hospital.” This affects future planning for hospital kitchens, heating, domestic hot water, medical equipment, emergency power, and utility-capacity design. Note: Peace Island Medical Center in Friday Harbor, Washington was the first U.S. all-electric acute-care hospital (a critical-access facility using geothermal). UCI is the first at large acute-care scale. UCI Health

Kaiser Permanente: three all-electric hospitals. Kaiser San Jose and downtown Sacramento eliminate natural gas for heating and cooling, reducing air pollution by approximately 8 million pounds per year. Kaiser Sunnyside (Oregon) broke ground on a 7-story, 615,000 sf all-electric replacement tower. All-electric is no longer a pilot; Kaiser is turning it into a repeatable capital delivery model. The pattern is spreading beyond California. Kaiser Permanente

BC Cancer Centre / New Surrey Hospital: fully electric MEP design. Salas O’Brien is providing the MEP design for one of the first fully electric hospitals in British Columbia. The project demonstrates that fully electric systems can support heavy clinical loads including cancer treatment while maintaining strict safety and reliability standards. Salas O’Brien

Energy & Resilience

NACHC/DOE: up to $57M for solar microgrids at rural FQHCs. The National Association of Community Health Centers and DOE’s Office of Clean Energy Demonstrations are funding solar microgrids at health centers in HHS Region IV (Southeast). Expected to cover up to 70% of solar/battery system cost and potentially combinable with IRA direct pay. This could scale the FQHC microgrid model and is directly relevant to “energy as medicine.” NACHC / DOE OCED

DOE San Carlos Apache Hospital Community Microgrid. DOE issued a categorical exclusion for a 1 MW battery + 750 kW solar microgrid at the San Carlos Apache Healthcare Corporation campus in Arizona. Tribal healthcare resilience is moving from concept to project development. PV arrays placed on logistics buildings to guarantee operational continuity in a remote, grid-vulnerable area. DOE

NYSERDA: $20M+ for hospital energy efficiency (New York). Funding for projects reducing hospital energy use and greenhouse gas emissions. Hospitals with constrained internal capital can use state programs to de-risk deep energy retrofits. NYSERDA

VA: $596M in Q2 FY2026 infrastructure improvements. Part of a $4.8 billion FY2026 non-recurring maintenance budget. Scopes include electrical systems, boiler plants, facility modernization for EHR integration, elevators, and major building upgrades. This is a system-scale signal that U.S. healthcare infrastructure capital is flowing into replacement of legacy plant and enabling systems, not just expansion. VA

VCH $28M CEC LDES grant: deployment advancing. Valley Children’s Hospital’s non-lithium LDES system — believed to be the largest hospital battery system in the world — continues advancing toward expected commissioning by 2029. Combined with Kaiser Richmond, Kaiser Ontario, and the LDES for Healthcare Summit on July 13, the LDES healthcare pathway is becoming concrete. CEC

Codes & Standards

2030 IECC moves decarbonization to optional appendix. The ICC Board confirmed that key decarbonization and energy efficiency measures become optional in the 2030 IECC, with strict cost-effectiveness criteria. This fractures the regulatory landscape: some jurisdictions will adopt the weaker baseline while others push harder. Meanwhile ASHRAE is going the opposite direction with 90.1 Addendum bh. The codes are splitting. New Buildings Institute

Joint Commission restructures physical environment standards. Eliminated the old “Environment of Care” and “Life Safety” chapters, replaced with 8 new “Physical Environment” (PE) standards aligning with CMS Conditions of Participation. Massive compliance shift for facility managers. TAHFM / George Mills

NFPA 800 battery safety code + ASHE Battery Safety Task Group. NFPA 800 covers full lifecycle — manufacturing through end-of-life. Maximum allowable quantities, thermal runaway thresholds, alignment with NFPA 70/72/855. ASHE’s Battery Safety Task Group (HFM, May 17) is collecting incident data and building risk-based guidance for hospital operations. Battery deployment is crossing from innovation into governance. NFPA / HFM

FGI Bulletin #30: 2026 release update. Release timing for 2026 FGI Codes/Handbooks affects whether AHJs reference 2022 or 2026 editions. Projects straddling adoption transitions face rework risk. FGI

ASHRAE Guideline 43: operational ventilation management. Fills the gap between ASHRAE 170 design standards and day-to-day hospital operations. Requires written ventilation management plans, documented excursion management, and operational testing. Ventilation compliance is moving from design intent into documented operational management. EHE Inc.

ACHA carbon-neutral healthcare design white paper kicking off. Task force led by David Allison announced May 29. New external channel for codifying infrastructure-side carbon-neutral design guidance. ACHA

Canada

CHES British Columbia Conference: May 31–June 2. Starting this weekend. CHES

Spanish-Speaking Americas

Latin America: hybrid DC microgrids growing. Chronic grid instability and rising energy costs are driving rapid adoption of hybrid DC microgrids across public and private hospitals. Engineering codes increasingly demanding resilient islanding capabilities. DC microgrids are favored over AC for higher efficiency when paired directly with onsite solar and batteries. Industry analysis

Nantes University Hospital: zero-carbon construction logistics. Europe’s largest hospital project (230,000 m²) is using electric delivery vehicles, biogas trucks, and 100% reusable bins and cable reels to slash Scope 3 embodied carbon during construction. This is the first time we’ve seen construction-phase emissions addressed at this scale in healthcare. Connects to the Chile green hydrogen construction pilot from Issue 9. Sacyr / Nantes

Europe

EU EPBD deadline: May 29. See U.S. Energy Markets section above for full detail. The regulatory cliff arrives this week. European Commission

Nottingham City Hospital £34.8M (still reverberating). Three weeks after publication, the story of the UK’s last coal-heated hospital continues generating coverage across Sustainable Times, Building Better Healthcare, New Civil Engineer, BusinessGreen, Energy Live News, Health Estate Journal, and IOM3. The level of media attention confirms this as one of the most important NHS infrastructure stories of the year. 16,023 tonnes CO₂ eliminated annually, £1.4M in verified savings. Multiple sources

UK NHS: £37B “industrialised” hospital building framework. 10 firms named for offsite-led construction of 10 new facilities. Standardized delivery, modular clusters, centrally managed procurement. Hospital delivery is being re-engineered as an industrial product. Supported by a multi-year capital settlement through 2029/30 covering estate safety, RAAC remediation, diagnostics, mental health, and digital transformation. Construction News / RLB

Skanska: €50M Turku University Hospital Phase 2 (Finland). 24,000 m² of new psychiatric care space. Complex structural modification within an operating campus. Highlights the European focus on integrating expansion into existing hospitals without disrupting clinical care. Skanska

Africa

Gavi $28M Health Facility Solar Electrification: completing June 2026. 1,277 health facilities across Zambia, Ethiopia, Pakistan, and Uganda. 25 million people in catchment areas. Zambia inaugurated its first solar clinic in August 2025; the program is on track for June completion. The financing model specifically addresses the primary reason previous solar efforts failed: insufficient funding for system maintenance. CHAI providing technical assistance for blended public/private financing. If confirmed, this would be the largest coordinated health facility solarization program ever completed. Gavi

Kenya: 10 new Level 4 Mother & Child hospitals. Sh4.5 billion Build-Equip-Transfer programme over three fiscal years. Designed to improve maternal and newborn services for over 1 million underserved women and children. This pairs network expansion with a delivery and financing structure — not a one-off announcement. ABDAS

Service-based “lease-to-own” solar financing scaling. Following successful pilots like Top Care in Kenya, service-based models are bypassing massive upfront capital costs for rural solar installations. Clinic operators manage long-term service contracts with developers rather than owning infrastructure, allowing 24/7 energy-intensive operations without absorbing O&M risk. WRI / Selco

Asia / Pacific

India: 100 MW solar across 25,000 health facilities. The IKEA Foundation and Selco Foundation are financing installation of 100 MW of solar PV and energy-efficient equipment across 25,000 health facilities in 12 Indian states. India is the world’s 7th largest healthcare carbon emitter. This aggressive rollout proves that low-carbon healthcare is both a climate strategy and a direct public health intervention to secure reliable power during frequent grid outages. Selco Foundation / IKEA Foundation

Saudi Arabia: Seha Virtual Hospital connects 170 hospitals via AI. Driven by Vision 2030, Saudi Arabia’s Seha Virtual Hospital uses AI-driven patient screening across 170+ hospitals. The UAE’s 1GW AI cluster supports home-centric predictive care. Middle Eastern healthcare capital is shifting from beds to digital infrastructure, cybersecurity, and remote monitoring. The MEA region averages $7.29M per data breach. Saudi MOH / Vision 2030

Hong Kong: 1,500-bed hospital expansion with drones + BIM. Leighton Asia is using drone capture plus BIM integration on a public hospital expansion including a new 20-storey block. Digital site intelligence de-risking hospital expansion in live clinical environments. Leighton Asia

Goodwood Eldercare: South Australia’s first 6-Star Green Star aged care. $40M, 100-resident facility. 100 kW solar, all-electric building, stormwater reuse, 150,000L rainwater storage, LED controls, double glazing. Senior care as proving ground for all-electric, climate-resilient, health-supportive buildings. Green Star

IFHE Global Connection

IFHE June 10 webinar: Healthcare Decarbonization & Design. Troy Savage, Mazzetti. Covers IFHE Global Carbon Challenge + 2026 International Building Award entry guidance. Two sessions for global time zones. Register

IFHE Building Award 2026: submissions due July 1. Recognizing new healthcare facilities and major renovations. Sustainability, innovation, functionality, accessibility, patient-centered design. IFHE

IFHE Carbon Challenge: submissions due July 31. Carbon performance benchmarking. IFHE

LDES for Healthcare Summit: July 13, Salt Lake City. FREE for hospital owners. National Lab scientists, hospital owners who have deployed LDES, ASHE, and Joint Commission presenters. CEUs provided. One-time event. Register on Eventbrite

International N₂O piping decommissioning trend continues. Healthcare systems globally documenting emissions reductions, operational savings, and safety improvements from decommissioning leaking centralized nitrous oxide systems. WFSA statement, UHS Carbon Reduction Project, ATACH resources, IHEA sessions. Practical operational decarbonization through medical gas infrastructure. WFSA / IHEA

HCD Magazine confirms IFHE/HCD co-location (May 22). IFHE positioned inside the HCD platform for October World Congress — shared expo, keynotes, networking. HCD Magazine

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

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IFHE Global Events Calendar

JUNE

Jun 4–5: ZORG.tech Congress 2026, Belgium. zorgtech.be

Jun 9–10: SAFHE 2026, Cape Town. safhe.co.za

Jun 10: IFHE Webinar: Healthcare Decarbonization & Design (Troy Savage, Mazzetti). Register

Jun 10: IHEA: Operational Technology in Practice (Australia)

Jun 15–17: European Healthcare Design Congress, London. europeanhealthcaredesign.eu

Jun 16–17: ÖVKT Forum Krankenhaustechnik, Vienna

Jun 17: CHES Canadian Healthcare Construction Course

Jun 19: NZIHE conference presentation submission deadline

Jun 23: FKT: Sector coupling — CHP + heat pumps + renewables. fkt.de

Jun 24–25: 2nd Healthcare Facility Design & Build Summit (Innovatrix). innovatrix.eu

JULY

Jul 1: IFHE Building Award submissions deadline

Jul 7: IHEEM Authorising Engineers Conference

Jul 9: IHEA: Sunshine Hospital predictive maintenance (Australia)

Jul 13: LDES for Healthcare Summit, Salt Lake City — FREE for hospital owners. Register on Eventbrite

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Jul 15: IHEA: Built to Withstand — Multi-Hazard Resilience (Australia)

Jul 23: FKT: Waste management in healthcare (Germany)

Jul 30: IHEA: Intelligent Infrastructure in Healthcare Facilities (Australia)

Jul 31: IFHE Carbon Challenge submissions deadline

AUGUST–SEPTEMBER

Aug 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Aug 19–21: ABDEH XI CBDEH 2026, Brazil. abdeh.org.br

Sep 15: CHES IPAC Webinar: Flexible Endoscope Basics

Sep 20–22: CHES National Conference, St. John’s, NL. ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference — Resiliens i sundhedsvæsenet (Denmark)

OCTOBER–NOVEMBER

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

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

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

Subscribe to the IFHE Newsletter

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From the Field

LDES for Healthcare Summit — July 13, Salt Lake City

The Kaiser Richmond microgrid project used a grant from the California Energy Commission to show the value of a PV and battery system as a backup power source for healthcare. In this case, the system serves only the life safety branch of the Essential Electrical System. Since the installation of the system, the hospital has demonstrated the ability to reduce facility utility costs by approximately 15%, and demonstrated capability to support critical loads without reliance on diesel under certain conditions. This project was not supported by the NEC at the time, and its success helped to pave the way for newer versions of the code that began to recognize the potential of these kinds of solutions. Several projects since then, including Kaiser Ontario and Valley Children’s Hospital, have extended the concept significantly. Each of them is showing the value of Battery Energy Storage Systems (BESS), and even Long Duration Energy Storage (LDES, generally more than 8 hours) for healthcare facilities.

While we were working on these projects, I came across the US Long Duration Energy Storage Consortium. The Consortium is a 3-year program. It brings together scientists from across the US National Laboratories, all focused on helping to advance the science, policy, and markets for LDES systems. I was able to engage a couple of years ago, and this year, the Consortium appointed me to their Leadership Team.

Much more exciting, though, is the upcoming LDES for Healthcare Summit we are arranging. This summer, the Consortium will be having its final Annual meeting, July 14–15 in Salt Lake City. But, the day before, Monday July 13, Mazzetti and the Consortium, supported by the Utah Society of Healthcare Engineering (USHE) will be hosting a LDES for Healthcare Summit. The Summit will bring together the country’s leading LDES scientists from the Consortium. It will include hospital owners and designers who have actually deployed such systems. Chad Beebe, of ASHE, as well as representatives of The Joint Commission will be presenters.

At a time when PJM capacity prices have increased more than 1,000% in two years and diesel is over $5.60 per gallon nationally — and over $7 in California — storage is no longer optional. It is infrastructure.

The event, which will provide CEUs, will be free to health facility owners, and charge a low fee to others, to help cover costs. Mazzetti will underwrite the balance of the event costs. We are looking for one or more sponsors to help defray travel costs for some of our owner speakers. You can learn more and register here: LDES for Healthcare Summit on Eventbrite

This will be a one-time event. I hope to see you there.

— Walt Vernon

IFHE Global Scan

U.S. Energy Markets

Diesel: $5.596/gal nationally, $7.222/gal in California (May 18). EIA weekly data shows diesel declining from the April peak ($5.80) but still $2.06/gal higher than a year ago. California’s $7.22/gal is especially significant because California hospitals also face the strictest air-quality permitting, generator runtime constraints, and emissions compliance requirements in the country. Globally, Reuters reports Asian refinery cuts tied to the Iran conflict are threatening 1–2 million barrels per day of diesel and jet fuel supply. India hiked diesel prices 90 paise/liter on May 19 — the second increase in a week. Diesel is not just a fleet cost — it affects emergency generator budgets, construction escalation, waste hauling, mobile clinical operations, and long-duration outage planning. EIA / Rigzone

PJM Hot Weather Alert + Emergency Energy Alert Level 1 (May 18). PJM issued its first Hot Weather Alert and EEA1 of the season on May 18. This is no longer a forecast — it is a real-time reliability event affecting 65 million people across 13 states. These alerts correlate with scarcity pricing, demand response calls, and heightened outage risk. For hospitals in PJM territory, this is the leading indicator of “why resilience pays”: demand charges, capacity costs, and outage risk all tighten simultaneously. The PJM capacity auction record of $329.17/MW-day makes every peak event a direct budget hit. PJM Markets & Operations

2030 IECC moves decarbonization to optional appendix. The ICC Board confirmed that the 2030 International Energy Conservation Code will move key decarbonization and energy efficiency measures into a secondary appendix of optional actions, with strict cost-effectiveness criteria. This fractures the regulatory landscape for multi-state health systems: some jurisdictions will adopt the weaker baseline while others push harder through state-level amendments. Meanwhile, ASHRAE is moving in the opposite direction with 90.1 Addendum bh mandating clinical space setbacks. The codes are splitting — and healthcare facilities are caught in the middle. New Buildings Institute

English-Speaking Americas

Codes & Standards

Joint Commission restructures physical environment standards for 2026. The Joint Commission eliminated the old “Environment of Care” and “Life Safety” chapters and replaced them with 8 new “Physical Environment” (PE) standards designed to align directly with CMS Conditions of Participation. This is a massive compliance shift for facility managers — engineering teams must adapt to a dramatically streamlined set of standards while ensuring seamless alignment with NFPA 101 and CMS requirements for emergency power, lighting, and hazard management. TAHFM / George Mills

NFPA 800: full lifecycle battery safety code enters mainstream (May 18). Facility Executive published a detailed overview of NFPA 800, the new provisional code covering battery systems from manufacturing through transport, installation, operation, emergency response, and end-of-life. The code introduces maximum allowable quantities and thermal runaway thresholds that will change how batteries are stored, charged, and managed. It aligns with NFPA 241, NFPA 70, NFPA 72, and NFPA 855. For hospitals deploying BESS or microgrids, this means compliance documentation, training, detection/notification systems, and emergency response integration are becoming part of the total installed cost — not optional extras. AHJs will increasingly demand this documentation. Facility Executive

ASHE Battery Safety Task Group: guidance pipeline confirmed (May 19). HFM Insider reported that the ASHE Battery Safety Task Group (of which the author is a member) is collecting incident data, surveying field professionals, and building risk-based guidance aligned with codes to support day-to-day hospital operations. The market is moving from “install a BESS” to “prove lifecycle safety, thresholds, and emergency response readiness.” HFM Insider / ASHE

FGI Bulletin #30: 2026 FGI Codes/Handbooks release update (May 21). The Facility Guidelines Institute published Bulletin #30 with updated release timing for the 2026 FGI Codes and Handbooks. FGI codes are treated as enforceable baselines by many AHJs and consolidate minimum program, space, risk assessment, infection prevention, and building system requirements. For health systems with projects in design or plan review, release timing determines whether AHJs reference the 2022 or 2026 editions — creating potential rework risk and change-order exposure if scope straddles the adoption transition. FGI

ASHRAE 170 surgical suite monitoring guidance tightening. Engineering and compliance bodies are issuing stricter guidance on balancing infection control with decarbonization in surgical suites, focusing on ASHRAE 170/90.1 requirements for ventilation turndowns when ORs are unoccupied. Hospitals must install advanced room-level controls that safely reduce air changes while maintaining positive pressure and strict humidity ranges. This is the paradigm shift in action: from static prescriptive design to dynamic performance-based operations. Envigilance / Price Industries

Energy & Resilience

VCH $28M CEC LDES grant: deployment advancing. Valley Children’s Hospital’s non-lithium long-duration energy storage system — believed to be the largest hospital battery system in the world — continues advancing. Combined with Kaiser Richmond and Kaiser Ontario, this is the third major California hospital microgrid project demonstrating that BESS and LDES are viable infrastructure for Essential Electrical Systems, not just pilot technologies. CEC LDES Program

Community microgrids as “health resilience hubs.” A $15.3M solar + storage community microgrid project serves a health clinic, public safety facilities, and community loads with up to 24 hours of backup. Funded through a utility Microgrid Incentive Program. Separate examples include a 40% ITC-eligible project in New York and a Spokane resilience hub reporting reduced utility bills. For health systems, the “hub model” allows partnering into community resilience infrastructure rather than owning everything. Microgrid Knowledge

Cybersecurity

Fox Tempest: cybersecurity as clinical continuity risk (May 22). Microsoft disrupted Fox Tempest infrastructure used to generate more than 1,000 fraudulent code-signing certificates across hundreds of Azure tenants, making malware appear legitimate and evading defenses. The American Hospital Association flagged this as a sector risk. This is not merely an IT story — hospitals depend on digital certificates, connected software, building automation, imaging systems, energy controls, and vendor-managed systems. Cyber compromise is becoming a continuity-of-care and facility-operations risk. Treat this as a prompt to validate downtime modes for BAS/controls, nurse call, EHR-dependent workflows, and emergency power monitoring. AHA / Microsoft

Canada

CHES Ontario Conference: May 24–26, London, Ontario. Active healthcare engineering event this week. CHES

Canada $5B Health Infrastructure Fund confirmed. Federal funding over 3 years referenced in 2026–27 departmental plan. Government of Canada

Spanish-Speaking Americas

Brazil: battery storage falls short of potential (May 23). PV Magazine reports on an ABSAE webinar discussion highlighting that Brazil’s BESS market is constrained by regulation, grid rules, and limited ancillary-service markets. Storage is being positioned as a grid modernization lever, but hospitals planning renewable PPAs or behind-the-meter storage need to understand that curtailment risk and tariff volatility remain real planning variables in this market. PV Magazine

Latin America/Caribbean: WMO climate report flags water stress (May 18). The UN World Meteorological Organization’s regional State of the Climate report highlights water shortages and infrastructure disruptions straining healthcare systems across Latin America and the Caribbean. For hospitals, this means rising water procurement costs, more frequent service interruptions, higher cooling energy exposure, and flood/drought resilience as design requirements — connecting directly to the ASHRAE 189.3 water resilience work the author is leading. UN Geneva / WMO

Europe

EU EPBD transposition deadline: May 29 — THIS THURSDAY. Member states must transpose the revised Energy Performance of Buildings Directive into national law by May 29. The EPBD establishes zero-emission building standards, legally binding timelines to phase out fossil-fuel boilers, mandatory Building Automation and Control Systems (BACS) for non-residential buildings, and whole-life carbon assessments for new hospital construction. Fossil fuel heating subsidies already ended January 1, 2025. New public buildings must meet zero-emission standards by January 1, 2028. National building renovation plans are due December 31, 2026. For European hospitals, this is not aspirational — it is a regulatory cliff with massive capital planning implications. European Commission

PROJECT SPOTLIGHT — Nottingham City Hospital: £34.8M — UK’s last coal-heated hospital switches to clean energy. Nottingham City Hospital has completed a landmark £34.8 million decarbonization program, ending coal-fired heating across the entire NHS estate. The two-phase project, delivered by Vital Energi and funded through the Public Sector Decarbonisation Scheme (Salix Finance), replaced aging coal and gas boiler systems with a new energy center incorporating air-source heat pumps (400 kW), solar PV panels, waste-heat recovery (160 kW water-source heat pump), a centralized Building Management System upgrade, and over 6,600 LED lighting fixtures. Results: 16,023 tonnes of CO₂ eliminated annually and £1.4 million in verified annual energy savings. All work was completed within a fully operational acute hospital, including precision demolition of two chimney stacks — one directly adjacent to the Cardiac Centre. “Nottingham City Hospital was the last hospital in the UK still burning coal, and that chapter is now closed.” Sustainable Times / Building Better Healthcare / New Civil Engineer

Additional NHS decarbonization projects funded this cycle. Pilgrim Hospital: £23M to shift heating/hot water from fossil fuels to electric. Newham Hospital: £13.8M for rooftop solar, heat pumps, LED, electrical infrastructure. West Middlesex University Hospital: all-electric Ambulatory Diagnostic Centre with fully electric air-handling units replacing gas-fired coils. Trafford Hospital: first NHS hospital to upgrade entire energy system within a live environment for total decarbonization (Dalkia leading). Building Better Healthcare

WHO Europe: “Climate change is a health crisis — and fixing it is a health opportunity” (May 17). The WHO Pan-European Commission on Climate and Health demanded governments redirect spending from fossil fuel subsidies toward climate-resilient health systems and clean energy. Positions hospital decarbonization as a core requirement for health security, not just an environmental goal. Provides the highest-level global policy cover for hospital engineers and capital planners arguing for decarbonized infrastructure. WHO Europe

European Healthcare Design Congress: June 15–17, London. QEII Centre. Theme: “Agile not fragile.” 14 award categories. EHD

International Conference on Health Promoting Hospitals: Malmö, Sweden (this week). Mazzetti’s Austin is presenting on “Strategies for Improving Energy Resilience for Healthcare — Without Burning Down the Planet.” The conference, organized by the International Network of Health Promoting Hospitals & Health Services, is themed around creating sustainable and resilient healthcare. The program included a visit to Region Skåne to study Sweden’s preventive care investment model. It is encouraging to see healthcare energy resilience entering the health-promotion conversation alongside clinical prevention — infrastructure and clinical outcomes are increasingly inseparable. HPH Network

Africa

Malawi: Mwanza District Hospital hydrogen-battery system (May 12, still reverberating). The world-first solar + hydrogen electrolyser + battery system at Mwanza District Hospital continues to generate international attention. The system produces hydrogen from solar-powered electrolysis for thermal needs (cooking for patient guardians), with battery storage powering maternity wards. This replaces charcoal and diesel in one of the world’s least-electrified countries. Loughborough University

Uganda/DRC: Ebola outbreak — WASH as first resilience system. PAHO/WHO issued an epidemiological alert (May 21) on Bundibugyo virus disease in DRC and Uganda. The Global WASH Cluster updated its Ebola response toolkit (May 20), centering water, sanitation, and hygiene infrastructure for health facilities, isolation centers, and points of entry. Innovation: Africa reports that 69% of Ugandans lack access to clean water — making handwashing and environmental cleaning impossible without infrastructure intervention. Water is the first resilience system in outbreaks. This connects directly to the ASHRAE 189.3 water resilience standard the author is developing. PAHO/WHO / Global WASH Cluster

Nigeria: Renewed Hope Solarisation Project. 148 MW of solar across universities and hospitals. One pediatric hospital previously needed 200 liters of fuel per day for electricity; now powered by 96 solar panels with more consistent electricity and lower costs. ESI-Africa

SAFHE 2026: June 9–10, Cape Town. Strongest near-term IFHE member event in Africa. SAFHE

Asia / Pacific

WHO WHA79: three infrastructure-relevant resolutions (May 22–23). The 79th World Health Assembly adopted resolutions on: (1) teleradiology and digital infrastructure, calling for massive investment in secure IT, server capacity, cybersecurity, and regulatory capacity; (2) Emergency, Critical, and Operative (ECO) care strategy 2026–2035, explicitly citing insufficient support systems, limited equipment, and continuity-of-care gaps; and (3) the updated Global Code of Practice on health workforce recruitment, emphasizing co-investment in health system infrastructure in source countries to retain staff. All three reinforce that physical infrastructure — power, water, medical gases, digital systems — is not secondary to clinical care. It is a prerequisite. WHO

ASHE decarbonization financing whitepaper coming. Announced at the Campus Energy Summit panel. Supplements existing Decarbonization Academy resources and addresses the primary bottleneck to hospital sustainability: capital funding. ASHE

India diesel price hikes: second increase in one week (May 19). Oil Marketing Companies hiked petrol and diesel by 90 paise per liter, citing the West Asia conflict and elevated Brent prices. Delhi diesel now Rs 91.58/liter. The Hormuz disruption is a global healthcare infrastructure issue — not just American. Zee News

Asia-Pacific construction resilience (Aon, May 19). Aon’s 2026 report finds construction activity remains resilient across APAC but insurers are placing greater emphasis on NatCat exposure, project governance, and delay risks. “Hyperscale data centres, battery and semiconductor plants are driving demand for higher-value, more complex builds.” The same contractors, materials, and insurance capacity hospitals need are being consumed by data center construction. Aon / Media OutReach

CHCC 2026, Tianjin: May 23–25. Happening this weekend. China’s major hospital construction conference. CHCC

IFHE Global Connection

IFHE Building Award 2026: submissions open. Recognizing new healthcare facilities and major renovations. Evaluation criteria: sustainability, innovation, functionality, accessibility, patient-centered design. Strongest current opportunity for global visibility and benchmarking. IFHE

IFHE June 10 webinar: Healthcare Decarbonization & Design. Troy Savage, Mazzetti. Covers Carbon Challenge + Building Award entry guidance. IFHE

International N₂O piping decommissioning trend. Healthcare systems globally are documenting emissions reductions, operational savings, and safety improvements by decommissioning leaking centralized nitrous oxide systems. Sources: UHS Carbon Reduction Project, WFSA statement on deactivating piped N₂O, ATACH resources. This is the N₂O companion to the EU desflurane ban — concrete operational decarbonization through medical gas infrastructure redesign. WFSA / UHS / ATACH

FKT cross-promoting IFHE Building Award to German audiences. Highlighting sustainability, accessibility, urban integration, and patient-centered planning. FKT

NZIHE call for presentations: still active. IHEA amplifying. Covers sustainability, facilities engineering, biomedical, digital health. NZIHE / IHEA

IFHE 2026 Congress: October 17–20, New Orleans. Registration live. Register

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

IFHE Global Events Calendar

MAY (THIS WEEK)

May 24–26: CHES Ontario Conference, London, Ontario

May 27–28: AVAIMS II Encuentro Digital Internacional (Venezuela)

May 28: IHEA site tours: Zip Water + Galvin Engineering (Australia)

May 29: EU EPBD transposition deadline — fossil fuel boiler phase-out becomes law

May 31–Jun 2: CHES British Columbia Conference. ches.org

JUNE

Jun 4–5: ZORG.tech Congress 2026, Belgium. zorgtech.be

Jun 9–10: SAFHE 2026, Cape Town. safhe.co.za

Jun 10: IFHE Webinar: Healthcare Decarbonization & Design (Troy Savage, Mazzetti). ifhe.info

Jun 10: IHEA: Operational Technology in Practice (Australia)

Jun 15–17: European Healthcare Design Congress, London. europeanhealthcaredesign.eu

Jun 16–17: ÖVKT Forum Krankenhaustechnik, Vienna

Jun 17: CHES Canadian Healthcare Construction Course

Jun 23: FKT: Sector coupling — CHP + heat pumps + renewables. fkt.de

Jun 24–25: 2nd Healthcare Facility Design & Build Summit (Innovatrix). innovatrix.eu

JULY

Jul 1: IFHE Building Award submissions deadline

Jul 9: IHEA: Sunshine Hospital predictive maintenance site tour (Australia)

Jul 13: LDES for Healthcare Summit, Salt Lake City — FREE for hospital owners. Register on Eventbrite

Jul 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Jul 15: IHEA: Built to Withstand — Designing for Multi-Hazard Resilience (Australia)

Jul 23: FKT: Waste management in healthcare (Germany)

Jul 30: IHEA: Intelligent Infrastructure in Healthcare Facilities (Australia)

Jul 31: IFHE Carbon Challenge submissions deadline

AUGUST–SEPTEMBER

Aug 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Aug 19–21: ABDEH XI CBDEH 2026, Brazil. abdeh.org.br

Sep 15: CHES IPAC Webinar: Flexible Endoscope Basics

Sep 20–22: CHES National Conference, Canada. ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference — Resiliens i sundhedsvæsenet (Denmark)

OCTOBER–NOVEMBER

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

Nov 16–18: IHEA National Symposium, Fremantle. ihea.org.au

Nov 27–28: HEAJ 55th Conference, Japan

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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Where Healthcare Infrastructure Meets the Climate Imperative

Week of May 16, 2026 • Issue No. 10

From the Field

The New Paradigm

I’ve written now a couple of times about Monica’s invitation to me to present at the Facilities and Campus Energy Summit last week. I’ll start by reiterating how much I valued the meeting, the presentations, and the excellent conversations I had with many old friends, and new ones.

During my presentation, I recorded it using a voice recorder and an LLM to analyze it and give me feedback. It basically told me that I tried to cram too many ideas into too little time, and probably left the audience feeling slightly bewildered. So, I thought I might try to unpack some of them in a forum where I have a bit more time. (In my defense, I only had 18 minutes! And, I’m always worried about being a boring presenter, so I probably go overboard on trying to provide interesting stuff to think about).

Indeed, the LLM did not even pick up on my central theme, which was that we are now in the midst of what Thomas Kuhn, in his seminal work The Structure of Scientific Revolutions, called a paradigm change.

Kuhn’s work is variously described as being either a history or a philosophy of science. His insight was that science does not often proceed in the continuous way that we might imagine. Instead, it proceeds through a series of somewhat stair-stepped ways of thinking. At each step, a bundle of related ideas becomes a dominant framework, within which all other ideas operate. The framework is barely noticed, in a way, maybe like the dots in a dot to dot coloring book. All scientific work, then, falls within it, connecting the dots and filling in the colors. But, the paradigm, the dots, creates the limits within which thought occurs.

As time goes on, however, we learn more things that don’t fit. The paradigm comes under increasing strain. And finally, in a somewhat discontinuous way, the entire paradigm must shift in response, turning the page to the next dot to dot picture.

My argument was that today, we are living through exactly such a shift in our mental models.

I have written before about my experience on the NFPA 70 committee. Last cycle, when we were working on changes that would permit the use of microgrids (such as the one we are building at Valley Children’s Hospital) to serve as the source for the Essential Electrical System of the hospital, one of my respected colleagues on the panel turned to me and said, “Walt, what is it with you people from California! We have been doing things the same way for 40 years, and it always works! Why do we have to change?” Indeed.

For forty years, our paradigm has worked, and worked well. Indeed, in many ways (like Newtonian physics), it still works well. We rely, typically, on an infinite, reliable, inexpensive electrical external utility for a large portion of our energy needs. Then, for the rare instances when that system fails, we have a reliable diesel generator, standing by, to assume a large part of the facility load. It almost always works.

But –

Rising electricity demand. Aging electrical grid. Inadequate capacity in generation. Inadequate capacity in transmission. Increasing percentage of intermittent generation. Increasing percentage of inverter based generation. Regulations to electrify buildings. Regulations regarding air quality. Regulations and concerns for climate change. Increasing frequency of severe weather events. All resulting in sharply escalating prices for electricity. New technologies. New energy procurement structures. New designs for project finance.

We are being forced to color outside the lines, and it is time for us to turn the page to the next energy paradigm.

I tried to drive this through three examples of advancing regulations that give us greater flexibility and improved outcomes. In the weeks ahead, I’ll unpack each one. We are sketching in the new dots of the new paradigm, together.

— Walt Vernon

IFHE Global Scan

U.S. Energy Markets

The EIA released its May Short-Term Energy Outlook on May 12 — the day of the Campus Energy Summit. The data is dramatic, and it validates every element of the paradigm shift described above.

