The Hospital of the Future:
Transformative potential
of technology

Introduction

Meet Ted, the patient of the future.  An ordinary 35-year-old man from New York. It’s 2050, and Ted is comfortably sleeping in his apartment in midtown Manhattan.  Sharp chest pain wakes Ted up at 3 A.M.  He feels nauseous, has trouble breathing, and vomits.  What to do?

There is a robot next to his bed named “Sunny.”  Ted says, “Sunny, connect me with the nearest hospital in the area.”  A monitor drops from the bedroom ceiling, and a woman appears wearing scrubs with monitors in the background.  She says, “HI Ted, my name is Becky from Corwell Health. Can you describe how you’re feeling?”

As Ted describes his symptoms, his Fitbit measures his vital signs, the monitor in front of him measures his respiratory rate, and the Apple watch records an EKG.

Becky looks at the results on one of the monitors beside her and notifies Dr. Grant.  Dr. Grant orders Sunny, the robot, to perform an XRAY on Ted.  The results are instantly available to Dr. Grant, and suddenly, Ted’s bedroom has turned into an Intensive Care Unit.

As Ted concludes his visit with Dr. Grant, a driverless car arrives in front of Ted’s apartment. Sunny meets the car and retrieves a bag with an Rx label on the front. Ted takes the medication, and his symptoms are relieved. He is able to go back to sleep.

This is not science fiction, nor is it even a bold perspective on the influence of technology. It’s a glimpse of a not-too-distant future full of significant advances.

A digital transformation is underway.  But what exactly do hospitals of the future look like?

US healthcare spending has been projected to exceed 24 percent of GDP by 2040 ⁽¹⁾ while spending on healthcare and long-term care in the European Union is projected to reach 13 percent of GDP by 2060 ⁽²⁾. Payers, employers, and governments are struggling to fund the ever-growing cost of healthcare, thus putting more pressure on providers to deliver high-quality care affordably.

Another two issues are the capital requirements and availability caused by aging infrastructure and the need to invest in new technologies.

There is a shift in healthcare from treating diseases in hospitals to managing health, emphasizing the need for improved quality and value creation.

Patient empowerment, using technology, is driving the healthcare evolution, thus leading to increasingly more informed patients and individuals who are actively engaged with their health and well-being ⁽³⁾.

Tomorrow’s patient may never actually step inside a hospital.

As the above example describes, the “patient of the future,” which I named Ted, perhaps is the new normal. Ted lives in the not-too-distant future; he continues to see Dr. Grant every week, but he’s never sat in a waiting room.

There’s no way Ted wants to go to today’s “hospital.”  If Ted wants overnight care, he wants it to be specialized, customized, and de-centralized – not generic and industrialized.

However, before we get to Ted’s reality, a multitude of changes are occurring in the healthcare industry.

The “Questions” that we need to ask:

1. How do we get closer to Ted’s reality?
2. What do we need to do differently to meet the needs of the patient of the future?
3. How will the business model need to change?

The world is changing for hospitals. Emerging technologies and consumer demand force Hospitals to adapt and rethink their offerings to fit future needs.  Standalone hospitals are no longer the answer, as new trends are sweeping across the globe.

1. Integrating Emerging Technologies

Incorporating new technology into patient care is paving the way to create “the world as Ted imagines it.”  A small glimpse of the “trends” are described below:

• Artificial Intelligence (AI): Eliminates the time when patients are not receiving direct care. Enhances diagnosis, improves predictive interventions, and optimizes clinical productivity.
  1. Automation power: Humber River Hospital (HRH) in Toronto launched a brand-new facility that automates approximately 80 percent of its front and back-of-the-hospital services, compared to 38% 5 years ago, resulting in a more seamless patient experience ⁽⁴⁾.
  2. Diagnostic assistance: AI can provide “real-time” decision support and improve clinicians’ diagnostic accuracy.  It can help identify conditions such as ADHD and sleep disorders and quantify coronary artery calcification^(5)(6)(7)
• Devices: Portable, wearable, ingestible, and/or implantable devices can monitor health information and deliver therapies autonomously. Several are available:
  1. Stanford University’s team has developed mobile platforms that can detect skin cancers using mobile phone images with the same accuracy as dermatologists ⁽⁸⁾. These platforms provide a route for quick, accessible screening for melanoma worldwide.
  2. CellScope has an application that enables a smartphone or tablet to function as a high-power microscope to identify parasite levels in blood samples from people with onchocerciasis—advanced diagnostics in remote environments ⁽⁹⁾.
• Data analytics and access: Today, most treatment decisions are based on standardized guidelines, using evidence from clinical trials. However, some hospitals are instituting “biobanks” to deliver more personalized and higher-quality care ⁽¹⁰⁾.
  1. Dana-Farber Cancer Institute, based in Boston, has expanded its data sets to include genetic, lifestyle, and physiological information. This approach recognizes risk factors for disease development and identifies biomarkers for treatment ⁽¹¹⁾.
  2. Platforms and applications that store, transmit, and analyze continuously expanding medical data sets can be used to improve both medical education and surgical planning.

