Smart hospitals built on an ICT environment of interconnected assets not only improve existing patient care procedures and clinical outcomes, but also achieve overall excellence in healthcare delivery.

A number of factors are rapidly driving a new paradigm in healthcare delivery. Increasing cost of care, need to improve access to care, inherent complexity in treatment options, and increasing involvement of patients in the care delivery cycles – all of these factors have fostered an environment where hospitals or other care delivery institutions have started shifting focus from treating episodes to managing overall health of patients, while focusing on overall value of care rather than efficiency. The industry is utilizing multidisciplinary care approaches and fostering a model toward a continuum of care for the patient. In this context more and more hospitals are investing heavily in information and communication technology (ICT) capabilities in different areas of management and operations.

This burgeoning deployment of ICT capabilities has evolved into the concept of smart hospitals with the objective of achieving excellence in healthcare delivery. From the implementation of electronic medical records (EMR) and patient data management to more complex systems integrating telemedicine systems, the focus has been on automation of existing operations and driving efficiency. However, with increasing maturity in technology adoption, most healthcare executives are realizing that building a smart hospital is about fundamentally rethinking the hospital capabilities and adopting an integrated approach to design, management, and operation of the facility.

The main objective behind the smart hospital vision is to build a facility that uniquely balances three key aspects – excellence in clinical outcome, efficiency in the supply chain, and enhancement of the patient experience. Conventional healthcare delivery models have often been based on a belief that ideal health-service delivery requires finding an optimal balance between the three. However, more recently, healthcare institutions have started to drive these three elements, conventionally considered contradictory to each other, simultaneously. There is growing experience and illustrations among hospitals in different markets that show how all three dimensions can be driven concurrently and, in many ways, complement each other. The smart hospital concept is coming of age as more and more healthcare institutions start to enhance capabilities in an integrated fashion across these three dimensions of service delivery excellence.

While modern hospitals have gone in for some level of IT infrastructure, overall hospitals in the country spend less than 1 percent of their turnover on IT infrastructure. The central government has set up the statutory body National eHealth Authority (NeHA) to attain high quality of health services for all Indians through the cost-effective and secure use of information and communication technologies in health and health-related fields. This will help generate huge data and better understanding of the needs of healthcare – areas where investments are needed for maximum benefit, assessing benefits of spending outcome, legislation, and healthcare insurance.

Framework to Achieve Excellence in Healthcare Delivery

Building a smart hospital means fully integrating technology and digital capabilities into day-to-day functioning. Processes are designed to leverage technology-led efficiencies; patient–service interfaces leverage digital tools; and people capabilities are even built for the hospital staff to manage and operate these digitalized services. Building a smart hospital is more than simply bringing together connected devices on a high-speed networking infrastructure. It is about rethinking the care processes, management systems, and even physical facilities to drive a new way of delivering care.

In order to achieve overall excellence in healthcare delivery, the healthcare-delivery institution needs to examine four key domains.

Patient services and interfaces. In designing smart hospitals, there needs to be a complete rethink of how patients use different services in the hospital. From digitalizing the appointment in the outpatient section to developing digitalized patient rooms which support audio–video communication systems for virtual, off-schedule interactions between patients and doctors, this can have significant impact on overall patient services. Kiosks placed in the outpatient section to support information dissemination, patient registration, and billing systems can not only reduce waiting times for a better patient experience, but also minimize space consideration in the design of waiting areas and enhance space utilization for more medical services.

Care processes and orchestration. With increased proliferation of wearables, sensors, and communication devices, the way the patients interact with providers can be fundamentally shifted. Not only can some of the care processes be shifted out of the hospital setting, but the multispecialty, team-based care model can be facilitated across a network of hospitals. Video-streaming capabilities from surgical rooms can provide live feeds for training purposes, as well as give the clinician access to external expertise. Integration of patient data and live feed from sensors in the patient room displayed across a digital device with the doctors can enable doctors to do virtual rounds of patients' rooms and improve the frequency of interaction between patients and doctors.