Strait of Hormuz effectively closed; 10.5M b/d shut in. The most significant energy supply disruption since the 1973 oil embargo. EIA assesses Iraq, Saudi Arabia, Kuwait, UAE, Qatar, and Bahrain collectively shut in 10.5 million barrels per day of crude production in April. The Strait is not expected to reopen until late May, and pre-conflict production may not return during the forecast period for some producers. Brent crude spiked to $138/bbl on April 7 and averaged $117/bbl for April; EIA forecasts ~$106/bbl for May–June, declining to $89 in Q4 and $79 in 2027. Global oil inventories are falling at 8.5 million b/d in Q2. The UAE left OPEC effective May 1, and OPEC spare capacity is now forecast at just 2.5 million b/d in 2027, down from 3.8 million previously. DOE has released 17.5 million barrels from the Strategic Petroleum Reserve since March. For hospitals: diesel costs, logistics, vendor pricing, and the economic calculus of every backup generator are affected. On-site renewable energy and storage are not just decarbonization tools — they are hedges against exactly this kind of geopolitical shock. EIA STEO May 12

Commercial electricity to surpass residential for first time on record in 2027. EIA projects commercial electricity demand growth of 2.2% in 2026 and 5.3% in 2027, driven almost entirely by data center load. This is unprecedented: for the first time in the history of U.S. electricity markets, commercial consumption will exceed residential. Residential electricity prices are up 5% in 2026, with the largest increases along the East Coast. For hospital CFOs, this is not a sustainability talking point — it is a budget line item that is structurally increasing, and it will not reverse. Hospitals that have not yet modeled their demand charge exposure, time-of-use rate structure, and behind-the-meter generation economics should begin immediately. EIA STEO

PJM capacity auction: $329.17/MW-day — historic record. The 2026–2027 PJM capacity auction concluded at a record $329.17/MW-day, an increase of more than 1,000% over two years. PJM is the regional grid operator for 13 states and the District of Columbia, serving approximately 65 million people. Capacity charges account for roughly 25% of commercial energy bills in this territory. Hospitals in the PJM footprint face severe, unavoidable operating budget strain. However, this drastically shortens ROI timelines for behind-the-meter solar, battery storage, demand response, and thermal energy systems — turning resilience investments into urgent financial necessities. PJM is now considering three market reform pathways, and Maryland’s governor is pushing reforms arguing data centers should pay for the infrastructure they drive rather than socializing costs across all ratepayers. Integrity Energy

PJM wholesale electricity prices up 76% YoY. Bloomberg reports wholesale power prices in PJM rose 76% year-over-year, driven by surging demand from data centers. Hospitals are exposed to these same wholesale markets either directly (for those that procure on the open market) or indirectly through utility rate pass-throughs. A Nevada utility has also been reported redirecting a large share of electricity supply toward data center growth, reducing available capacity for other users. The pattern is clear: hospitals are now competing directly with hyperscale digital infrastructure for grid capacity, interconnection priority, and affordable electricity. Bloomberg

NERC Level 3 alert: data centers as documented grid threat (May 4). On May 4, NERC issued its highest-urgency alert after documenting multiple events since 2022 in which 1,000+ megawatts of computational load (data centers) dropped off the bulk power system in seconds, leaving grid operators with almost no time to respond. These “customer-initiated load reductions” occur when data center protection circuits detect power quality issues and automatically disconnect — creating frequency and voltage instability that can cascade into broader outages. NERC has mandated seven essential actions for transmission owners, planners, and balancing authorities, with responses due by August 3, 2026. NERC also plans to register entities with computational loads of 20 MW or more under mandatory reliability standards. For hospitals: every frequency/voltage event affects medical equipment, power quality, and continuity of care. Hospital microgrids with islanding capability are a direct defense against these grid stability events. NERC / Utility Dive / Carbon Direct

FERC large-load interconnection: action by June. FERC has announced it will act by June 2026 on reforms for integrating large new electrical loads into the grid. The proceeding is driven primarily by data centers but may include requirements for large loads to bring their own power supply. This matters to hospitals because the regulatory architecture for large loads may reshape utility planning assumptions, capacity cost allocation, interconnection wait times, and the value of behind-the-meter generation and storage. Hospitals expanding campuses, adding microgrids, or connecting on-site renewables to the grid should monitor this docket closely — the rules being written now for data centers will spill into healthcare interconnection economics within a few years. FERC

Three Mile Island restart decision expected June/July. Constellation Energy is seeking approval to restart the former Three Mile Island nuclear unit, now branded Crane Clean Energy Center, with output contracted to supply Microsoft data centers. The restart would transfer grid injection rights from the existing PJM system to a dedicated corporate buyer. This illustrates how large technology loads are reshaping generation, transmission rights, and clean-firm-power strategy — the same markets and infrastructure that hospitals depend on for reliable, affordable power. When a nuclear plant restarts to serve a single data center customer, the grid that hospitals use becomes a secondary market. Reuters

New EIA energy security datasets launched May 13. For the first time, EIA will publish quarterly tracking of global strategic petroleum reserves and crude oil flows through key shipping chokepoints (including the Strait of Hormuz). This is essential context for hospitals that depend on diesel for backup generation, medical supply logistics, and transportation — and for those making the case that on-site renewable energy is, among other things, a hedge against geopolitical fuel supply risk. EIA

English-Speaking Americas

Key Signals

Valley Children’s Hospital: $28M CEC LDES grant confirmed. The California Energy Commission confirmed a $28 million grant for Valley Children’s Hospital in Madera, California, to deploy a non-lithium long-duration energy storage system integrated into the hospital’s campus microgrid. This is believed to be the largest hospital battery system in the world and demonstrates the viability of LDES in acute care settings. The system is designed to provide clean backup power for extended outages, replacing the traditional dependence on diesel generators. Mazzetti is the engineer of record and the Sextant Foundation is a project partner. This project serves as a blueprint for how hospitals can integrate storage into their essential electrical systems — not as a pilot, but as a core infrastructure asset. CEC LDES Program

NFPA 800: new battery safety code under development. NFPA announced on May 12 that it is developing a provisional battery safety code (NFPA 800) covering the full lifecycle of battery systems — design, installation, storage, use, and disposal. This is separate from, and in addition to, the expanded NFPA 855 (2026), which introduces hazard mitigation analysis requirements for energy storage systems. Together, these two codes are becoming gating factors for hospital battery deployment: any health system planning a BESS or microgrid will need to navigate both. The tension is real — the technology is at the tipping point (as discussed in Issue 8), but safety codes are simultaneously raising barriers to deployment. This is directly relevant to the ASHE Battery Safety Task Group (of which the author is a member) and to the LDES for Healthcare Symposium planned for July 13. NFPA

ASHRAE 90.1 Addendum bh: unoccupied setback requirements for clinical spaces. A significant new energy-saving requirement mandates ventilation turndown and temperature setbacks in operating rooms, procedure rooms, and imaging suites when unoccupied. This shifts hospital HVAC design from continuous baseline operation — where ORs run at full air changes 24/7 regardless of use — to dynamic, occupancy-based control. The addendum formally reconciles ASHRAE 90.1 with ASHRAE 170 (ventilation for healthcare). For facilities teams, this means investing in advanced building automation, occupancy sensing, and clinical coordination systems to capture the energy savings while maintaining clinical readiness. It is a concrete example of the paradigm shift: from static prescriptive design to dynamic performance-based operations. HFM Magazine

MTG ILCHES proposal circulated to ASHRAE/NFPA stakeholders (May 13). A proposal for a new integrated low-carbon healthcare energy systems standard was circulated to ASHRAE and NFPA stakeholders on May 13. The proposed Multidisciplinary Task Group (MTG ILCHES) would bring together ASHRAE, NFPA, The Joint Commission, and other organizations to create a unified standard for behind-the-meter energy resilience in healthcare — replacing the current paradigm of separate, siloed codes for electrical, thermal, fire safety, and accreditation. If approved, this would represent the most significant reframing of healthcare energy standards in decades: from “backup power” as an insurance policy to integrated resilience as a design principle. Author / ASHRAE

Construction & Capital

Hartford HealthCare: ~$1B investment announced May 5. Hartford HealthCare’s flagship reinvention includes a 14-story tower with 216 private patient rooms, three floors of procedure space, a new emergency department, and smart room technology throughout. Construction begins 2027. This is Connecticut’s largest hospital investment and reflects the bifurcation trend: large, well-capitalized systems are building billion-dollar replacement facilities while smaller and rural systems struggle with deferred maintenance. MCD Magazine

Mercy Hospital Wentzville (Missouri): $650M new campus. A 400,000 sf, 75-bed new acute care campus — the first new acute care hospital built in Missouri in nearly a decade. The central utility plant is already under construction (started summer 2025), with the hospital tower underway in early 2026. Design by CannonDesign, engineering by IMEG, construction by McCarthy. The embedded central utility plant follows the same pattern seen at JPS Fort Worth and HCA Ocala — hospitals are increasingly designing utility infrastructure as a first-order system, not an afterthought. Mercy Health

Ochsner Children’s Hospital (New Orleans): groundbreaking April 29. The Gayle and Tom Benson Ochsner Children’s Hospital broke ground in New Orleans — the same city that will host the 29th IFHE World Congress in October 2026. This provides a natural connection point for IFHE attendees to see new healthcare construction in the host city. HCO News

Healthcare construction spending up 11.6% to $30.7B. ConstructConnect reports 15 projects exceeding $1 billion announced in 2025 alone. The market is bifurcating: large systems building replacement mega-campuses while financially constrained systems focus on renovations, deferred maintenance, and incremental capacity. Rural hospitals face existential threats — a DTN report this week details how severe capital constraints prevent facility modernization, force deferred maintenance, and block deployment of resilient energy systems in the areas most vulnerable to grid instability and extreme weather. HFMA / ConstructConnect / DTN

Canada

Canada: $5B Health Infrastructure Fund (federal, 3 years). Canada’s 2026–27 infrastructure departmental plan references $5 billion dedicated to a Health Infrastructure Fund, alongside broader building retrofit, climate adaptation, and community infrastructure funding. The Canadian Coalition for Green Health Care’s “Preparing Canada’s Health Care Buildings for Net-Zero” initiative is actively building leadership and workforce capacity to reduce emissions from hospitals, clinics, and long-term care homes. These two signals together indicate that Canadian healthcare infrastructure is entering a funded modernization cycle, not just an aspirational one. Government of Canada / CCGHC

Spanish-Speaking Americas

Brazil: renewable curtailment losses reaching 25%. Reuters reports that renewable energy producers in Brazil are downsizing operations because grid operational restrictions have reduced output and revenue by as much as 25%. Battery-storage integration remains underdeveloped and insufficiently regulated. This is a critical warning for hospitals buying renewable electricity through PPAs or planning energy procurement strategies: headline renewable capacity and actual delivered energy are increasingly divergent. Curtailment risk, transmission constraints, and storage regulation must be part of any hospital energy procurement analysis, not just the price per kilowatt-hour. Reuters

Colombia: renewable auction announced amid gas shortfall. Colombia has announced a forthcoming renewable energy auction while simultaneously considering gas infrastructure measures to address a domestic gas shortfall. Health systems operating in markets that depend on gas and hydroelectric generation need to watch fuel security and grid diversification carefully — particularly as geopolitical disruptions (Hormuz) drive global fuel price volatility into every regional market. Reuters / Colombia

Chile: transmission congestion constraining renewable value. Chile’s persistent renewable curtailment problem continues to demonstrate that building solar and wind capacity is necessary but not sufficient. Major HVDC transmission lines and utility-scale storage are being developed to address grid congestion, but the timeline is years, not months. For Chilean hospitals planning electrification or renewable procurement, the gap between installed renewable capacity and deliverable renewable energy remains a real planning risk. Chile energy press

Europe

EU EPBD transposition deadline: May 29, 2026 — 12 days away. EU member states are finalizing national building renovation plans to transpose the revised Energy Performance of Buildings Directive into national law. The EPBD establishes zero-emission standards for buildings and sets legally binding timelines to phase out fossil-fuel boilers, adopt whole-life carbon assessments in hospital construction, and implement deep energy retrofits. The European Commission held a summit on May 13 to support implementation. For European hospitals, this is not a voluntary aspiration — it is a regulatory cliff. The era of the fossil-fuel hospital boiler is effectively over in Europe, and the capital planning implications are enormous: massive investments in heat pump infrastructure, thermal networks, building envelope improvements, and electrified heating systems will be required within legally mandated timeframes. European Commission

Portugal: €22.6B resilience plan after storms and Iberian blackout. Following severe storms and the Iberian Peninsula blackout, Portugal announced a €22.6 billion national resilience plan, with approximately €4 billion targeted to electricity and gas grids, energy storage, and hydroelectric infrastructure. Grid resilience, climate adaptation, and infrastructure hardening are being treated as national security and economic priorities. For hospitals, this is a model of how energy resilience can be framed at the policy level: not as a facilities management issue, but as a matter of national preparedness. The plan also signals significant public investment that hospitals may be able to access or benefit from through grid-hardening programs. Government of Portugal

NHS £1B decarbonization framework launched. The North of England NHS Commercial Procurement Collaborative (NOE CPC) launched a £1 billion national framework covering decarbonization and energy infrastructure across 20 lots spanning the full project lifecycle — from strategic planning and feasibility through funding applications, scheme delivery, contract management, and audit. The largest lot (£200M) provides a total-service-provision model for organizations acting as principal partners for full-lifecycle decarbonization. This represents the NHS’s shift from Green Plans (aspirational documents) to execution at scale. The bid deadline was May 1, 2026. For IFHE members: this is the most advanced national-scale healthcare decarbonization procurement framework in the world. Mills & Reeve

Imperial College Healthcare NHS: £47.4M continuing £120M decarb program. Imperial is investing £47.4 million over the next two years to continue overhauling energy systems across Charing Cross, Hammersmith, and St Mary’s hospitals, bringing total investment to £120 million since 2021. Heat pumps installed at Charing Cross delivered a 27% reduction in building energy emissions in the first year alone. The program includes additional heat pumps, solar panels, improved insulation, cooling system upgrades, and energy management controls. The target: 43% emissions reduction versus 2020/21 levels, saving 20,233 tonnes CO₂e annually. Funded through the Public Sector Decarbonisation Scheme and NHS England. Imperial NHS Trust

NHS EUI benchmarking study published April 29. A landmark study of 1,104 acute NHS hospital sites in England found a persistently high average energy use intensity (EUI) of 211 kWh/m² in 2024/25, with total acute-sector energy consumption of 9.99 billion kWh — approximately 75% from natural gas. Clinical floor area share showed the strongest association with EUI (R² = 0.27). Sites with heat decarbonization plans and heat pump installations tended to have higher EUI, suggesting these interventions are being prioritized at the most energy-intensive facilities. This is the first national-scale benchmarking assessment of NHS hospital energy performance and provides a data foundation for targeting investments. MDPI Buildings

Germany: €600M geothermal drilling guarantee in Deutschlandfonds. Germany’s Deutschlandfonds includes a €600 million guarantee framework specifically for geothermal drilling risk, alongside broader decarbonization and energy-transition support. This moves geothermal from a purely technical discussion into risk-sharing finance structures — exactly the kind of mechanism needed to unlock hospital geothermal deployments where drilling risk has been the primary barrier. Connects directly to last week’s IFHE geothermal webinar and the broader EU heat pump acceleration under the Industrial Accelerator Act. German Government

European Healthcare Design Congress: June 15–17, London. The 12th European Healthcare Design Congress moves to the QEII Centre in Westminster under the theme “Agile not fragile: Designing for resilience, renewal and regeneration.” The program covers 10 thematic streams including healthcare estate modernization, net-zero design, digital infrastructure, and community health hubs. 14 award categories recognize excellence in healthcare design globally. Organized by SALUS Global Knowledge Exchange and Architects for Health. EHD

Africa

PROJECT SPOTLIGHT — Malawi: world-first battery-electrolyser at Mwanza District Hospital. On May 12, Loughborough University formally handed over a world-first integrated solar microgrid, hydrogen electrolyser, and battery energy storage system at Mwanza District Hospital in Malawi. The system uses solar-generated electricity to produce hydrogen through electrolysis; the hydrogen is then used to power cookers for patient guardians within the hospital, replacing charcoal and diesel. The battery provides electrical storage for hospital operations including maternity wards. This is one of the most innovative healthcare energy projects anywhere in the world: it combines renewable electricity, green hydrogen for thermal needs, and battery storage in a single integrated system at a district hospital in one of the world’s least-electrified countries. It connects directly to the Kenya Consolata Hospital’s aspiration to produce green hydrogen for medical oxygen and to the KVH hydrogen fuel cell project in the United States. Loughborough University

South Africa: Eskom power surplus — first winter without load-shedding in nearly a decade. The Financial Times reports that Eskom now says South Africa has a power surplus and may see its first winter without rolling blackouts since 2017. While municipal debt and aging infrastructure remain significant risks, this is a pivotal shift for hospital resilience planning: the conversation moves from constant crisis-mode load-shedding response toward longer-term questions of cost optimization, municipal reliability, renewable integration, and asset lifecycle planning. Financial Times

Africa: $11B+ in clean energy investment announced at Nairobi summit. More than $11 billion in renewable energy investments were announced around the France-Africa Summit in Nairobi, covering hydropower, solar, wind, sustainable aviation fuel, and clean cooking. While not healthcare-specific, energy access investment is foundational to hospital reliability and health-system resilience across the continent. One in four primary health facilities in sub-Saharan Africa still lacks electricity. AP News

Africa telecom towers accelerating solar transition. AP reports that African telecom operators are moving cell towers from diesel to solar/hybrid systems as energy costs reach up to 60% of tower operating expenses in off-grid regions. These solarized towers are becoming distributed energy anchors for rural communities — and potential resilience infrastructure for nearby health facilities, emergency communications, and digital health systems. AP News

Asia / Pacific

ADB: $70B energy and digital infrastructure plan through 2035. The Asian Development Bank announced a $70 billion program to expand energy and digital infrastructure across Asia-Pacific, including grid interconnections, cross-border electricity trade, and broadband access. For hospitals, this is enabling infrastructure: reliable power and digital connectivity are prerequisites for modern, resilient health systems. The program signals that the institutional development-finance community is treating energy and digital infrastructure as a unified investment category — the same convergence happening inside hospitals. ADB

India: NBCS 2026 removes 45m height cap for hospitals. India’s National Building Construction Standards 2026 allow hospital buildings to exceed the previous 45-meter height limit, with ICUs permitted above 45 meters subject to enhanced fire-safety provisions. This is a major codes-and-capacity signal for land-constrained urban hospitals. However, the fire/life-safety tension remains real: Times of India reported that Ahmedabad Municipal Corporation’s own LG Hospital placed critical care units on the 9th floor despite earlier guidance favoring ground-floor ICUs after a fatal fire. India’s healthcare infrastructure market is projected to reach $45 billion by 2027 and requires 3 million additional hospital beds by 2047. Business Today India

New Zealand: Dunedin Hospital seismic resilience embedded in design. The Dunedin Hospital rebuild includes base-isolation structural work intended to keep the hospital operational during earthquakes and natural disasters, with early construction phases scheduled through 2026. This is a clean example of resilience embedded in structural design from the beginning — not retrofitted later — and relevant to any hospital in a seismically active region. The approach mirrors California’s SB1953 seismic compliance requirements that have driven decades of hospital replacement construction. NZ Government

Australia: Maryborough Hospital A$4.4M electrical upgrade. Queensland reporting describes a new main switchboard, conversion of the old switchboard to a distribution board, and backup-generator improvements at Maryborough Hospital. This is not glamorous, but it is exactly the kind of core electrical infrastructure investment that determines whether a hospital can maintain power during grid events. It belongs in the same category as Catholic Medical Center’s $27M infrastructure package from Issue 7 — the “unsexy but decisive” work that keeps hospitals running. Courier Mail

CHCC 2026, Tianjin, May 23–25. China’s Hospital Construction Conference and International Hospital Build & Infrastructure Exposition is the largest hospital construction event in Asia-Pacific. The 2026 edition covers smart hospitals, logistics automation, medical engineering, operational efficiency, and facility management. China’s hospital construction market integrates these disciplines at a scale that few other countries attempt. CHCC

IFHE Global Events Calendar

MAY

May 19: FKT: Li-ion battery safety in healthcare (Germany). fkt.de

May 20: IHEA: Medical Air & Vacuum Plant AS 2896 (Australia)

May 21: ZORG.tech: BEO-field & BACS regulation (Ghent)

May 23–25: CHCC 2026, Tianjin, China. chccchina.com

May 27–28: AVAIMS II Encuentro Digital Internacional (Venezuela)

May 28: IHEA site tours: Zip Water + Galvin Engineering (Australia)

May 29: EU EPBD transposition deadline — fossil fuel boiler phase-out becomes law

May 31–Jun 2: CHES British Columbia Conference. ches.org

JUNE

Jun 4–5: ZORG.tech Congress 2026, Belgium. zorgtech.be

Jun 9–10: SAFHE 2026, Cape Town. safhe.co.za

Jun 10: IFHE Webinar: Healthcare Decarbonization and Design

Jun 10: IHEA: Operational Technology in Practice (Australia)

Jun 15–17: European Healthcare Design Congress, London. europeanhealthcaredesign.eu

Jun 16–17: ÖVKT Forum Krankenhaustechnik, Vienna

Jun 23: FKT: Sector coupling — CHP + heat pumps + renewables. fkt.de

Jun 24–25: 2nd Healthcare Facility Design & Build Summit (Innovatrix). innovatrix.eu

JULY

Jul 1: IFHE Building Award submissions deadline

Jul 9: IHEA: Sunshine Hospital predictive maintenance site tour (Australia)

Jul 13: LDES in Healthcare Symposium, Salt Lake City — National Labs presenting. Email the author.

Jul 14–15: U.S. LDES Consortium Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Jul 15: IHEA: Built to Withstand — Designing for Multi-Hazard Resilience (Australia)

Jul 23: FKT: Waste management in healthcare (Germany)

Jul 30: IHEA: Intelligent Infrastructure in Healthcare Facilities (Australia)

Jul 31: IFHE Carbon Challenge submissions deadline

AUGUST–SEPTEMBER

Aug 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Aug 19–21: ABDEH XI CBDEH 2026, Brazil. abdeh.org.br

Sep 20–22: CHES National Conference, Canada. ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference — Resiliens i sundhedsvæsenet (Denmark)

OCTOBER–NOVEMBER

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

Nov 16–18: IHEA National Symposium, Fremantle. ihea.org.au

Nov 27–28: HEAJ 55th Conference, Japan

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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HEALTH INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Week of May 9, 2026 • Issue No. 9

From the Field

There is a lot of hoopla these days about all-electric hospitals, everyone claiming to be the first.

In fact, a lot of hospitals around the world are already all-electric, or mostly all-electric. Through the years, I have been able to tour a lot of these places, and one of the great things about being part of an organization like the IFHE is that we are able to learn from each other around the world. A great example is the Village Health Works Hospital that I have written about in the past, in Kigutu, Burundi. This hospital is fortunately located in a very temperate climate, which makes it much easier, of course. It also uses a fair amount of passive systems. Like many buildings around the world, it relies on solar thermal for heating water. Until about a month ago, it relied mostly on a set of four diesel generators that provided it with needed electricity. And, just in time to help avoid the soaring diesel fuel prices created by the US-Israeli war on Iraq, we were able to get its new solar and battery system up and running so that today, its energy is mostly free. Mostly free means a lot to a hospital that is trying to serve the poorest of the poor.

And, we have also been doing it, or mostly doing it, in the US for literally decades.

Mazzetti worked with PeaceHealth in Friday Harbor, Washington State, on the Peace Island Hospital and Outpatient Care building. It is a small rural facility. Every time I am in a conversation about healthcare sustainability, people say something to the effect that it is easy for larger facilities, that are part of large systems, to make these investments, but that it’s hard for critical access, or rural, or essential hospitals to possibly make such investments. Peace Island proves them all wrong.

For details, I would refer you to the excellent case study HERE.

But, for today, the thing I want to point out is the beautiful photograph at the top of this page. This is a borehole for the Geothermal Heat Pumping system for this hospital. It has been providing all of the thermal energy to the hospital for more than a decade.

I point this out because next week, IFHE is hosting a webinar on the science and possibility of this technology to serve hospitals. I urge you all to attend it. You can sign up here: ifhe.info/education/upcoming-webinars

And, by the way, next week, after the Facility and Campus Energy Summit, I will be meeting at Valley Children’s Hospital and an FQHC in Fresno with a solar and storage microgrid developed by Direct Relief. I hope to write about these next week.

Please join us. If a small, rural, critical access, essential hospital in a cold climate can do it, we can ALL do it.

— Walt Vernon

Global Scan

English-Speaking Americas

Energy Markets & Grid

PJM capacity prices up >1,000% in two years. Reuters reports PJM considering three market reform pathways due to supply-shortage concerns and surging data center demand. Potential shortages as soon as 2027. For hospitals in the PJM footprint: capacity charges, demand response, and behind-the-meter generation are no longer optional. Reuters

NERC draft summer 2026 assessment: improved but fragile. Three subregions at elevated risk (SaskPower, New England, WECC-Northwest), down from six last year. 59 GW of new resources came online. But long-term trajectory worsening—224 GW summer peak demand growth projected over 10 years. Energy Central

NERC Level 3 alert on data center load losses. Expected May 4. Data centers unexpectedly disconnecting from the grid causing frequency and voltage stability issues in Eastern and Texas interconnections since 2022. Essential actions mandated for transmission owners. Hospitals are downstream of these events. Utility Dive

Diesel: $5.64/gal (May 4). EIA projects Q2 average $5.61, Q3 $5.00, Q4 $4.59. Brent crude $115/bbl forecast Q2. DOE released 17.5M barrels from SPR since March. Next EIA STEO release: May 12—the day of the Campus Energy Summit. EIA

Virginia: commercial electricity sales soaring from data centers. EIA “Today in Energy” confirms data center load is reshaping utility economics in real time. Direct evidence hospitals are competing for grid capacity. EIA

ISO 22366:2026 published: organizational energy resilience. Defines energy resilience as governance-linked system responsibility—not an engineering afterthought. Not healthcare-specific but directly applicable to hospital energy systems and microgrids. ISO

Construction & Capital

Hartford HealthCare: nearly $1B investment. May 5 announcement. 14-story tower, 216 private beds, three floors of procedure space, new ED, smart rooms. Construction begins 2027. Connecticut’s largest hospital reinvention. MCD Magazine

U.S. Army Corps: $2B energy resilience contract pipeline. Microgrids, storage, and backup systems. Military leads, healthcare follows within a few years. Institutional proof that resilience infrastructure is a funded national priority. Microgrid Knowledge

Santa Barbara County: $15.3M community microgrid. Supporting neighborhood clinic and critical services. Healthcare-adjacent resilience funding flowing through utilities. Independent

Canada

Canada: $5B Health Infrastructure Fund. Federal, over 3 years. Referenced in 2026–27 infrastructure departmental plan alongside building retrofit, climate adaptation, and community infrastructure funding. Government of Canada

Canadian Coalition for Green Health Care: net-zero healthcare buildings. Preparing leadership and workforce capacity to reduce emissions from hospitals, health centres, clinics, and long-term care homes. CCGHC

Caribbean

Cuba: solar charging station amid chronic blackouts. AP reports solar-powered station opened in Santa Clara in April. ~30 kW solar, 60 kW battery. Cuba also installing solar panels at hospitals. Island-grid resilience signal. AP News

Project Finance & Codes

FERC large-load interconnection: action by June 2026. Large-load tariff design may reshape utility planning, capacity costs, and the value of behind-the-meter generation for hospitals. FERC / Reuters

IFHE geothermal webinar May 13. Future-Proofing Hospitals with Geothermal Heating & Cooling. Featuring Mazzetti’s Jonathan Hernandez and Brightcore Energy. IFHE frames around rising costs, aging infrastructure, decarbonization, and resilience. IFHE

Spanish-Speaking Americas

Brazil: R$1.2B for 541 health units across 505 municipalities. Decentralized primary-care infrastructure across 26 states. Potentially the largest single health-access construction signal in Latin America this cycle. Brazil Government

Brazil: Atlas Renewable Energy PPA for Rede Primavera hospitals. ~40% savings vs. free-market energy costs, ~260 tonnes CO₂ reduction annually. Energy procurement as healthcare cost strategy. Atlas Renewable Energy

Chile: green hydrogen at Sótero del Río hospital construction. Sacyr pilot reducing construction-phase emissions from machinery. One of the first concrete examples of hospital construction decarbonization, not just operational. Many people think hydrogen is an interesting anomaly; it is coming. Sacyr

Colombia fossil fuel transition summit. Colombia and Netherlands co-hosting in Santa Marta (April 24–29). May influence regional energy policy affecting hospital costs and renewables. Government of Colombia

APAES (Asociación Peruana de Arquitectos y Especialistas en Salud) in Peru is exploring IFHE membership and we are looking forward to welcoming them soon!

Europe

Germany: €50B hospital transformation fund live. Available since January 1, 2026 through 2035. Modernization of hospital structures. One of the most important European healthcare infrastructure finance signals. German Federal Ministry of Health

Slovakia classifies hospitals as NATO defense spending. FT reports two hospital projects counted toward 2% GDP target. Whatever the accounting merits, the signal is important: hospitals framed as resilience, civil-defense, and national-security infrastructure. Financial Times

UK NHS: £15B New Hospital Programme per 5-year cycle. But UK Public Accounts Committee reports 7 RAAC hospitals may not be replaced until 2032–33. Maintaining those hospitals while protecting patients now expected to cost £1B. Deferred estate risk becoming a major capital and safety issue. NHS England / UK PAC

IFHE-EU now includes 10 countries. Belgium, Germany, Finland, France, Austria, Norway, Italy, Denmark, Switzerland, and Spain. Others considering joining. IFHE-EU

Africa

Burundi: UNDP Smart Facilities for Health. First five solar-powered, digitally monitored health facilities inaugurated February 2026. Phase 2 expanding to additional district hospitals. Standardized hybrid packages (45 kWp PV, 115 kWh BESS). UNDP

Mali: MSF solar at Niafounke hospital. Solar installation to strengthen autonomy and continuity of care in a remote, insecure region. Solar framed as mission continuity, not sustainability branding. MSF

Africa telecom towers going solar. AP reports energy accounts for up to 60% of tower OpEx in off-grid regions. Diesel costs driving transition. Towers may become anchors for broader distributed-energy systems—including healthcare. AP News

World Bank Mission 300: hospitals explicitly included. Connect 300M people to electricity by 2030. Healthcare and power infrastructure linked at the development-finance level. World Bank

Asia / Pacific

China: CHCC 2026, Tianjin, May 23–25. Major hospital construction, smart hospitals, logistics, medical engineering, operational efficiency. One of the most important near-term Asia/Pacific healthcare infrastructure events. CHCC

India: NBCS 2026 removes 45m height cap for hospitals. Allows taller hospital buildings and ICUs above 45m with enhanced fire-safety norms. Could unlock vertical expansion in land-constrained urban areas. But fire/life-safety tension remains central. Business Today India

Australia: Gladstone Hospital 51-bed modular expansion. Response to deteriorating infrastructure including decommissioned areas and unsafe conditions. Modular as crisis-capacity / estate-risk response. Courier Mail

South Korea: IFHE chapter visit planned later this year. I will be visiting with KIHA after the IHF meeting in Soel later this year, as part of an Asia/Pacific membership tour. KIHA / IFHE

Calendar & What to Watch

MAY

May 11: IHEA WA — Charging Ahead: EV Infrastructure for Healthcare Facilities (Australia)

May 12–13: Facilities & Campus Energy Summit, DC — Walt Vernon speaking May 12, 2:10 PM. facilitiesenergy.ascentisgrp.com

May 12: EIA Short-Term Energy Outlook release

May 13–14: IFHE Webinar: Geothermal Heating & Cooling for Hospitals (two sessions for global time zones). ifhe.info

May 14: CHES Manitoba Conference. ches.org

May 14: IHEEM BS 7671 Amendment 4 webinar. iheem.org.uk

May 19: FKT: Fire/explosion risk — safe handling of lithium-ion batteries in healthcare. fkt.de

May 19–20: IHEEM Northern Ireland Conference

May 20: IHEA Lunch + Learn: Medical Air & Vacuum Plant (AS 2896 Compliance)

May 21: ZORG.tech Studieavond, Ghent — BEO-veld & BACS legislation

May 23–25: CHCC 2026, Tianjin, China. chcc.org.cn

May 27–28: AVAIMS II Encuentro Digital Internacional 2026 (Venezuela)

May 28: CARB cap-and-invest board vote

May 31–Jun 2: CHES British Columbia Chapter Conference. ches.org

JUNE

Jun 4–5: ZORG.tech Congress 2026, Brussels Gate, Belgium. zorgtech.be

Jun 9–10: SAFHE 2026 Conference, Cape Town. safhe.co.za

Jun 16–17: ÖVKT Forum Krankenhaustechnik 2026, Vienna

Jun 23: FKT: Sector coupling in hospitals — CHP + heat pumps + renewables. fkt.de

JULY

Jul 1: IFHE International Building Award submissions deadline. ifhe.info

Jul 13: LDES in Healthcare Symposium, Salt Lake City — National Labs presenting. Email the author.

Jul 14–15: U.S. LDES Consortium Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Jul 23: FKT: Waste management — typical errors and how to do it better

AUGUST–SEPTEMBER

Aug 19–21: ABDEH XI Congresso Brasileiro para o Desenvolvimento do Edifício Hospitalar (Brazil). abdeh.org.br

Sep 20–22: CHES National Conference (Canada). ches.org

Sep 22–24: ÖVKT-TAGUNG, Pörtschach am Wörthersee (Austria)

Sep 30–Oct 1: FKT 7. Fachmesse Krankenhaustechnologie, Gelsenkirchen. fkt.de

Sep 30–Oct 2: FSTA Årskonference 2026 — “Resiliens i sundhedsvæsenet” (Denmark)

OCTOBER–NOVEMBER

Oct 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct 17–20: 29th IFHE/AMFP World Congress + HCD, New Orleans. Register: hcdexpo.com

Nov 16–18: IHEA National Symposium, Fremantle — “Bringing Everyone Together.” ihea.org.au

Nov 27–28: HEAJ 55th Conference (Japan). heaj.org

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

Subscribe to the IFHE Newsletter

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HEALTH INFRASTRUCTURE PULSE

Week of May 2, 2026 • Issue No. 8

From the Field

I was recently appointed to the Leadership Team for the US Long Duration Energy Storage Consortium. I have been part of this organization for a couple of years, now, and it has been an extraordinary opportunity to learn deeply about the opportunities for these emerging technologies and their application for healthcare buildings.

I remember when solar panels were seen as exotic luxuries for a healthcare facility. Today, my VHW fellow board-member David Hochschild says, for our Burundi project, the panels are less expensive than a piece of wood of the same size. (In Burundi, they are able to buy the panels without tariffs). Over the years, we are all familiar with the curves showing how the price of solar has fallen to this point, and healthcare organizations around the world are taking advantage.

Well, batteries are at that same tipping point, as we speak. I am fortunate to have had the chance to deploy batteries at scale for three California hospitals, and yes, even in a remarkable, truly world-class microgrid in Burundi!

But, paradigms shift hard, even at the tipping point.

I am currently working with a healthcare client that owns multiple buildings, of multiple types, across multiple states. We recently had a meeting with the LDES consortium leaders to talk about the opportunities for them. The Consortium members were offering to model the sites for potential deployment of LDES systems. The person in charge, having experienced years of being turned down by the internal finance team said no. He did not see the value in pursuing such an analysis because, even if it showed a financial return, the health system, battered by financial pressures, would never be able to afford the capital to make such an investment.

Ironically, this same organization is worried about investing in all-electric hospitals because of concern for rising prices of electricity.

There are answers. Most healthcare owners I talk to resonate with the first principles that informed our work at Valley Children’s Hospital – we need energy resilience; we need operational cost reductions; and, if it’s possible after achieving those two, we would love to have lower environmental impact.

Today, healthcare owners work in an environment where they can have all three. Together with Eric Berzon, retired VP from Kaiser Permanente, Robyn Helmlinger, Healthcare Partner at Orrick, and Kate Sherwood, CEO of ZeroEnergy, we have submitted a long-awaited paper to the NAM Editors, focusing on how to pay for decarbonizing healthcare. In the old days, we looked at technology, regulations, project finance, and energy procurement as four separate disciplines, each of which could be separately optimized. Today, the opportunities lie at the intersection, and healthcare owners need to be working in this sweet spot. What is even more difficult than that is that all of these forces are also dynamic, and moving, and moving in different ways in different places.

As with Valley Children’s, I will keep trying to help this healthcare system to build energy resilience, lower its energy costs, and lower its environmental impact. It is both a sprint and a marathon.

We can ALL do it.

