HOSPITALS OF THE FUTURE - How technology will play a major role in defining hospitals of tomorrow

BY: Dr George Fernandes (GM Medical Advisory Services) - 21 Oct-2020

COVID-19 is affecting 215 countries and territories around the world. As of October 17th, 2020, the total cases recorded are 39,656,147 and the total deaths 1,110,250. The healthcare systems throughout the world felt the stress and disruptions. Countries struggled to understand how to handle the pandemic and kept changing their guidelines and policies on day to day or weekly bases based on immediate past experiences and learning. 

The medical fraternity had never experienced such an impactful pandemic before and lacked the resources and skills especially in the first few months of the rapid spread of the infection. Most hospitals were never built to handle a pandemic of such a magnitude. Further, they suffered from decreased manpower as healthcare workers were affected, quarantined or afraid to come back to work and essential supply chains were disrupted. Protocols on admission, diagnosis and treatments kept changing which further complicated on how to handle a COVID-19 patient. U.S. hospitals are predicted to lose more than $200 billion in revenue by June 30, according to a report by American Hospital Association. The industry group estimates the total revenue hit from the pandemic at about $50 billion a month among health-care facilities since March. Hundreds face bankruptcy, industry experts say. The story is similar for other hospitals in other parts of the world. 

Prior to the pandemic, hospitals were usually built to treat a very low number of infectious patients. Very few hospitals had separate units to treat out-patients and in-patients, separate ICUs and operation theaters for infectious patients. Simple preventive measures such as hand hygiene compliance rates were about 50% among the healthcare staff. Disinfection of surfaces was bare minimum limited to floors. There was very little focus on ventilation or air exchanges with the hospital rooms. Hospital policies and processes on out-patient and in-patient were not focused on infection control practices. The hospital governance body were slow in their decision making process. The top management of hospitals accounted for more than 40% of human resource budget. The management was not necessarily accustomed to switching gears and operating in crisis mode. They were simply not well-equipped to do it, and have scrambled to implement fixes, such as meeting more often and holding meetings virtually – practices to which they're not accustomed. Decision making processes were too complex and long. Multitasking through multi-skilling was not a priority for the hospital employees. The breakdown of the supply chain management system was evident during the COVID-19 as hospitals were unable to get supplies. Automation, the budgets on software as well as hardware would be less than 3 % of the gross hospital budgets in India. Communication was muted or limited. Hospitals relied more on manpower than on automation of processes. Hence when the healthcare employees got affected during the COVID-19, systems and processes broke down leading to chaos and panic which reflected within the community and further escalated through various media channels. The hospitals spent a lot on providing services that were not necessary meant to be done at a hospital such as long term recovery or did not monitor the average length of stay for disease treatments. Hence during the COVID-19 infection, hospitals suffered a near 60%-70% drop in revenue. With a decreased of manpower coupled with limited resources, hospitals could not provide comprehensive services under one roof. Lack of partnerships between various healthcare providers further delayed a continuity of care for the patient, hence increasing the morbidity and mortality rates. The current healthcare system is primarily physician-centered and driven by increasing units of activity rather than how well the job is done.
 
The hospitals of the future will take all the learning from the ClOVID-19 as they move forward. New hospitals that will be built will have an advantage as they can now design the hospitals differently with five topics of focus: distancing/separation; patient, staff, and supply flow; materials/surfaces; smart technology; and surge design. 

The ‘Hospital of the Future’ vision looks at building smarter, safer and sustainable hospitals which will be driven by design thinking and smart technology to meet the most pressing challenges such as smart integration of technology the changing demand for healthcare services as a result of the ageing population personalised care dwindling financial resources

The hospitals will have a people-centered strategy and design engagement to develop future proof hospitals which helps healthcare providers to innovate care delivery by early strategizing, planning and optimizing assets, redefining experiences and workflows, as well as providing a future-proof care infrastructure. The idea is to go beyond feasibility report and understand social context and cultural preferences of future patients. This will help derive desired future healthcare experiences by mapping department specific patient journeys from 'before arrival' to 'post departure', which finally helps in establishing the detailed workflows for future ready smart hospitals. 