However, technology will not replace our doctors and nurses. When you arrive at a hospital in the future, technologies are likely to assist with your initial scans and tests, enhance the quality of your care, and expedite your discharge. But it will still be the human doctors and nurses who make the decisions and deliver your care.

2. Reinvention

To move toward the hospital of the future, a “reinvention” needs to take place. This must include a digital backbone that will integrate care in the facility, community, and home. A new shape is taking form, starting from the inside (smart hospital) to the outside (virtual wards) and encompassing what the patient expects (precision medicine).

1. Smart Hospital – The current smart hospital concept supports automation in administrative workflows to boost productivity, reduce errors, and tackle workforce shortages. With advancements in engineering and AI, automation is also emerging in core medical tasks, such as diagnostic imaging, patient monitoring, fine surgical procedures, nursing, prevention and rehabilitation, and data management and analytics.  A smart hospital is primarily a hospital without borders, extending to any place of interest outside the health system, encompassing any place where the patient resides, such as home and workplace, recreational areas, or any point of care ⁽¹²⁾.
2. Virtual Wards – The concept of virtual wards has existed for some time ⁽¹³⁾.  The COVID-19 pandemic expanded the use of virtual wards, which had an apparent good effect on managing selected patients with COVID-19 using a pulse oximeter and monitoring them through secondary care.  Large-scale investment is being made to extend the “point of care” where the patients themselves are, thanks to remote care and telehealth services. This means that patients can now be monitored and receive healthcare recommendations from the comfort of their homes.  Such approaches have already been piloted in countries like the UK, the US, Singapore, and Australia ^(14)(15).  As they become more common in the future, hospitals must be adequately equipped and designed to support such a modality of care delivery.
3. Precision medicine – A new medical model that uses data about genetic, environmental, and lifestyle factors to guide individual patient care. It supports – but does not replace – clinicians’ decision-making. This is evident in new drug development.  New drug therapies are guided to use a patient’s own cells or deliver targeted genetic material to treat disease more successfully and eliminate side effects ⁽¹⁶⁾.
   • A prime example is the CRISPR Revolution – NIH scientists have developed a way to edit genomes precisely inside living cells. They have successfully edited the disease-causing mutation in blood-forming cells in people with sickle cell disease ⁽¹⁷⁾. If CRISPR could be targeted effectively, then the thousands of genetic diseases that currently lack treatment might be cured.

3. The business model must change in two ways: 1. value-based partnerships and 2. fixed asset reallocation.

Most consumer hassles are due to issues other than providing clinical care—namely, living a healthy lifestyle, accessing and navigating the system, and paying for care. Innovating on these dimensions requires hospitals to reframe their propositions and brands, providing a value-based partnership.

The value-based partnership is occurring across two dimensions:

1. Connecting the member and patient experience:
   Providers are launching joint ventures with payers to deliver a VIP experience.  This means rapid access to a clinician and a seamless transition from the intake process to discharge. Providence St. Joseph Health partnered with Microsoft to offer a health bot and expanded urgent care centers where they offer “Express Care.”  Patients can be seen, treated, and discharged at express care in under 2 hours.  Services are expanded beyond low acuity care to include health and wellness, nutrition counseling, sleep and stress management, fitness programs, and more. The physical space feels more like a hotel than a hospital waiting room ⁽¹⁸⁾.
2. Optimize the performance of individual parts.
   The exponential rise in healthcare spending and staffing shortages are forcing hospitals to reassess their economics and do “more for less.” This means enhancing clinical productivity and linking fragmented services, thus reducing variability and waste. A notable example is Intermountain Healthcare, which announced last year that it is reorganizing its geographical structure around two areas—community care and specialty care ⁽¹⁹⁾. The former will focus on preventative services, like health screenings and primary care. The specialist group aims to deliver the proper care at the right time through specialist and hospital inpatient settings.

Fixed asset reallocation

Systems face declining inpatient utilization and are left with excessive and expensive bed capacity.  The current response is to close floors, resulting in gaps in care and staffing issues.

1. Healthcare systems must adapt current models and redesign with the future in mind.  This means: 1. repurpose spaces that enable care delivery beyond the physical walls, 2. streamline processes around partners, vendors, and solutions across the system, and 3. create flexible areas that can be repurposed over decades.
2. New York City’s Mount Sinai took this approach. Instead of shuttering its legacy 1,139-bed downtown hospital, the system is transforming a traditional inpatient facility into an integrated ambulatory hub, with a full-service emergency department, 70 short-stay beds, and a half million square feet of multidisciplinary ambulatory services, including physician offices, urgent care centers, retail clinics, and pharmacies ⁽²⁰⁾.