— Walt Vernon

IFHE Global Scan

English-Speaking Americas

Energy & Resilience

NERC: more regions at summer risk than ever. Forecast flags potential power shortfalls across Midwest, Texas, Southeast, and parts of the West. Early extreme heat waves could strain generation and transmission. For hospitals, a single demand event can add five-figure costs to a monthly utility bill. NERC summer outlook

Diesel at $5.47–$5.65/gal actual. AAA data shows diesel at $5.47 (April 22) and $5.65 in early April. Peaking above $5.80 in Q2. Brent crude averaged $103/bbl in March, forecast $115 Q2. For hospitals: backup generation, emergency logistics, transportation, and vendor costs all affected. EIA STEO

California batteries: 44% of evening demand. March 29 record. Storage is no longer peripheral to grid operations. The question for hospitals shifts from “is storage real?” to “what is the right first application?” CAISO

Direct Relief: resilient power now in 25 countries. 39 US sites, $14.7M+ invested. 7 Florida microgrids expected operational before June 1 hurricane season. First Florida Power for Health microgrid completed at Treasure Coast Community Health ($353K, 46 kW solar, 214 kWh battery, 19 hours backup). Jamaica National Health Fund solar commissioned. “As federal government has rescinded grants, smaller providers turn to private funding.” Direct Relief

Munson Medical Center (Michigan): 2.5 MW CHP. Halved grid consumption, saving $70K/month. 28% emissions cut. CHP enables full operations during grid outages—key for winter storms. Federal incentives and rising grid prices make such projects increasingly attractive. Munson Healthcare

Klickitat Valley Health: FEMA BRIC grant canceled. Solar + battery microgrid for entire hospital + adjacent school district. Trump administration canceled before construction started. Cautionary tale on federal funding risk. Tech Brew

Fleet Electrification

NHS: £4M for 1,000 EV charging sockets. Supporting 500 new electric ambulances. Decarbonizing 460 million journey miles. Fleet electrification is no longer an automotive procurement issue—it is a facility electrical infrastructure challenge requiring dedicated high-voltage trenching. GOV.UK

Codes & Standards

JCI 8th Edition: 1,551 standards cut to 774. Digital compliance shift. Assessors abandoning paper binders for digital QMS and LMS. Facilities without integrated digital tracking will struggle with 2026 readiness. emPower eLearning

Medical waste: e-manifests mandatory late 2026. Drain disposal of pharmaceutical waste banned (Subpart P). Aerosol cans reclassified as universal waste. Fines up to $75K/violation. 99% of US medical waste incinerators have shut since the 1990s. MedPro Waste Disposal

Joint Commission revised NFPA/CMS requirements. Effective March 1, 2026. Accreditation language, CMS requirements, and NFPA-based expectations continue to move together. Joint Commission

NFPA weekly update April 21–25. TIA 26-1 posted for NFPA 99 2026 edition. NFPA 72 first draft meeting July 1 for 2028 edition. HFM Magazine

Georgetown Climate Center: IRA for hospital boilers. Hospitals use 3x energy per square foot vs. typical offices. IRA can phase out fossil-fuel boilers, simultaneously slashing SO₂ and NOx. Boiler replacement is a direct community health intervention. Georgetown Climate Center

EPA EtO sterilizer rule reconsideration. Comment period ran through May 1. Tension between infection control, device supply, air toxics, and community risk is now a real facilities and supply-chain issue. EPA

Project Finance

Reusable device lifecycle carbon review. Systematic review confirms reusable devices have vastly lower lifecycle emissions than single-use. But the “carbon hotspot” shifts to central sterile processing—autoclaves, washers, water, energy. Reuse is not simple sustainability; it is an infrastructure commitment. PMC / Systematic Review

Crude oil driving up single-use medical plastic costs. Sustained $103–115/bbl oil prices inflating costs of petroleum-derived disposable medical supplies, further incentivizing circular economy procurement. EIA

Spanish-Speaking Americas

Dominican Republic: $80M net-zero hospital. Hospiten Punta Cana: 68-bed, 118,000 sf, targeting LEED Zero + WELL Platinum + net-zero energy. On-site solar, advanced efficiency. One of the Caribbean’s first net-zero hospitals. Medical tourism anchor. 16minutos

Brazil: Enel São Paulo R$9.7M for 4 public hospitals. Energy-efficiency modernization including HVAC, LED, and solar PV. Utility-regulated efficiency funds linked to hospital operational improvement. Enel

Costa Rica: Hospital Tony Facio procurement failure. No bidders for turnkey design-build contract. Contractors deterred by risk allocation and financial terms. Authorities re-evaluating procurement strategy. Governance matters as much as design. Delfino.cr

Europe

Hexham General Hospital (UK): £20M+ heat pump retrofit. Northumbria Healthcare NHS replacing gas/oil boilers with large air-source heat pumps + new HV substation. Public Sector Decarbonisation Scheme grant. Demonstrates how existing hospitals can be retrofitted for low-carbon operations. Salix Finance / NHS

Ealing Hospital (UK): £5.9M energy upgrade. Carbon reduction, cost savings, and energy resilience. NHS decarbonization tied to site-level infrastructure renewal. Salix Finance

EU desflurane ban effective January 2026. GWP ~2,540. One hour’s use = driving ~300 km in emissions. European hospitals have shifted to alternatives, yielding 27% drop in anesthesia-related emissions since 2014 with no impact on patient care. Medical process emissions as a decarbonization lever. EU regulation

Belgium: CHP at CHR de la Haute Senne. Luminus Solutions installed new CHP unit after efficiency improvements left existing boiler room oversized. Even as electrification grows, some hospitals find room for high-efficiency thermal/electric co-generation. A nuanced transition story. Luminus

Netherlands: national “Green Hospital” standard by 2027. Consortium of Dutch hospitals and engineering firms announced plans (April 28) for energy-neutral, climate-resilient design standard. Dutch consortium

BS 7671 Amendment 4: IHEEM webinar May 14. Equipotential bonding busbars, Group 1/2 medical locations, medical IT circuits. Electrical compliance in healthcare remains a live technical topic. IHEEM

IHEEM Wales Conference May 6–7. Theme: “Navigating Uncertainty – Contingency and Resilience in Healthcare Estates.” IHEEM

Africa

Kenya: Consolata Hospital Mathari microgrid. 765 kW solar + 783 kWh battery. Supplies up to 80% of electricity. Eliminates ~500 tons CO₂/year. Hospital exploring green hydrogen for medical oxygen next. One of the strongest African hospital energy projects this year. Consolata Hospital Mathari

Burundi: Aptech equips 5 additional health facilities. 20–65 kWp PV, 45–140 kWh storage per site. 16–17 hours/day power, covering 50–90% of energy needs. Published April 23, 2026. Ecofin Agency

Central African Republic: 3 health facilities get solar. Aptech Africa. 102 kWp combined across Bégoua, Bédé Combattant, and Boye Rabe Hospital. Only 15–17% of CAR population has grid access. Green Building Africa

South Africa Gauteng: ~10 MW solar across public hospitals. Installed since March to combat load-shedding. National authorities revising hospital design standards to encourage self-generation and microgrids. South Africa DOH

Sida/CHAI: solar for thousands of facilities. Sweden and Clinton Health Access Initiative partnership across South Africa, Eswatini, Malawi, Kenya. Blended finance model. “One in four primary health facilities in sub-Saharan Africa lacks electricity.” CHAI

AfDB: $9.6M SADC regional health resilience. Upgrading laboratories and health facility infrastructure in six countries. Pandemic preparedness and climate-resilient health systems. AfDB

Asia / Pacific

Queensland hospital wing: 1.2 MW solar + battery. Opened April 30. Cat 5 cyclone-rated. Campus microgrid. Projected 60% grid electricity reduction. Combining energy autonomy and climate resilience in design. Queensland Health

China: 300 off-grid rural clinics solar program. National health authorities launched April 27. Solar + battery systems by 2027. Improving electricity access and cutting diesel in remote areas. China MOH

India: MOH roundtable on climate-resilient healthcare. April 28, following up on ADB principles. Growing number of hospitals achieving LEED/GRIHA certifications. Solar, water recycling, waste reduction. India MOH / ADB

EU desflurane ban: global ripple. Many non-EU hospitals voluntarily following suit. 27% drop in anesthesia emissions. Medical gas management as a facility-level decarbonization tool with zero impact on patient care. EU / WHO

IFHE Global Connection

IFHE geothermal webinar May 13. “Future-Proofing Hospitals with Geothermal Heating & Cooling.” Featuring Mazzetti. IFHE

IFHE International Building Award 2026. Submissions deadline July 1. Recognizes exemplary new hospital builds or renovations demonstrating sustainable, resilient design. IFHE

IHEEM Wales Conference May 6–7. Contingency and resilience in healthcare estates. IHEEM

IHEEM BS 7671 webinar May 14. Amendment 4, medical locations, medical IT circuits. IHEEM

AMFP North Texas Healthcare Summit May 7. Regional healthcare built-environment leadership. AMFP

IFHE 2026 Congress registration live. October 17–20, New Orleans, co-located with HCD. Register

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

Calendar & What to Watch

May 6–7: IHEEM Wales Conference. iheem.org.uk

May 7: AMFP North Texas Healthcare Summit. amfp.org

May 12–13: Facilities & Campus Energy Summit, DC — Walt Vernon speaking May 12, 2:10 PM. facilitiesenergy.ascentisgrp.com

May 13: IFHE Webinar: Geothermal Heating & Cooling. ifhe.info

May 14: IHEEM BS 7671 Amendment 4 webinar. iheem.org.uk

May 19–20: IHEEM Northern Ireland Conference. iheem.org.uk

June 4–5: ZORG.tech Congress, Belgium. zorgtech.be

June 9–10: SAFHE 2026, Cape Town. safhe.co.za

July 1: IFHE International Building Award submissions deadline. ifhe.info

July 13: LDES in Healthcare Symposium, Salt Lake City — National Labs presenting. Email the author.

July 14–15: U.S. LDES Consortium Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Aug. 2–5: ASHE Health Care Facilities Innovation Conference. ashe.org

Oct. 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct. 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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Week of April 26, 2026 • Issue No. 7

This week’s strongest signal: hospitals are entering an era where infrastructure strategy matters as much as clinical strategy. Grid capacity, electrification, microgrids, project finance, procurement models, and aging-estate risk are converging. The question is no longer whether hospitals need better infrastructure—it is whether they can design, finance, and govern it fast enough.

From the Field

What I’ll Be Talking About on May 12

Next week, I will be speaking at the Facilities and Campus Energy Summit in Washington, DC.

Other speakers, by the way, include a large number of friends and colleagues – Mike Chihoski, VP, UCHealth; Steve Carberry, former VP Yale New Haven, Brian Weldy, former VP HCA Healthcare, and many many more.

I will be speaking from the perspective that design of healthcare energy infrastructure is no longer simply a technical exercise. Today, designing healthcare energy infrastructure – and doing it right - involves designing the technology systems, sure, but also, and often more important, the project finance systems, the resulting energy procurement systems, and the network of legal and regulatory systems that together, make the project work.

The macro pressures around us are moving much faster than our mental models, and it is time for us to understand those forces, and take advantage of changes that are opening before us.

In particular, the NFPA codes have been moving in recent years away from the antiquated notion that an infinite, reliable, inexpensive utility will be there most of the time, and that we just need to invest in an expensive insurance policy called a diesel generator for times when that utility fails. Today, an array of on-site energy systems can provide power to both sides of the transfer switch, giving us possibilities for radically different kinds of designs.

And, just in the nick of time. With the increasing rollout of building performance standards, all-electric codes, air quality management regulations, and similar legal pressures, healthcare buildings need this kind of flexibility. And with increasing loads on the electrical grid making that grid no longer infinite, reliable, and inexpensive, healthcare facilities need new solutions that take advantage of rapidly changing rate structures that will be increasingly coming down the pike.

I will talk a bit about what is happening in the NFPA codes that will help us. I will talk about a proposed new chapter for the International Green Construction Code on low-carbon on-site energy resilience systems, and the opportunities this will create. I will also discuss a new initiative I am working on to bring together a number of organizations including ASHRAE, The Joint Commission, and others to create an integrated standard for behind the meter energy resilience standard.

I recently submitted a paper to the National Academy of Medicine on how to finance Healthcare Decarbonization, together with Eric Berzon, retired Vice President and Assistant Treasurer at Kaiser Permanente, Robyn Helmlinger, Partner of Orrick, and Kate Sherwood, CEO of ZeroEnergy, and I will touch on some of these opportunities.

There is a lot of pressure on healthcare energy systems these days. Most healthcare owners tell me their priorities are resilience and cost, in that order. And, if they can get it, low carbon. Now, with emerging opportunities to integrate new technologies, new regulatory developments, new energy procurement strategies, and new project finance structures, we can do it all.

I hope to see you there!

Details: facilitiesenergy.ascentisgrp.com

— Walt Vernon

IFHE Global Scan

English-Speaking Americas

Key Signals

ERCOT demand forecast: a warning for every high-growth region. 367,790 MW projected demand by 2032 vs. 85,508 MW peak in 2023. 410 GW of large-load interconnection requests, 87% data centers. FERC intends to act by June. NERC launched Project 2026-02 for computational load reliability standards. Hospitals will compete with data centers for grid capacity. ERCOT forecast

Kaiser Permanente proposes all-electric replacement hospital in San Francisco. 300-bed, 623,000 sf, 14-story, all-electric. Replaces 1954 Geary campus. Construction 2028, completion 2033. Kaiser’s third all-electric hospital after Sacramento and San Jose. Connects seismic replacement, urban land use, electrification, and California decarbonization strategy. SF Chronicle / SFist

Reid Health: 3.75MW Tier 4 microgrid saving $625K/year. EPA Tier 4 certified PowerSecure microgrid guaranteeing 100% standby power through 160 hours of strategic peak operation. Resilience first, then ROI. A microgrid is not a backup system—it is an active financial asset. PowerSecure case study

DOE backs Montezuma County Hospital BESS. Federal support for microgrid controller + battery capable of islanding entire campus load at a rural Colorado hospital. A signal that BESS is taken seriously beyond academic medical centers. DOE project page

FERC demand response / aggregator rules on April agenda. Revisiting the DR opt-out framework. Hospitals wanting to participate in aggregated demand response live downstream of these governance choices. Perkins Coie analysis

California Load Management Standards: implementation reports filed. CEC Docket 23-LMS-01. Signal-responsive load shifting becoming operational—exactly what hospitals need as electrification grows. CEC docket log

ASHRAE/ASHE Guideline 43: ventilation as managed program. Companion to 170-2025. Shifts from “meet the spec at turnover” to “demonstrate ongoing performance.” Affects commissioning, monitoring, and maintenance staffing. ASHRAE

Essential vs. non-essential / on-site vs. off-site: NEC terminology shift. From 2026, NEC framing moves to Essential Electrical System vs. non-essential, on-site vs. off-site sources. On-site can be used “anytime”—enabling demand response and peak shaving, not just backup. IAEI Magazine

Construction & Capital Projects

JPS Health Network (Fort Worth, TX): $1.5B, 1.1M sf hospital within a $2.5B master facility plan. Completion 2030. KERA / Fort Worth Report

HCA Florida Ocala: $200M expansion—seven-story tower, 62 private rooms, new central utility plant. Ocala-News

WVU Medicine: $350M+ in 2026 capital across WV, MD, OH. Three-year total exceeds $1.2B. WVU Medicine

HSHS Green Bay: $270M overall; $17.2M NICU at St. Vincent Children’s. Private room conversion. The Business News

Catholic Medical Center (Manchester, NH): $27M infrastructure modernization (electrical, HVAC, elevators, fire safety). The “unsexy but decisive” category. CMC

Samaritan Healthcare (Moses Lake, WA): $225M replacement hospital, 174,000 sf, three-story. Rural replacement remains a sustained construction category. Terrapin CG

Gundersen/Bellin (Emplify Health) + Xcel Energy (WI): All-renewable microgrid with islanding, expected complete 2026. Battery + solar + landfill gas. Gundersen Health

Outpatient now 40%+ of U.S. healthcare construction. Ambulatory surgery centers and cancer hubs dominating capital, shifting investment from centralized mega-campuses. Roche Constructors analysis

Project Finance & Energy Procurement

HFMA: 41% of systems cutting capital; AI is #1 priority. ROI now the critical factor for 77% of purchasing decisions (up from 50%). Growth projects lead; infrastructure competes. For energy projects, this means EaaS, C-PACE, and off-balance-sheet structures are not optional—they are the only path to deployment for most systems. HFMA Fast Finance

C-PACE now available in 30+ states for healthcare. Commercial Property Assessed Clean Energy financing enables hospitals to fund energy efficiency, resilience, and renewable energy improvements through property tax assessments—no upfront capital, no competition with clinical priorities. A key tool for addressing deferred infrastructure maintenance. SitelogIQ C-PACE guide

IRA direct pay for non-profit hospitals. The Inflation Reduction Act’s elective pay provisions allow tax-exempt hospitals to receive direct payment for clean energy tax credits (ITC, PTC) that were previously available only to for-profit entities. This fundamentally changes the economics of solar, storage, and microgrid deployment for non-profit health systems. IRS / Treasury

Solar PPA pricing: $28–42/MWh through 2027. BloombergNEF projects U.S. solar PPA prices will remain in the $28–42/MWh range. VPPAs offer non-profit hospitals financial settlement without physical delivery. Multi-buyer aggregated PPAs (like the Energize pharma/healthcare cohort) are reducing procurement costs and risk for institutional buyers. BloombergNEF / Sustainability Atlas

Canada

Ontario healthcare pipeline: 25 projects in pre-procurement or active procurement, combined estimated value exceeding C$30B. Infrastructure Ontario

South Niagara Hospital: 1.3M sf, structural work expected complete April 2026. Major scale and regional transformation. South Niagara Hospital

Peel Memorial Phase 2: Progressive contracting model—early engagement, risk management. Bird Construction

Caribbean

Grenada Project Polaris: Broke ground late March 2026. New general hospital with Mount Sinai partnership, replacing St. George’s General Hospital. Completion 2029. One of the Eastern Caribbean’s most significant healthcare projects. Government of Grenada

Sint Maarten Medical Center: Government intervened to ensure labor permits and financial oversight for island’s largest infrastructure project amid supply chain and cost inflation. Soualiga Newsday

Spanish-Speaking Americas

Key Signals & Projects

Peru: $3.3B healthcare PPP portfolio. PROINVERSIÓN 2026 pipeline includes New Central Military Hospital ($751M, 30-year concession). Puno hospital modernization signed under France G2G (296 beds, 7 ORs). Piura/Trujillo high-complexity hospitals by 2028. Andina / PROINVERSIÓN

Brazil: smart public hospital + IDB guarantee. First smart public hospital linked to SUS (2026–2029). IDB approved first guarantee for a hospital PPP in Mato Grosso do Sul—multilaterals using guarantee structures to support hospital PPPs. BNamericas

Colombia: Hospital San Juan de Dios revival. $430M (1.6 trillion pesos) to revive Bogotá’s historic hospital complex after 20+ years of closure. 24 buildings, 16 hectares. Restoring legacy healthcare assets, not just building new. Reuters / Colombia

Colombia-Netherlands fossil fuel transition summit. Santa Marta, April 24–29. Not healthcare-specific but may influence regional energy policy affecting hospital costs and renewables. Government of Colombia

Europe

Key Signals

Glasgow QEUH: £50M+ spent on construction remediation. Water and ventilation problems at Queen Elizabeth University Hospital, excluding public inquiry costs. Cautionary case on design quality, infection risk, commissioning, accountability, and lifecycle cost. BBC Scotland

EU Horizon Europe 2026: climate-resilient healthcare. Health calls include carbon-neutral and climate-resilient healthcare systems as funded research topics. Decarbonization entering EU research/policy mainstream. European Commission

Healthcare Estates 2026 (Manchester, Oct. 13–14). IHEEM theme: “Mind the Gap: Are We Heading for a Two-Tier Estate?” Net Zero Innovation and Sustainable Achievement awards. IHEEM

NHS Scunthorpe goes geothermal. CeraPhi Energy awarded contract to deliver geothermal heating via repurposed 550m borehole, integrated into new energy centre and heat network. ThinkGeoEnergy

FKT promoting IFHE. FKT posted item pointing German healthcare engineers to IFHE. Active 2026 program: digital infrastructure, Gelsenkirchen conference (Sept. 30–Oct. 1), innovation prize (due July 31). FKT

ZORG.tech Congress (Belgium, June 4–5). Continuing Belgian/European healthcare technology convening. ZORG.tech

EU refrigerant cliff hits hospital chillers. Accelerated F-gas phase-out impacting hospital chiller procurement starting late 2026. Natural refrigerant transition (ammonia, CO₂, propane) requires new safety protocols and mechanical room ventilation. European Commission F-gas

Prefabrication as baseline: global shift. MEP racking, bathrooms, and modular headwalls officially standard for major contractors. Engineers must finalize equipment specs months earlier. ASHE / HFM survey

Africa

Key Signals & Projects

Côte d’Ivoire: €241M UKEF for 6 new hospitals. UK Export Finance backing design, construction, and equipping in Bouaké, Boundiali, Katiola, Kouto, Minignan, and Ouangolodougou. Export credit agencies remain vital for Francophone Africa healthcare. GOV.UK

Nigeria: N27.3 trillion pension debate for hospital PPPs. Legislative debate to unlock institutional pension assets for “Health Infrastructure Bonds” with AfDB first-loss guarantees. If realized, a transformative financing mechanism. Pension Policy International

Nigeria NERC Mini-Grid Regulations 2026. Framework covering up to 5 MW isolated, 10 MW interconnected. Clearer permitting for health facility PV + battery systems. BusinessDay Nigeria

Ghana: 2026 budget hospital program. 6 new regional hospitals, 10 Agenda 111 completions, 4 resumed abandoned projects. Tamale Teaching Hospital cardiology centre under construction. GhanaWeb

Burundi: UNDP solar health facility rollout. Phase 2 commissioning 9 hospitals in April 2026 (45 kWp PV, 115 kWh BESS per site, 12–25 hours backup). Covers ~20% of district hospitals nationwide. UNDP

SAFHE 2026 (Cape Town, June 9–10). Theme: “Synergy in Action: Shaping the Future of Healthcare Together.” Engineers, architects, clinicians, infection specialists, facility managers. SAFHE

Asia / Pacific

Key Signals & Projects

Queensland Coomera Hospital (Australia): A$2.55B, 600-bed staged delivery (400 beds by 2031, 200 by 2032). Emergency, ICU, OR, maternity, mental health, oncology, ambulatory. Queensland Government

Sydney Adventist Hospital (Australia): $690M Wahroonga Estate campus redevelopment. New hospital facilities, residential towers, campus transformation. Sydney Adventist Hospital

Mount Barker Hospital (SA, Australia): $365.8M redevelopment, tripling inpatient capacity from 34 to 102 beds. SA Health

Victoria New Melton Hospital (Australia): 274-bed new hospital, 700+ direct construction jobs. Victorian Government

Singapore Mount Elizabeth: S$350M Project Renaissance completed—first major campus overhaul since 1979. AI-enabled systems, complex-care capacity, digital innovation. Mount Elizabeth Hospital

Singapore: new eastern private hospital land release. First new private hospital site in nearly 20 years. Singapore using infrastructure planning, design standards, and capacity expansion together. Singapore MOH

Singapore Healthcare Facility Design Standards. Faster, more consistent, technology-enabled delivery. Links construction standardization, smart design, and digital infrastructure. Singapore MOH

India Victoria Hospital Q-block (Bengaluru): 10-storey, 629-bed addition opening May 2, 2026. General wards, OR complex, helipad. Indian Express

India NewEra Hospitals (Nagpur): Premji Invest-backed expansion from 350 to 800 beds. Three new hospitals. Quaternary care outside major metros. Economic Times

Hong Kong hospital expansion: 20-storey block adding ~1,500 beds. Drone-enabled construction monitoring on live healthcare campus. Leighton Asia

JCI 8th Edition: sustainability in accreditation. Effective Jan. 1, 2025. Includes Global Health Impact chapter. JCI Sustainable Healthcare Certification available to non-accredited organizations outside U.S. JCI

IFHE Global Connection

LDES for Healthcare Summit: National Labs secured. Agreement with U.S. National Laboratories to present at July 13 one-day symposium in Salt Lake City. LDES moving from grid strategy into facility-level planning. Email the author for information. LDES Consortium

IFHE 2026 Congress registration live. 29th IFHE World Congress, October 17–20, New Orleans, co-located with HCD Conference + Expo. Register here

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

Signal Bank

Parked for future issues.

All-Electric Hospitals: Peace Island Medical Center record correction (standalone piece). Kaiser Sunnyside, Kaiser Ontario, Kaiser SF proposed. Trend tracking.

Water-Energy Nexus: Mexico City greywater mandates. South Africa ESG water disclosures. California 72–96 hour requirement. ASHRAE 189.3 water resilience task force (author leading).

Refrigerant & Thermal: ASHRAE 170 decoupling debate. UAE AI-dynamic tariffs. India solar absorption chillers.

Climate, Finance & Hedging: NAM financing paper. California insurance +41–88% by 2035. VCH Phase 2 unfunded. Direct Relief Florida microgrids. Carbon market AB 1911. CARB cap-and-invest (May 28).

Grid-Interactive: California V2G fleet pilots. Data centers as grid assets. California regulators vs. data center diesel. Large-load tariff proliferation. Maine data center ban.

Smart Hospitals & Cybersecurity: NFPA 99 cybersecurity. Circularity / medical equipment lifecycle (ASHRAE/UCOP). QMS digital patient tracers for JCI.

Calendar & What to Watch

May 4–7: IEEE PES T&D, Chicago. ieee-pes.org

May 6–7: IHEEM Wales Conference, ICC Newport. iheem.org.uk

May 12–13: Facilities & Campus Energy Summit, DC — Walt Vernon speaking May 12, 2:10 PM. facilitiesenergy.ascentisgrp.com

May 13: IFHE Webinar: Geothermal Heating & Cooling for Hospitals. ifhe.info

May 19: FKT: Li-ion battery safety in healthcare. fkt.de

June 4–5: ZORG.tech Congress, Brussels Gate, Belgium. zorgtech.be

June 9–10: SAFHE 2026, Cape Town. safhe.co.za

July 13: LDES in Healthcare Symposium, Salt Lake City — National Labs presenting. Email the author.

July 14–15: U.S. LDES Consortium Annual Meeting, Salt Lake City. ldesconsortium.sandia.gov

Sept. 30–Oct. 1: FKT Conference, Gelsenkirchen. Innovation prize apps due July 31. fkt.de

Oct. 13–14: IHEEM Healthcare Estates, Manchester. iheem.org.uk

Oct. 17–20: 29th IFHE World Congress + HCD, New Orleans. Register: hcdexpo.com

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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Where Healthcare Infrastructure Meets the Climate Imperative

Week of April 19, 2026 • Issue No. 6From the Field

From the Field

When I was in college, I had never travelled west of the Mississippi. One of my best friends went to Stanford, and he told me once that the world begins and ends in San Francisco. Growing up in Texas and Kansas, and going to school and beginning my career in Tennessee, California always seemed like a mystical, faraway place. But, in 1992, I moved to California, and I have been working there ever since.

Some people say that a lot of things start on the West coast, and then migrate to the rest of the country. A PricewaterhouseCoopers analysis of five years of electric vehicle sales data found that most U.S. states lag California by approximately five years in EV adoption. For building codes, grid market structures, and financing frameworks, the lag tends to be longer. The pattern repeats across virtually every energy domain: California moves, and the country follows, usually within a decade. I have some friends in other states who like to remind me that more people are leaving California these days than coming in. They like to remind me of some of the things that California tries that don’t work.

But that is exactly the point. I think we know, in California, that we don’t have everything figured out. We don’t pretend to have all the answers. But what we do have is a determination to constantly push the boundaries, and to pursue the best science to seek new and better answers, often almost as an act of resistance to the inertia of “the way we’ve always done it.” In 2017, as the Federal Government threatened to shut down the satellites that were being used to study the changing climate, then Governor Jerry Brown declared that “We’ll launch our own damn satellites.”

Through the years, at Mazzetti we have been fortunate to be the engineers for several projects funded by the California Energy Commission. We have been able to design the CEC Pilot projects for every renewable energy microgrid designed to power the essential electrical system for a hospital. Most recently, we are working with the CEC and Valley Children’s Hospital on a possible grant to help VCH to develop what we hope will be the largest single Long Duration Energy Storage behind-the-meter system at any hospital in the world. And, as I have written previously, I am fortunate to be working now with David Hochschild from the CEC on our microgrid in Burundi. That hospital, using only solar and micro-hydro and batteries, is now 100% off the grid, uses almost no fossil fuels, and has almost no power outages. All of these projects have helped provide proof of concept that we can drive forward regulations, technologies, and solutions in ways that make things better for everyone.

Years ago, when VCH first hired me to help them develop their energy strategy, we talked about timing of investments in the microgrid I recommended. We debated the fact that installed costs continue to fall, so maybe it’s smart to wait until things are cheaper, and all of the technology is figured out. But we also talked about the facts that it is very difficult to predict future energy costs, but that the trends are pointing in a consistent direction. And we decided that we would save more in the long run by acting now. Those decisions are already proving correct, and these advantages will grow and compound over time, as the very real pressures on our California grid accelerate.

This week, I attended the California Clean Energy Summit. This meeting brought together policy makers, entrepreneurs, financiers, utilities, community choice aggregators – the full panoply of people who are, as we speak, creating new models for our utility systems. I went as a participant, and to learn more about what others are doing, and what is on the horizon for the future for all of us.

California continues to press forward on its aggressive climate goals; some of the most aggressive in the world. We continue to build sub-national climate agreements with the rest of the world. Like the rest of the country, we see an increasingly fragile electrical grid, especially as inverter-based resources create volatility that the grid was not designed to handle. We see capital migration; SunWest Bank talked about the fact that they have increased microgrid investment 300% since 2024, partly because the OB3 preserved the 30% Investment Tax Credit for battery storage.

At the same time, demand is rising, and transmission is not. Transmission and Distribution costs are growing at 10% compounded annual growth rate, and we cannot build it fast enough. This is, and will, create greater costs even as we face a collective affordability problem.

All of this means acceleration of behind-the-meter energy systems for healthcare will be the right answer.

I am glad that I have been fortunate to be part of a conversation among people who know we don’t have all the answers, but who are determined to do better, nonetheless. I am glad because it can help all of us.

— Walt Vernon

Key Signals This Week

1. The energy cost data is getting harder to ignore. New LBNL/Brattle analysis shows commercial electricity prices rose from 10.7¢/kWh in 2019 to 13.4¢/kWh in 2025—a 25% increase driven not just by fuel, but by distribution, transmission, new generation, storm recovery, and capacity costs. EIA now expects U.S. electricity demand to rise 1.2% in 2026 and 3.3% in 2027, with commercial-sector growth reaching approximately 6% in summer 2027. Diesel is expected to peak above $5.80/gal in April and average $4.80/gal for 2026. Brent crude is forecast at $96/barrel due to Hormuz disruption. U.S. LNG exports hit a record 11.7 million metric tons in March. Gas storage is comfortable (1,900 Bcf, 3% above average)—but electricity demand and diesel exposure are where the real pressure is building.

2. FERC to act on large-load interconnection by June. On April 16, FERC said it will decide by June on the large-load interconnection docket—aimed at timely, orderly integration of data centers and other major loads into transmission infrastructure. For hospitals, this matters because utility posture, queue timing, and local grid economics are increasingly shaped by non-healthcare load growth. NERC’s January 2026 Long-Term Reliability Assessment confirms tightening resource-adequacy conditions nationwide.

3. VCH Phase 2 LDES unfunded after federal cuts. Valley Children’s Hospital’s microgrid Phase 1 (solar, fuel cells, short-duration batteries) remains on track for 2026 commissioning. But Phase 2—long-duration storage, designed with Sandia National Laboratories and believed to be the largest hospital battery system in the world—has lost its federal funding source. State support may be in play. This is the LDES financing bottleneck in real time: the technology works, the design is done, and the money is the constraint.

4. Big capital is still moving—with utility plants locked in. JPS (Fort Worth) broke ground on a $1.5B, 1.1M sf hospital within a $2.5B master plan. HCA Florida Ocala announced a $200M expansion including a new central utility plant. WVU Medicine announced $350M+ in 2026 capital projects across multiple states. Kent Hospital (RI) is financing modernization through HUD FHA Section 242. The pattern: utility plant infrastructure is being designed in from day one, not bolted on later. That’s the wedge where electrification, thermal strategy, and resilience can be positioned upstream. Yet HFMA reports many systems plan to cut capital spending while prioritizing AI—raising the question of whether resilience gets funded or deferred.

5. Gundersen/Bellin: another operational hospital microgrid. Emplify Health (Gundersen/Bellin) and Xcel Energy describe an all-renewable energy microgrid expected complete in 2026, integrating a new battery system with existing solar and landfill-gas energy partnership. The system has explicit islanding capability. This is another proof point joining Kaiser Ontario, KVH, and VCH in the growing portfolio of operational hospital microgrids.

6. EU refrigerant cliff hits hospital chillers. The European Commission has formalized an accelerated timeline to ban high-GWP fluorinated greenhouse gases in new commercial cooling equipment, heavily impacting hospital chiller procurements starting late 2026. Facility directors must pivot capital planning toward chillers using natural refrigerants (ammonia, CO₂, propane)—which require significantly different safety protocols, leak detection, and mechanical room ventilation. This is a near-term capital planning disruption for every European health system.

7. Mexico City mandates hospital greywater reuse. In response to unprecedented municipal water rationing, local health authorities are mandating that all acute-care facilities over 100 beds capture, treat, and reuse 100% of non-clinical greywater for cooling tower make-up and landscape irrigation. Facility engineers must retrofit dual-piping systems and install decentralized membrane bioreactors. Water resilience is becoming as critical as power resilience—and ASHRAE 189.3 is considering similar on-site water requirements (the author is leading the task force).

8. California hospitals pilot V2G fleet integration. Three major California health systems have launched pilots to transition non-emergency transport fleets to EVs with bidirectional chargers, using vehicles to shave peak electrical demand during the afternoon ramp. Electrical engineers must redesign campus parking and charging infrastructure to interact with hospital microgrid controllers—treating fleet vehicles as a dynamic component of the facility’s BESS. Hospitals are transitioning from passive electricity consumers to active grid participants.

9. NHS Scunthorpe goes geothermal. CeraPhi Energy was awarded a contract to deliver geothermal heating at Scunthorpe General Hospital by repurposing a 550m borehole, with integration into a new energy centre and heat network. This is a concrete, operational example ahead of IFHE’s May 13 webinar on geothermal heating and cooling for hospitals.

IFHE Global Connection

From IFHE

IFHE published a Newsletter Extra on April 9, promoting the glazing webinar, noting that past webinar recordings are being prepared for member viewing, welcoming Grundfos as a new affiliate partner, and encouraging participation in the 29th IFHE World Congress in New Orleans (October 17–20, 2026, co-located with the Healthcare Design Conference + Expo, hosted by AMFP and EmeraldX).

IFHE 2026 Awards update. The Cut the Carbs Award now recognizes both absolute performance and improvement—a significant shift toward measured energy outcomes rather than narrative sustainability. A New Buildings Award is also launching in 2026 with explicit focus on measured energy performance. Country-level and global top performers will be recognized at the New Orleans Congress.

IFHE’s webinar on high-performance glazing systems in healthcare buildings was held April 8–9.

From IFHE Members

IHEEM (United Kingdom) had the busiest visible week among IFHE members. Public items included a groundbreaking ceremony for the South East Wales Diagnostics and Treatment Centre; a major upgrade for Musgrove Park Hospital’s nuclear medicine department; a report that emergency repairs are consuming up to half of NHS maintenance budgets; a Greater Manchester Pension Fund / BlackRock healthcare investment venture; and a free webinar on BS 7671 Amendment 4 scheduled for May 14.

IHEA (Australia) amplified the IFHE glazing webinar and posted a sector roundup noting steady investment in hospital upgrades, mental-health infrastructure, and demand tied to ageing populations. IHEA also circulated the NZIHE Annual Conference 2026 call for presentations (November, Auckland).

CHES (Canada) posted an April 1 webinar on infection prevention and control in construction for long-term care, and has an active spring conference calendar: Maritime Chapter (early May), Manitoba (May 14), BC Chapter (May 31–June 2), and the National Conference in September.

AMFP (United States) has an active spring event calendar including gatherings in Colorado (April 16), St. Louis (Schneider Electric Healthcare Showroom Tour, April 14), Houston (Adaptive Reuse: Transforming Legacy Buildings, April 16), Arizona (April 23), and Charlotte (April 22). AMFP is the U.S. host partner for the 2026 IFHE World Congress.

AEIH (Spain) has its 42º Congreso Nacional de Ingeniería en el Sector de la Sanidad upcoming in Málaga.

FKT (Germany) has an online seminar on hospital ventilation systems scheduled for April 21.

SAFHE (South Africa) is preparing for the SAFHE 2026 Conference on June 9–10 in Cape Town.

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

Looking Ahead

May 12–13: Facilities & Campus Energy Summit, Washington, DC

I will be speaking at the 6th Annual Facilities & Campus Energy Summit on May 12 in Washington, DC. My session—“Powering Health Care Infrastructure with Long Duration Energy Storage, Microgrids and More”—runs 2:10–2:40 PM on Day 1. I’ll cover the regulatory changes enabling on-site energy sources for Essential Electrical Systems, the different forms of LDES and their characteristics for the healthcare setting, evolving microgrid configurations, and the first installation of LDES in a hospital essential electrical system.

The summit brings together leaders from higher education, healthcare systems, federal facilities, and life sciences campuses who share the challenges of large energy footprints, critical power needs, and a mix of old and new buildings. The healthcare panel earlier that morning features Mount Sinai, Kaiser Permanente, UCHealth, Jefferson Health, and Baylor Scott & White. A Goldman Sachs / KeyBanc / RBC Capital Markets financing panel follows in the afternoon. NREL’s thermal storage research and a FuelCell Energy microgrid case study flank my session.

If you work in healthcare facility energy and will be in DC that week, I’d welcome the chance to connect. Campus and facility owners/operators attend complimentary. Details: facilitiesenergy.ascentisgrp.com

July 13: LDES for Healthcare Symposium, Salt Lake City

We are planning a one-day symposium on LDES in healthcare on July 13, preceding the U.S. Long Duration Energy Storage Consortium’s final Annual Meeting (July 14–15) in Salt Lake City. We are aiming to make it free or nominal cost for healthcare owners. Agenda and registration details are forthcoming. If you are interested in attending, speaking, or contributing case studies, please email me.

Codes, Standards & Regulation Watch

United States

FERC large-load interconnection: decision by June 2026. April 16 announcement. Aimed at timely integration of data centers and other major loads into transmission. Shapes utility posture and grid economics for hospital microgrids. NERC’s January 2026 reliability assessment confirms tightening resource adequacy nationwide.

NYSERDA EBC:Hospitals webinar April 22. The $20M Empire Building Challenge for hospitals (covered last issue) has an informational webinar on April 22 at 10 AM ET. Up to $5M per hospital. Proposals due September 15. Contact EBChospitals@nyserda.ny.gov. Prioritizing disadvantaged communities.

HFMA: systems cutting capital, prioritizing AI. April 14 survey report says many health systems plan to reduce capital spending while prioritizing AI-based clinical technology. For infrastructure teams, this raises the question: does resilience get funded or deferred in the next budget cycle?

International Codes & Standards

EU Energy Efficiency Directive: mandatory audits by October 2026. Under Directive 2023/1791, facilities with annual energy consumption above 10 terajoules must complete mandatory, independent energy audits by October 2026. By October 2027, facilities above 85 TJ must implement a certified energy management system (ISO 50001 or equivalent). Hospitals are explicitly included as commercial-sector energy users. Annual energy savings obligations rise to 1.5% in 2026–2027 and 1.9% in 2028–2030. The public sector must reduce consumption by at least 1.9% per year and renovate at least 3% of total floor area annually. This is the most consequential regulatory development for European hospital energy management in a decade.

EU Energy Performance of Buildings Directive: transposition deadline May 29, 2026. Member states must transpose the revised EPBD into national law by late May 2026. The directive targets greenhouse gas reduction, energy consumption, and renovation of worst-performing buildings. For hospitals operating in multiple EU jurisdictions, compliance timelines are imminent.

EU post-2030 energy efficiency framework: consultation open. The European Commission launched a 12-week public consultation (closing June 12, 2026) to shape energy efficiency rules for the decade ahead. The legislative proposal is scheduled for Q4 2026. Separately, an Electrification Action Plan for heating and cooling is expected Q1 2026, and Energy Efficiency and Renewable Energy Framework revisions are expected Q3 2026. The Environmental Omnibus Proposal simplifies compliance for industrial emissions, medium combustion plants, and battery regulations—with direct impact on hospital CHP, backup power, and BESS installations.

Australia: Victoria mandates all-electric healthcare infrastructure. The Victorian Health Building Authority (VHBA) now requires all-electric infrastructure for healthcare facilities under 10,000 m². Larger facilities must include a plan to transition away from natural gas. Victoria’s goal is 100% carbon-neutral renewable electricity for public hospitals. NABERS (the National Australian Built Environment Rating System) is expanding to hospitals before 2030—133 Victorian public hospitals participated in the 2024 NABERS Sustainable Portfolio Index. A federal program to extend Commercial Building Disclosure to hospitals is being planned.

Academic signal: hospitals as “industrial-scale energy hubs.” A January 2026 paper in Scientific Reports proposes reclassifying hospital energy demand toward industry-like requirements, arguing that the current tertiary-sector classification results in less stringent regulations despite hospitals frequently consuming more energy than other commercial buildings. The proposed hybrid regulatory framework would bring industrial-level energy audits, performance benchmarks, and financial incentives to healthcare—an argument that aligns directly with IFHE’s positioning of healthcare infrastructure as mission-critical climate infrastructure.

UK: NHS England and IHEEM introduce Authorising Engineer register. As of April 15, NHS trusts in England were formally notified that practising Authorising Engineers advising on NHS infrastructure will need IHEEM Registered Authorising Engineer certification and inclusion on a central register. The change is expected to be reflected in the revised HTM 00. This is a significant governance signal: the UK is tightening professional standards for the people who sign off on healthcare infrastructure safety.