Logistics and support-services design. Extending the technology infrastructure to minimize wastage of consumables, and using advanced RFID and Wireless LAN technology to identify and report location and utilization of medical and nonmedical resources in the hospital could help hospitals achieve significant reduction in capital expenditure (CapEx) and operating expenditure (OpEx). Reduction in downtime of critical facilities, synchronization with patients' treatment schedules, and even inventory management across single- or multisite hospital operations could have significant efficiency impact on hospital operations. Optimizing the movement of clinical and nonclinical equipment throughout the hospital would not only enhance overall efficiency, but also ensure access to well-maintained equipment.

Organization and capability design. In order to ensure full leverage of digital capabilities in the hospital setting, there needs to be adequate focus on the way the organization structure and people capabilities are designed. In a hospital, where the care and support processes are fundamentally thought through differently, the capabilities of the clinician and nonclinical staff to support this new model of operations in terms of management systems, governance, and technology competency need to be ensured.

Technological Innovations Driving a Smart Hospital

The next technological revolution combining vast amounts of available data, cloud computing services, and machine learning is creating artificial intelligence-based solutions to provide expert insight and analysis on a mass scale, at a relatively low cost. Connected medical devices are already transforming the way the healthcare industry works. Very soon the widespread adoption of technology-enabled care will ensure that the concept of smart hospital becomes a reality in the country.

Blockchain technology. This allows each separate patient data source to be a block part of a complete, unalterable patient data profile which can then be shared securely with healthcare providers or research organizations. Blockchain can help organizations bridge traditional data silos, dramatically increase IT and organizational efficiencies, keep business and medical data secure, and streamline patients' access to medical data. It has the potential to help overcome limitations of large-scale sharing of health data currently holding back innovation; namely data security and patient privacy concerns during the data exchange process. It increases transparency not only between the patient and doctor, but between different healthcare providers.

Bio-telemetry technology. It collects meaningful data and analytics through sensors to monitor variability in heart rate and other vital signs throughout the day. Wearable technology, including smartwatches, eyeglass displays, and electroluminescent clothing, are among the many devices under development or already in the marketplace. It can be used to monitor patients in their own homes and provide objective insights into what's happening between hospital or clinic visits; and help clinicians determine how patients are responding to treatment or medication and how their recovery is progressing.

Drug development and precision medicine. Since the launch of the Human Genome Project, more than 1800 disease genes have been discovered, and over 2000 genetic tests for human conditions developed. Genomics is a major part of digital health, not a side note. Computers and robotics are necessary to, among other things, scale genomic sequencing and enable gene editing. This development has benefitted oncology most, and on a much smaller scale, nononcology indications have explored targeted approaches, primarily split between therapeutic areas of the central nervous system, infectious disease, and the autoimmune disease cystic fibrosis.

Virtual rehabilitation in orthopedics. Physical therapy is a big part of orthopedic care. As the era of value-based care and bundled payments takes hold, there will be an expansion in availability of new sensor devices connected to a mobile app that can guide patients through their daily exercise routine following orthopedic surgery; recording range-of-motion, which is key to better clinical outcomes. The data is also shared in real time so clinicians can tweak exercise protocols, and a virtual avatar can guide patients through exercises.

Outlook

Hospitals first need to identify the impact on their MedTech infrastructure, facility design, IT infrastructure and operations, and the overall information management approach. Only when a hospital focuses on all of these domains, can it truly identify and detail a vision that will allow it to become smart.

A smart hospital built on an ICT environment of interconnected assets is aimed at improving existing patient care procedures and introducing new capabilities. Providers need to work in collaboration with health system partners to apply the technology that can help achieve the necessary changes. Embracing digital technology and big data will help deliver not only improved patient outcomes but also lower healthcare costs, while delivering personalized care to patients. An example of how machine learning and information technology is changing healthcare is radiology, where experts believe as much as 80 percent of activity could be replaced by machine algorithms. Other leading areas include oncology and dermatology. Information technology can and will change almost everything we know and believe about healthcare.


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