Hospitals will set to join forces in hospital networks and collaborate with other healthcare providers in order to only take on part of the care package. This changing role will have an impact on the infrastructure, which is set to differ according to the care components on offer.  The future is all about combining expertise in ‘focused factories’, technological platforms and partnerships for logistics and other services. For hospitals to take on their future role, they will need a smooth information exchange between all stakeholders. Moreover, legal and financial obstacles must be cleared. Another essential aspect will be the focus on healthcare professionals’ well-being. 

Hospitals will need to rethink on what services they will want to provide. With the advent of faster technology both for information gathering, diagnosis and treatment, there will be a shift of patients from inpatient care to outpatient and ambulatory care. For example, development of non-invasive procedures, faster diagnostic equipments for radiology and laboratory, advanced anesthesia techniques to decrease the recovery rate, precision technology such as robotics will decrease the need for inpatient and long care stay. Out-patient care has already seen a transition with the increased utilization and empowerment of physicians in telemedicine practices.  Home care has further decreased the requirement of patients attending the hospital for non-critical care such dialysis, blood test etc.  Medical equipments are available to evaluate and monitor various critical health parameters remotely which can be communicated to their respective physicians. However, many complex and very ill patients will continue to need acute inpatient services. Hospitals will basically become intensive care units because medical technology will have advanced to the point where so many things can be done on the outside. Hospitals will always have ERs for severe trauma that will always support highly complex and risk-oriented service lines such as intensive and cardiac care, perinatal and NICU. But time spent in those units is going to become very less as much of the monitoring and diagnosis would have been done prior to arrival with the use of technology. This will help the aging infrastructure in some countries and increased demand for more beds in others, with hospitals considering on rethinking on how to optimize inpatient and outpatient settings and integrate digital technologies into traditional hospital services to truly create a health system without boundaries. 

Digital technology could help transform unsustainable healthcare systems into sustainable ones, equalize the relationship between medical professionals and patients, provide cheaper, faster and more effective solutions for diseases. Responding to pressure to contain skyrocketing cost, healthcare providers and policymakers will begin to dramatically change how care is delivered by shifting the focus to reflect the value of care rather than volume. Hospitals and health systems will be looking for ways to lower readmission rates and administer higher-quality. Healthcare providers will focus primarily on population health management as new payment systems give them an incentive to contain costs by keeping people out of the hospital setting; this will include caring for people with one or more chronic conditions, which will be the bulk of the disease distribution. Hospitals will likely accomplish that through tactics such as giving people access to health coaches, remote health devises for monitoring, remote access to physicians for guidance and pharmacists who can help them manage their medications.

There are different ways by which medical technology is and will redefining healthcare

Many of these use-case concepts are already in play.  Hospitals should be planning how to integrate technology into newly-built facilities and retrofit it into older ones. Technology will likely underlie most aspects of future hospital care. But care delivery—especially for complex patients and procedures—may still require hands-on human expertise. 

1. Redefined care delivery: Emerging features including centralized digital centers to enable decision making, continuous clinical monitoring, targeted treatments (such as 3D printing for surgeries), and the use of smaller, portable devices will help characterize acute-care hospitals. In the hospital of the future, we're going to see this reversal of telehealth, where the patient is immersed in a virtual world and has a care team virtually connected surrounding that individual at whatever location and time. What we know as telehealth today will also likely expand in the future, where providers will work to meet the need to reach broader communities with their best clinicians, and the solution will involve virtual communication. Nanotechnology: Nanoparticles and nanodevices will soon operate as precise drug delivery systems, cancer treatment tools or tiny surgeons. Nanotechnology is also making progress in the form of smart patches. At CES 2020, France-based company  Grapheal demonstrated its smart patch that allows continuous monitoring of wounds and its graphene core can even stimulate wound healing. As the technology evolves, we will see more practical examples of nanotechnology in medicine. Future PillCams could even take biopsy samples for further analysis while remote-controlled capsules could make the prospect of nano-surgeons a reality. Robotics: One of the most exciting and fastest growing fields of healthcare is robotics; developments range from robot companions through surgical robots until pharmabotics, disinfectant robots or exoskeletons. 3D-printing: 3D-printing can bring wonders in all aspects of healthcare. We can now print biotissues, artificial limbs, blood vessels and the list goes on and will likely keep on doing so.