India: hospital solar procurement accelerating. Quality Care India signed solar-power agreements with AMPIN Energy and Radiance Renewables for hospital facilities in Odisha, Chhattisgarh, and Maharashtra. Combined with Asia-Pacific’s position as the fastest-moving region on healthcare decarbonization (BMJ analysis, per earlier scan), India’s hospital renewable procurement is becoming a concrete trend.

Fiji: climate-resilient health facility upgrades. WHO reported KOICA-supported renovation of a critical health facility including solar panels, power-system upgrades, and new roofing, explicitly linking the work to climate resilience. Pacific island nations remain the front line of climate-health infrastructure adaptation.

Netherlands: Green Deal on Sustainable Healthcare 3.0. Over 200 hospitals and care institutions have signed the updated voluntary commitment, targeting 55% emissions reduction by 2030 and net zero by 2050. The deal now includes the pharmaceutical industry and covers circular healthcare, medication environmental impact, and staff health promotion—one of the most comprehensive national healthcare decarbonization frameworks in the world (OECD, 2025).

Norway: mandatory hospital emissions dashboards. All Norwegian hospitals comply with ISO 14001 environmental certification. The Directorate for Health publishes an online dashboard covering Scopes 1, 2, and 3 emissions for hospitals and specialist services—making Norway one of the only countries with fully transparent, mandatory hospital emissions reporting (OECD, 2025).

Major Projects & Construction

JPS Health Network (Fort Worth, TX): Broke ground on a $1.5B, 1.1M sf hospital within a $2.5B master facility plan. Completion targeted for 2030. Funding beyond the original bond coming from operational budget.

HCA Florida Ocala Hospital: $200M expansion adding 470,423 sf, a new patient tower with 62 private rooms, a new central utility plant, and an 806-space parking garage. Construction starting later in 2026. Note the embedded utility plant—that’s where electrification and resilience get locked in.

WVU Medicine: $350M+ in 2026 capital projects across West Virginia, Maryland, and Ohio, including a new patient tower at Camden Clark. Three-year total exceeds $1.2B in approved capital improvements.

Kent Hospital (Warwick, RI): Multi-phase modernization (ambulatory services building, cath lab expansion, ED upgrades) financed through HUD FHA Section 242. An alternative financing model worth watching.

Gundersen/Bellin (Emplify Health) + Xcel Energy (Wisconsin): All-renewable energy microgrid expected complete in 2026, integrating new battery system with existing solar and landfill-gas energy partnership. Explicit islanding capability.

NHS Scunthorpe General Hospital (UK): CeraPhi Energy awarded contract to deliver geothermal heating by repurposing a 550m borehole, with integration into a new energy centre and heat network.

Valley Children’s Hospital (Madera, CA): Phase 1 microgrid (solar, fuel cells, short-duration batteries) on track for 2026 commissioning. Phase 2 long-duration storage has lost federal funding; state support potentially in play.

UF Health Shands (Gainesville, FL): Recently completed inpatient dialysis expansion—highlighting the energy intensity of 24/7 specialty care spaces, cited as a case example in 2026 healthcare energy planning.

Sources: KERA/Fort Worth Report; Ocala-News.com; WVU Medicine; RINewsToday; Gundersen Health; ThinkGeoEnergy; Valley Children’s; HCO News.

Calendar & What to Watch

April 15: Ghana Free Primary Healthcare Programme launch

April 16: AMFP Colorado gathering; AMFP Houston: Adaptive Reuse

April 21: FKT (Germany) online seminar: hospital ventilation systems. fkt.de

April 22: CHES webinar: Energy and Sustainability. ches.org | NYSERDA EBC:Hospitals webinar, 10 AM ET. nyserda.ny.gov

May 4–7: IEEE PES T&D Conference & Exhibition, Chicago. ieee-pes.org

May 4–15: IHEEM Healthcare Facility Planning Course (online). iheem.org.uk/events

May 6–7: IHEEM Wales Regional Conference, Exhibition and Awards, ICC Newport. iheem.org.uk

May 12–13: Facilities & Campus Energy Summit, Washington, DC — Walt Vernon speaking May 12, 2:10 PM. facilitiesenergy.ascentisgrp.com

May 13: IFHE Webinar: Future-Proofing Hospitals with Geothermal Heating & Cooling. ifhe.info

May 14: IHEEM free EBB webinar. iheem.org.uk | CHES Manitoba Conference. ches.org

May 19: FKT webinar: Lithium-ion battery safety in healthcare settings. fkt.de

June 9–10: SAFHE 2026 Conference, Cape Town. safhe.co.za

June 17: CHES webinar: The Resilient Hospital: Future-Proofing Critical Healthcare Systems. ches.org

July 13 (planned): LDES in Healthcare Symposium, Salt Lake City — email the author for information

July 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

August 10: California SB 253 first Scope 1 & 2 reporting deadline

October 17–20: 29th IFHE World Congress + HCD Conference, New Orleans. amfp.org/IFHE2026

November 2026: NZIHE Annual Conference, Auckland — call for presentations open

On the Reading List

• Energy Service Contracts Grow as Operators Spread Costs (Facilities Dive, Apr. 9)

• AES Pulls Battery Project Near Palomar Medical Center (Canary Media, Apr. 9)

• NAM Climate and Health Summit 2026

• NFPA 800: Battery Safety Code (FacilitiesNet)

• Princeton Medical Center: A Cancer Center for Healing Patients and the Planet (Penn Medicine)

• NYS Empire Building Challenge: $20M for Hospital Electrification

• WHO World Health Day 2026: Stand with Science

• Facilities & Campus Energy Summit 2026 Agenda

• Subscribe to the IFHE Newsletter

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

Subscribe to the IFHE Newsletter

Week of April 12, 2026 • Issue No. 5

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From the Field

Thank You, National Academies, and Dr. Dzau

Four years ago, I was privileged to be asked by the National Academies of Science, Engineering, and Medicine, NASEM, to write a paper suggesting ways that the National Academy of Medicine, NAM, could address the existential health crisis represented by humanity’s collective impact on the climate. Doing so was one of the highlights of my professional career. I asked my friends Don Berwick and Eric Berzon to be co-authors. I assembled three circles of experts; one focused on how to redesign health delivery; one focused on how to deliver the infrastructure that supported that mission, and one focused on how to lead and pay for the needed transformation. Our work and our paper helped to frame NAM’s President, Dr. Victor Dzau, to launch his Action Collaborative to Decarbonize, and, now, to also strengthen the US Health Sector against the increasingly obvious impacts of the changing climate.

This week, NASEM held its Annual Gathering, at its Washington, D.C. Headquarters, bringing together a wide group of healthcare professionals from around the country to discuss our next year’s work. I always feel a kind of awe, when I am able to enter that space.

Over time, NAM’s Dr. Dzau has done a remarkable job of assembling a group of climate and health experts, committed not only to studying the issue, but to taking action to change our trajectory. Through the years, I have met, become friends with, deepened friendships with, found inspiration from, and found ways to make a difference in this community. I read recently that religion requires communal worship, and that social movements benefit from a similar kind of social effervescence. What is most sacred about this social effervescence, though, is that it is deeply grounded in science, in its best form.

At the same time we were meeting though, others in the US were meeting, declaring that the climate crisis is “a sham,” and response is “alarmism,” and creating a long-running climate misinformation ecosystem. This movement, with its own cult-like social dynamics organized around opposition to mainstream science and climate policy, was having its gathering at the same time, last week.

Every time I go to the NASEM temple of truth, I spend a bit of time at their statue of Albert Einstein. It is often difficult, as it seems to be very popular. It is especially popular with groups of school kids, who like to rub the statue’s nose, for good luck. When I am there, I rub a different nose. Surrounding the statue are a number of symbolic carvings and quotes. One that I always stand before, and ponder, is that “The right to search for truth implies also a duty; one must not conceal any part of what one has recognized to be true.”

Thank you, Albert. Thank you, NAM. Thank you NASEM. Thank you to the many many colleagues I have who have been inspired by the collective commitment to what science recognizes as true. Now, as Dr. Dzau designed, let us redouble our Action.

From Burundi: Outages Dropped to Zero

I have a field update from the Sextant Foundation’s Village Health Works project in Burundi that I want to share, because it is the most concrete proof I have that on-site renewable energy systems work—not in theory, not in a model, but in a hospital that was experiencing 10 to 20 power outages per day.

The Phase 1 solar-plus-storage system—313 kW of solar PV and 614 kWh of battery storage—has been energized. Since commissioning, power outages at the hospital have dropped from 10–20 per day to zero. Zero. That is what energy resilience looks like for a hospital that serves one of the poorest communities on earth, in a country where fewer than 15% of people are connected to the grid and black-market diesel costs $10–13 per liter. Not one drop of diesel fuel, not one watt from a utility. Solar, hydro, and batteries. It can be done.

Further phases are planned, including the replacement of charcoal-burning equipment with electrified alternatives powered by expanded solar. The hospital currently burns charcoal sourced from the surrounding rainforest. We are seeking funding for Phase 3: HERE.

This is why we do this work. This is what “energy as medicine” means in practice.

Personal Updates

ASHE Battery Safety Task Group. On April 2, I was appointed to the ASHE Battery Safety Task Group. This group is developing healthcare-specific guidance for battery energy storage system deployment in hospitals—addressing fire safety, siting, AHJ approval, and the unique requirements of critical healthcare facilities. This work connects directly to the NFPA 800 Battery Safety Code (public comment opened January 20, 2026) and to the community-opposition challenges we are seeing with utility-scale BESS siting near hospitals.

NEC 2029 public input. NFPA 70 public input for the 2029 NEC edition closed April 9. As I wrote last week, I submitted a number of suggestions, including one a Code-for Article 517 to move healthcare electrical design toward a performance-based reliability framework, strengthening the code foundation for microgrids and on-site energy systems.

— Walt Vernon

Key Signals This Week

1. Rochester Regional Health signs 30-year EaaS contract. Nine hospitals, one 30-year Energy-as-a-Service agreement with ENFRA—deploying behind-the-meter microgrid controls, solar arrays, and enterprise-wide heating/cooling optimization. Projected first-year savings: $6.9 million (Facilities Dive, Apr. 9, 2026). This is the financing model that makes hospital decarbonization replicable: no massive upfront capital, guaranteed savings covering debt service, resilience built in from day one.

2. Community opposition blocks 320MW battery near Palomar Medical Center. AES withdrew its Seguro battery project in San Diego County after fierce local pushback over thermal runaway risk—the proposed site was just 1,600 feet from Palomar Medical Center (Canary Media, Apr. 9, 2026). This is the battery siting tension hospitals must navigate: behind-the-meter, facility-integrated storage is a much safer regulatory path than utility-scale BESS sited near patient care facilities.

3. New York invests $20M in hospital electrification—as grid strain deepens. Governor Hochul’s Empire Building Challenge targets acute care facilities specifically for low-carbon HVAC and electrification retrofits (NYS Governor’s Office, Apr. 9, 2026). The urgency is underscored by NYISO data showing large-load requests now exceeding 10,000 MW, with fossil plants over 50 years old comprising roughly 25% of supply. Meanwhile, an EnergyCAP 2026 survey found 88% of hospitals report rising utility costs, with double-digit energy cost increases more common in healthcare than any other sector. At the same time, Hochul has proposed delaying CLCPA emissions regulations to 2030—and Indiana’s new law blocks local benchmarking ordinances entirely. The state-level policy landscape is fragmenting.

4. 88% of hospitals report rising utility costs—and the data confirms it. The EnergyCAP 2026 State of Utilities Survey found that double-digit energy cost increases are more common in healthcare than any other sector, with 71% of hospitals prioritizing forecast accuracy as a top 2026 goal. New LBNL/Brattle analysis confirms the trend: commercial electricity prices rose from 10.7¢/kWh in 2019 to 13.4¢/kWh in 2025—driven not just by fuel, but by distribution, transmission, new generation, storm recovery, and capacity costs. EIA now expects total U.S. electricity demand to rise 1.2% in 2026 and 3.3% in 2027, with commercial-sector growth especially strong (approximately 6% in summer 2027). NYISO’s reliability outlook warns that large-load requests now exceed 10,000 MW in New York alone, with fossil plants over 50 years old making up approximately 25% of supply. Hospitals are identified as vulnerable large continuous loads. The grid’s problems are becoming healthcare’s budget problem. For healthcare, the pressure on power costs is increasingly coming from load growth, not just fuel.

Diesel is where geopolitical stress shows up most clearly. EIA expects diesel to peak above $5.80/gal in April and average $4.80/gal in 2026. Brent crude is forecast to average $96/barrel this year due to Hormuz-related disruption. U.S. LNG exports hit a record 11.7 million metric tons in March, underscoring how global events shape domestic energy assumptions. Gas storage ended the winter at about 1,900 Bcf (3% above the five-year average)—gas is not in shortage mode, but electricity demand and diesel exposure are where the real pressure is building. For hospitals, diesel affects backup generation, emergency logistics, transportation, and vendor costs—even when natural gas fundamentals look relatively calm.

5. Kaiser Sunnyside breaks ground on fully electric tower. Kaiser Permanente’s newest hospital tower in Oregon is engineered to be fully electric with a zero-emission central plant, completely decoupled from natural gas. Another data point in the growing all-electric hospital portfolio.

6. Penn Medicine automates OR energy setbacks. Surgical scheduling software integrated directly into building automation systems to lower temperature and slow air exchange rates when operating rooms are unoccupied—cutting one of the largest energy sinks in a hospital without compromising infection control. This is the kind of operational decarbonization that works now, without capital construction.

7. WHO World Health Day: “Stand with science.” April 7, 2026. The theme launched a year-long campaign on scientific collaboration and multilateral cooperation. Coming the day before the NAM Climate and Health Summit, the timing reinforced the message: the global health community is aligning on climate as a health crisis—and on science as the foundation for action.

8. WMO: hottest 11 years on record. The World Meteorological Organization confirmed that 2015–2025 were the hottest 11 years in the instrumental record, with Earth’s energy imbalance at the highest level in the 65-year measurement record. Reuters separately reported on the growing risk of “uninsurable infrastructure” from climate-related physical damage—a financial signal that connects directly to the resilience investment case for hospitals.

IFHE Global Connection

From IFHE

IFHE published a Newsletter Extra on April 9, promoting the glazing webinar, noting that past webinar recordings are being prepared for member viewing, welcoming Grundfos as a new affiliate partner, and encouraging participation in the 29th IFHE World Congress in New Orleans (October 17–20, 2026, co-located with the Healthcare Design Conference + Expo, hosted by AMFP and EmeraldX).

IFHE 2026 Awards update. The Cut the Carbs Award now recognizes both absolute performance and improvement—a significant shift toward measured energy outcomes rather than narrative sustainability. A New Buildings Award is also launching in 2026 with explicit focus on measured energy performance. Country-level and global top performers will be recognized at the New Orleans Congress.

IFHE’s webinar on high-performance glazing systems in healthcare buildings was held April 8–9.

IFHE 2026 Awards update: The Cut the Carbs Award now recognizes both absolute performance and improvement—measuring real energy outcomes, not just narrative sustainability. A New Buildings Award is launching for the 2026 Congress cycle. Country-level and global top performers will be recognized. This is a significant shift: IFHE is positioning its awards around measured energy performance.

From Members

IHEEM (United Kingdom) had the busiest visible week among IFHE members. Public items included a groundbreaking ceremony for the South East Wales Diagnostics and Treatment Centre; a major upgrade for Musgrove Park Hospital’s nuclear medicine department; a report that emergency repairs are consuming up to half of NHS maintenance budgets; a Greater Manchester Pension Fund / BlackRock healthcare investment venture; and a free webinar on BS 7671 Amendment 4 scheduled for May 14.

IHEA (Australia) amplified the IFHE glazing webinar and posted a sector roundup noting steady investment in hospital upgrades, mental-health infrastructure, and demand tied to ageing populations. IHEA also circulated the NZIHE Annual Conference 2026 call for presentations (November, Auckland).

CHES (Canada) posted an April 1 webinar on infection prevention and control in construction for long-term care, and has an active spring conference calendar: Maritime Chapter (early May), Manitoba (May 14), BC Chapter (May 31–June 2), and the National Conference in September.

AMFP (United States) has an active spring event calendar including gatherings in Colorado (April 16), St. Louis (Schneider Electric Healthcare Showroom Tour, April 14), Houston (Adaptive Reuse: Transforming Legacy Buildings, April 16), Arizona (April 23), and Charlotte (April 22). AMFP is the U.S. host partner for the 2026 IFHE World Congress.

AEIH (Spain) has its 42º Congreso Nacional de Ingeniería en el Sector de la Sanidad upcoming in Málaga.

FKT (Germany) has an online seminar on hospital ventilation systems scheduled for April 21.

SAFHE (South Africa) is preparing for the SAFHE 2026 Conference on June 9–10 in Cape Town.

Subscribe to the IFHE Newsletter: ifhe.info/newsletter

Looking Ahead

May 12–13: Facilities & Campus Energy Summit, Washington, DC

I will be speaking at the 6th Annual Facilities & Campus Energy Summit on May 12 in Washington, DC. My session—“Powering Health Care Infrastructure with Long Duration Energy Storage, Microgrids and More”—runs 2:10–2:40 PM on Day 1. I’ll cover the regulatory changes enabling on-site energy sources for Essential Electrical Systems, the different forms of LDES and their characteristics for the healthcare setting, evolving microgrid configurations, and the first installation of LDES in a hospital essential electrical system.

The summit brings together leaders from higher education, healthcare systems, federal facilities, and life sciences campuses who share the challenges of large energy footprints, critical power needs, and a mix of old and new buildings. The healthcare panel earlier that morning features Mount Sinai, Kaiser Permanente, UCHealth, Jefferson Health, and Baylor Scott & White. A Goldman Sachs / KeyBanc / RBC Capital Markets financing panel follows in the afternoon. NREL’s thermal storage research and a FuelCell Energy microgrid case study flank my session.

If you work in healthcare facility energy and will be in DC that week, I’d welcome the chance to connect. Campus and facility owners/operators attend complimentary. Details: facilitiesenergy.ascentisgrp.com

July 13: LDES for Healthcare Symposium, Salt Lake City

We are planning a one-day symposium on LDES in healthcare on July 13, preceding the U.S. Long Duration Energy Storage Consortium’s final Annual Meeting (July 14–15) in Salt Lake City. We are aiming to make it free or nominal cost for healthcare owners. Agenda and registration details are forthcoming. If you are interested in attending, speaking, or contributing case studies, please email me.

Codes, Standards & Regulation Watch

NFPA 800: Battery Safety Code. Public comment period opened January 20, 2026 for this new comprehensive battery safety code. ASHE has formed a Battery Safety Task Group (the author was appointed April 2) to develop healthcare-specific guidance. The AES/Palomar withdrawal this week underscores why hospitals need to be at the table as these standards develop.

CMS FY2027 IPPS proposed rule. Displayed April 10. Sets the framework for New Technology Add-on Payments (NTAP), which directly affects facility budgets and spatial planning for integrating novel medical technologies.

NYS Empire Building Challenge: $20M for hospital electrification. Governor Hochul announced April 9. Targets acute care facilities for low-carbon HVAC and electrification retrofits.

Indiana blocks local benchmarking ordinances. New state law took effect March 17, preventing Indianapolis from enforcing its utility-reporting ordinance for large buildings. A counterpoint to New York’s approach.

AHA 2026 Advocacy Agenda. Released this week, lobbying against “site-neutral” payment policies that would financially threaten the ambulatory and off-campus construction boom.

International Codes & Standards

EU Energy Efficiency Directive: mandatory audits by October 2026. Under Directive 2023/1791, facilities with annual energy consumption above 10 terajoules must complete mandatory, independent energy audits by October 2026. By October 2027, facilities above 85 TJ must implement a certified energy management system (ISO 50001 or equivalent). Hospitals are explicitly included as commercial-sector energy users. Annual energy savings obligations rise to 1.5% in 2026–2027 and 1.9% in 2028–2030. The public sector must reduce consumption by at least 1.9% per year and renovate at least 3% of total floor area annually. This is the most consequential regulatory development for European hospital energy management in a decade.

EU Energy Performance of Buildings Directive: transposition deadline May 29, 2026. Member states must transpose the revised EPBD into national law by late May 2026. The directive targets greenhouse gas reduction, energy consumption, and renovation of worst-performing buildings. For hospitals operating in multiple EU jurisdictions, compliance timelines are imminent.

EU post-2030 energy efficiency framework: consultation open. The European Commission launched a 12-week public consultation (closing June 12, 2026) to shape energy efficiency rules for the decade ahead. The legislative proposal is scheduled for Q4 2026. Separately, an Electrification Action Plan for heating and cooling is expected Q1 2026, and Energy Efficiency and Renewable Energy Framework revisions are expected Q3 2026. The Environmental Omnibus Proposal simplifies compliance for industrial emissions, medium combustion plants, and battery regulations—with direct impact on hospital CHP, backup power, and BESS installations.

Australia: Victoria mandates all-electric healthcare infrastructure. The Victorian Health Building Authority (VHBA) now requires all-electric infrastructure for healthcare facilities under 10,000 m². Larger facilities must include a plan to transition away from natural gas. Victoria’s goal is 100% carbon-neutral renewable electricity for public hospitals. NABERS (the National Australian Built Environment Rating System) is expanding to hospitals before 2030—133 Victorian public hospitals participated in the 2024 NABERS Sustainable Portfolio Index. A federal program to extend Commercial Building Disclosure to hospitals is being planned.

Academic signal: hospitals as “industrial-scale energy hubs.” A January 2026 paper in Scientific Reports proposes reclassifying hospital energy demand toward industry-like requirements, arguing that the current tertiary-sector classification results in less stringent regulations despite hospitals frequently consuming more energy than other commercial buildings. The proposed hybrid regulatory framework would bring industrial-level energy audits, performance benchmarks, and financial incentives to healthcare—an argument that aligns directly with IFHE’s positioning of healthcare infrastructure as mission-critical climate infrastructure.

Major Projects This Week

Northside Hospital Atlanta (Georgia): Broke ground April 6 on a 67,537 sf, two-story ED expansion to separate ambulatory and high-acuity traffic.

Kaiser Sunnyside Medical Center (Oregon): Groundbreaking on a fully electric hospital tower with zero-emission central plant.

Princeton Medical Center Cancer Center (New Jersey): Advancing construction with green roofs, rain gardens, terracotta insulation, and solar arrays designed to supply 50% of annual energy demand. Targeting LEED Gold with embodied carbon tracking.

North Canberra Hospital (Australia): Early site works initiated this April for the territory’s largest-ever health infrastructure investment.

Hospital Los Cabos, Christus Muguerza (Mexico): Recognized April 8 with an Architecture Madrid Award for hurricane-prone, high-solar-gain climate design. Features double-skin façade, solar-responsive geometry, and rooftop patient therapeutic terraces. Positioned as a medical tourism anchor facility.

Southward Hospital and Diagnostic Centre (Nigeria): Completed and operational in Kogi State. Integrates MRI, CT, and digital X-ray to reduce medical tourism and regional care gaps.

Ghana Free Primary Healthcare Programme: Launching April 15, backed by GH¢34 billion allocation, with WHO technical teams deployed to standardize facility infrastructure and codes.

Mater Dei Hospital, Bulawayo, Zimbabwe: Commissioned March 10, 2026. 750 kWp solar PV + 1 MWh battery storage, powering ICU, operating theatres, and maternity. Funded by Old Mutual and UN Joint SDG Fund. Expected annual generation exceeds 1.3 million kWh. Diesel dependency materially reduced.

Nigeria RE4PHC Solarization Project: 238 primary health centres across 12 states (2024–2026). Reported outcomes: 92% improvement in vaccine cold-chain reliability, 78% increase in safe night-time deliveries, 65% reduction in operating energy costs. These are the hard numbers that prove solar health facility electrification works at scale.

Mater Dei Hospital, Bulawayo, Zimbabwe: Commissioned March 10, 2026. 750 kWp solar PV + 1 MWh battery storage powering ICU, operating theatres, and maternity. Funded by Old Mutual and the UN Joint SDG Fund. Expected annual generation exceeds 1.3 million kWh, materially reducing diesel dependency.

Nigeria RE4PHC Solarization Project: 238 primary health centres solarized across 12 states (2024–2026). Reported outcomes: 92% improvement in vaccine cold-chain reliability, 78% increase in safe night-time deliveries, 65% reduction in operating energy costs. These are not pilot numbers—this is system-scale deployment with measured clinical impact.

Hospital Los Cabos (Christus Muguerza), Mexico: Recognized April 8 with an Architecture Madrid Award. Designed for hurricane-prone, high-solar-gain climate with double-skin façade, solar-responsive geometry, and rooftop therapeutic terraces. A medical tourism anchor facility demonstrating climate-adapted design in Latin America.

Sources: Facilities Dive (Apr. 9); Northside Hospital (Apr. 6); Penn Medicine (Apr. 2); GhanaWeb (Apr. 8); NYS Governor (Apr. 9); Canary Media (Apr. 9).

Calendar & What to Watch

April 15: Ghana Free Primary Healthcare Programme launch

April 16: AMFP Colorado gathering; AMFP Houston: Adaptive Reuse

April 21: FKT (Germany) online seminar: hospital ventilation systems

May 4–7: IEEE PES T&D Conference & Exhibition, Chicago

May 12–13: Facilities & Campus Energy Summit, Washington, DC — Walt Vernon speaking May 12

May 14: IHEEM free webinar: BS 7671 Amendment 4; CHES Manitoba Conference

June 9–10: SAFHE 2026 Conference, Cape Town

July 13 (planned): LDES in Healthcare Symposium, Salt Lake City — email the author for information

July 14–15: U.S. LDES Consortium Final Annual Meeting, Salt Lake City

August 10: California SB 253 first Scope 1 & 2 reporting deadline

October 17–20: 29th IFHE World Congress + HCD Conference, New Orleans

November 2026: NZIHE Annual Conference, Auckland — call for presentations open

On the Reading List

• Energy Service Contracts Grow as Operators Spread Costs (Facilities Dive, Apr. 9)

• AES Pulls Battery Project Near Palomar Medical Center (Canary Media, Apr. 9)

• NAM Climate and Health Summit 2026

• NFPA 800: Battery Safety Code (FacilitiesNet)

• Princeton Medical Center: A Cancer Center for Healing Patients and the Planet (Penn Medicine)

• NYS Empire Building Challenge: $20M for Hospital Electrification

• WHO World Health Day 2026: Stand with Science

• Facilities & Campus Energy Summit 2026 Agenda

• Subscribe to the IFHE Newsletter

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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This week I am departing from the usual format. One story dominates this issue, and it deserves the space. On April 4, 2026, I submitted a Public Input to the National Electrical Code — Article 517, the healthcare facilities article — that I believe is the most significant regulatory proposal I have made in a thirty-year career. It would create a performance-based compliance path for healthcare microgrids, replacing the binary utility-plus-diesel architecture that has governed hospital electrical systems since the code was written. The deadline for others to file supporting Public Inputs is April 9th. I want you to understand what I am proposing, why I am proposing it now, and what I am asking of you.

The most important shift in hospital energy thinking right now is not a technology. It is a mental model. For decades, the question has been: ‘what is my backup?’ The question that is emerging, and that this proposal is designed to answer, is: ‘what combination of on-site power, storage, fuel strategy, and performance verification will allow this facility to continue operating reliably under real-world instability?’ That is a fundamentally different question. And the code needs to catch up to it.

Also, starting this week, I am adding a new section: IFHE Member News. Every issue will carry a brief scan of what IFHE member organizations around the world are doing — events, conferences, calls for papers, training programmes, and other public signals of activity. The healthcare engineering community is global. This section is a small step toward making that visible every week.

FEATURE

A Decade in the Making: NEC Public Input - better, faster, cheaper - and environmentally friendly

By Walt Vernon, PE, JD — Editor, The Infrastructure Pulse

Mazzetti, Sextant, and I have been designing microgrids in California hospitals for more than a decade. Not microgrids in the sense of another cogen plant — but full-on microgrids, with batteries, fuel cells, photovoltaics, and diesel in various combinations. Even hydroelectric plants in Africa. The California Energy Commission has funded most of this work as demonstration projects, intended to prove feasibility and surface the barriers. There have been a lot of barriers. We have been working through them steadily, one by one.

The work started at Kaiser Richmond — the first hospital capable of serving part of the Essential Electrical System (the Life Safety Branch) without diesel. Then Kaiser Ontario, ten times the capacity, with solar, fuel cells, and batteries serving the full facility EES load. Then Valley Children’s Hospital in Madera, California — which we believe will be the largest hospital battery system in the world. And alongside all of that, the Burundi microgrid project through the Sextant Foundation, bringing reliable power to health facilities that have never had it.

Each project taught us something. Each project created new ways to think, and new opportunities. Through the years, I have been able to leverage the lessons learned from these demonstration projects to encourage changes to NFPA 99, NFPA 70 (the National Electrical Code), and even CMS (the Categorical Waiver). Each advance in the codes allowed the next innovation to emerge.

The Dance Between Projects and Code

This is how progress actually happens in our industry. A project reveals what is possible. The possibility runs into a code barrier. You work the barrier — through the AHJ, through a waiver, through a demonstration, through a committee. The code moves. The next project goes further. The code moves again.

I filed what I hope will be the next move on April 4th.

But, and here is the deal. The formal window closes on April 9. I still have time to change my proposal. If folks out there would like to kick the tires and help me make it better, I would appreciate it.

What the Current Code Requires — and Why It Is Obsolete

Article 517.4 of the National Electrical Code requires a utility supply sized for the entire facility. Section 517.30(A) requires that the Essential Electrical System be served by two or more independent sources — in historical practice, a utility feeder on one side of a transfer switch and a diesel generator on the other. The transfer switch selects between them when one fails.

This binary architecture made sense when on-site generation meant one large rotating machine and the utility was a relatively reliable, infinite source. Neither of those conditions reliably holds today. The grid is increasingly stressed by load growth, severe weather, and aging infrastructure. The utility is no longer the default reliable source it once was. And on-site generation now means something entirely different.

When you have many parallel strings of batteries, fuel cells, and photovoltaics interconnected on a common bus, failure of any one string reduces available capacity slightly — it does not interrupt supply to any load. The system degrades gracefully. That is a fundamentally different failure mode than a single diesel that either starts or does not. The current code cannot accommodate this architecture because it was not written for it.

What the Public Input Proposes

The proposal creates a performance-based alternative compliance path — modeled on the performance paths in ASHRAE 90.1 and the International Energy Conservation Code — called the Healthcare Microgrid. Under this path, a facility may use any combination of utility supply and on-site sources on each of two independent buses, provided:

• Each bus independently has sufficient capacity to serve all essential electrical system loads.

• On-site sources — excluding utility — have sufficient aggregate capacity across both buses to serve the entire essential system without utility supply.

• Each bus includes at least one grid-forming source capable of black-start.

• A licensed professional engineer demonstrates, using IEEE 493 methodology, that the proposed system’s reliability is equal to or greater than the prescriptive utility-plus-diesel baseline.

• The system can sustain essential loads for 96 hours without utility supply, demonstrated through an energy analysis based on actual expected load — not nameplate capacity — displacing NFPA 110’s fuel storage requirements with a more rational energy accounting method.

The prescriptive path — utility plus diesel — remains fully available. Nobody is required to use this. This is an option for those who can demonstrate equivalency.

This proposal does not arrive in a vacuum. The 2026 NEC has already moved materially in the direction of enabling hospital microgrids: Article 130 formalizes Power Control Systems, Article 705 clarifies distributed energy resource interconnection, and Section 700.12(F) explicitly allows emergency loads to connect to microgrids through UL 3008-listed equipment. CMS has recognized the direction through its Categorical Waiver. This Public Input puts a coherent reliability framework under those openings — connecting the technical permission already in the code to a performance standard that makes it usable for hospital essential electrical systems.

Why this is stricter than the status quo, not more permissive

The equivalency standard requires demonstrated reliability equal to or better than utility-plus-diesel. A system that is less reliable cannot pass. And unlike the prescriptive path — which requires no ongoing demonstration of anything — this path requires revalidation of the reliability analysis every five years and after any material change. A prescriptive utility-plus-diesel installation with a failing generator and deferred maintenance is never required to prove anything after commissioning. A healthcare microgrid built under this path is. The floor is the current code. The ceiling is however good you can make it.

The Reliability Mathematics

I want to address the concern that I expect some colleagues will raise: that this is a way to install a less reliable system. I understand that concern. The utility-plus-diesel model is deeply familiar. We have designed to it, inspected to it, and surveyed to it for decades. New things are hard to trust when patient safety is at stake.

But consider what reliability science actually shows. In a utility-plus-diesel system, every utility interruption is a demand event on the generator. Generator failure-to-start runs approximately 3–4% per demand, per IEEE 493. That means every grid outage is a roughly 1-in-30 chance of a complete essential system interruption. In a two-bus distributed source bundle, there is no single demand event. Both buses serve essential loads continuously. The probability of essential load interruption requires simultaneous failure of independent sources on both buses — the product of two already-small independent probabilities. The mathematics are not close.

I took a class in reliability as an electrical engineering undergraduate at Vanderbilt University. It was taught by Dr. Ensign Johnson (he once told me my grandfather was his Sunday School teacher). I loved that class, and I have spent thirty years looking for a place to use it. This is the place.

The Regulatory Path Forward

Filing the NEC Public Input is the first step, not the last. The parallel work that matters equally:

• A companion proposal to NFPA 99, the Health Care Facilities Code, which is the document CMS actually references for Essential Electrical System requirements. The NEC change alone does not move the needle for CMS-regulated facilities. In fact, NFPA 70 often FOLLOWS NFPA 99, even though the timing requires Proposals to NFPA 70 before proposals to 99.

• Engagement with The Joint Commission. I am working with TJC to review this proposal with the goal of ensuring that systems built under this compliance path can be surveyed without creating a deficiency. That conversation is underway.

• The public comment period that follows NEC action. When the Code-Making Panel acts on this proposal, there will be an opportunity for public comment. I want the industry to show up for that.

The deadline for supporting Public Inputs is April 9, 2026

If you believe this proposal is sound — or if you have concerns you want on the record before the panel acts — file a Public Input at nfpa.org. A supporting PI does not have to be long. It can be a single paragraph stating that you support the concept and believe the performance path will serve the industry. Volume of support matters.

I also want to hear from you directly. What do you think? What concerns do you have? What have I missed? Reply to this newsletter. The real debate will happen in the room when the Code-Making Panel meets. I want to walk in knowing what the industry is thinking.

1. RESILIENCE & DECARBONIZATION

Hospital Microgrids: The Industry is Moving Whether the Code Catches Up or Not

A new analysis from Trystar documents four major trends reshaping hospital power in 2026: on-site generation and storage as continuous strategic assets rather than emergency-only backup, hybrid configurations combining renewables with fuel cells and generators, intelligent energy management systems optimizing dispatch across source types, and growing recognition that “emergency only” backup is no longer sufficient for facilities dependent on power-sensitive clinical equipment. The analysis describes a fundamental shift in how hospitals think about electrical infrastructure — from a cost center managed for minimum compliance to a strategic asset managed for continuous resilience.

Source: Trystar, Healthcare Power Resiliency in 2026 (January 2026)

Editor’s take: This is the industry context for the NEC proposal above. The code is the last barrier, not the first. The technology is ready. The projects are happening. The regulatory framework needs to catch up.

Berkeley Lab: Regulatory Barriers to Hospital Microgrids Now Authoritatively Documented

Lawrence Berkeley National Laboratory released a three-part series on regulatory barriers to microgrids on March 30, 2026, which is rapidly becoming the canonical policy reference for utilities and regulators. Key finding for healthcare: single-property microgrids on hospital campuses still face inconsistent treatment across states for interconnection, standby charges, and ownership models — even after the CMS Categorical Waiver opened the clinical compliance door. The Berkeley Lab work documents the gap between what the technology can do and what the regulatory environment currently permits, providing authoritative backing for exactly the kind of code-based performance path proposed in this week’s NEC Public Input.

Source: Lawrence Berkeley National Laboratory, March 30, 2026; pv-magazine-usa.com

Editor’s take: Berkeley Lab’s work and the NEC Public Input are converging on the same diagnosis from different directions. Berkeley Lab says the regulatory barriers are real and documented. The NEC PI proposes a code-level solution. Together they make the case that this is a systemic problem requiring a systemic fix — not a project-by-project waiver process.

California Title 24 Now in Force: Mandatory PV + Storage for New Non-Residential Buildings

California’s 2025 Energy Code — Title 24 — took effect January 1, 2026, making photovoltaic and battery energy storage systems mandatory or significantly expanded requirements for many new non-residential construction projects, including hospitals and healthcare facilities. California health systems are now forced early adopters of integrated PV-plus-storage, even where resilience was not the initial driver. Public comment windows for related electrical, mechanical, and plumbing code updates remain open through May 11, 2026 — an important leverage point for healthcare voices in the California code process.

Source: HCAI / California Building Standards, January 2026; maktinta.com

Editor’s take: California is creating the installed base of hospital PV-plus-storage that the national NEC proposal is designed to accommodate. Every California hospital now building under Title 24 is building toward the Healthcare Microgrid compliance path — whether they know it or not. The May 11 comment window is worth noting for any IFHE member with California operations.

Iran War, Diesel Prices, and Why the Hedge Argument for On-Site Generation Just Got Stronger

Diesel prices are rising sharply in the wake of the Iran war, creating fuel supply pressure that reaches every diesel-dependent backup system in the world — including in Burundi, where the Sextant Foundation’s microgrid project is now even more urgent, as black-market diesel has become prohibitively expensive. The hedge argument for on-site renewable generation has never been clearer: Kaiser Ontario’s microgrid, which integrates solar, fuel cells, and battery storage, experienced no energy cost increase during the Ukraine invasion’s energy price shock because on-site generation hedged against the price volatility. That same logic applies now, globally, to any facility with diesel dependency.