Three parties are driving the business model change: 1. Patients, who want longer, healthier lives; 2. Payers facing budgetary pressures (and, in some cases, financial losses); and 3. Technological Innovations like Sunny (robotics) and AI (automation).

Conclusion

The world of Ted is on its way.  It’s a world where medical robots, artificial intelligence, and other technologies will be synonymous with the word “assistant.”  The future hospital is different from what we know and see today.  The healthcare industry is moving outward and eventually using autonomous cars and ambulances.

The future hospital is a connected network of entities that share information instantly, coordinate care, and meet patients where they are.

The future hospital will have babies at birth centers (not labor and delivery), home monitoring (not observation floors), phone imaging (not imaging centers), and cancer care at the bedside (not infusion centers).

The evolution of the Hospital is inevitable because of technological developments and consumer demand. While technologies will drive innovation, regulation and funding will remain two stable limitations of breakthroughs. A tug-of-war will ensue with periods of equilibrium.

The Hospital will continue to transform just like banking, grocery shopping, notary services, and everything else. It won’t be easy, but it will happen. Once healthcare providers, payers, and regulators catch up with the existing technology, the hospitals of tomorrow will expand to the outside as they become more efficient, more affordable, and better versions of what we have today.

Resources

1. World Economic Forum. (2012). The financial sustainability of health systems: A case for change. McKinsey & Company.

2. Appleby, J. (2013). Spending on health and social care over the next 50 years. The King’s Fund.

3. Dukhanin, V., Topazian, R., & DeCamp, M. (2018). Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review. International journal of health policy and management, 7(10), 889–903.

4. Kutscher, B. (2016, April 30). Inside North America’s first all-digital hospital. Modern Healthcare.

5. Tenev, A., Markovska-Simoska, S., Kocarev, L., Pop-Jordanov, J., Müller, A., & Candrian, G. (2014). Machine learning approach for classification of ADHD adults. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 93(1), 162–166.

6. EnsoData. (2024, February 20). Latest EnsoData FDA 510(k) clearance enables AI-powered sleep diagnosis using pulse oximetry devices. EnsoData.

7. Lovett, L. (2021, September 27). Zebra Medical Vision lands FDA clearance for tool to detect cardiovascular disease. MobiHealthNews.

8. Esteva, A., Kuprel, B., Novoa, R. A., Ko, J., Swetter, S. M., Blau, H. M., & Thrun, S. (2017). Dermatologist-level classification of skin cancer with deep neural networks. Nature, 542(7639), 115–118.

9. Kamgno, J., Pion, S. D., Chesnais, C. B., Bakalar, M. H., D’Ambrosio, M. V., Mackenzie, C. D., … Boussinesq, M. (2017). A Test-and-Not-Treat Strategy for Onchocerciasis in Loa loa–Endemic Areas. New England Journal of Medicine, 377(21), 2044–2052.

10. Stanford Medicine. (2017). Stanford Medicine 2017 health trends report: Harnessing the power of data in health.

11. Hawcutt, D. B., Francis, B., Carr, D. F., Jorgensen, A. L., Yin, P., Wallin, N., … Pirmohamed, M. (2018). Susceptibility to corticosteroid-induced adrenal suppression: A genome-wide association study. The Lancet Respiratory Medicine, 6(4), e15.

12. Kaldoudi E. (2023). Smart hospital: The future of healthcare. Computational and structural biotechnology journal, 24, 87–88.

13. Lewis, G., Vaithianathan, R., Wright, L., Brice, M. R., Lovell, P., Rankin, S., & Bardsley, M. (2013). Integrating care for high-risk patients in England using the virtual ward model: lessons in the process of care integration from three case sites. International journal of integrated care, 13, e046.

14. NHS England. (n.d.). Virtual wards. Retrieved from https://www.england.nhs.uk/virtual-wards/#:~:text=Virtual%20wards%20allow%20patients%20to,such%20as%20COVID%20virtual%20wards.

15. Gunasegaran, T. (2022, January 26). COVID-19 virtual ward helped Singaporean health system save over 3,500 bed days. Healthcare IT News.

16. Magrabi, F. (2021, November 16). What could the hospital of the future look like? The Lighthouse. As told to Georgia Gowing.

17. National Institutes of Health (NIH). (2023, November 16). The CRISPR Revolution.

18. Leventhal, R. (2020, April 16). At Providence St. Joseph Health, digital health meets key COVID-19 needs. Healthcare Innovation.

19. Intermountain Healthcare. (2017, October 12). Intermountain Healthcare changing internal structure to better serve patients and communities.

20. Mount Sinai Health System. (n.d.). Facts and figures.