2. Digital patient experience: Digital and artificial intelligence (AI) technologies can help enable on-demand interaction and seamless processes to improve patient experience.  More than turn- over of beds, improved patient flow at the hospital of the future will mean a more efficient and effective admissions process, discharge process, and everything in between. Artificial intelligence has the potential to redesign healthcare completely. AI algorithms are able to mine medical records, design treatment plans or create drugs way faster than any medical professional.  As the future of medicine and healthcare is closely connected to the empowerment of patients as well as individuals, patients will be able to take care of their own health through technologies such as health trackers, wearables and sensors. They are great devices to get to know more about themselves and retake control over their own lives. These devices will also help remote monitoring of the patients. Blockchain to make interoperability a reality-Using blockchain technology to solve interoperability problems between healthcare organizations seems like the solution that the industry has dreamed of for years. Blockchain can create decentralized record systems with multiple locations that can be shared with multiple stakeholders in the healthcare system. Instead of a single, client-server database, healthcare data including both clinical and financial data would be available in an independent, transparent database. Healthcare technology companies are thinking in novel ways to enhance patient engagement and satisfaction. For example, technology that gives patients the ability to determine compression and positioning during mammography received satisfaction scores near 80%.

3. Enhanced talent development: Robotic process automation (RPA) and AI can allow caregivers to spend more time providing care and less time documenting it. Virtual reality (VR) will change the lives of patients and physicians alike. In the future, you might watch operations as if you wielded the scalpel. VR is being used to train future surgeons and for actual surgeons to practice operations. Augmented reality differs from VR in two respects: users do not lose touch with reality and it puts information into eyesight as fast as possible. These distinctive features enable AR to become a driving force in the future of medicine; both on the healthcare providers’ and the receivers’ side.

4. Medical tricorder: When it comes to gadgets and instant solutions, there is the great dream of every healthcare professional: to have one almighty and omnipotent device, with which you can diagnose and analyse every disease.

5. Operational efficiencies through technology: Digital supply chains, automation, robotics, and next-generation interoperability can drive operations management and back-office efficiencies.  NASA-inspired command centers in hospitals-Imagine a comprehensive, interactive, digital command center where clinicians can get real-time multiple source data through an entire hospital. The command center can communicate with cross-functional staff within the hospital, and can outperform delivery activities, such as patient discharges. This system estimates that the command center’s efficiencies will save the organization 40% in efficiencies and double benefits to patients. Billing is one of the biggest sources of confusion and frustration in the entire healthcare process. Miscommunications can happen easily, and chasing down people is never fun. Patient Access Solutions make the entire process easier, and also make the audit process a breeze.

6.  Improved environment and experience designs in the hospital: The well-being of patients and staff members, with an emphasis on the importance of environment and experience in healing, will likely be important in future hospital designs. Various technologies to help make the hospital environment as comfortable as possible and help in the healing process.

7. Genome sequencing: The whole Human Genome Project cost approximately $2.7 billion for the US government. Such a test has so much potential! Through this, you can get to know valuable information about your drug sensitivity, multifactorial or monogenic medical conditions and even your family history. Moreover, there are already various fields leveraging the advantages of genome sequencing, such as nutrigenomics, the cross-field of nutrition, dietetics and genomics. Another developing area of individualized care involves using genomics to diagnosis patients with diseases that escape easy identification. For example, it can be used to identify conditions in pediatric populations whose symptoms don't fit a known syndrome.

Technological disruption is transforming every aspect of the future of healthcare, from how patients are diagnosed to how they’re treated. The future of healthcare will be depend on how well we develop the accuracy in the technology we create. The aim will remain the same to achieve clinical excellence, improved quality, excellent patient experience, zero error rates and improved outcomes. 
 

 

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