A separate Politico analysis this week documents the emerging policy case for data centers to function as grid assets — dispatchable, grid-interactive facilities that provide resilience services to the broader network. Walt Vernon has long predicted that healthcare will follow this model. Hospitals with on-site generation and storage that can island, shed non-essential load, and provide grid services are not just resilient — they are grid assets with revenue potential under emerging tariff structures.

Source: Axios, March 2026; Politico, April 2, 2026; Sextant Foundation field notes

Editor’s take: The Iran war is accelerating a transition that was already underway. Every facility with diesel backup is exposed to this price volatility. Every facility with on-site renewable generation and storage is hedged against it. That is a financial argument for healthcare microgrids that does not depend on climate policy, regulatory mandates, or grant programs. It depends only on arithmetic.

KVH Update: Court Orders Federal Microgrid Grants Reinstated

A federal judge has ordered the Trump administration to reinstate the pulled BRIC disaster preparedness grants, allowing rural hospital planners — including Klickitat Valley Health in Goldendale, Washington — to restart stalled microgrid projects. KVH had planned a solar-and-battery microgrid capable of powering the hospital and a neighboring school district, working alongside its existing hydrogen fuel cell. The whipsaw from cancellation to court-ordered reinstatement illustrates the structural vulnerability of hospital resilience projects built on discretionary federal grants. A code-based compliance path in the NEC does not depend on which administration controls the FEMA budget.

I was privileged to work on the hydrogen fuel cell part of the project, and I am hoping I will have the chance to do more!

Source: OPB / Federal court order, April 2026

Editor’s take: Federal reinstatement is welcome. It does not solve the structural problem. Hospitals that build resilience infrastructure on discretionary grants will always be exposed to the next administration’s priorities. A permanent, code-based compliance path is the answer that survives elections.

Heywood Healthcare Activates Campus Solar — Massachusetts

Heywood Healthcare has activated a long-stalled solar array on its Gardner, Massachusetts campus in partnership with National Grid, primarily as a financial strategy to stabilize escalating utility costs rather than as a sustainability initiative. The utility-developer partnership structure — rather than hospital capital investment — is a replicable financing model for mid-size systems that cannot absorb upfront generation costs. The next step for systems like Heywood is battery storage to capture the full value of that generation during peak demand periods.

Source: Gardner News Magazine, January 2026

Editor’s take: Mid-size health systems are discovering that utility partnerships reduce the capital barrier to solar adoption to near zero. The NEC proposal is designed for exactly the next step: adding storage to those solar installations under a rational compliance framework.

ASHE Launches Hospital Battery Safety Task Force — Chad Beebe Leading

The American Society for Health Care Engineering is launching a Battery Safety Task Force, led by Chad Beebe, to develop guidance for hospital-scale battery energy storage system deployment in healthcare facilities. The task force responds to growing industry concern about battery safety following the Moss Landing incident and California’s subsequent regulatory response, and to the rapid growth of hospital battery deployments that has outpaced available safety guidance. Walt Vernon will serve on the task force. Chad Beebe will also speak at the LDES for Healthcare Summit in Salt Lake City on July 13.

Separately, NFPA has opened public comment on NFPA 800, its new comprehensive Battery Safety Code, which will shape hospital-scale storage siting, fire protection, and response planning requirements nationally. The ASHE task force and NFPA 800 process are moving in parallel — together they are building the governance framework that serious hospital battery deployments require.

Source: ASHE / NFPA, April 2026

Editor’s take: Battery storage is no longer a technology that hospitals admire from a distance. It is becoming a mainstream safety, permitting, and governance issue. Any hospital planning a serious storage deployment in the next two to three years needs a credible safety case — siting, fire protection, community confidence, AHJ comfort — before the economics conversation. The ASHE task force is the right place to build that framework.

Vieques Microgrid: The Pattern Holds for Low-Resource Health Facilities

Eight miles off Puerto Rico’s eastern coast, a community-owned microgrid on Vieques — the island devastated by Hurricane Maria in 2017, whose hospital has never reopened — is demonstrating the same pattern that has driven hospital microgrid adoption on the mainland. A Cornell University initiative funded through Volkswagen’s class-action settlement is deploying solar and battery storage at a community farm serving as a resilience hub, with a green hydrogen fuel cell system planned for 2027. The system is expected to halve electricity costs while providing complete grid independence — the same value proposition that makes healthcare microgrids compelling for low-resource health facilities in Burundi and across sub-Saharan Africa.

Source: Cornell Chronicle, April 2026

Editor’s take: The technology and the project finance model work at every scale. The barrier is almost always regulatory — not technical and not economic. That is what the NEC proposal is designed to address.

2. FACILITY DESIGN & CONSTRUCTION

Protection Coordination: The Technical Challenge Nobody Talks About

As inverter-based resources become the dominant generation technology in hospital microgrids, protection coordination — ensuring that overcurrent devices operate correctly under fault conditions — is emerging as the critical technical challenge. Inverter-based sources typically supply 1.2 to 2.0 times rated current under fault conditions, compared to 6 to 10 times for rotating machines. This difference fundamentally changes how protection systems must be designed and coordinated. The NEC Public Input filed this week addresses this directly: the proposal requires that every healthcare microgrid built under the new compliance path demonstrate fault current adequacy, either through listed grid-forming inverters meeting UL 1741 SB, rotating generating units on each bus, or a PE-sealed short-circuit coordination study.

Source: NEC Public Input 517.30(C), Section (4); UL 1741 SB; IEEE 1547-2018

Editor’s take: This is the technical requirement that will shape inverter procurement for healthcare microgrids for the next decade. Grid-forming capability and fault current performance need to be on every specification checklist now, not after the protection study reveals a gap.

Scientific Reports: Coordinated Multi-Node Battery Placement Cuts Energy Not Supplied by 55–63%

A new peer-reviewed study in Scientific Reports develops a resilience optimization framework for hospital microgrids integrating PV, multi-node battery storage, and medical load prioritization under grid outage conditions. Using a mixed-integer linear programming model evaluated across Monte Carlo outage scenarios, the study finds that coordinated multi-node battery placement — as opposed to single centralized storage — reduces Energy Not Supplied to critical loads by 55 to 63 percent compared to baseline configurations, while maintaining supply to life-critical loads in 95 percent or more of stochastic outage scenarios. The study introduces a multi-tier hospital load hierarchy — ICU, OR, imaging, pharmacy — based on Value of Lost Load.

Source: Nazartalab & Alavi-Rad, Scientific Reports (2026). DOI: 10.1038/s41598-026-34992-x

Editor’s take: The multi-node, parallel-string architecture that this research validates is precisely the architecture the NEC proposal is designed to accommodate. The academic literature and the code proposal are converging on the same answer.

Global Project Signals — Africa

Egypt — Badr City Central Laboratories, 90% Complete. The Egyptian Ministry of Health announced that the 40,000 sqm Badr City Central Laboratories complex has surpassed 90% completion, with trial operations for the 7,700 sqm main building scheduled to begin July 2026. Designed to international diagnostic standards, the facility consolidates regional laboratory capacity at a scale that demands ISO cleanroom-grade HVAC zoning, cold-chain resilience, and highly reliable backup power for continuous reagent storage. Separately, the Obour General Hospital — 189 beds, 47 ICU beds, 5 operating theaters serving one million residents — has reached 99% completion.

Namibia — N$1 Billion Windhoek District Hospital. The Development Bank of Namibia has injected N$1 billion for construction of a new 500-bed Class C facility in the Khomas Region, designed to directly relieve critical bed shortages at existing national referral hospitals. The facility enters primary construction phase this month.

Source: Daily News Egypt, April 4, 2026; Caprivi Vision, April 1, 2026

Editor’s take: Egypt and Namibia represent the two dominant African infrastructure investment models this week: Egypt concentrating diagnostic capacity in large centralized facilities with sophisticated MEP requirements; Namibia deploying sovereign capital into new acute care bed capacity at scale. Both models generate significant engineering engagement opportunities for IFHE members active on the continent.

★ California Mandates 96-Hour On-Site Water Storage for Hospitals — ASHRAE 189.3 Following

California state law requires hospitals to maintain a minimum 72 to 96-hour supply of potable water on-site — a resilience standard that parallels the energy autonomy requirements in this week’s NEC Public Input. ASHRAE Standard 189.3, the standard for the design of high-performance green buildings in the health care sector, is now considering a similar requirement for on-site water storage in future addenda. I serve on the ASHRAE 189.3 committee and I’m leading the task force developing this language - HELP WANTED!

The parallel between energy autonomy and water autonomy is not coincidental — both reflect the same underlying shift in hospital resilience planning: critical facilities cannot depend on external supply chains for resources that are foundational to clinical operations. The 96-hour energy autonomy requirement in the NEC proposal was calibrated against exactly this kind of multi-day resilience standard.

Source: California Health and Safety Code; ASHRAE 189.3 committee work, April 2026

Editor’s take: Water storage and energy storage are converging as paired resilience requirements for hospitals. Facilities planning major infrastructure investments should be sizing both simultaneously — and should expect ASHRAE 189.3 to formalize the water standard in the same timeframe that the NEC PI is working through the code cycle.

3. SMART BUILDINGS & GRID INTERACTIVITY

World Bank $500M BRIDGE Project: Digital Connectivity as Healthcare Infrastructure

The World Bank has approved $500 million to physically hardwire 16,900 health facilities across West Africa with fiber-optic connectivity as part of the BRIDGE project, deploying 90,000 kilometers of cable to support real-time epidemiological tracking, telemedicine, and early warning systems. The project treats high-speed digital infrastructure as a prerequisite clinical asset on par with the buildings themselves — a recognition that reliable internet connectivity is as foundational to modern care delivery as reliable power. Each connected facility will require designated secure server space, uninterruptible power supplies to maintain network uptime, and integration with health information systems.

Source: World Bank, April 2026

Editor’s take: The infrastructure implications of the BRIDGE project extend well beyond IT. Hardwiring 16,900 facilities with fiber means 16,900 new UPS installations, 16,900 server room designations, and 16,900 facilities where power reliability just became a digital health requirement as well as a clinical one. The BRIDGE project makes the case for reliable on-site power in African health facilities more urgent, not less.

WMO Climate Report: Earth’s Energy Imbalance at 65-Year High

The World Meteorological Organization’s new annual climate report has added Earth’s energy imbalance as a key tracking indicator for the first time, and reports that the imbalance is now at its highest level in the 65-year observational record. The last eleven years were the warmest on record. For hospital infrastructure planners, this is not environmental context — it is the operating environment. More extreme heat events mean higher cooling loads, greater stress on HVAC systems, more frequent grid demand peaks, and higher probability of outage events precisely when clinical demand for power is highest. The WMO report underscores that hospital energy systems are being designed for a fundamentally harsher world than the one in which Article 517 was written.

Source: World Meteorological Organization, 2026; wmo.int

Editor’s take: Every degree of additional warming increases the probability of the scenario the NEC proposal is designed to address: a grid outage during an extreme heat event, at peak clinical demand, in a facility whose essential system relies on a generator that may or may not start. The WMO data is the engineering design basis for why performance-based hospital power systems matter.

Energy Autonomy vs. NFPA 110: Why the Current Fuel Storage Rule Is Wrong

NFPA 110 requires fuel storage sized to run generators at nameplate capacity for the required autonomy period — typically 96 hours. Nameplate capacity is sized for peak demand. Average essential system demand in a hospital over a 96-hour period is typically 50 to 65 percent of peak. The result: NFPA 110 requires roughly 1.5 to 2 times more fuel than the facility will actually consume during the autonomy period. For diesel, this is expensive and wasteful. For batteries, the equivalent oversize is prohibitive.

The NEC Public Input replaces this nameplate-hours methodology with an energy analysis based on actual expected load — the integral of demand over time — using measured facility data or an approved load model. Battery storage is credited as an energy buffer: it absorbs excess generation when source output exceeds load demand, and dispatches when demand peaks, allowing fuel-based sources to be sized to average load rather than peak. Battery credit is calculated at end-of-warranty capacity, not beginning-of-life, ensuring the analysis reflects real-world performance throughout the system’s service life.

Source: NEC Public Input 517.30(C), Section (8); NFPA 110 (current edition)

Editor’s take: This methodological shift matters enormously for project economics. A hospital that can size its fuel and battery storage to actual expected consumption — rather than nameplate times hours — can right-size its system and dramatically improve project cost and feasibility. This is one of the changes that makes the healthcare microgrid path financially viable at scale.

The Global Narrative Shift: From “Net Zero” to “Survivability”

New academic and policy work — particularly a BMJ analysis published January 2026 that continues to be heavily cited — is explicitly reframing the healthcare decarbonization imperative through the lens of health resilience, heat risk, and outage survivability rather than emissions reduction. The BMJ positions Asia-Pacific as the global center of gravity for this shift, driven by the region’s exposure to tropical cyclones, extreme heat events, and the healthcare system continuity failures that follow. A parallel Nature study is quantifying health risk tradeoffs in power-system decarbonization under heat stress conditions specifically relevant to hospital resilience planning in megacities. The ‘energy as medicine’ framing — energy reliability as a direct clinical outcome — is emerging as the vocabulary that bridges infrastructure engineering and public health leadership.

Source: BMJ, January 2026; Nature, January 2026

Editor’s take: The survivability reframe matters strategically. ‘Net zero’ is a contested political term in many jurisdictions. ‘Survivability,’ ‘energy as medicine,’ and ‘outage resilience’ are patient safety terms — and patient safety arguments are politically durable in a way that climate arguments are not. IFHE members making the case for healthcare microgrid investment should be leading with survivability language, not sustainability language.

4. BIOMEDICAL ENGINEERING & AI

NYC Health + Hospitals CEO Lobbies to Replace Radiologists with AI

The CEO of NYC Health + Hospitals — the largest public hospital system in the United States — has publicly challenged existing state regulations, advocating for code changes that would allow artificial intelligence to conduct primary autonomous readings of X-rays and mammograms without radiologist involvement. The push is driven by labor cost pressures and a belief that AI diagnostic accuracy has crossed the threshold for clinical deployment as a primary reader. The infrastructure implications are significant: autonomous AI radiology requires high-density edge computing directly within imaging suites, massive on-site computing power, and highly reliable power — interruptions that might be tolerable in an administrative context become clinically unacceptable when AI is performing primary diagnosis in real time.

Source: Radiology Business, March 31, 2026

Editor’s take: AI-driven radiology is not a future scenario — it is being actively lobbied for by the leadership of the largest public hospital system in the country. Imaging suite power and computing infrastructure specifications need to be rethought now for facilities planning capital projects in the next three to five years.

William Osler Health System: Designing Clinical Spaces Around AI Before Epic Launch

Canada’s William Osler Health System is engaged in a fundamental pre-launch redesign of clinical workflows and physical IT touchpoints ahead of its Fall 2026 Epic EHR implementation — embedding generative AI tools directly into point-of-care workflows rather than retrofitting them after go-live. The approach inverts the traditional sequence: instead of designing clinical spaces and then bolting on AI, Osler is designing the physical spaces around the AI workflows from the start. This includes computing density, terminal placement, Wi-Fi architecture, and secure physical access at every patient bedside.

Source: Hospital News, March 26, 2026

Editor’s take: The Osler model — AI-first clinical space design — is the leading indicator of where healthcare facility design is heading. Facilities planning renovations or new construction in the next two to three years that are not designing for AI-native workflow density are planning for obsolescence.

Load Prioritization: The Clinical Input Healthcare Microgrids Need

The Scientific Reports study referenced in Pillar 2 introduces a formal multi-tier hospital load hierarchy for microgrid dispatch optimization: ICU, operating rooms, imaging, and pharmacy, ranked by Value of Lost Load. This is a concept that biomedical engineers and clinical engineers have always understood intuitively — not all hospital loads are equal — but that has rarely been formalized in a way that can drive automated energy management system decisions.

Healthcare microgrids built under the proposed NEC compliance path will need exactly this kind of clinical load priority mapping to optimize dispatch across the autonomy period. The energy management system needs to know which loads shed first, which shed last, and which never shed. That information lives in the biomedical engineering and facilities operations teams, not in the electrical design documents. This is a new interface between clinical operations and infrastructure engineering that the industry will need to develop.

Source: Nazartalab & Alavi-Rad, Scientific Reports (2026)

Editor’s take: Biomedical engineers will be essential participants in healthcare microgrid design — not just for equipment power requirements, but for clinical prioritization decisions that drive dispatch logic. If your facility is considering a microgrid, start that conversation with your HTM and clinical operations teams now.

JCI Global Health Impact Chapter: Accreditation Now Drives Decarbonization Faster Than LEED

International hospitals are auditing their governance, procurement, and infrastructure carbon footprints ahead of enforcement of The Joint Commission International’s new Global Health Impact chapter, developed with the Geneva Sustainability Centre. Because the chapter is tied directly to clinical accreditation — not voluntary green building certification — it is rapidly displacing LEED, BREEAM, and similar frameworks as the primary driver of international hospital decarbonization planning. Facilities that have treated sustainability as an optional certification are discovering that their accreditation now depends on it.

Mazzetti was able to help two of the first hospitals in the US to achieve the US TJC Sustainability certification. We are now working with a major hospital in Rwanda to help the achieve Interational Certification.

Source: JCI / Geneva Sustainability Centre, April 2026

Editor’s take: For U.S. facilities, the JCI development is a leading indicator of where TJC domestic standards are heading. The accreditation-sustainability linkage that is now being enforced internationally will arrive domestically. The facilities that are ahead of it will have a significant advantage.

EPA Rolls Back Ethylene Oxide Cancer Rules — What Are the Alternatives?

The EPA has rescinded its ethylene oxide emission regulations, removing federal cancer-risk controls on a chemical used in medical device sterilization at facilities serving hospitals across the country. Ethylene oxide is a known carcinogen; the original rules were designed to reduce community exposure around sterilization facilities. Their removal creates a clinical and community health concern for health systems that source sterilized devices from EtO-dependent suppliers, and raises urgent questions about alternative sterilization modalities — vaporized hydrogen peroxide, nitrogen dioxide, electron beam, and X-ray sterilization — and their scalability for the full range of heat-sensitive medical devices. For hospital biomedical and sterile processing teams, this is a supply chain risk and a community health story simultaneously.

Source: New York Times, March 13, 2026

Editor’s take: The EtO rollback is a biomedical engineering supply chain problem dressed as a regulatory story. Health systems that rely heavily on EtO-sterilized single-use devices should be auditing their sterilization supply chain now — not for compliance, but for resilience. The alternative modalities exist; the question is whether the supply chain has capacity if EtO facilities face community pressure or litigation in the absence of federal regulation.

Mark your calendar: The 29th IFHE World Congress will co-locate with the HCD Conference + Expo in New Orleans, October 17–20, 2026 — the largest convergence of global healthcare engineering and design leadership ever held in the United States. Registration opens spring 2026. Details at ifhe.info. The LDES for Healthcare Summit on July 13 in Salt Lake City will feature Chad Beebe of ASHE on hospital battery safety governance alongside speakers from the U.S. Consortium for Long Duration Energy Storage.

The proposal described in this issue — NEC Public Input for new section 517.30(C), Healthcare Microgrid — was filed with NFPA on April 4, 2026. The public input period for the NEC remains open through April 9, 2026. Supporting Public Inputs may be filed at nfpa.org.

IFHE MEMBER NEWS

A weekly scan of public activity across IFHE member organizations worldwide. This is a standing section of The Infrastructure Pulse — updated every issue. Where sites appear quiet, it reflects search visibility rather than inactivity; many members publish on calendars, PDFs, and social channels not easily surfaced in a web pass. Members with news to share are encouraged to send it directly to the editor.

Europe

Germany — FKT: Particularly strong signals this week. Multiple 2026 online seminars underway and active promotion of the 2026 hospital-technology trade fair and programme. FKT continues to be one of the most publicly active IFHE member organizations in Europe for technical content.

France — IHF: Publishing a full 2026 agenda including regional IHF Days and training programming. French-language content for IFHE members seeking continental European CE engagement.

Spain — AEIH: Promoting 2026 Hospitecnia courses for members. Hospitecnia is Spain’s primary healthcare facilities engineering education platform.

Bosnia and Herzegovina — Verlab: Highly active in March-April 2026, with one item particularly worth highlighting for IFHE members globally.

Verlab Opens 2026 Conference-Grant Call — CardioPharmaGENET

Verlab in Bosnia and Herzegovina has opened a 2026 Dissemination Conference Grant Call under its CardioPharmaGENET programme, supporting participation in international conferences and helping expand cross-border healthcare research collaboration. The call offers funding for both in-person and online conference participation, with rolling review through July 31, 2026. Verlab’s active engagement in EU-funded research networks and its investment in dissemination infrastructure make it one of the most internationally connected IFHE member organizations in southeastern Europe. IFHE members with relevant conference activity before July 31 should review eligibility.

Contact: Verlab, Bosnia and Herzegovina — verlab.ba

Italy — SIAIS: Site active but strongest surfaced item was 2025 national congress material. Fresh 2026 activity may be in less-searchable channels.

Africa

South Africa — SAFHE: Strongest African signal this week. The SAFHE 2026 Conference in Cape Town is live with an open call for abstracts under the theme “Synergy in Action: Shaping the Future of Healthcare Together.” SAFHE is one of the most internationally engaged IFHE member organizations on the continent and a natural partner for Sextant Foundation and IFHE Africa programming.

Latin Americas

Costa Rica — ACOAIH: Clear near-term signal. The 8th International Congress on Hospital Infrastructure 2026 is live and open for registration: October 14–16, 2026, San José. Themes, speakers, and sponsorship information are posted. This is the primary Latin American healthcare engineering congress this cycle and merits IFHE and IFHE member promotion.

Argentina — AADAIH: Very active. An open 2026 yearbook article call is live, alongside a full 2026 activity calendar, multiple diploma and certificate programmes, and a 2026 sponsorship push. AADAIH is one of the most organizationally robust IFHE members in Latin America.

Asia-Pacific

Indonesia — IAHE: Continuing seminar activity, including an online hospital master-plan seminar. Indonesia remains one of the more visible Asia-Pacific IFHE members for public-facing educational content.

Japan, Malaysia, Singapore, South Korea, and Australia may well have active programming. This scan did not surface comparably clear fresh public 2026 event pages — likely a website visibility issue rather than inactivity. A structured roster scan is the recommended next step for a complete picture.

English Americas

Canada — CHES: One of the most publicly active IFHE member organizations this week. Full 2026 webinar series underway. National conference: September 20–22, 2026. November 2026 webinar on reusables in healthcare is already listed. CHES is a strong model for member-organization public communication and event programming.

United States — AMFP: Active event calendar and chapter infrastructure. The dominant near-term U.S. signal remains the IFHE World Congress co-located with HCD Conference + Expo in New Orleans, October 17–20, 2026 — hosted by AMFP. See calendar.

IFHE Federation Level

The IFHE Digest 2026 is now available. The January 2026 refrigerant management webinar continues to be promoted. World Congress New Orleans messaging is active across multiple member channels. Several member organizations are amplifying IFHE-level content when their own sites are quieter — a healthy pattern for federation coherence.

“Storage as medicine.” That phrase appeared in a 24x7 Magazine analysis this week about power outages, heat waves, and the threat they pose to home medical device users. It is the right framing. Energy reliability is not a facilities management metric. It is a clinical outcome. Every hour of uninterrupted power is an hour of uninterrupted care. That is what the NEC proposal is ultimately about.

A note on scale: WHO and UNICEF report that nearly one billion people still rely on health facilities with either no electricity or unreliable electricity. The regulatory frameworks we are arguing about this week — NEC Article 517, NFPA 99, TJC survey standards — govern the high end of the global spectrum. The Sextant Foundation’s work in Burundi and the UNICEF/GAVI programs in Zambia address the other end. The distance between those two ends is the entire scope of the global healthcare engineering challenge. IFHE sits in the middle of both.

ABOUT THE EDITOR

Walt Vernon is CEO and Principal of Mazzetti, an employee-owned benefit corporation focused on engineering at the intersection of healthcare and climate. He is President of the International Federation of Healthcare Engineering (IFHE) and founder of the Sextant Foundation, which advances clean energy for low-resourced health facilities globally. He holds degrees in electrical engineering, business, law, and energy law. He helped write the NEC provisions enabling hospital microgrids and serves on the ASHRAE 189.3 committee. He was recently appointed to the leadership team of the U.S. Consortium for Long Duration Energy Storage, run by Sandia National Labs.

Where Healthcare Infrastructure Meets the Climate Imperative

Week of March 29, 2026 • Issue No. 4 • IFHE Global Scan

From the Field: What I Learned at IEEE EPF

I just returned from the second IEEE PES Energy Policy Forum in Washington, DC. I first joined IEEE about 40 years ago, as an electrical engineering student at Vanderbilt. Early in my career, I was fortunate to be an author, and then the assistant editor, for the IEEE/ANSI standard for electrical systems in health facilities. But for a long time after that, my relationship with IEEE was superficial—so much of what they did seemed beyond what we were doing in designing healthcare electrical systems.

No more. This conference reinforced what I’ve been seeing in the field: the conditions outside the hospital are changing faster than most healthcare facility teams realize, and those conditions will increasingly determine what projects can do and when they can do it.

Here are the five things I took away that matter most for healthcare:

1. Storage is a project-enablement tool, not just a resiliency add-on. The session on “Enabling Large Loads with Energy Storage,” moderated by Sandia’s Ray Byrne, was one of the strongest of the conference. The panel argued that storage accelerates energization, buffers utility constraints, reduces peak impacts, improves load behavior, and preserves optionality as grid conditions evolve. Different storage technologies solve different problems—and longer-duration storage still faces market-design barriers even where it is technically compelling. For hospitals, this means LDES needs to be packaged not as a green accessory but as a tool that makes the entire energy project possible.

2. Interconnection is now a negotiation and timing problem, not just a design problem. Multiple sessions made clear that interconnection queues are binding constraints. Large-load interconnection is becoming harder not just because of volume, but because modern loads are more electronics-driven, software-mediated, and dynamic. Future load-serving projects will need stronger utility-facing data and performance narratives. We experienced this directly at Valley Children’s Hospital—had we not resolved our interconnection challenges, the project would have faced a three-year delay.

3. The grid is simultaneously getting less reliable and more expensive. The NERC fireside chat made clear that even if load-growth forecasts are uncertain in detail, the scale is large enough to be system-shaping—especially given slow transmission and generation timelines. Reliability risk, resource adequacy, gas-electric coordination, and the mismatch between fast load growth and slow infrastructure buildout were central themes. For hospitals, every grid constraint is a clinical risk.

4. Resilience is becoming a structured investment category. Two sessions—“Grid Resilience in Practice” and “Resilience as a Strategic Imperative”—treated resilience not as an engineering problem but as an investment, valuation, and ecosystem challenge. The Air Force perspective was especially notable: resilience as mission continuity and national security. Hospitals are mission-critical facilities. We should be framing our resilience investments the same way.

5. Capital follows risk clarity, not technical promise. The “Money Talks” panel was direct: behind-the-meter and distributed energy systems become much more attractive when their resilience, reliability, and direct owner value can be clearly monetized. Rate design and load shape will matter more to hospital owners than many project teams currently assume. For our LDES work, this means the financial narrative has to be as strong as the engineering narrative.

These five themes—storage as enablement, interconnection as constraint, grid deterioration, resilience as investment, and the primacy of financial clarity—are the conditions shaping every hospital energy project we design. The grid’s problems are becoming healthcare’s problems. Our job is to solve them at the building level.

Also this week: Ukraine now has 56 hospitals operating on onsite solar under active conflict conditions. I want you to look at the photo at the top of this issue. That is a hybrid solar power plant being handed over to Kharkiv Municipal Clinical Hospital No. 8, with support from Norway and UNDP. In Ukraine, sustainability is not about a plaque on the wall. It is about resilience, resource availability, and survival. IFHE is actively engaged in supporting Ukrainian hospital infrastructure, and this image captures why this work matters more than any policy paper ever could.

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— Walt Vernon

Executive Summary

This week’s scan is shaped by two field experiences: the IEEE PES Energy Policy Forum in Washington, DC (March 23–26) and the continuing arc from last week’s PDC Summit sessions on LDES. The IEEE EPF surfaced five themes with direct healthcare implications: storage as project enablement, interconnection as binding constraint, grid deterioration, resilience as investment category, and the primacy of financial clarity. The NEC 2026, now being adopted by early jurisdictions, introduces provisions that fundamentally change microgrid economics—and NEC Article 517 needs a performance reframing from “alternate source” to “on-site source.” From Ukraine, 56 hospitals now operate on onsite solar under active conflict—the most powerful real-world demonstration of decentralized healthcare energy resilience at scale. In Europe, the Nantes CHU ($1.4B, 230,000 m²) advances as the continent’s largest hospital project, while Maseru Regional Hospital in Lesotho completes as a $60M climate-adapted template for southern Africa. In the U.S., CMS interpretations now allow hospital microgrids as compliant emergency power, and the Tempe, AZ resilience hub program is deploying $20M in municipal microgrid infrastructure with medical refrigeration. Diesel price shocks from geopolitical instability continue to make the case for on-site renewables as a financial hedge—from Burundi to Baltimore.

Key Signals This Week

1. IEEE EPF: grid constraints are healthcare’s problem. Seventeen sessions over three days in Washington surfaced a consistent message: the grid is simultaneously less reliable, more expensive, and more constrained by interconnection queues that delay new capacity by years. Hospitals are downstream of all of these constraints. See From the Field above for the five key takeaways.

2. Ukraine: 56 hospitals on onsite solar under conflict. Ukraine has installed onsite solar at 56 hospitals, materially strengthening operational resilience under active war conditions (now.solar, per Copilot scan; UNDP Ukraine, Mar. 2025). Norway and UNDP handed over a hybrid solar power plant to Kharkiv Municipal Clinical Hospital No. 8 in March 2025. This is one of the clearest real-world demonstrations of decentralized healthcare energy resilience at scale—and a direct validation of the thesis that on-site renewables are not a sustainability luxury but a clinical continuity tool.

3. NEC 2026 rewrites microgrid economics. Power Control Systems (Article 130), redesigned load calculations (Article 120), and clearer DER interconnection rules (Article 705) fundamentally alter hospital microgrid project economics (Microgrid Knowledge; pv magazine USA, Jan. 2026). Section 700.12(F) now allows emergency loads to connect to microgrids through UL 3008-listed equipment. NEC 517 still needs the performance reframing from “alternate source” to “on-site source.” See Deep Dive.

4. CMS categorical waiver for microgrids remains underused. CMS issued a categorical waiver several years ago allowing hospitals to use onsite microgrids (CHP, solar, storage, fuel cells) as compliant emergency power—supporting full-facility resilience rather than life-safety only. Despite this, the waiver is not being widely used. With the NEC 2026 provisions now enabling emergency microgrid operation through UL 3008-listed equipment, and grid reliability deteriorating, the regulatory path for hospitals to move beyond diesel-only backup is clearer than ever. The barrier is awareness and adoption, not permission.

5. Diesel price shocks make the case for renewables. Geopolitical instability is driving diesel and gas price increases globally (Axios, Mar. 17, 2026). Hospitals are critical facilities on thin margins—energy efficiency, on-site power, and renewables are financial hedges. Kaiser Ontario’s microgrid demonstrated this during the Ukraine crisis: no cost increase. In Burundi, where diesel is $10–13/liter on the black market (per UNDP reporting), solar is the only viable path. The author is finishing a paper on financing healthcare decarbonization in which this hedging strategy is a central element.

6. Battery safety frameworks evolving rapidly. California’s post-Moss Landing legislation is setting new BESS safety standards (Canary Media, Mar. 2026). ASHE has launched a battery safety committee to develop healthcare-specific guidance—a recognition that hospitals deploying battery systems face unique siting, fire safety, and AHJ approval challenges. For hospitals deploying battery systems, a credible safety case—fire safety, zoning, response plans, AHJ comfort—is essential for permitting and community acceptance. The NEC 2026 UL 3008 provisions for emergency microgrid operation are part of this evolving framework.

Regional Signals

North America

IEEE EPF field signals. See From the Field above. Key themes: storage as project enablement, interconnection as binding constraint, grid getting less reliable and more expensive, resilience as investment category.

CMS categorical waiver underused. The CMS categorical waiver allowing onsite microgrids as compliant emergency power has been available for several years but remains underutilized. Energy-as-a-Service models are gaining traction in rural healthcare, positioning resilience as an operating service tied to CMS Emergency Preparedness expectations. The combination of CMS waiver + NEC 2026 provisions + IRA tax credits creates a clearer path than ever for hospitals ready to act.

Tempe resilience hubs: $20M municipal microgrid program. Tempe, Arizona is deploying rooftop solar, BESS, and islanding controls at community hubs to provide secure medical refrigeration and safe cooling during grid failures—relieving emergency room pressure during blackouts.

EPB Chattanooga: nested microgrids demonstrated. Oak Ridge National Laboratory and EPB are testing next-generation microgrid controls allowing boundaries to expand or contract in real time (Microgrid Knowledge, Mar. 18, 2026). The system includes approximately 58 MWh across five interconnected microgrids supporting critical facilities. The “nested microgrid” concept has direct implications for hospital campus energy planning.

SMUD: 160 MW / 640 MWh BESS. Sacramento Municipal Utility District is advancing a massive battery system on a decommissioned nuclear site, providing regional backup capacity that indirectly secures power for nearby healthcare infrastructure.

JFL Hospital, U.S. Virgin Islands. The Office of Disaster Recovery executed the contract on March 26 for the new hospital build, commencing a 12-month design phase for a highly resilient, energy-efficient facility designed to withstand Category 5 hurricanes.

Sources: IEEE PES EPF (Mar. 23–26, 2026); Microgrid Knowledge; unisonenergy.com; Canary Media; USVI ODR (Mar. 26, 2026).

Europe

Nantes CHU: Europe’s largest hospital advances. Construction of the 230,000 m² Nantes University Hospital ($1.4 billion) is progressing through a highly complex logistics phase: 1,500 km of cables, 500 distribution boards, 160 active delivery points. The project is demonstrating how zero-waste supply chain logistics (reusable plastic bins, cable reel recovery) can work at mega-project scale under strict European ESG mandates (Sonepar, Dec. 2025).

European hospital construction pipeline. Multiple projects advancing: Achern Ortenau Hospital Campus, Germany (32,000 m², 30,000 patients/year, 2028); Wroclaw Oncology Hospital, Poland (671-bed, four-storey cancer center); Evora Public Central Hospital, Portugal ($210M, final interior fit-outs); Costa del Sol Hospital Expansion, Spain (35,000 m², late 2026); Hassleholm Orthopedic Center, Sweden (24,000 m²).

EU 2040 climate target: final approval. The EU Council gave final green light on March 5, 2026. This locks in the decarbonization trajectory for European hospital construction, renovation, and procurement for the next 15 years.

Sources: Sonepar; World Construction Network; EU Council (Mar. 5, 2026).

Asia-Pacific

Fastest-moving region on healthcare decarbonization. BMJ analysis frames Asia-Pacific as the proving ground for system-level healthcare decarbonization, driven by convergence of emissions share, climate risk, and population growth (per Copilot scan). Infrastructure investment is increasingly framed as “health-in-infrastructure,” integrating climate resilience, emissions reduction, and health outcomes.

India: HIE data center expansion. Rapid expansion of Health Information Exchange software solutions across India is triggering upgrades to hospital data center cooling and cybersecurity networks. Combined with the 30-hospital private-sector expansion reported last week, India’s healthcare infrastructure build-out is among the fastest globally.

Cryogen-free MRI approaching clinical deployment. High-temperature superconducting (HTS) coil MRI systems that eliminate liquid helium are moving from research to pilot stage. If commercialized, this removes the need for quench exhaust piping and fundamentally alters imaging suite HVAC and architectural requirements—a significant facility design simplification.

Sources: BMJ; AIIB; ISMRM.

Africa & Middle East

Ukraine: 56 hospitals on onsite solar. The most significant resilience signal of the week. Under active conflict, Ukraine has installed onsite solar at 56 hospitals (now.solar). Norway and UNDP provided a hybrid solar plant to Kharkiv Municipal Clinical Hospital No. 8 in March 2025. IFHE is actively engaged in supporting Ukrainian hospital infrastructure. In Ukraine, sustainability is about resilience, resource availability, and survival.

Maseru Regional Hospital, Lesotho: completed. The POWERCHINA-constructed 23,900 m² hospital ($60M) received top MOFCOM evaluation. The facility integrates dual-source CT scanners within ISO Class-5 clean operating rooms, powered by solar water heating tailored to extreme diurnal temperature shifts. A template for climate-adapted healthcare construction in southern Africa.

Morocco smart hospitals. New regional university hospitals in Agadir, Rabat, and Laâyoune are physically integrating telemedicine hubs and the Dossier Médical Partagé (DMP) for secure regional patient data exchange.

Nigeria: NSIA diagnostic centers. The Nigeria Sovereign Investment Authority is co-developing advanced, digitally connected centers of excellence for oncology and radiology across Lagos, Kano, and Umuahia.

Uganda biogas for health facilities. SEforAll reports on biogas innovation powering Ugandan health facilities in displacement settings. Directly relevant to the Sextant Foundation’s work and the planned VHW Phase 3, where the hospital currently burns charcoal from the surrounding rainforest.

Sources: now.solar; UNDP Ukraine (Mar. 2025); China-Africa SPS; GITEX Future Health Africa; SEforAll.

Latin America & Caribbean

JFL Hospital, USVI: contract executed. See North America section. The new hospital design phase is underway, prioritizing multi-story, renewable-energy-conscious construction to withstand Category 5 hurricanes.

PAHO resilient hospitals framework. Implementation continues ahead of storm season. Caribbean and Central American facilities are shifting capital toward passive survivability designs and backup power systems.

Sources: USVI ODR (Mar. 26, 2026); PAHO.

Deep Dive

NEC 2026, Article 517, and the Performance Reframing Healthcare Needs

The 2026 National Electrical Code is the most significant update for hospital energy systems in a generation. But the provision that matters most for healthcare’s future isn’t in the new articles—it’s in the old one that needs to change.

What NEC 2026 Changes Now

Three provisions alter hospital microgrid economics immediately. First, Power Control Systems (now in Article 130) formalize the use of real-time load data for system sizing—potentially eliminating hundreds of thousands of dollars in unnecessary service upgrades. Second, Section 700.12(F) allows emergency loads to connect to microgrids through UL 3008-listed equipment, enabling battery-first dispatch with generator backup. Third, clearer DER interconnection rules in Article 705 address backfeed protection, ground-fault requirements, and multi-source isolation—ambiguities that slowed permitting on projects like KVH and Valley Children’s.

What NEC 517 Still Gets Wrong

Article 517 still requires service from an off-site system and frames on-site generation as an “alternate source.” The embedded assumption: the utility grid is the primary, reliable, cost-effective power source, and everything else is backup.

That assumption is breaking down. The IEEE EPF made this vivid. The NERC fireside chat confirmed that load growth is system-shaping and infrastructure is not keeping up. The “Big Loads, Small Bills” panel showed that affordability depends on timing, utilization, and regulatory cost allocation—not just average energy cost. The Forbes analysis of grid reliability, the ERCOT price projections, the interconnection queue data—all point the same direction: the utility is not always there, not always sufficient, not always affordable.

In NEC committee discussions, many members still treat the utility as a kind of holy grail. They push back on continuous-operating microgrids. We have largely overcome that resistance through provisions like 700.12(F), but not completely.

The reframing that NEC 517 needs: move from “there is a utility and a diesel” to “you must have enough on-site power, with enough reliability, to ensure continuous operation of the essential system.” This is a performance standard, not a prescriptive one. It does not mandate any particular technology. It says: prove that your system works, reliably, for the duration required.

This is not a theoretical exercise. The author helped write portions of the NEC that opened the door to hospital microgrid systems and is actively working on this performance-based reframing. A dedicated article is forthcoming.

Sources: Microgrid Knowledge, “How NEC 2026 Changes Microgrid Economics”; pv magazine USA (Jan. 2026); NEC 2026 Articles 120, 130, 517, 700.12(F), 705; IEEE PES EPF sessions (Mar. 2026).

Codes, Standards & Regulation Watch

NEC 2026 adoption underway. Early-adopter jurisdictions are implementing now. Key healthcare provisions: PCS (Article 130), emergency microgrid operation via UL 3008 (Section 700.12(F)), DER interconnection (Article 705). See Deep Dive.

CMS microgrid categorical waiver. Issued several years ago but still underutilized. Allows hospital microgrids as compliant emergency power. Combined with NEC 2026 and IRA provisions, the regulatory and financial path is now clear—the barrier is awareness and adoption.

EPA waste combustion rules finalized. First update in 20 years. Lower limits for nine pollutants at 57 facilities (Waste Dive, Mar. 9, 2026). May affect hospitals considering on-site waste-to-energy, including pyrolysis.

EPA rolls back EtO regulation. Ethylene oxide—a carcinogenic gas widely used in hospital sterilization—is no longer federally regulated (NYT, Mar. 13, 2026). State-level rules will vary. Alternative sterilization technologies deserve urgent evaluation.

Battery safety: California post-Moss Landing + ASHE committee. New California state legislation establishing BESS safety standards. ASHE has launched a dedicated battery safety committee to develop healthcare-specific guidance. Hospitals deploying batteries must develop credible safety cases for permitting and AHJ approval.

State energy storage legislation. Multiple states advancing: Colorado HB1051, Hawaii SB3254, Maine docket 2025-00343, Ohio 25-0741-EL-ORD, New Jersey moving forward (Inside Climate News, Mar. 27), Massachusetts reducing barriers (Solar Power World). Patchwork creating both opportunities and compliance complexity for multi-state health systems.

California BPS advancing. CEC Building Energy Performance Strategy report signals building performance standards coming for California healthcare facilities.

NESC for storage near critical infrastructure. Large-scale BESS deployment near hospitals is driving strict new adherence to NESC guidelines for stormwater controls and secure fire-containment footprints.

JCI IPD planning guidelines. JCI accreditation evaluations are increasingly scrutinizing inpatient department layouts for infection prevention spacing, natural cross-ventilation, and physical separation of clean, dirty, and service zones.

Signal Bank: Parked for Future Issues

The following topics surfaced this week but are being held for dedicated coverage.

Codes & Reliability: NEC 517 performance reframing (dedicated article forthcoming). How to size on-site fuel under real disruption assumptions. Interconnection delays as hidden risk (VCH case study). ASHRAE 189.3 on-site water resilience standard (the author is leading the task force; California mandates 72–96 hours of on-site water supply for hospitals). Demise of TEAMS and implications. NYC energy code update.

Sterilization & Waste: EtO alternatives now that federal regulation is rolled back. On-site pyrolysis for healthcare waste (EPA FR-2026-03-10 waste combustion rule implications). PFAS in agricultural pesticides (2.5M lbs/year in California, per LA Times).

Smart Hospitals & Infection Control: Smart hospital shift from hardware to software/data (MobiHealthNews). SARS-CoV-2 RNA in 39% of hospital air samples despite good ventilation (CIDRAP)—management may be more effective than ventilation alone (IAPD findings). Climate change impact on medical imaging quality (ASHRAE/UCOP study in progress). Aerosol science research on particle behavior in clinical settings (Aerosol Science & Technology, 2024).

Climate, Finance & Hedging: Financing healthcare decarbonization paper (in progress). Climate-driven health impacts as missing financial risk (Climate Week NYC). Green infrastructure capital piling up faster than it deploys (E+E Leader). Suppliers who decarbonize first will win contracts (E+E Leader). Uganda VHW Phase 3 (biogas/solar to replace charcoal from rainforest). IFHE Ukraine hospital work. Oil disinformation as the new tobacco (future essay). NAM Climate and Health Summit 2026.

Energy & Grid: ERCOT data center demand: potential 79% price hike by 2027. National Academies grid reliability report. Geothermal as future firm clean power for districts/campuses (IEEE EPF session). GridEx power grid cybersecurity exercises. Octopus Energy / Uplight: flexible digitalized grids. Resource and energy certificates (REC) financial modeling.

Fleet & Transport: Fleet electrification—EVs avoided 2.3M barrels of oil daily in 2025 (Bloomberg). More attractive given fuel price volatility.

Biomedical Technology: Cryogen-free MRI (HTS coils, eliminates helium quench piping). Ceiling-mounted patient-handling lifts (structural/electrical retrofit implications). ACR MR safety practices for gradient upgrades. Medical societies calling for decarbonization—form follows function (Lancet Americas).

Calendar & What to Watch

May 4–7: IEEE PES T&D Conference & Exhibition, Chicago — Data centers, grid resilience, renewables, cybersecurity

May 2026: GITEX Future Health Africa, Morocco — Smart hospital architecture, energy resilience, digital infrastructure

June 2026: ENERGY STAR/DOE transition 90-day period concludes

July 13 (planned): LDES in Healthcare Pre-Conference Symposium, Salt Lake City — email Walt Vernon for more information

July 14–15: U.S. Long Duration Energy Storage Consortium Final Annual Meeting, Salt Lake City

August 2026: ASHE PDC Summit 2026

August 10: California SB 253 first Scope 1 & 2 reporting deadline

September 21–25: IEEE PES/IAS PowerAfrica Conference, Nairobi, Kenya

October 2026: 29th IFHE World Congress, New Orleans — Call for papers: Resilient Design in Coastal Zones

On the Reading List

• NEC 2026 Changes Microgrid Economics (Microgrid Knowledge)

• America’s Electric Grid Has a Reliability Problem (Forbes, Mar. 2026)

• Norway and UNDP Enhance Kharkiv Hospital Energy Resilience (UNDP Ukraine)

• EPB Chattanooga Nested Microgrid Demo (Microgrid Knowledge)

• Interconnection Reform and AI Data Centers (RMI)

• Biogas Innovation Powers Ugandan Health Facilities (SEforAll)

• Battery Safety: California Moss Landing Legislation (Canary Media)

• National Academies: Grid Reliability

• NAM Climate and Health Summit 2026

• Nantes CHU Construction Logistics (Sonepar)

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 was recently appointed to the leadership team of the U.S. National Consortium on Long Duration Energy Storage.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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From the Field

I am writing this issue while sitting on a plane to Washington, DC. This week, I will attend the second IEEE Power Engineering Society’s Energy Policy Forum. I first joined IEEE (the Institute of Electrical and Electronics Engineers) about 40 years ago, while still an electrical engineering student at Vanderbilt University. Early in my career, I was fortunate to be an author, and then the assistant editor for the IEEE/ANSI standard for electrical systems in health facilities. But, since that time, my relationship to IEEE has been superficial; so much of what IEEE did seemed beyond the things we were doing in designing healthcare electrical systems.

No more. In so many ways, this is the most exciting time to be an electrical engineer in health facilities. Things are changing so fast around us—the technologies available to us, the macro forces acting on the utilities and the opportunities these create for developing on-site energy systems that have radically better economics than our old diesel generator paradigm, and rapid advances in so many parts of the energy and interconnection and emission worlds of regulation. This particular meeting is one of the few I attend these days, in which I can actually learn. Last year was their first, and I remember being a sponge, the entire time.

We in the healthcare engineering world have so much possibility in front of us. But, so much of it is new, and newness brings with it risks.

Last week, I was fortunate to participate in two sessions at the ASHE PDC focused on different aspects of emerging Long Duration Energy Storage (LDES) systems. One session focused on the possibilities of hydrogen—something I will write on much more extensively, in the future. The second focused on electrical LDES systems, a much more mature and easily understood family of technologies. Both are exciting.

I am working now with a large not-for-profit health system. Like many, they are worried about escalating electricity prices. (Today, we are also strongly reminded of the economic risks that our dependence on fossil fuels in general create for us!) One of the easiest ways to mitigate some of this risk is through the deployment of LDES systems.

I joined the U.S. National Consortium on LDES a year ago. This is such an exciting group, and I wish I had known about it earlier. The Consortium seeks to bring together all of the U.S. National Laboratories and focus them on the development of technologies, policies, practices, and economic levers to help the U.S. to rapidly develop and take advantage of this emerging area of technology. Given the other work I have been doing in the area of behind-the-meter energy systems for healthcare, the synergy was clear.

A month ago, I was appointed to the leadership team of this amazing group, focused on accelerating the usefulness and the use of this critical technology. The Consortium features a number of “Tiger Teams” and I populated most of them with Mazzetti teammates, including myself, wherever possible. One of their Tiger Teams is Customer Adoption. This team focuses on how to help different industries and applications make better use of these emerging technologies. I have been working with this team for several months now, including a presentation I organized for them with colleagues from Kaiser Permanente and Valley Children’s Hospital to help think about the issues of the healthcare industry, and to begin to create some thinking around how to build awareness and tools and deployment of LDES in healthcare.

From that has emerged an idea that we are working to develop now. The Consortium was funded by the previous Administration. Though not killed by the current administration, its funds end this year. In July, we are hosting the final Annual Meeting of the Consortium on July 14–15. We are planning to add an extra day for a pre-conference summit on LDES in healthcare. I am very excited about this, and I think it can accelerate the needed transition of healthcare energy systems. If you are interested, if you have case studies, if you just want to come, please reach out to me. We are aiming to make it free to healthcare owners, or only a nominal cost to cover food—registration details are forthcoming. It is so important that we, as an industry, take advantage of this precious resource that our best national scientists have helped to launch.

Please enjoy the rest of this newsletter!

If you think it’s valuable, please forward it to your colleagues.

If you think it’s really valuable, subscribe here.

Thank you all.

— Walt Vernon

Executive Summary

This week’s scan is anchored by field signals from the ASHE PDC Summit in Houston (March 8–11). The scan window also captures the ENERGY STAR program’s formal transfer from EPA to DOE (MOA signed March 3), with significant implications for healthcare benchmarking; accreditation bodies embedding sustainability into core standards for the first time (JCI 5th Edition); and India’s announcement of 30 new private-sector hospitals—one of the largest expansion signals in recent years. From Burundi, the UNDP inaugurated five solar-hybrid health facilities—the country’s first—with Phase 2 scaling to nine more district hospitals by April. U.S. hospital construction spending is trending toward $28–$31 billion in 2026, with a surge in 25,000–60,000 sf microhospitals reshaping engineering practice alongside billion-dollar mega-projects. Across all regions, three structural shifts are converging: the move toward distributed, smaller-format care delivery; the maturation of savings-financed microgrid and LDES systems as standard infrastructure (now explicitly backed by DOE policy); and the transformation of hospital IT from specialized service to facility “nervous system.”

Key Signals This Week

1. PDC Summit field report: I presented two sessions on breakthrough hospital energy systems—hydrogen fuel cell (illustrated by our Klikitat Valley Hospital project, using 100 kW Kohler/Toyota PEM, believed to be the first hydrogen fuel cell system at a U.S. hospital; see HFM Magazine, “Rural Hospital Invests in Hydrogen”) and Long Duration Energy Storage in the form of electrical batteries as exemplified by Valley Children’s Hospital battery (14 MWh combined when Phase 2 is complete—which would make it the largest hospital battery system in the world, per CEC CEQA filing, Feb. 2025). Both projects demonstrate that on-site energy systems take work at the nexus of changing technology, project finance, energy procurement, and regulatory evolution.

2. ENERGY STAR transfers to DOE: EPA and DOE signed a 10-year Memorandum of Agreement on March 3, 2026, establishing DOE as lead agency for the ENERGY STAR program (Facilities Dive, Mar. 2026). Portfolio Manager—used by more than 330,000 buildings representing roughly 25% of U.S. commercial floor space, according to BOMA International—will transition to DOE oversight. Congress funded the program at $33 million for FY2026. Industry groups call for transparency and staff continuity during the 90-day transition period. IFHE has been actively advocating for healthcare-specific scoring continuity. The IFHE Cut the Carbs Award, recognizing the accomplisments of our members, uses this platform as our engine.

3. Burundi solar health facilities inaugurated: UNDP’s Smart Facilities for Health initiative inaugurated five solar-hybrid health facilities on February 10, 2026—Burundi’s first (UNDP Burundi, Feb. 2026). Phase 2 (nine additional district hospitals, 45 kWp solar + 115 kWh battery each) is underway with commissioning expected April 2026. Total program investment: approximately $2.6 million for 14 facilities representing roughly 20% of Burundi’s district hospitals. Black-market diesel in Burundi costs $10–13 per liter—more than seven times the official rate, according to UNDP reporting.

4. U.S. hospital construction: mega-projects persist, but the strategic gravity is shifting to smaller formats: Forecasts still point to a sustained U.S. hospital construction cycle: ConstructConnect projects hospital construction starts at $28.4B in 2026, rising to $34.3B by 2029. At the same time, industry survey data suggests the portfolio is diversifying—not just more “big hospitals,” but more distributed care formats. The 2026 Hospital Construction Survey (HFM/ASHE) shows microhospitals moving from a rounding error to a real category: 6% of respondents are currently building a microhospital and 4% plan one within three years—a meaningful jump from prior years.

The engineering implication is subtle but profound. Distributed acute and procedural footprints (microhospitals, ASCs, satellites) shift the problem from bespoke, campus-scale central-plant heroics to repeatable, modular infrastructure: standardized electrical/IT backbones, right-sized utility “kits,” and highly adaptable ceiling/service zones that can absorb rapid service-line churn. Meanwhile, the big projects haven’t gone away—lists of $1B+ hospital projects keep surfacing—yet the most consequential long-term change may be where care is delivered and how quickly facilities must be reconfigured.

5. Accreditation embeds sustainability: JCI’s 5th Edition laboratory standards field review explicitly introduces Sustainable Healthcare and digital/data-security requirements into accreditation for the first time. Joint Commission March 2026 updates also revise interpretations on labs, staffing, and fire drills to align with NFPA and international norms. This convergence of accreditation and sustainability means decarbonization is migrating from voluntary to compliance-linked.

Regional Signals

Latin America & Caribbean

PAHO resilient hospitals framework. Implementation of the PAHO “Resilient Hospitals Operational Framework” continues to prioritize “black-sky” hazard preparedness across the region. Facilities are shifting capital toward robust backup power systems and passive survivability designs to withstand prolonged extreme weather events—a direct parallel to the microgrid resilience strategies gaining traction in North America.

ROI-driven smart-hospital investment. Health systems across Latin America are moving away from monolithic digital transformation toward targeted, ROI-driven investments in interoperability, modular hospital platforms, imaging AI, and smart-hospital analytics. Regional procurement is increasingly shaped by healthcare trade fairs and integrated hospital + medtech marketplaces, reinforcing convergence between facility upgrades and technology adoption.

Supply chain localization. Persistent global shipping delays are forcing a shift toward locally sourced building materials for healthcare retrofits. Project timelines are adapting to incorporate regional prefabrication rather than relying on international MEP component imports—a trend that may accelerate as tariff and trade policy uncertainty continues.

Sources: PAHO Resilient Hospitals programme; regional construction and health technology reporting.

North America

PDC Summit takeaways. The ASHE PDC Summit (March 8–11, Houston) drew 3,500+ professionals across seven learning tracks. Dominant themes included prefabrication as the new standard (MEP racking, bathroom pods compressing timelines 20–30%), grid-interactive efficient buildings, behavioral health design principles bleeding into acute care, and the financial architecture of decarbonization. The Vista Awards recognized team-based PDC innovation.

Lee Health Fort Myers: $481M campus topped out. Skanska topped out the five-story hospital (168 beds, 18 ORs, 24 ICU beds, 44 ED beds) plus 122,000 sf medical office building. Opening 2028. Major replacement hospital project in high-growth Florida corridor.

Dana-Farber cancer hospital: construction begins. Construction started March 16, 2026 on Dana-Farber Cancer Institute’s new hospital at One Joslin Place in Boston’s Longwood Medical Area. Part of the Dana-Farber Beth Israel Deaconess Cancer Collaboration. Opening 2031.

IU Health Indianapolis: $2.31B mega-project. The 864-bed downtown Indianapolis hospital—part of a $4.3 billion campus—is using a “Team of Teams” management model with cost-plus contracting, embedded owner staff, and performance incentives. Over $100M in owner-held contingency. Prefab components valued at $200M+ on the Ohio State Wexner project are compressing timelines by 4–6 months.

Kaiser Redlands: 321-bed campus advancing. Redlands Planning Commission unanimously recommended approval of the phased Kaiser Permanente medical campus on 36.5 acres. Environmental review flagged GHG emissions and vehicle miles traveled as “significant and unavoidable.” Commissioners stressed ongoing climate impact monitoring through phased buildout.

Microhospital surge reshaping engineering. The fastest-growing segment of U.S. hospital construction is the 25,000–60,000 sf microhospital and freestanding ASC. These small-format facilities demand a fundamentally different engineering approach: scalable modular infrastructure, highly adaptable ceiling grids for rapid service line changes, and right-sized mechanical systems replacing the massive centralized plants of traditional acute care. The trend is both a design challenge and a decarbonization opportunity—smaller footprints are inherently easier to electrify.

Microgrid debt financing matures. Facilities are successfully securing multi-million dollar bonds for solar+BESS+CHP microgrids by using guaranteed energy savings to cover debt service. The standard for backup power is moving beyond diesel-only toward integrated systems providing 7–14 days of resilience while reducing daily utility bills by up to 25%. This savings-financed model—where the energy cost reduction pays for the capital investment—is the transaction structure that makes hospital microgrids replicable at scale.

PROJECT SPOTLIGHT — Valley Children’s Hospital, Madera, CA

Phase 1 microgrid (1.32 MW solar, 2.2 MW fuel cell, 2 MWh battery) under construction, going online 2026. Phase 2: 12 MWh long-duration flow battery in design by Mazzetti, with Sandia National Laboratories providing technical support. CEC approved initial $4.3M engineering grant with potential to $28M. Combined 14 MWh would be the largest battery system at any hospital in the world, to the best of the author’s knowledge. DOE’s $30M grant rescinded in 2025; hospital and CEC pressing forward using own funds plus IRA provisions.

Valley Children’s Healthcare; CEC CEQA filing (Feb. 2025); Microgrid Knowledge; YourCentralValley.com (Oct. 2025).

Implication: Demonstrates that a children’s safety-net hospital can lead on energy resilience without federal funding, using IRA provisions and state partnerships. Directly relevant to IFHE advocacy on microgrid policy and Sextant Foundation’s work on replicable models.

Sources: ASHE PDC Summit 2026; Construction Dive (Mar. 13, 2026); ENR (Mar. 9, 2026); BIDMC (Mar. 2026); HFMA (Mar. 2026); Community Forward Redlands (Mar. 2, 2026).

Europe & Middle East

Central/Eastern Europe: 14.2% cost trend. Financial projections for 2026 indicate a healthcare cost trend increase of approximately 14% in Central and Eastern Europe, according to regional benefits consulting data. Facilities are fast-tracking energy efficiency upgrades and building automation to offset inflationary pressures on operational budgets—making the business case for microgrids and deep energy retrofits even more compelling.

Radiopharmaceutical infrastructure emerging. The use of targeted radiopharmaceuticals is gaining significant traction across European oncology centers. This trend has direct facility implications: hospitals require highly specialized, heavily shielded infrastructure, specialized HVAC and waste handling systems, and supply chain logistics integrated directly into core building design. Radiopharmacy suites may become a standard feature of new oncology center construction.

Spain: 35% emissions reduction through operations. A Spanish public hospital has reported achieving a 35% reduction in emissions through operational decarbonization tied directly to governance practices, staffing protocols, and ISO-aligned management systems—without major capital construction. If confirmed at scale, this is a significant signal: European hospitals may be proving that measurable decarbonization is achievable now through operational discipline, not just future builds. The approach pairs governance reform with building automation and energy efficiency upgrades.

EU EPBD implementation advancing. Member states are transposing the recast Energy Performance of Buildings Directive with emphasis on digital twins, intelligent lighting controls, and climate-resilient design. While not healthcare-specific, the directive’s trajectory toward grid-interactive buildings will increasingly affect hospital operations and renovation planning across the EU.

UK New Hospital Programme. The Hospital 2.0 Alliance continues under Willmott Dixon, signaling industrialized, programmatic delivery of UK hospital construction. The model emphasizes standardization, cost control, and portfolio-wide modernization—directly relevant to IFHE members working on programmatic healthcare facility delivery.

OECD decarbonization benchmarks. The Netherlands allocated €42 million within the Ministry of Health budget for 2023–2026 for sustainable health system projects. The Czech Republic has completed 26 Energy Performance Contracting projects in its health sector. Victoria, Australia has mandated all new public hospitals be fully electric on 100% renewables.

PROJECT SPOTLIGHT — NHS Net Zero Programme, United Kingdom

The NHS remains committed to net-zero by 2040 (Scope 1 & 2) and 2045 (Scope 3), making it the world’s first health system to embed net-zero into legislation. The New Hospital Programme’s Hospital 2.0 Alliance is delivering standardized, factory-built hospital modules designed to meet net-zero requirements from day one. Multiple schemes are in design or early construction phases.

NHS England Net Zero; Willmott Dixon / Hospital 2.0 Alliance.

Implication: The NHS model—legislating net-zero for an entire health system—remains the global benchmark. IFHE’s co-authorship of WHO climate-resilient facility guides draws directly on this experience.

Sources: BUILD UP / EPBD; OECD Decarbonising Health Systems (2025); NHS England; Willmott Dixon.

Asia-Pacific

CHCC 2026: prefabrication becomes dominant. The upcoming China Hospital Construction Conference (CHCC 2026) in Tianjin is heavily spotlighting “application-ready” prefabricated hospital components. Modular cleanrooms, pre-built operating rooms, and intelligent logistics systems are becoming the dominant method for compressing construction timelines across the Asia-Pacific region. For IFHE members, this signals that the prefab revolution is no longer a Western trend—it is the global standard.

AI-driven operational efficiency. Volume-Based Procurement (VBP) pricing pressures across Asian health systems are forcing aggressive overhead reduction. Hospitals are investing heavily in AI for building controls and advanced logistics robotics to automate daily facility management—from predictive HVAC optimization to autonomous supply delivery. This is the operational expression of the IT-infrastructure-as-facility-core pattern emerging globally.

India: major private-sector hospital expansion. One of the most significant private-sector healthcare expansion announcements in recent years: reports indicate plans for approximately 30 new hospitals nationwide, aimed at closing regional access gaps and scaling advanced care into tier-2 and tier-3 cities. Public-sector momentum continues via national programs focused on district-level critical care, laboratories, and integrated public health systems. India’s infrastructure build-out is among the fastest globally and demands engineering standards adapted to tropical climate zones, variable grid quality, and high patient volumes.

India robotics expansion. Himachal Pradesh plans to introduce robotic surgery across state medical colleges. CK Birla Hospital Delhi achieved robot-assisted breast cancer milestones. These expansions reshape facility requirements: OR power density, networking, sterile processing workflows, and specialized training environments.

Australia hospital investment. UnitingCare Queensland’s A$250 million Wesley Hospital expansion (10-storey, day surgery, radiation oncology, advanced imaging) targets 2028 completion. Victoria’s mandate that all new public hospitals be fully electric on 100% renewables continues to set the standard for the Asia-Pacific region.

PROJECT SPOTLIGHT — Wesley Hospital, Brisbane, Australia

A$250 million, 10-storey expansion including day surgery suites, radiation oncology, and advanced imaging. Completion targeted for 2028 under UnitingCare Queensland. The project significantly increases the campus’s electrical intensity and continuity requirements.

Courier Mail (Brisbane); UnitingCare Queensland (2025).

Implication: High-acuity specialty growth projects like Wesley demand integrated energy and infrastructure planning from day one. Victoria’s all-electric mandate for new public hospitals will increasingly influence private-sector design decisions.

Sources: Times of India; PIB India; Courier Mail (Brisbane); Victoria State Government.

Africa & Middle East

Burundi: first solar-powered health facilities. UNDP inaugurated five solar-hybrid health facilities on February 10, 2026 at Kibumbu District Hospital—Burundi’s first. Each system provides 16–17 hours of clean backup electricity, supplying 50–90% of facility energy needs depending on location. Phase 2 (nine additional district hospitals) is underway, with each receiving 45 kWp solar and 115 kWh battery storage. Total program: $2.6 million, 14 facilities, approximately 548 tons CO₂ avoided annually. Aptech Africa designed, supplied, and installed the systems using Deye inverters, Jinko Solar modules, and remote monitoring.

IFC Egypt green finance. Five new projects announced February 15, 2026, including $150 million with Banque Misr for green lending and $15 million for GMED Holding to expand medical equipment production across Egypt and East Africa. IFC committed a record $71.7 billion to developing countries in FY2025.

Rwanda CHUK relocation. The new CHUK complex in Masaka is near completion with relocation expected to begin in March 2026. Rwanda continues to invest in centralized referral hospital infrastructure.

Digital infrastructure leapfrogging. AU-WHO collaborations are funding digital health and AI workforce training across the continent. New facility designs must prioritize high-bandwidth satellite or fiber connectivity to support telehealth and remote patient monitoring hubs. Across sub-Saharan Africa, decentralized renewable energy is leapfrogging traditional grid development, establishing solar+BESS as the baseline for new rural healthcare facilities—a pattern the Burundi UNDP program exemplifies.

PROJECT SPOTLIGHT — UNDP Smart Facilities for Health, Burundi

Phase 1: five solar-hybrid health facilities operational since February 10, 2026, funded through Global Fund C19RM at $943,885. Phase 2: nine additional district hospitals, $1.67 million, commissioning April 2026. Each Phase 2 site: 45 kWp solar PV + 115 kWh battery, 12–25 hours backup power. Addresses black-market diesel crisis ($10–13/liter, 7× official rate) and grid reliability (<15% population connected). Remote digital monitoring enables real-time performance tracking.

UNDP Smart Facilities for Health (Feb. 10, 2026); pv magazine (Feb. 18, 2026); Green Building Africa (Feb. 19, 2026); Aptech Africa.

Implication: Directly relevant to Sextant Foundation’s mission and IFHE’s Work Plan on healthcare facility electrification in low-resource settings. The Burundi model—standardized hybrid systems with digital monitoring—is the kind of replicable approach that scales. At $67,000–70,000 per facility in Phase 1, the economics are compelling vs. ongoing diesel dependence.

Sources: UNDP Burundi (Feb. 2026); pv magazine (Feb. 2026); Green Building Africa; Aptech Africa; IFC Press Release (Feb. 15, 2026); Ukweli Times (Rwanda).

Global Patterns

The shift to distributed care. The traditional mega-hospital campus is being supplemented—and increasingly replaced—by scalable microhospitals and ambulatory centers. The U.S. microhospital surge, Latin America’s modular facility investment, and Asia-Pacific’s prefab dominance all point the same direction: engineering standards must scale down gracefully to smaller, decentralized settings without sacrificing resilience or clinical capability.

Hospital construction is surging globally. U.S. hospital construction spending is projected at $28–$31 billion in 2026 (ConstructConnect; HFMA, Mar. 2026), trending to $38.8 billion by 2030. Fifteen projects exceeding $1 billion were announced in 2025 alone, according to ConstructConnect data cited by HFMA. The bifurcation is clear: large, well-capitalized systems are building billion-dollar replacement hospitals, while financially strained systems focus on renovations and deferred maintenance. The busiest U.S. states are Florida, Texas, and North Carolina.

Microgrids are becoming standard—and financeable. Kaiser Ontario (2 MW solar, 9 MWh battery, 1 MW fuel cell), Valley Children’s (14 MWh combined), Klickitat Valley Health (hydrogen), and NYU Langone (4 MW battery) represent a convergence. Critically, the financing model is maturing: hospitals are securing bonds for solar+BESS+CHP microgrids using guaranteed energy savings to cover debt service. A January 2026 Scientific Reports paper provides a formal optimization framework validating 55–63% reductions in energy not supplied and 95%+ supply to life-critical loads.

IT infrastructure as facility core. The explosion of AI diagnostics (Merlin, imaging AI), IoMT devices, and cybersecurity threats is transforming hospital IT networks from specialized services into the fundamental “nervous system” of the building. Secure-by-design server environments, high-density power and cooling for edge computing, and physically hardened IT infrastructure within the hospital footprint are becoming as critical as mechanical and electrical systems. Cybersecurity premarket guidance from FDA compounds the facility planning burden.

Continuous compliance monitoring. Regulatory standards and ASHRAE 170-2025 are pushing facilities from manual facility checks toward automated, 24/7 environmental monitoring for pressure, temperature, and humidity. IoT-based continuous monitoring is replacing manual ball-in-tube pressure checks—a shift with implications for building automation system design, network infrastructure, and ongoing maintenance contracts.

ENERGY STAR transition: implications for healthcare. The March 3 MOA transferring ENERGY STAR to DOE affects every hospital that benchmarks energy performance. The healthcare-specific ENERGY STAR score is the industry standard for facility benchmarking. IFHE is monitoring to ensure scoring methodology continuity. See Deep Dive II.

Deep Dives

I. From the Field: PDC Summit and the Two Industry Firsts

The ASHE PDC Summit (March 8–11, Houston) brought together 3,500+ professionals. Two sessions presented by this newsletter’s author—on the Klickitat Valley Health hydrogen fuel cell and the Valley Children’s Hospital battery energy storage system—drew significant attention as concrete examples of what the hospital energy transition looks like in practice.

The core thesis of both presentations: on-site energy systems for hospitals are developing at the nexus of four converging forces—changing technology, project finance opportunities, energy procurement opportunities, and regulatory evolution. Understanding any one in isolation misses the picture. A hydrogen fuel cell is not just an engineering decision; it is simultaneously a financing decision, a procurement decision, and a regulatory navigation exercise. The same is true of long-duration battery storage.

KVH summary: Klickitat Valley Health in Goldendale, WA—a 25-bed critical access hospital—is operating what is believed to be the first hydrogen fuel cell system for hospital emergency power in the United States (HFM Magazine; Kohler/Toyota press release, Feb. 2024; Mazzetti project profile). The 100 kW Kohler/Toyota PEM system (second-generation Mirai fuel cell stack) supplements the hospital’s diesel generators, powering non-emergency circuits. Mazzetti served as hydrogen system engineers. The system received state approval in March 2025 after navigating overlapping codes (NFPA 70, 853, 55, IFC, IBC) none of which were designed for hospital hydrogen applications. KVH secured $3 million through a Washington state legislative appropriation and is leveraging IRA elective pay provisions for clean energy components as part of a $16 million phased resilience plan with PNNL and Sandia National Laboratories technical assistance (PNNL ES4SE, Nov. 2024; WA Dept. of Commerce/CETCAP).

VCH summary: Valley Children’s Hospital in Madera, CA is building what would be, to the best of the author’s knowledge, the largest hospital battery system in the world. Phase 1 (1.32 MW solar, 2.2 MW fuel cell, 2 MWh battery) is under construction, going online 2026 (Valley Children’s Healthcare; DOE Better Buildings). Phase 2 adds a 12 MWh long-duration flow battery designed by Mazzetti with Sandia National Laboratories technical support, bringing the campus total to 14 MWh (CEC CEQA filing, Feb. 2025). CEC approved $4.3M for engineering, with potential to $28M. The original $30M DOE grant was rescinded in 2025 (YourCentralValley.com, Oct. 2025). Valley Children’s is pressing forward with its own capital, CEC funding, and IRA provisions. The system will provide triple redundancy (grid + microgrid + diesel) and is projected to supply approximately 80% of hospital energy needs.

Audience response to both sessions centered on three questions: how to navigate the permitting complexity of novel technologies, how to structure project finance for tax-exempt hospital systems using IRA provisions, and how to make the business case to boards that see diesel backup as “good enough.” These are the questions the industry needs to be answering—and the projects are generating the data to do it.

Sources: ASHE PDC Summit 2026; HFM Magazine; Mazzetti project profiles; Kohler/Toyota; CEC; PNNL ES4SE.

II. ENERGY STAR Moves to DOE: What Healthcare Needs to Know

On March 3, 2026, EPA and DOE signed a 10-year Memorandum of Agreement establishing DOE as the lead agency for the ENERGY STAR program. This is the most significant structural change to the program in its 30-year history, and healthcare facilities professionals need to understand the implications.

Background. The Trump administration’s FY2026 budget proposed eliminating EPA’s Atmospheric Protection Program, which oversees ENERGY STAR. Twenty-two senators argued ENERGY STAR is protected under federal statute and cannot be unilaterally terminated. Congress ultimately funded the program at $33 million with bipartisan support. The MOA provides a structured transition path rather than an abrupt shutdown.

Portfolio Manager continuity. ENERGY STAR Portfolio Manager is used by more than 330,000 buildings representing approximately 25% of all U.S. commercial floor space, according to BOMA International (BOMA statement, Mar. 10, 2026). For hospitals, Portfolio Manager provides the industry-standard 1–100 energy performance score based on national healthcare-specific energy use data. Over 70 U.S. cities and states reference Portfolio Manager in building performance standards and benchmarking ordinances. BOMA, USGBC, and the Institute for Market Transformation are calling for staff continuity and transparent transition planning during the 90-day implementation period.

Healthcare-specific concerns. The healthcare ENERGY STAR score uses a regression model calibrated to the Commercial Buildings Energy Consumption Survey (CBECS) hospital data. If DOE modifies or deprioritizes this scoring methodology, hospitals lose their primary benchmarking standard—affecting green building certifications (LEED), compliance reporting, Fannie Mae/Freddie Mac green financing, and internal sustainability tracking. EPA lost significant institutional knowledge in 2025 through buyouts, early retirements, and layoffs as part of DOGE-driven workforce reductions.

IFHE advocacy position. IFHE has been actively monitoring this transition and advocating for continuity of the healthcare-specific scoring methodology. The federation’s position: Portfolio Manager is critical infrastructure for healthcare energy management, and any changes to hospital scoring methodology should involve healthcare engineering stakeholders. Healthcare facilities professionals should back up their Portfolio Manager data now and monitor the transition closely.

Sources: Facilities Dive (Mar. 2026); BOMA statement (Mar. 10, 2026); Multi-Housing News (Mar. 2026); Conservice; Verdani Partners; Institute for Market Transformation.

III. Burundi: Solar Health Facilities and the Black-Market Diesel Economy

Burundi faces one of the most severe energy crises in sub-Saharan Africa. Fewer than 15% of the population is connected to the national electricity grid; in rural areas, the figure is approximately 2% (UNDP Burundi). Frequent outages, compounded by a deepening fuel crisis, have forced hospitals to rely on diesel from the black market—where prices reach $10–13 per liter, more than seven times the official rate, according to UNDP reporting. The inflated costs disrupt laboratory services, compromise vaccine storage, and interrupt critical care.

The UNDP’s Smart Facilities for Health initiative, launched in 2023 with $2.21 million from the Global Fund’s COVID-19 Response Mechanism (C19RM), is Burundi’s first systematic attempt to address this. Phase 1, now fully operational across five sites since February 10, 2026, provides each facility with 16–17 hours of clean backup electricity, supplying 50–90% of facility energy needs depending on location.

Phase 2 is underway and will extend the model to nine additional district hospitals. Each will receive a standardized hybrid installation: 45 kWp of solar PV capacity and 115 kWh of battery storage, providing 12–25 hours of backup power depending on demand. Commissioning is scheduled for April 2026. The systems were designed, supplied, and installed by Aptech Africa using Deye hybrid inverters and Jinko Solar modules, with remote digital monitoring for real-time performance tracking.

The economics are compelling. Phase 1 cost $943,885 for five facilities—roughly $189,000 per site. Phase 2 adds $1.67 million for nine sites—approximately $186,000 per site. Against the backdrop of black-market diesel at $10–13/liter, the payback period on avoided diesel costs is measured in years, not decades. Upon completion, 14 facilities representing approximately 20% of Burundi’s district hospitals will have reliable, clean energy—and the model is designed to be replicated.

This is directly relevant to the Sextant Foundation’s mission and IFHE’s broader Work Plan on healthcare facility electrification in low-resource settings. The Burundi model—standardized hybrid systems, digital monitoring, phased rollout funded through global health mechanisms—is exactly the kind of replicable approach that scales. The WHO/UNICEF goal of solarizing 10,000 primary health centers needs thousands of installations like these.

Sources: UNDP Smart Facilities for Health (Feb. 10, 2026); pv magazine (Feb. 18, 2026); Green Building Africa (Feb. 19, 2026); Aptech Africa; Global Fund C19RM.

Codes, Standards & Regulation Watch

ENERGY STAR EPA→DOE: MOA signed March 3, 2026. 10-year agreement. 90-day transition period. Healthcare scoring methodology continuity is the key concern. See Deep Dive II.

Joint Commission / JCI March 2026 updates: Revised interpretations this month affect laboratories, staffing certification, and fire-drill requirements—reducing compliance burden while aligning more tightly with NFPA and international norms. Notably, the JCI Laboratory Standards 5th Edition field review explicitly introduces Sustainable Healthcare and digital/data-security requirements into accreditation for the first time. This is a significant signal: sustainability is moving from voluntary aspiration to accreditation baseline. Publication July 2026; effective January 2027.

LDES positioned as healthcare priority: DOE and national laboratories (including Sandia, which is providing technical support for the Valley Children’s Phase 2 battery) are now explicitly positioning long-duration energy storage as a priority solution for healthcare resilience. Hospitals are treated as ideal early adopters for LDES due to large continuous loads, regulatory islanding requirements, and existing capital tied up in under-utilized diesel backup. The U.S. Long Duration Energy Storage Consortium Annual Workshop (July 2026) is increasingly relevant to healthcare systems.

ASHRAE 170-2025: Published earlier this year. Optional natural ventilation provisions, systems-level OA calculations, unoccupied turndown for outpatient spaces, new FGI 2026 space types. Significant energy implications for healthcare facilities. New provisions are also driving the shift from manual spot checks to 24/7 automated continuous pressure monitoring.

California SB 253: First Scope 1 & 2 reporting deadline August 10, 2026 for entities above $1B revenue. Scope 3 follows 2027.

Calendar & What to Watch

March 23–26: IEEE PES Energy Policy Forum, Washington, DC — Grid reliability, load growth, interconnection, and storage policy

April 2026: Burundi UNDP Smart Facilities Phase 2 commissioning (9 district hospitals)

June 2026: ENERGY STAR/DOE transition 90-day period concludes

July 2026: JCI Laboratory Standards 5th Edition publication (with Sustainable Healthcare requirements)

July 13 (planned): LDES in Healthcare Pre-Conference Summit — agenda and registration details forthcoming; reach out to the author if interested

July 14–15: U.S. Long Duration Energy Storage Consortium Final Annual Meeting

August 10: California SB 253 first Scope 1 & 2 reporting deadline

October 2026: 29th IFHE World Congress, New Orleans — Call for papers: Resilient Design in Coastal Zones

January 2027: JCI 5th Edition effective; SB 253 Scope 3 reporting begins

On the Reading List

• UNDP: Burundi Inaugurates First Solar-Powered Health Facilities

• Facilities Dive: Energy Star Is Moving to DOE

• HFMA: Hospital Construction Spending Forecast to 2030

• HFM Magazine: Rural Hospital Invests in Hydrogen

• Scientific Reports: Hospital Microgrid Resilience Optimization (Jan. 2026)

• ENR: IU Health Indianapolis — Team of Teams

• DOE Better Buildings: Valley Children’s Healthcare Microgrid

• OECD: Decarbonising Health Systems Across OECD Countries

• WHO: Accelerating Access to Electricity in Health-Care Facilities

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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THE INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Week of March 16, 2026 • Issue No. 2

🌍 Translation: If you are reading this internationally, most browsers and Substack allow instant translation. Look for the ‘Translate’ option in your browser or right‑click and select ‘Translate to your language.’ This newsletter is read globally across the healthcare engineering community.

EXECUTIVE SUMMARY

The week of March 15, 2026 presents a global healthcare infrastructure landscape in which multiple urgent signals are converging simultaneously. In English Americas, a $28.4B U.S. hospital construction rebound — concentrated in microhospitals and ASCs — is colliding with a policy transition window before IRA credits phase out, creating time-sensitive infrastructure decisions at scale. In Europe, the EPBD transposition deadline of May 29 is accelerating hospital portfolio compliance mapping that many systems have not yet begun. In Africa, the largest coordinated clean energy finance commitment in recent history arrived today (Mission 300 + EIB €1B), while on the ground in Burundi, a hospital microgrid is being physically wired this week — solar inverters connected, batteries going into racks, main interconnection scheduled for next Saturday. Globally, solar+BESS microgrids are increasingly supplementing traditional diesel backup systems, the ENERGY STAR program is transitioning from EPA to DOE, and the refrigerant industry is contesting its phase-down at the U.S. Supreme Court while IFHE has already hosted two webinars preparing members for the transition regardless of outcome.

Key Signals This Week

• Integrated microgrids increasingly part of hospital resilience strategy Hospitals across multiple regions are increasingly deploying solar + battery + generator microgrids financed through energy savings — moving beyond diesel-only backup as a resilience strategy.

• Policy deadlines accelerating infrastructure decisions The U.S. OBBBA solar/wind credit transition window (July 5 construction start) and the EU EPBD transposition deadline (May 29) are creating a concentrated period in which many hospital systems will make energy commitments with long-term consequences.

• ★ Burundi hospital microgrid installation underway Solar inverters connected to the main distribution panel, battery modules in racks, and full electrical integration scheduled for next Saturday — a real-time field demonstration of distributed energy as healthcare infrastructure.

• ENERGY STAR program transitioning from EPA to DOE On March 3, 2026, EPA and DOE signed a Memorandum of Agreement establishing DOE as the lead federal agency. More than 330,000 buildings rely on ENERGY STAR Portfolio Manager; continuity of healthcare-specific scoring is a key question for hospital facility teams.

• AI emerging as a new hospital infrastructure load Healthcare systems in Asia-Pacific — already leading globally on agentic AI adoption — are generating new electrical, cooling, and data infrastructure demands that hospital engineers are beginning to design for.

• Africa’s largest clean energy commitment arrives — health facility targeting is the gap EIB pledged €1B to Mission 300 today, the largest coordinated sub-Saharan Africa clean energy commitment in recent history. Grid-level investment does not automatically deliver clinic-level reliability — that translation requires deliberate engineering and governance.

REGIONAL SIGNALS

1. Latin-Speaking Americas

PAHO Resilient Hospitals Framework Driving Capital Toward “Black-Sky” Preparedness

Implementation of the PAHO Resilient Hospitals Operational Framework is prioritizing prolonged grid-failure scenarios across the region. Facilities are shifting capital toward robust backup power and passive survivability design against multi-day extreme weather events. PAHO’s October 2025 report notes that four out of ten health facilities in Latin America and the Caribbean are exposed to natural hazards, and that Jamaica’s PAHO-retrofitted Smart Hospitals remained operational under Category 5 hurricane conditions.

Sources: PAHO, ‘Protecting health systems by reducing disaster risk’ (October 13, 2025, paho.org); PAHO Resilient Hospitals and Disaster Risk Reduction Initiative (paho.org/en/topics/disaster-risk-reduction-health)

▶Infrastructure implication: LAC hospitals are increasingly designed against grid-absence scenarios — the same resilience logic driving U.S. microgrid adoption, but with substantially less access to the finance tools that make it work.

Solar Electrification for Healthcare Expanding Across the Region

Solar electrification projects for health facilities are expanding across LAC, supported by IDB green infrastructure lending. IDB has committed $494M to green health infrastructure since 2013, with EDGE sustainability standards embedded in loan terms. However, WHO data shows only 72% of LAC health facilities have reliable electricity, with rural facilities significantly worse.

Sources: IDB ClimaHealth (2023); WHO Health-Care Facility Electrification Fact Sheet

▶ Infrastructure implication: Green finance standards are advancing faster than baseline reliability — the region needs both simultaneously, not sequentially.

Supply Chain Localization Reshaping MEP Procurement

Persistent global shipping delays are pushing healthcare retrofits toward locally sourced materials and regional prefabrication — away from imported MEP components.

Source: Roche Constructors, ‘Healthcare Construction Trends 2026’ (December 2025, rocheconstructors.com); Building Design+Construction, U.S. healthcare sector trends

▶ Infrastructure implication: Project cost models and delivery timelines need to be rebuilt around regional supply chains.

PROJECT SPOTLIGHT — Brazil: Largest Hospital Rooftop PV Now Operating

A Brazilian hospital secured the equivalent of $2 million USD from Brazil’s National Electric Energy Agency (ANEEL) for energy system upgrades including the installation of the largest rooftop photovoltaic plant among hospitals in Brazil — a 1,190.75 kWp system. Between August 2024 and August 2025, the system generated 1,452,300 kWh, avoiding 886 metric tons of CO₂ annually and saving approximately $115,000 in that period. The project was embedded within a broader climate action plan linking energy system upgrades to heat resilience, air quality, and water conservation for the hospital’s service area.

Source: Green Hospitals Global, ‘Resilience in Action: How Hospitals Around the World Are Adapting to a Changing Climate’ (greenhospitals.org)

▶ Infrastructure implication: Brazil’s ANEEL funding mechanism — linking hospital energy upgrades to national grid agency investment — is a financing model that other LAC systems could replicate. The project also demonstrates integration of energy resilience and climate adaptation planning as a single investment thesis.

PROJECT SPOTLIGHT — Grenada: Project Polaris National Hospital Groundbreaking, March 27, 2026

The Government of Grenada is breaking ground on March 27, 2026, on a new national hospital under Project Polaris — the flagship healthcare infrastructure initiative — sited in Calivigny, St. George. Project Polaris is described as the centerpiece of Grenada’s healthcare transformation agenda. Energy system specifications for the new facility have not yet been publicly detailed.

Source: NOW Grenada, ‘Grenada to break ground on new hospital under Project Polaris’ (nowgrenada.com, March 11, 2026)

▶ Infrastructure implication: New hospital construction in small island developing states presents a high-leverage energy design opportunity: the choice between solar-primary and diesel-dependent locks in operating costs and resilience profile for 40+ years. Grenada’s grid is vulnerable to hurricane disruption. IFHE and the Sextant Foundation should engage at the design and specification stage — this project warrants direct outreach.

2. English-Speaking Americas

$28.4B U.S. Hospital Construction Rebound: The Microhospital Surge

U.S. hospital construction starts projected at $28.4B in 2026, heavily weighted toward 25,000–60,000 sq ft microhospitals and ambulatory surgery centers. Engineering focus is shifting from massive centralized plants to modular, scalable MEP infrastructure and adaptable ceiling grids that support rapid service line changes. The ASHE/HFM 2026 Hospital Construction Survey found 6% of respondents currently building a microhospital — a jump in a category that was typically under 1%.

Sources: ConstructConnect Project Intelligence forecast (February 2026, news.constructconnect.com); HFM Magazine / ASHE 2026 Hospital Construction Survey (February 12, 2026, hfmmagazine.com); Roche Constructors, ‘Healthcare Construction Trends 2026’

▶ Infrastructure implication: Central plant logic doesn’t scale down. The dominant U.S. healthcare design challenge has shifted — modular MEP frameworks purpose-built for small-format facilities are the new requirement.

OBBBA Credit Cliff: Six Weeks to Solar/Wind Construction Start

The One Big Beautiful Bill Act has created a hard July 5, 2026 construction-start deadline for solar and wind projects to qualify for the Section 48E Clean Electricity ITC and Section 45Y Production Tax Credit. Section 179D terminates for projects beginning construction after June 30, 2026. Fuel cells and energy storage are explicitly exempted from the accelerated wind/solar phase-out. The IRA’s direct pay mechanism for nonprofit hospitals remains intact, with new domestic content requirements for 2026 construction starts.

Sources: Arnold & Porter Advisory (2025); IRA Tracker, iratracker.org; Novogradac Renewable Energy Tax Credit Center (2026)

▶ Infrastructure implication: Any hospital with solar or wind in planning needs a go/no-go decision within weeks. Fuel cell and storage projects have better runway and a tax-favorable position under the new law.

Savings-Financed Microgrids: The Model Is Established

Hospitals are successfully securing multi-million dollar bonds for solar+BESS+CHP microgrids by using guaranteed energy savings to service the debt — targeting 7–14 days of operational resilience with up to 25% reduction in daily utility costs. The savings-financed microgrid model is now proven at acute care scale, with a growing pipeline of California Energy Commission-funded hospital projects and expanding replication across other states. The Valley Children’s Hospital long-duration storage project ($28M CEC grant, Sandia National Laboratories technical support) remains the benchmark for extended-duration hospital systems.

Sources: Intersolar & Energy Storage North America (April 2025); California Energy Commission LDES Program; Fierce Healthcare (April 2025)

▶ Infrastructure implication: The savings-financed integrated microgrid model is established and increasingly replicable. For hospitals planning new or upgraded energy systems, integrated solar+BESS+generator configurations are now a credible alternative — and in many cases a more favorable financial case — than diesel-only backup.

ENERGY STAR Transitions from EPA to DOE

On March 3, 2026, the U.S. Department of Energy and the Environmental Protection Agency signed a Memorandum of Agreement establishing DOE as the lead federal agency for the ENERGY STAR program — a 10-year agreement transferring oversight of the program and its intellectual property, trademarks, IT systems, and databases. More than 330,000 buildings — representing nearly 25% of U.S. commercial floor space — use ENERGY STAR Portfolio Manager. Healthcare organizations rely on Portfolio Manager for energy benchmarking, regulatory compliance in seven states and 48 local governments, and IFHE has been an active advocate for the program’s continuation and its relevance to healthcare facility management.

Sources: Facilities Dive, ‘Energy Star is moving to DOE. Industry groups are hopeful’ (March 2026, facilitiesdive.com); BOMA International press release (March 10, 2026, prnewswire.com); EPA-DOE Memorandum of Agreement (March 3, 2026)

▶ Infrastructure implication: The program’s mission and tools appear intact, but the transition creates uncertainty about future priorities, healthcare-specific scoring methodologies, and Portfolio Manager continuity. This is an active IFHE advocacy moment — early engagement with DOE matters.

ASHRAE Standard 170 Update: Automated Pressure Monitoring Now Required

The latest revision of ANSI/ASHRAE/ASHE Standard 170 introduces options for natural ventilation and new total outdoor air calculations. Critically, it mandates 24/7 automated continuous pressure monitoring, replacing manual spot checks as the compliance standard.

Source: ANSI/ASHRAE/ASHE Standard 170, Ventilation of Health Care Facilities (2025 revision); ASHE and ASHRAE joint publication

▶ Infrastructure implication: Continuous automated monitoring is now a code requirement — with direct implications for BAS integration, controls design scope, and capital cost, particularly in microhospitals where systems were not previously designed for this.

Rising Utility Demand Improving Hospital Storage Economics

Utilities across the U.S. are reporting accelerating electricity demand driven by data centers, electrification, and industrial expansion. Utilities are increasingly redesigning tariff structures to reward peak-demand reduction and flexible loads, improving the economics of behind-the-meter storage at hospitals.

Sources: U.S. Energy Information Administration (EIA), Short-Term Energy Outlook; Utility Dive, ‘Utilities are spending billions on the data center boom’ (2026); Wood Mackenzie LDES Market Report (March 2026)

▶ Infrastructure implication: Hospitals with battery storage are positioned for a double tailwind — declining storage costs plus improving demand response revenue. The financial case for hospital BESS strengthens without any subsidy.

Chicago Relaunches Building Energy Benchmarking

Chicago has relaunched its municipal building energy benchmarking program, continuing a national trend of city-level energy disclosure requirements that directly affect hospital systems operating in major metro areas. The City of Chicago Department of Environment relaunched the program in Fall 2025 with a new support team and web platform. The January 15, 2026 benchmarking compliance deadline covers buildings over 50,000 sq ft, including hospitals.

Source: City of Chicago Department of Environment, ‘Mayor Brandon Johnson, Department of Environment Relaunch the Chicago Energy Benchmarking Program’ (chicago.gov, Fall 2025)

▶ Infrastructure implication: Municipal benchmarking programs are expanding and tightening. Active ENERGY STAR Portfolio Manager compliance is increasingly a legal obligation, not a voluntary practice.

PROJECT SPOTLIGHT — Treasure Coast Community Health, FL: Resilience Microgrid Completed February 2026

Treasure Coast Community Health — the only Federally Qualified Health Center in Indian River County, FL — completed a 46kW solar + 214kWh battery storage microgrid in February 2026, providing up to 19 hours of backup power. Fully funded by a $353,000 Direct Relief Power for Health grant. Florida’s first completed Power for Health project; eight more under development statewide. TCCH serves nearly 28,000 patients annually across eight locations in a hurricane-prone region where power outages cost health centers an average $41,000 per day.

Source: Microgrid Knowledge, ‘New Medical Clinic Microgrid Ensures Access to Care for Underserved on Florida’s Atlantic Coast’ (February 10, 2026, microgridknowledge.com)

▶ Infrastructure implication: At $353,000 fully grant-funded, Treasure Coast defines the accessible lower end of healthcare energy resilience. Direct Relief’s Power for Health Initiative is an underappreciated replication vehicle for FQHCs — eight more Florida projects in pipeline with a model applicable across the Gulf and Caribbean coast.

PROJECT SPOTLIGHT — AdventHealth System: 100% Renewable Electricity Milestone Targeting Year-End 2026

AdventHealth is on track to reach 100% renewable electricity system-wide by end of 2026 via 7,500 on-site solar panels (completed March 2025, generating 4,200 MWh/year) and a 90MW virtual power purchase agreement with Scout Clean Energy’s Texas wind farm (~380,000 MWh/year). The two programs together account for the system’s full electricity load — more than one terawatt-hour annually. Midterm targets: 50% emissions reduction by 2030, net zero by 2050.

Sources: MedCity News (May 2024); AdventHealth corporate overview (updated March 2026); Microgrid Knowledge (February 2026)

▶ Infrastructure implication: A major U.S. health system reaching 100% renewable electricity — through direct solar and wind procurement rather than offsets — is the largest healthcare energy milestone of 2026 in North America. The on-site solar + off-site PPA pairing is a viable model for large systems that cannot site sufficient generation on campus alone.

PROJECT SPOTLIGHT — New York NYSERDA: $30M Hospital Electrification Fund Now Open

NYSERDA’s Empire Building Challenge: Hospitals program opened this month with $30M available for demonstration projects showcasing replicable electrification retrofits at existing hospitals. Awards up to $5M per facility (75% of project cost) for building system electrification, electrification readiness, and comprehensive energy efficiency. Informational webinar March 18, 2026. Eligible: licensed in-patient acute care hospitals that have completed a feasibility study.

Sources: Governor Hochul press release (governor.ny.gov, March 10, 2025); NYSERDA Empire Building Challenge: Hospitals (nyserda.ny.gov)

▶ Infrastructure implication: NYC Local Law 97 emissions penalties are now in effect for large buildings. The $30M EBC program provides both capital offset and a compliance pathway — the combination of regulatory pressure and available funding makes 2026 the year to act. IFHE U.S. members should be aware of this application cycle.

PROJECT SPOTLIGHT — Kaiser Permanente: Two New Hospital Campuses with Integrated Solar + BESS

Following the 2025 commissioning of the nation’s largest hospital-based renewable microgrid at Ontario Medical Center (2MW solar / 9MWh BESS / 1MW fuel cell, developed with Faraday Microgrids and Mazzetti), Kaiser Permanente has confirmed that two new hospital campuses under construction in San Jose and Sacramento will include integrated on-site solar and battery storage from the ground up. A third green microgrid is under construction at a Fresno medical office. The Ontario project demonstrated that renewable-primary, battery-first-response systems can fully displace diesel as primary backup at acute care scale.

Sources: Fierce Healthcare (April 23, 2025); Kaiser Permanente press release (prnewswire.com, April 17, 2025); Faraday Microgrids (faradaymicrogrids.com)

▶ Infrastructure implication: Kaiser’s programmatic expansion — Ontario as proof of concept, San Jose and Sacramento as replication — is the most significant ongoing commitment to hospital-scale renewable microgrids in U.S. healthcare. The zinc-bromide battery chemistry (non-flammable, non-lithium) used at Ontario is particularly relevant to fire safety and infection-control requirements in acute care settings.

3. Europe + Middle East

EPBD Transposition Deadline: Six Weeks Away

All EU member states must transpose the revised Energy Performance of Buildings Directive (EU/2024/1275) into national law by May 29, 2026. The recast introduces zero-emission building mandates (public buildings from 2028, all new buildings by 2030), minimum energy performance standards requiring renovation of the worst-performing 16% of non-residential buildings by 2030, building renovation passports, and Smart Readiness Indicator requirements for large non-residential buildings over 70kW. From May 20, 2026, all Energy Performance Certificates must use a standardized EU template including IAQ recommendations and system lifespan assessments.

Sources: European Commission EPBD portal; REHVA EPBD tracker; One Click LCA EPBD Guide (2025)

▶ Infrastructure implication: European hospitals in the lowest-performing quartile face legally binding renovation obligations on a defined timeline. Portfolio mapping against MEPS thresholds cannot wait.

Thermal Energy Storage Deployed at Israeli Hospital

Israeli company Brenmiller Energy has signed a seven-year, $3.55 million thermal energy storage project with Wolfson Medical Center in Holon, near Tel Aviv. The system — using crushed rock to store high-temperature heat charged from renewable energy or off-peak grid electricity — will replace the hospital’s diesel boilers, reducing fuel oil consumption to near zero and saving an estimated $1.3 million annually while cutting the facility’s carbon footprint by 3,900 tons per year. This is the first hospital installation for Brenmiller’s technology, which is already deployed in Israel, the U.S., Romania, Italy, and Brazil.

Source: Times of Israel, ‘Israeli green thermal storage company signs 7-year deal with Wolfson Hospital’ (timesofisrael.com, February 2024); Brenmiller Energy company announcements (bren-energy.com)

▶ Infrastructure implication: Thermal storage is an underutilized complement to battery storage in hospital energy systems — lower capital cost for HVAC-dominant loads, no fire risk, well-suited to the Middle East and Mediterranean climates where cooling drives the majority of hospital energy demand.

Central/Eastern Europe: Healthcare Cost Pressures Accelerating Energy Efficiency Urgency

Global medical cost trends are projected to rise 10.3% in 2026, with Central and Eastern European healthcare systems among the most pressured — driven by aging populations, historical underinvestment, and accelerating demand for private care as public system capacity strains. Facilities across the region are increasingly fast-tracking energy efficiency upgrades and building automation investment to offset operational budget pressure.

Sources: WTW, 2026 Global Medical Trends Survey (November 2025, wtwco.com); Frontiers in Public Health, ‘Change in healthcare costs in Europe 2018–2023’ (2026, doi:10.3389/fpubh.2026.1774180)

▶ Infrastructure implication: In CEE, energy cost reduction is now a financial survival strategy — not a sustainability goal. This fundamentally changes the ROI calculus and approval pathways for efficiency investment.

Radiopharmaceutical Infrastructure: Specialized Design Requirement Growing

Targeted radiopharmaceuticals — including radioligand therapies and theranostic agents — are gaining significant traction in European oncology centers following Novartis’s Pluvicto label expansion and strong EMA approvals in late 2025. The Europe nuclear medicine market is projected to grow from $2.47 billion in 2025 to $5.15 billion by 2030 at a 15.8% CAGR. Facilities require heavily shielded infrastructure — hot cells, shielded infusion rooms, specialized waste handling — and supply chain logistics integrated directly into core building design. Unlike small-molecule drug programs, radiopharmaceuticals begin to decay at the moment of creation, requiring flawless high-speed delivery infrastructure from production site to patient.

Sources: MarketsandMarkets, Europe Nuclear Medicine Market (marketsandmarkets.com); McKinsey, ‘Unlocking the therapeutic potential of radiopharmaceuticals in oncology’ (January 2026, mckinsey.com); Alira Health, ‘Navigating the Global Nuclear Medicine Supply Chain’ (December 2025)

▶ Infrastructure implication: Radiopharmaceutical suites are a growing and technically demanding category — distinct from standard nuclear medicine — requiring shielding, HVAC, waste, and logistics design expertise that few healthcare engineering firms currently carry.

ESG Disclosure Frameworks Tightening Across Europe and Middle East

ESG disclosure requirements continue to evolve across European and Middle East markets. The EU Corporate Sustainability Reporting Directive (CSRD, Directive 2022/2464) is now in phased implementation, requiring large companies and eventually smaller ones to report on energy performance, emissions, and resilience. Healthcare systems in scope are increasingly expected to report energy performance data with the same rigor applied to financial data.

Sources: EU Corporate Sustainability Reporting Directive (CSRD), Directive 2022/2464 (eur-lex.europa.eu); European Commission CSRD implementation guidance (2025)

▶ Infrastructure implication: Energy metering, benchmarking, and reporting infrastructure is becoming a compliance requirement. The systems and expertise IFHE members provide are now embedded in regulatory obligations.

Saudi Arabia $65B + UAE $52B: The World’s Largest Active Hospital Build

Saudi Arabia carries more than 70% of the GCC’s active healthcare project pipeline, estimated at over $18B, with a national commitment of $65B for healthcare infrastructure under Vision 2030. UAE has committed Dh192B ($52B) in federal healthcare spending for 2024–2026. Low-carbon requirements and embodied carbon reporting are now standard conditions of project approval across the region.

Sources: MENA Hospital Projects Forum; Egis Infrastructure Outlook (2026); Saudi Hospital Design & Build Expo

▶ Infrastructure implication: This is the largest active hospital construction market in the world, with green building and energy performance design as table stakes for engagement.

PROJECT SPOTLIGHT — Royal Shrewsbury Hospital, England: Heat Pumps Crane-Lifted Into Place, January 2026

A crane lifted heat pumps onto the roof of the Treatment Centre at Royal Shrewsbury Hospital on January 28, 2026 — the latest phase of a £16.2M decarbonisation project delivered by Vital Energi through the Carbon and Energy Fund (CEF) Framework. Simultaneous rooftop solar installation is underway. Final systems include a 1.6MW air and water source heat pump array, rooftop solar, upgraded building energy management systems, improved insulation, and low-energy AHU fan replacements. Projected outcome: £1M/year energy cost savings, 3,000+ tonnes of CO₂ reduction annually. Funded through the UK Public Sector Decarbonisation Scheme.

Sources: Shrewsbury and Telford Hospital NHS Trust press releases (sath.nhs.uk, January 28 and June 13, 2025); Vital Energi project announcement

▶ Infrastructure implication: RSH illustrates the physical reality of NHS heat pump deployment in live clinical environments — crane operations, phased installation, patient care maintained throughout. The CEF Framework that funds it is a replicable public procurement vehicle; IFHE European members should understand how PSDS and CEF work in combination.

PROJECT SPOTLIGHT — Imperial College Healthcare NHS Trust, London: £47.4M Active Decarbonisation Phase

Imperial College Healthcare NHS Trust is in the active 2025/26–2026/27 phase of a £120M multi-year programme, committing £47.4M over two years for Charing Cross and Hammersmith hospitals. Current works include additional heat pumps at Charing Cross, ground source heat pumps, and first-ever solar panels at Hammersmith. The programme has already delivered a 27% reduction in building-related emissions at Charing Cross in a single year following the first heat pump installation. Total PSDS grant funding secured to date: £91.6M. Programme target: 43% emissions reduction vs. 2020/21 baseline — equivalent to 20,233 tCO₂e annually.

Sources: Imperial College Healthcare NHS Trust (imperial.nhs.uk, 2026); Building Better Healthcare (buildingbetterhealthcare.com)

▶ Infrastructure implication: A 27% emissions drop in a single year — achieved in a live clinical environment — is the kind of documented result that moves policy. IFHE European and Global South members should study the Imperial programme as a replicable model for phased heat decarbonisation in existing hospital stock.

PROJECT SPOTLIGHT — Dubai Health + Positive Zero: 14.1MW Solar Across 26 Healthcare Facilities

Dubai Health has partnered with Positive Zero to deploy on-site solar rooftop and carport systems with a combined capacity exceeding 14.1MW across 26 healthcare facilities in Dubai — the largest solar car park capacity within the UAE healthcare sector. In the first year of operation across the first 13 facilities, solar generation is expected to deliver nearly 10,700 MWh of clean energy. Over the project lifecycle, the initiative is projected to reduce close to 167,000 metric tons of CO₂ emissions. As part of the partnership, Positive Zero is delivering the first Cooling-as-a-Service (CaaS) project at Al Jalila Children’s Hospital, expected to provide up to 15% energy savings. The partnership was announced approximately three weeks ago.

Sources: Business Today Middle East, ‘Dubai Health Partners with Positive Zero to Power 26 Facilities with Solar Energy’ (businesstoday.me, February 2026); Zawya, ‘Dubai Health accelerates clean energy transition’ (zawya.com)

▶ Infrastructure implication: Dubai Health’s portfolio-wide solar deployment — 26 facilities, 14.1MW, with Cooling-as-a-Service at Al Jalila Children’s — sets a new benchmark for regional healthcare energy transition and directly supports the UAE’s Net Zero by 2050 Strategic Initiative. The CaaS model at Al Jalila is worth watching: if demand-side cooling services can be delivered as a managed service rather than capital expenditure, it could unlock decarbonization investment in facilities with constrained capital budgets.

4. Africa

★ FIELD SIGNAL — Burundi Hospital Microgrid: Construction Progressing This Week

Work is advancing on the hospital microgrid project in Burundi. According to electrical project manager Jeff Rodriguez, the local engineering contractor has completed connections between the solar inverters and the solar main distribution panel. Battery storage installation also began this week, with battery modules placed into racks and electrical connections to the inverter system scheduled for completion shortly.

The next major milestone occurs next Saturday: the solar distribution system will be connected to the hospital’s main electrical distribution panel. To safely complete the interconnection, the project team will temporarily power the facility using a 150 kW generator backfeed — allowing the hospital distribution system to be safely de-energized during solar integration.

This project sits against a stark backdrop. Burundi faces one of the most severe energy crises in sub-Saharan Africa, with fewer than 15% of the population connected to the national grid and rural electrification at just 2%. Hospitals have been forced to source diesel from the black market at $10–13 per liter — more than seven times the official rate — to keep generators running.

Source: IFHE field report — Jeff Rodriguez, electrical project manager; UNDP Smart Health Facilities, Burundi

▶ Infrastructure implication: This is a real-time demonstration of distributed energy as healthcare infrastructure in one of the world’s most resource-constrained settings. The engineering sequence — inverter-to-panel connections, generator backfeed for safe de-energization, battery rack installation — is the field knowledge that IFHE is uniquely positioned to document and disseminate to the global healthcare engineering community.

Mission 300 + EIB €1B: Largest Africa Clean Energy Commitment to Date

The European Investment Bank pledged more than €1B in financing for renewable energy across sub-Saharan Africa in support of Mission 300 — the World Bank and African Development Bank initiative targeting 300 million new electricity connections by 2030. EIB Global invested €3.1B across Africa in 2025 across energy, healthcare, and infrastructure. Published today, March 15, 2026.

Source: Highways Today, March 15, 2026

▶ Infrastructure implication: This is the macro finance signal that makes health facility electrification at scale theoretically achievable. Converting bulk grid expansion into clinic-level reliability remains the engineering and governance gap that IFHE and Sextant Foundation are positioned to address.

Solar Microgrids Establishing the New Baseline for African Health Facilities

Community-scale solar microgrids are leapfrogging traditional grid development across the continent. The UNDP Solar for Health program has equipped approximately 1,000 health centers in 15 countries since 2017. The SELCO Foundation supported solarization of 2,000 public health facilities in India in 2021–2022 and is on track for 25,000 facilities across 12 Indian states by 2026. In many rural healthcare electrification programs, solar+BESS is emerging as the preferred primary power architecture — particularly where grid infrastructure remains unreliable or absent.

Sources: UNDP Solar for Health Program; WHO Bulletin (2023)

▶ Infrastructure implication: The design standard has shifted. Engineering standards, O&M frameworks, and staff training protocols need to keep pace.

Power and Connectivity Must Be Co-Designed

AU-WHO collaborations are funding digital health and AI workforce training across the continent. New facility designs must prioritize high-bandwidth satellite or fiber connectivity to support telehealth and remote patient monitoring hubs alongside power systems.

Sources: WHO, ‘Energizing Health: Accelerating Electricity Access in Health-Care Facilities’ (2023); UNDP Solar for Health Program (undp.org/smart-facilities); African Union-WHO Digital Health collaboration frameworks

▶ Infrastructure implication: A solar-powered clinic without broadband cannot deliver the full value of the investment. Power and connectivity infrastructure must be co-designed, not sequenced.

PROJECT SPOTLIGHT — Nigeria: UNICEF/GAVI/eHealth Africa Deliver 28 Solar-Powered Primary Health Centres in Kano State

UNICEF, GAVI, and eHealth Africa officially handed over 28 fully solar-powered primary healthcare facilities to Kano State, Nigeria on August 11, 2025 — part of an ongoing initiative to solarize 238 primary healthcare centres across 12 Nigerian states. The initiative focuses on zero-dose Local Government Areas where children remain unvaccinated and essential healthcare is unavailable. Since commissioning, patient attendance has increased by over 100% across the facilities. Facilities now operate 24/7 and provide round-the-clock maternal and child health services, vaccine storage, and uninterrupted immunization campaigns. Separately, the Abia State Government commissioned a 150kVA solar power system with 430kWh battery storage at the Abia State Specialist and Diagnostic Centre, with 10 similar facilities planned.

Sources: eHealth Africa, ‘UNICEF, GAVI, eHealth Africa Deliver 28 Solar Powered Primary Healthcare Facilities to Boost Maternal and Child Care in Kano State’ (ehealthafrica.org, August 18, 2025); ESI-Africa, ‘Nigeria: Solar energy powering healthcare from North to South’ (esi-africa.com, 2025)

▶ Infrastructure implication: A doubling of patient attendance at solar-powered PHCs is one of the most powerful arguments for healthcare energy investment available. Nigeria’s state-by-state replication model — 238 facilities across 12 states — is the most active implementation programme in Africa. IFHE and Sextant Foundation should be engaged with this programme at the technical and standards level.

PROJECT SPOTLIGHT — Sweden/CHAI Partnership: Blended Finance for Health Facility Electrification in 4 African Countries

The Swedish Government and the Clinton Health Access Initiative announced a partnership in February 2025 to mobilize resources for solar electrification of thousands of healthcare facilities across South Africa, Eswatini, Malawi, and Kenya. The initiative tackles a financing model challenge: one in four primary health facilities in sub-Saharan Africa lacks electricity, while only half of hospitals have reliable power. The partnership’s core goal is to create a replicable blended public-private finance model that countries across Africa can use at national scale.

Source: Clinton Health Access Initiative press release (clintonhealthaccess.org, February 24, 2025)

▶ Infrastructure implication: The blended finance model is the missing piece. Sufficient solar technology exists; sufficient grid investment is now flowing at macro level via Mission 300 and EIB commitments. The gap is the project-level finance mechanism that connects grid-level capital to clinic-level delivery. The Sweden/CHAI model deserves close study.

5. Asia-Pacific

Agentic AI Transition: APAC Hospital Operations Leading Globally

IDC (February 2026) reports that 75% of APAC healthcare providers expect greater productivity gains from agentic AI than standard generative AI, with agentic AI’s share of healthcare AI budgets rising from 18% in 2025 to 29% in 2026. Volume-Based Procurement pricing pressures in Asian health systems are forcing overhead reduction — AI for building controls and logistics robotics is a primary response. Singapore reaches super-aged status (21%+ over 65) in 2026, intensifying infrastructure pressure.

Sources: IDC FutureScape: Worldwide Healthcare Industry 2026 Predictions — Asia/Pacific (February 2026); Changi General Hospital AI/Digital Ecosystem, PMC (2026)

▶ Infrastructure implication: Agentic AI systems are generating new electrical load, cooling demand, and power quality requirements that must be designed into hospital infrastructure — not retrofitted after deployment.

Prefabrication Becomes the APAC Construction Standard

CHCC 2026 — the 27th China Hospital Construction Conference and International Hospital Build and Infrastructure Exposition, May 23–25 at the National Convention and Exhibition Center in Tianjin — is spotlighting application-ready prefabricated hospital components: modular cleanrooms, pre-built operating rooms, and intelligent logistics systems. With 800+ exhibitors and 60,000+ professional visitors expected, prefabricated construction systems are gaining rapidly as the preferred method for compressing construction timelines across the region.

Source: PRNewswire, ‘CHCC 2026 Opens Registration’ (January 28, 2026, prnewswire.com); chccchina.com

▶ Infrastructure implication: Prefabricated OR and cleanroom systems require MEP rough-in standardization and interface protocols that are not yet universal — a standards development opportunity directly in IFHE’s mandate.

India and Southeast Asia Hospital Construction Accelerating

Rapid hospital construction growth is continuing in India and Southeast Asia, with renewable energy integration accelerating in healthcare facilities across the region. The Asia-Pacific hospital emergency microgrid market is expected to grow at 11.8% CAGR through 2033.

Source: DataIntelo Emergency Power Microgrid Market Report

▶ Infrastructure implication: India and Southeast Asia represent the next major wave of healthcare construction — with leapfrog potential on energy systems if engineering standards arrive ahead of the build wave.

Malaysia: Peer-Reviewed AI Hospital Energy Optimization Framework

A 2026 Scientific Reports paper from Malaysian researchers develops the first peer-reviewed framework for AI-driven smart grid optimization in hospital energy systems, integrating renewable generation, predictive maintenance, and building automation systems in a tropical climate context. The paper identifies Malaysian hospitals as the nation’s largest energy consumers in the built environment.

Source: Scientific Reports / PMC (2026)

▶ Infrastructure implication: The research base for AI-optimized hospital energy management in tropical APAC climates is now established. IFHE SE Asia members should track and pilot.

PROJECT SPOTLIGHT — India: Amanta Healthcare Commissions 10.8 MWp Captive Solar Installation

Amanta Healthcare has engaged Zodiac Energy for a 10.8 MWp captive solar installation in Kheda District, Gujarat — one of the largest announced healthcare captive solar projects in India in early 2026. The project reflects an accelerating trend across the Indian private hospital sector: solar as an economic investment rather than a sustainability measure, driven by commercial electricity tariffs that now significantly exceed solar generation costs. India added 31.24 GW of new renewable capacity in April–November 2025 alone, with solar costs at approximately ₹2–2.5/kWh versus ₹6/kWh for new thermal capacity.

Sources: SolarQuarter, ‘Major Corporate Solar Push: Amanta Healthcare Taps Zodiac Energy for 10.8 MWp Captive Solar Installation’ (solarquarter.com, January 2, 2026); S&P Global, ‘Asia-Pacific to boost renewable energy capacity in 2026’ (January 5, 2026)

▶ Infrastructure implication: The Indian private hospital sector has crossed the threshold where on-site solar is simply the cheapest electricity option. At ₹2–2.5/kWh solar vs. ₹6/kWh grid tariff, the economics no longer require a sustainability rationale — which is what drives adoption at scale. IFHE APAC members should be watching the Indian captive solar trend closely as a leading indicator for Southeast Asian markets within 2–3 years.

BIOMEDICAL ENGINEERING

FDA Cybersecurity Rules for Connected Medical Devices Now in Effect

Updated FDA cybersecurity guidance for connected medical devices took effect February 2, 2026, requiring manufacturers to actively monitor, disclose, and address vulnerabilities throughout a device’s entire lifecycle. The new framework — aligned with the FDA’s Quality Management System Regulation (QMSR) — mandates Software Bills of Materials (SBOMs) for premarket submissions, formal vulnerability management plans, and timely security patching. The rules apply to any device with software or connectivity capability, including Wi-Fi, Bluetooth, USB, and cellular. The scope of the challenge is significant: a recent industry report found 53% of connected medical devices in hospitals have known critical vulnerabilities.

Sources: FDA Cybersecurity in Medical Devices: QMSR Considerations (February 2026); Today’s Medical Developments (January 2026); Censinet, Inc. (March 2026); HHS OCR Cybersecurity Newsletter (January 2026)

▶ Infrastructure implication: Hospital HTM teams and biomedical engineers are now co-responsible with device manufacturers for cybersecurity compliance. Legacy device inventories need risk assessment against the new framework immediately — this is not only a regulatory obligation but a patient safety issue.

HTM Program Structures Under Pressure: Self-Operated vs. Outsourced vs. Hybrid

With evolving technologies, tighter budgets, and mounting regulatory complexity — including the new FDA cybersecurity requirements — healthcare systems are reassessing how to structure their Healthcare Technology Management (HTM) programs. Vizient analysis (January 2026) identifies three operating models: self-operated, fully outsourced, and hybrid. Each presents distinct tradeoffs on cost predictability, clinical responsiveness, and regulatory compliance capability. The complexity of managing connected medical device cybersecurity is accelerating the hybrid model, where internal BMETs maintain core equipment while specialized cybersecurity and imaging support is outsourced.

Source: Vizient, ‘HTM Teams Are Critical Partners in Driving How Technology Supports Care Delivery’ (January 2026)

▶ Infrastructure implication: The regulatory burden on biomedical engineering departments is growing faster than staffing levels. IFHE members should track how HTM program structures are evolving in their regions — and what workforce development is needed to meet the new compliance landscape.

WHO and Lancet: Global BMET Workforce Shortage Is a Patient Safety Crisis

A Lancet Global Health Commission analysis identifies a critical global shortage of qualified biomedical engineers and technicians (BMETs), arguing that there can be no truly effective healthcare system without them. The authors call on WHO, governments, and ministries of health to establish clear workforce ratio guidelines for BMETs, develop national health technology management policies, and ensure BMET representation at the ministerial level. In low-resource settings, the shortage directly impacts oxygen system reliability, device maintenance, and equipment lifecycle management — failures with immediate clinical consequences.

Source: ‘Biomedical Engineers Are Crucial for Effective Health-Care Systems,’ The Lancet Global Health (2025)

▶ Infrastructure implication: The BMET workforce gap is most acute in Africa and Southeast Asia — the same regions where the Sextant Foundation and IFHE are most active. Engineering without maintenance infrastructure is not sustainable. IFHE’s BMET workforce development agenda is directly relevant here.

CODES & REGULATIONS

FGI 2026 Facility Code: Guidelines Become Enforceable Law

The Facility Guidelines Institute is publishing the 2026 FGI Facility Code — a landmark shift from decades of design guidelines into enforceable regulatory language. In a significant structural change, advisory content formerly in appendices is being moved to separate handbooks, leaving only mandatory requirements in the code itself. Key content changes include new provisions for rural emergency hospitals, behavioral health units, and short-term outpatient centers; reorganized imaging and OR space requirements; mandates for single-occupancy rooms in residential care; and expanded guidance for modular and mobile environments. The base Facility Code will be publicly available at no cost; handbooks and digital tools will be available by subscription.

Sources: Facility Guidelines Institute press releases (2024); HFM Magazine ‘Take Action, Make Progress’ (2026); compasscryo.com FGI analysis (October 2025)

▶ Infrastructure implication: The shift from guidelines to enforceable code changes the compliance calculus for every hospital design and construction project in the 43 states that have adopted FGI documents. Healthcare engineers need to understand both the code and the handbooks — they are no longer the same document.

CMS Still Locked on 2012 NFPA Editions — Creating Growing Code Conflicts

CMS continues to require hospitals to comply with the 2012 editions of NFPA 99 (Health Care Facilities Code) and NFPA 101 (Life Safety Code) as Conditions of Participation — more than 13 years after adoption. Meanwhile, NFPA has issued multiple updates, and state and local authorities having jurisdiction have adopted newer editions, creating layered, conflicting compliance obligations. Momentum toward CMS updating to 2024 NFPA editions stalled following the recent administration change and CMS restructuring. Separately, NFPA is proposing a new dedicated cybersecurity chapter for the 2027 edition of NFPA 99, and FDA has updated its recognition of NFPA 99-2024 for hyperbaric chamber devices, effective December 26, 2026.

Sources: HFM Magazine (2026); ASHE NFPA 99 tracker; HFM Magazine, ‘NFPA Codes Open for Public Comment’

▶ Infrastructure implication: The CMS/NFPA version gap creates real compliance complexity for hospital facilities teams working across multiple jurisdictions. ASHE and IFHE should continue advocating for CMS to adopt current NFPA editions — the 13-year lag is no longer defensible technically or from a patient safety standpoint.

ASHRAE Standard 170 and EPBD: Ventilation and Building Performance Converging

Two major standards developments are converging this quarter. ANSI/ASHRAE/ASHE Standard 170’s latest revision introduces natural ventilation options and new total outdoor air calculations, while mandating 24/7 automated continuous pressure monitoring — replacing manual spot checks as the compliance standard. Simultaneously, the EU’s EPBD transposition deadline of May 29 is introducing Smart Readiness Indicator requirements for large non-residential buildings over 70kW, with IAQ recommendations now mandatory in all Energy Performance Certificates from May 20. Both developments push the same direction: continuous, automated, data-driven building performance management rather than periodic manual verification.

Sources: ANSI/ASHRAE/ASHE Standard 170 (2025 revision); European Commission EPBD portal; REHVA EPBD tracker

▶ Infrastructure implication: The regulatory direction is clear across both U.S. and European markets: continuous monitoring is the new compliance standard. Building automation systems need to be specified and procured with this in mind — and hospital IT infrastructure needs to support the data streams these systems generate.

MAJOR GLOBAL PATTERNS

1. Integrated microgrids are increasingly appearing as a standard energy strategy across healthcare markets.

Solar+BESS+CHP integrated microgrids — increasingly financed through utility savings — are supplementing and in some cases replacing diesel-only backup systems across English Americas, Middle East, and a growing number of facilities in LAC, Africa, and APAC.

2. Two simultaneous policy deadlines are accelerating major infrastructure decisions.

The EPBD transposition deadline (May 29) and the OBBBA credit transition window (July 5 construction start) are creating a six-to-twelve-week period in which many hospital systems will make energy infrastructure commitments with 20-year consequences.

3. The ENERGY STAR and refrigerant transitions are reshaping U.S. hospital compliance architecture.

The EPA-to-DOE transfer of ENERGY STAR and the AIM Act Supreme Court challenge are creating regulatory uncertainty — but the professional field, led by IFHE, is preparing for the transition regardless of legal outcome.

4. AI is emerging as a hospital infrastructure load, not just an operational tool.

Agentic AI adoption is generating new and growing electrical, cooling, and connectivity demands in hospital facilities. APAC is furthest along; other regions are beginning to see the same pressure within a 2–3 year lag.

5. Africa’s energy investment surge will only reach health facilities with deliberate targeting.

The largest coordinated Africa clean energy commitment in recent history is now active. Grid-level investment does not automatically translate to clinic-level reliability — the engineering, governance, and financing gap between the two is where IFHE and Sextant Foundation are positioned to contribute.

6. Small-format healthcare construction is accelerating a shift toward modular MEP engineering.

The microhospital surge in the U.S., prefabricated OR systems gaining ground in APAC, and solar-primary rural clinic design in Africa all point in the same direction: away from centralized plant logic and toward scalable, distributed infrastructure.

SIGNALS RELEVANT TO HEALTHCARE ENGINEERING

• ENERGY STAR → DOE transition — Portfolio Manager and healthcare-specific scoring continuity at stake; active IFHE advocacy moment

• Refrigerant/AIM Act Supreme Court challenge — IFHE leading with two webinars already delivered; transition preparation continues regardless of legal outcome

• OBBBA credit cliff (July 5) — six weeks to solar/wind construction start; fuel cells and storage exempted and tax-favored

• EPBD transposition (May 29) — European hospital MEPS compliance mapping overdue; worst-performing 16% of non-residential buildings face mandatory renovation

• ASHRAE Standard 170 update — 24/7 automated pressure monitoring now a compliance requirement, not best practice

• $28.4B U.S. construction rebound — microhospital surge demands new modular MEP design standards

• Burundi microgrid field progress — inverters connected, batteries in racks, main interconnection next Saturday; real-world documentation of solar integration in a low-resource hospital setting

CALENDAR

March 18, 2026

PDC Summit (Houston) session evaluations close

March 22, 2026

Next IFHE Global Scan — Issue 3 research (Burundi field notes, ENERGY STAR/DOE, hospital microgrid economics)

May 11–13, 2026

MedTech Forum — Lisbon, Portugal

May 20, 2026

EU: Standardized EPC template required across all member states

May 29, 2026

EPBD transposition deadline — all EU member states must have directive in national law

June 30, 2026

Section 179D (energy-efficient commercial buildings deduction) — last day to begin construction

July 5, 2026

Solar/wind Section 48E ITC & 45Y PTC — last day to begin construction

Aug 26–27, 2026

BIOMEDevice Boston — medical device engineering conference

Oct 17–20, 2026

IFHE 29th World Congress + HCD Conference & Expo — New Orleans, LA

Dec 26, 2026

NFPA 99-2024 compliance required for new hyperbaric chamber device submissions (FDA)

Dec 31, 2026

EU member states submit final National Building Renovation Plans

READING LIST

Energy Systems & Finance

• Arnold & Porter Advisory, ‘From IRA to OBBBA: A New Era for Clean Energy Tax Credits’ (2025) — arnoldporter.com

• California Energy Commission, Long Duration Energy Storage Program — energy.ca.gov

• Wood Mackenzie LDES Market Report (March 2026) — via Utility Dive

• Trystar, ‘Healthcare Power Resiliency in 2026: 4 Trends Reshaping Hospital Electrical Systems’ (January 2026) — trystar.com

• Mazzetti, ‘Hydrogen Power in Healthcare: A Rural Hospital’s Pioneering Journey’ — mazzetti.com

Biomedical Engineering & Medical Devices

• FDA, ‘Cybersecurity in Medical Devices: Quality Management System Considerations and Content of Premarket Submissions’ (February 2026) — fda.gov

• Vizient, ‘HTM Teams Are Critical Partners in Driving How Technology Supports Care Delivery’ (January 2026) — vizientinc.com

• The Lancet Global Health, ‘Biomedical Engineers Are Crucial for Effective Health-Care Systems’ (2025) — sciencedirect.com

• HHS OCR Cybersecurity Newsletter (January 2026) — hhs.gov

Codes, Standards & Regulation

• Facility Guidelines Institute, 2026 FGI Facility Code — fgiguidelines.org

• HFM Magazine, ‘Take Action, Make Progress’ — NFPA 99/101 CMS adoption gap analysis — hfmmagazine.com

• European Commission EPBD portal — energy.ec.europa.eu

• REHVA EPBD Tracker — rehva.eu

Global Health Facility Electrification

• UNDP Solar for Health Program — undp.org/smart-facilities

• UNDP, ‘Solar Energy Brings Stability to Burundi’s Health Facilities’ — undp.org

• EIB / Mission 300, ‘Europe Backs Africa’s Energy Future with Major Renewable Investment’ (March 15, 2026) — highways.today

• IFC, ‘IFC Announces Projects to Support MSMEs, Green Projects, and Healthcare in Egypt and East Africa’ (February 15, 2026) — ifc.org

Asia-Pacific & Global Signals

• IDC FutureScape: Worldwide Healthcare Industry 2026 Predictions — Asia/Pacific (February 2026) — idc.com

• Scientific Reports / PMC, ‘AI-Driven Smart Grid Optimization for Hospital Energy Systems in Malaysian Healthcare Facilities’ (2026)

• Scientific Reports / PMC, ‘Reclassifying Hospital Energy Demand Toward Industry-Like Requirements’ — Lakjiri & Ouassaid (2026)

About the Author

Walt Vernon holds degrees in electrical engineering, law, business, 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. Walt works at the intersection of healthcare infrastructure, technology, economics, and regulation.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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The goal of The Infrastructure Pulse is to highlight the infrastructure trends shaping healthcare delivery worldwide.

© 2026 The Infrastructure Pulse

THE INFRASTRUCTURE PULSE

Where Healthcare Infrastructure Meets the Climate Imperative

Week of March 3, 2026 • Issue No. 1

🌍 Translation: If you are reading this internationally, most browsers and Substack allow instant translation. Look for the ‘Translate’ option in your browser or right‑click and select ‘Translate to your language.’ This newsletter is read globally across the healthcare engineering community.

Initial takeaway: This week’s strongest signals combined major hospital expansion (Australia, U.S., India), climate and siting risk (Houston floodplain), medtech governance tightening (FDA QMSR, cybersecurity), breakthrough AI diagnostics (Merlin in Nature), and the convergence of energy architecture with clinical operations. Two industry firsts—the first hydrogen fuel cell emergency power system at a U.S. hospital and the largest battery energy storage system ever designed for a hospital—are being presented at the PDC Summit this week and are covered in depth in Part 2. Boards and facilities leaders need to evaluate projects through a combined lens of capacity, site risk, medtech integration, cyber/OT resilience, and energy architecture.

Part 1: The 5-Minute Briefing

1. Resilience & Decarbonization: From “Green” to Clinical Requirement

In 2026, resilient infrastructure is no longer an environmental add-on but a clinical necessity. Major health delivery organizations are actively implementing 50% emissions reduction by 2030 pledges. The narrative shift is visible in the numbers: Practice Greenhealth’s 2025 Environmental Excellence Awards drew a record 493 hospitals reporting $203 million in annual savings from environmental programs (up 15% YoY), with 185,000 metric tons of GHG avoided. The share of hospitals with formal climate resilience plans jumped from 38% in 2023 to 61% in 2024.

U.S. hospitals push ahead despite federal uncertainty. At Grady Memorial in Atlanta, replacing its offsite steam plant with an onsite system could save $30 million over 40 years, avoiding 2,500 metric tons of CO₂e annually. Henry Ford Health’s Wyandotte Hospital is exploring water-source heat pumps fed by the Detroit River. Jackson Health in Miami is prioritizing grid-independence after federal BRIC funding was cut, anticipating 10–15% electricity cost increases.

California’s SB 253 is live. CARB has set August 10, 2026 as the first Scope 1 & 2 emissions reporting deadline for entities above $1 billion in revenue doing business in California. Scope 3 follows in 2027. Penalties up to $500,000/year are authorized, with safe harbor for Scope 3 through 2030. The companion SB 261 (climate-related financial risk) remains under Ninth Circuit injunction.

Sources: Health Care Without Harm (2026); CARB Climate Transparency Regulation (Feb. 2026); PwC, Nixon Peabody, White & Case analysis; Practice Greenhealth 2025 Benchmark Report.

2. Facility Design & Construction: Prefab, Standards, and the PDC Summit

Prefabrication is standard in 2026. MEP racking, exterior panels, and bathroom pods are compressing construction timelines by 20–30%. Designers are moving away from centralized “racetrack” layouts toward decentralized nurse stations and micro-hospitals bringing care closer to communities.

ASHRAE 170-2025 published. The updated ventilation standard introduces optional natural ventilation, systems-level outdoor air calculations for mixed-use handlers, clarified unoccupied turndown for outpatient spaces, and new FGI 2026 space types. Turndown provisions are significant: average hospitals use 2.5× the energy of other commercial buildings ($5 billion annually in the U.S.). Natural ventilation provisions open pathways for designers in tropical low-resource settings.

Trauma-informed design surges. Acoustic performance has moved from amenity to clinical specification. Acuity-convertible rooms—using movable partitions and flexible MEP to convert standard rooms to ICU or behavioral health without structural renovation—are a defining 2026 trend.

ASHE PDC Summit opens this weekend. March 8–11 at Houston’s George R. Brown Convention Center, 3,500+ professionals across seven learning tracks including compliance/policy, impactful interior environments, and research/outcomes.

Sources: ASHE Standard 170-2025; ANSI Blog (Feb. 2026); ASHRAE Health Care Facilities Resources; ASHE PDC Summit 2026; HFM Magazine.

3. Smart Buildings & Grid Interactivity: Hospitals as Prosumers

Hospitals are evolving from passive consumers to active grid participants. Under 42 USC §17086, 2026 marks expanded federal demonstration programs for buildings as dynamic energy loads. Healthcare facilities are integrating wireless sensors to forecast energy needs and shift non-essential loads (laundry, HVAC cycles) during peak demand without impacting care.

NYU Langone’s partnership with Summit Ridge Energy on two 4 MW battery projects in Staten Island exemplifies the “prosumer” model: stored lower-carbon power deploys during peak hours while the hospital earns utility credits. At HIMSS26, Schneider Electric’s messaging explicitly ties healthcare energy resilience to AI adoption—clinical technology strategy now depends on facility power systems.

Two industry firsts at the PDC Summit. This week at the PDC Summit in Houston, Walt Vernon—this newsletter’s author—is presenting two sessions on breakthrough hospital energy systems. The first covers the Klickitat Valley Health hydrogen fuel cell project in Goldendale, Washington: the first hydrogen fuel cell system ever deployed for hospital emergency power in the United States, a Kohler/Toyota PEM system that received state approval in March 2025. The second session addresses the Valley Children’s Hospital battery energy storage system in Madera, California—a 12 MWh long-duration flow battery that, combined with the 2 MWh already in the Phase 1 microgrid, will make it the largest battery system at any hospital in the world. Both projects are covered in depth in Part 2.

IFC mobilizes $150M in Egypt. Five new projects announced February 15, 2026, including green lending via Banque Misr across energy efficiency, renewables, and green buildings, plus $15 million for GMED Holding to expand medical equipment production across Egypt and East Africa. IFC committed a record $71.7 billion to developing countries in FY2025.

Sources: IFC Press Release (Feb. 15, 2026); Practice Greenhealth; DOE Better Buildings Healthcare; Guidehouse 2026 Energy Providers Trends; Mazzetti; HFM Magazine.

4. Biomedical Engineering & AI: Breakthrough Week

Merlin AI published in Nature (March 4). The NIH-funded 3D vision-language model was trained on 15,000+ abdominal CTs paired with 1.8 million diagnostic codes. Across 692 phenotypes, Merlin predicted diagnostic associations over 81% of the time (90% for 102 codes). It predicts five-year chronic disease onset with 75% accuracy from healthy-patient scans—identifying biomarkers invisible to human eyes.

BiVACOR TAH: expanded FDA study. The March 2026 ACS Bulletin features the first magnetically levitated, continuous-flow total artificial heart. All five patients in the initial Early Feasibility Study were bridged to transplant and discharged. FDA has greenlit expansion to 15 additional patients. Bridge-to-transplant PMA anticipated late 2027; permanent implant by 2029.

AI regulatory patchwork persists. State-level AI laws continue proliferating without federal guardrails. Engineering departments are navigating compliance for automated clinical workflow tools across state lines—a growing burden for multi-state health systems.

FDA medtech governance tightening. QMSR implementation strengthens supplier quality expectations as facilities grow dependent on connected, software-heavy devices. FDA’s cybersecurity premarket guidance is tightening documentation requirements—device cyber risk now requires coordinated HTM/biomed, IT, and facilities planning.

Sources: NIH News Release (Mar. 4, 2026); Nature DOI: 10.1038/s41586-026-10181-8; ACS Bulletin Mar. 2026; BiVACOR/BusinessWire (Dec. 2024); FDA QMSR/cybersecurity guidance.

Part 2: The 12-Minute Deep Dive

I. From the Field: Hydrogen Fuel Cells and the World’s Largest Hospital Battery

Disclosure: the author of this newsletter, Walt Vernon, is a principal at Mazzetti and served as engineer of record on both projects described below. They are included because he will be presenting them at the 2026 PDC Conference in Houston March 9, 2026. These projects represent genuine industry firsts with direct relevance to every healthcare facilities professional reading this newsletter.

On-site energy systems for hospitals are developing at the nexus of four converging forces: changing technology, project finance opportunities, energy procurement opportunities, and regulatory evolution. Understanding any one of these in isolation misses the picture. A hydrogen fuel cell is not just an engineering decision—it is a financing decision, a procurement decision, and a regulatory navigation exercise, all at once. The same is true of long-duration battery storage. Vernon—who holds degrees in electrical engineering, business, law, and energy law—has been working at this intersection for years, and both projects below reflect that integrated approach.

Klickitat Valley Health: The First Hospital Hydrogen Fuel Cell

Klickitat Valley Health (KVH) in Goldendale, Washington is a 25-bed critical access hospital serving over 10,000 people in a rural district. When KVH’s Director of Support Services Jonathan Lewis arrived, he found the hospital’s electrical infrastructure relying on diesel generators dating to 1967—surplus World War II engines—with extension cords compensating for failures and state inspectors mandating urgent upgrades. The hospital lacked the $2 million needed for basic electrical work.

Lewis turned a constraint into a breakthrough. By bundling the electrical upgrades with a 100 kW hydrogen fuel cell into a Washington state legislative appropriations request, KVH secured $3 million in funding—more than the original ask—by aligning with the state’s interest in alternative energy demonstration. The fuel cell system, developed through a partnership between Kohler Energy and Toyota, uses a second-generation Toyota Mirai PEM fuel cell stack—the same technology from Toyota’s passenger vehicles, consolidated into a compact module for stationary power.

The system received state approval in March 2025, making KVH the first hospital in the United States to operate a hydrogen fuel cell as part of its emergency power strategy. The fuel cell currently supplements the hospital’s diesel generators, powering non-emergency outlets in patient rooms and the main conference room (which doubles as the emergency operations center). At full load the system provides roughly 4 hours of runtime; at connected loads, approximately 20 hours.

The engineering challenges were significant. Hydrogen is governed by multiple overlapping safety codes—NFPA 70, NFPA 853, NFPA 55, IFC, IBC, and OSHA standards—none of which were designed with hospital applications in mind. Major engineering firms declined involvement, citing the project as outside their expertise. Mazzetti was brought on as hydrogen system and fuel engineers, and engaged Total Hydrogen for code compliance, resolving setback distances, electrical classification zones, and storage requirements to achieve regulatory approval.

The broader vision extends beyond the fuel cell. KVH is executing a phased $16 million resilience plan that includes a community preparedness microgrid integrating the hospital with nearby school district buildings, solar and battery storage, and a district-wide heating and cooling system. The project has received technical assistance from the DOE’s Energy Storage for Social Equity (ES4SE) initiative through Pacific Northwest National Laboratory and Sandia National Laboratories, and KVH is leveraging IRA elective pay provisions—provisions that remain largely available to tax-exempt entities—to finance the clean energy components.

For the industry, KVH demonstrates that hydrogen emergency power is technically achievable even at small scale, in a rural setting, with creative funding. It also reveals the gaps: permitting pathways are immature, engineering expertise is scarce, green hydrogen supply is not yet available in most regions (KVH’s hydrogen is currently trucked from California at $1,600 per refill), and code frameworks need updating. These are solvable problems—but only if early adopters like KVH are willing to take the first step.

Sources: HFM Magazine, “Rural Hospital Invests in Hydrogen”; Kohler Energy / Toyota press release (Feb. 2024); Mazzetti project profile; PNNL ES4SE milestone (Nov. 2024); Washington State Dept. of Commerce / CETCAP.

Valley Children’s Hospital: Building the World’s Largest Hospital Battery

Valley Children’s Healthcare in Madera, California operates the only standalone pediatric acute-care hospital in California’s Central Valley, serving 1.3 million children—a majority on Medicaid—in a region plagued by wildfire risk, rolling blackouts, and some of the nation’s worst air quality. The hospital currently depends on a single aging substation transformer for power, backed by diesel generators. Mazzetti developed the concept for a renewable energy microgrid to fundamentally change that equation.

Phase 1 is now under construction: a 1.32 MW solar photovoltaic array (designed in the shape of the hospital’s mascot, George the Giraffe), a 2.2 MW fuel cell, and 2 MWh of battery storage. Valley Children’s is funding Phase 1 with its own capital, leveraging IRA tax credits including the Investment Tax Credit and the Low-Income Communities Bonus Credit. When operational in 2026, the microgrid will cover approximately 80% of the hospital’s energy needs, reduce greenhouse gas emissions by over 50%, and save an estimated $15 million over 25 years. It will provide triple redundancy: grid connection, microgrid, and diesel backup.

Phase 2 is the battery. Mazzetti is now designing a 12 MWh long-duration flow battery energy storage system—which, combined with Phase 1’s 2 MWh, will bring the campus total to 14 MWh, the largest battery system at any hospital in the world. The California Energy Commission approved an initial $4.3 million grant for preliminary engineering, detailed project planning, and commercial-scale design in February 2025, with the potential to award up to $28 million for the full system. Sandia National Laboratories is providing technical support for Phase 2.

The path here was not smooth. The original plan called for a 33 MWh non-lithium-ion system using zinc-bromine flow batteries from Australian manufacturer Redflow, supported by a $30 million DOE grant from the Long Duration Energy Storage demonstrations program and $25 million from CEC. In late 2025, DOE rescinded the $30 million grant as part of broader federal budget cuts—a decision the hospital called “disappointing.” The DOE’s public response suggested diesel generators were a more “affordable, reliable, and safe” alternative. Valley Children’s and Mazzetti recalibrated: the system has been redesigned at 12 MWh using flow battery chemistry, with CEC as the primary external funder and the hospital continuing to invest its own capital.

The project’s significance extends beyond scale. It demonstrates that a children’s safety-net hospital—not a wealthy academic medical center—can lead on energy resilience and decarbonization simultaneously, using available IRA provisions, state funding, and institutional commitment. Valley Children’s was the first hospital in California to earn The Joint Commission’s Sustainable Healthcare Certification, and is a U.S. DOE Better Climate Challenge partner with a commitment to net-zero by 2050.

Sources: Valley Children’s Healthcare Impact Report 2025; Valley Children’s press releases (2024–2025); Microgrid Knowledge (Sept. 2023, Jul. 2025); DOE Better Buildings; CEC CEQA filing (Feb. 2025); HCD Magazine; YourCentralValley.com (Oct. 2025); Mazzetti.

II. Major Projects & the Resilience Lens

Ben Taub Expansion: Floodplain as Governance Crisis (Houston)

Harris Health’s proposed $410 million expansion of Ben Taub Hospital—one of only two Level I trauma centers in Houston—has become a national case study in climate-risk governance. The plan to acquire 8.9 acres of Hermann Park through eminent domain has drawn fierce community opposition, with the Protect Hermann Park coalition arguing the expansion would place a critical facility on a 100-year floodplain.

The numbers driving urgency are stark: Ben Taub is operating beyond its 402-bed capacity, with projections showing need for 18,000 additional ER visits and 3,200 additional admissions annually by 2030. Harris Health CEO Esmaeil Porsa has stated that when the hospital goes on diversion, people die. The project is funded by a $2.5 billion bond approved by Harris County voters in 2023.

Harris County Commissioners voted January 30 to hold a Chapter 26 public hearing on March 19, when they will decide whether to condemn the parkland. Opponents argue the expansion conflicts with Harris Health’s own strategic plan calling for facilities in underserved outlying areas—and that building on floodplain-adjacent land represents an unacceptable long-term climate risk for a safety-net institution. For the IFHE community, this is a direct case study in how site risk, resilience, and community governance are converging in healthcare capital decisions.

Wesley Hospital Expansion (Brisbane, Australia)

UnitingCare Queensland is proceeding with a A$250 million, 10-storey medical building at The Wesley Hospital including day surgery, radiation oncology, and advanced imaging, with completion targeted for 2028. This is a strong example of high-acuity ambulatory and specialty growth that increases electrical intensity and continuity requirements—the kind of project that demands integrated energy and infrastructure planning from day one.

Capital Projects Pipeline

UTMB Health League City (Texas): UT System Regents approved a $300 million expansion, illustrating continued U.S. hospital capacity investment. Covenant HealthCare (Michigan): $25 million outpatient orthopedic center reinforcing distributed specialty growth. JIPMER (Puducherry, India): Newly inaugurated Regional Cancer Centre, with Himachal Pradesh announcing plans for a state Cancer Care Centre with robotic surgery—reshaping facility power, networking, and sterile processing requirements. Rwanda (CHUK): The new CHUK complex in Masaka is near completion with relocation expected to begin in March 2026.

Sources: Harris Health / Houston Public Media / Community Impact / ABC13 (Jan.–Feb. 2026); Courier Mail (Brisbane); UTMB; OurMidland; PIB India; Ukweli Times (Rwanda).

III. Grid-Interactive Healthcare: Financing the Transition

The financial architecture of hospital decarbonization is maturing. Facilities are stacking the §179D Energy Efficient Commercial Buildings deduction (available for nonprofit allocation on projects started before mid-2026), the Clean Electricity Investment Credit, utility demand-response payments, and state programs. Performance contracts and green revolving funds—like Cleveland Clinic’s $7.5 million Green Fund—allow savings from early projects to capitalize future investments. Kuakini Medical Center in Honolulu used an efficiency services agreement covering 100% of project construction and ongoing maintenance, eliminating upfront costs entirely.

Internationally, the OECD’s 2025 report on decarbonizing health systems notes that the Netherlands allocated €42 million within the Ministry of Health budget for 2023–2026 for sustainable health system projects. Victoria, Australia has mandated all new public hospitals be fully electric on 100% renewables. The Czech Republic has completed 26 Energy Performance Contracting projects in its health sector.

The EU dimension matters for healthcare. BUILD UP coverage of EPBD implementation emphasizes digital twins, intelligent lighting, and climate-resilient design. While not healthcare-specific, EU smart-building policy direction is moving toward grid-interactive buildings—hospitals that lag in adopting flexibility strategies will face increasing regulatory and operational pressure.

Sources: Georgetown Climate Center; DOE Better Buildings; NAM “Crossing the Decarbonization Chasm” (May 2025); OECD Decarbonising Health Systems (2025); Health Facilities Management; BUILD UP / EPBD.

IV. IFHE, WHO, and the Global Electrification Gap

The IFHE Digest 2026 signals an ambitious Work Plan at the intersection of net-zero and pandemic-recovery infrastructure. The WHO has tapped IFHE experts to co-author new Guides to Climate Resilient, Low Carbon Healthcare Facilities—positioning healthcare engineering at the center of global climate-health policy.

The 29th IFHE World Congress in New Orleans (October 2026) has issued a call for papers on resilient design in coastal zones—timely given that the Gulf Coast is among the most climate-exposed healthcare corridors in the world.

The electrification gap. WHO data shows roughly 1 billion people receive care in facilities with unreliable or absent power. Across sub-Saharan Africa, 41% of health facilities lack reliable grid access; 15% have no electricity whatsoever. WHO and UNICEF are solarizing 1,000 facilities across Ethiopia, Pakistan, Uganda, and Zambia with plans to scale to 10,000. In Somalia, a 5 kW solar-plus-battery system costs $48,000 over 20 years vs. $116,000 for diesel. The Zafiri investment vehicle (IFC, AfDB, Rockefeller Foundation) was capitalized at $300 million by 2026, targeting $1 billion—part of Mission 300 to connect 300 million people in sub-Saharan Africa to electricity by 2030.

Africa’s connected infrastructure narrative is strengthening. GITEX Future Health Africa commentary highlights investment in digitally enabled hospitals and clinics across Morocco and broader Africa—reinforcing that digital health transformation depends on physical infrastructure and interoperable facility systems, not just apps.

Sources: WHO Accelerating Access to Electricity in Health-Care Facilities; PMC/WHO Bulletin; AfDB Zafiri (Oct. 2025); World Bank Mission 300; Health Affairs (Jan. 2025).

V. Biomedical Engineering Deep Dive: Merlin, BiVACOR, and the Infrastructure Implications

Merlin’s publication in Nature this week warrants attention beyond radiology. Trained on Stanford’s dataset of 15,000+ 3D abdominal CTs paired with 1.8 million diagnostic codes and 6 million tokens of radiology reports, it is the first general-purpose 3D CT foundation model to outperform task-specific tools across diagnostic, prognostic, and segmentation tasks—validated across 50,000+ scans from four hospitals.

The infrastructure implications are real. Models like Merlin will accelerate demand for imaging suites and computational infrastructure within healthcare facilities. Data center capacity—cooling, power density, network connectivity—becomes a facility planning consideration on par with imaging room design.

The BiVACOR story is equally consequential for healthcare engineering. The single magnetically levitated rotor eliminates failure-prone membranes and valves. An Australian patient was discharged home, living outside the hospital for nearly four weeks before transplant. The expanded 15-patient EFS opens a pathway toward PMA.

India’s robotics expansion is a facilities signal. Himachal Pradesh plans to introduce robotic surgery across state medical colleges. CK Birla Hospital Delhi’s robot-assisted breast cancer milestone signals continued diffusion. For facilities teams, robotics expansion affects OR planning, sterile processing workflows, service contracts, power, networking, and training environments.

Sources: NIH (Mar. 4, 2026); Nature DOI: 10.1038/s41586-026-10181-8; ACS Bulletin Mar. 2026; BiVACOR; IEEE Spectrum (Mar. 2025); Times of India.

VI. Standards, Codes & Regulation Watch

JCI laboratory standards 5th edition: JCI has launched a field review for the 5th edition of its laboratory accreditation standards, with publication planned July 2026 and effective date January 2027. International labs and hospital quality teams should engage now.

UK Hospital 2.0 Alliance: Willmott Dixon’s appointment under the New Hospital Programme signals ongoing momentum for industrialized, programmatic delivery of UK hospital construction—with implications for standardization, cost control, and portfolio-wide modernization.

WHO guidance: No major new WHO facility guidance surfaced this week, but the climate-resilient and environmentally sustainable healthcare facilities program remains the foundational reference. The IFHE co-authorship of new WHO guides is the most significant development in this space.

Green building frameworks: No healthcare-specific breaking updates for LEED, BREEAM, WELL, EDGE, Green Star, or NABERS this week. These frameworks continue to shape procurement, reporting, and performance strategy—watch for new hospital certifications and framework updates affecting electrification and smart-building controls.

Sources: JCI Field Review announcement; Willmott Dixon / Hospital 2.0 Alliance; WHO climate-resilient healthcare facilities program; USGBC.

Calendar & What to Watch

March 8–11: ASHE PDC Summit 2026, Houston, TX — Including sessions on hydrogen fuel cells and long-duration energy storage for hospitals

March 19: Harris County public hearing on Ben Taub expansion / Hermann Park

August 10: California SB 253 first Scope 1 & 2 reporting deadline

July 2026: JCI Laboratory Standards 5th Edition publication

October 2026: 29th IFHE World Congress, New Orleans — Call for papers: Resilient Design in Coastal Zones

January 2027: JCI Laboratory Standards 5th Edition effective date; SB 253 Scope 3 reporting begins

On the Reading List

· HFM Magazine: Rural Hospital Invests in Hydrogen

· Mazzetti: Hydrogen Power in Healthcare — A Rural Hospital’s Pioneering Journey

· Valley Children’s Microgrid Project Update (Oct. 2025)

· DOE Better Buildings: Valley Children’s Healthcare Microgrid

· ASHRAE/ASHE Decarbonizing Hospital Buildings Guidebook

· OECD: Decarbonising Health Systems Across OECD Countries

· NAM: Crossing the Decarbonization Chasm (May 2025)

· WHO: Accelerating Access to Electricity in Health-Care Facilities

· Merlin: A CT Vision-Language Foundation Model (Nature, Mar. 2026)

· DOE Better Buildings: Healthcare Sector

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.

Working at the intersection of technology, energy, climate law and regulation, energy procurement, and project finance.

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