"When I imagine the hospital of the future, I think of the air traffic control tower."

High-speed networks, remote monitoring technology and big data processing and analysis are driving hospitals to achieve a new medical model change.

Organize | Wang Yuxin Zhang Zhen

Source | The Economist

In a small room in a modest area of Cleveland, a doctor, several nurses, and medical technicians are caring for 150 critically ill patients in need of special care. These patients are not admitted to the hospital building, but are spread out in different areas, and the clinic does not have specialists on night watch. The medical team members in the room could track their patients' vital signs in real time based on the beeping sound of the screen on the wall, and they could observe the patients in more detail through the cameras at the end of each bed. "These patients are ventricular premature beats (PVCs), and the situation is not optimistic." Heart specialist Jim Goldstein, pointing to a patient's electrocardiogram, said. If ventricular premature beats worsen, the flash will immediately alarm and the nurse will be in place immediately.

It is a remote intensive care unit operated by cleveland Clinic, the largest hospital group in the United States. Healthcare providers like them are rethinking the way hospitals operate. Today, hospitals are just one place where patients consult specialists, those experts diagnose diseases with the help of medical technicians and expensive medical equipment, and are the main places to implement medical interventions such as surgery and chemotherapy. But high-speed networks, remote monitoring technologies, and big data processing and analytics are changing all that. In the future, most of the medical process will be transferred and completed through other channels and methods.

These new areas are being taken over by primary care groups, insurance companies and health management agencies. As mobile phones become more powerful and patients can take more control over diagnosis and treatment, tech companies are playing an even more important role in healthcare. But hospitals with visionary visions, even as their roles change, still want to be at the heart of the entire healthcare ecosystem.

"When I imagine the hospital of the future, I think of people sitting in a room full of screens and phones." Cleveland Clinic President Toby Cosgrove said. Under this vision, the hospital is like an air traffic control tower, where medical teams can remotely monitor patients according to standards similar to those in the intensive care unit (ICU), and the hospital itself serves only as a place to receive emergency cases and provide expensive equipment testing. True hospital consultations are only available when different specialists are needed to collaborate. These patients will receive good care in the hospital, but due to the implementation of telemedicine care, the hospital will only accept a small number of patients.

A revolution in the healthcare model

In fact, hospitals have undergone several transformations. In the Middle Ages, hospitals were run by religious organizations and were sanctuaries, hospice and places of the dead for the poor. During the Enlightenment, modern medicine was born, and ambitious institutions such as Westminster in London and the Guy Campus of King's University london developed into complex organizations integrating nursing, medical care, research and education. Subsequently, the relief of the poor moved elsewhere, smaller institutions were either closed or merged, doctors gathered in large cities and gradually specialized, and nursing was specialised under the influence of Nightingale and his successors.

The next decade will change dramatically. Health care reform has always been difficult, as evidenced by Britain's crumbling NHS, France's on the brink of bankruptcy, or the endless debate over Obamacare in the United States. The rapidly aging demographic situation and the increasing cost of new medical treatments will further complicate reforms. But reform is urgent. Over the past half-century, the burden of disease has shifted except for the poorest countries. Infectious diseases are no longer a big problem; the problems we face now are chronic diseases associated with unhealthy lifestyle habits and longer lifespans. The contradiction between supply and demand between the health care services provided under the hospital system and the health needs is getting bigger and bigger.

Imagine what a hospital would look like. If obstacles are overcome, the provision of health services, the role of patients and the standards of good doctors, these long-established ideas will be abandoned. "Home can also be a hospital," says Lord Ara Darzi, a surgeon and professor at Imperial College London, a university that runs affiliated hospitals. Just as online banking makes consumers' lives easier and frees company employees from complex queries, online healthcare means fewer people need to come to the hospital to be cared for by medical staff. Caissa Healthcare, an integrated U.S. healthcare company that operates numerous hospitals, last year offered half of the consultations they offered were virtual, with medical experts communicating with patients by phone, email or video conference.

Kari Gali, a pediatric caregiver at the Cleveland Clinic who answers video calls, says the main limitation today is that she can't check her children's eyes or listen to their heartbeats. Because complex diagnostic methods, including blood tests and virtual images, are remotely controlled, more patients can receive the same quality of care as hospitals without leaving the home. A Dutch research company, gupta strategists, believes that in the Netherlands, 45% of the care given in hospitals today can be done better at home.

While it is difficult to transfer all the dialysis and chemotherapy out of the hospital, it is also a goal that is being tried. As remote monitoring evolves better, some chronic patients who need to be hospitalized can stay home and only need to be admitted if their condition worsens. Shifting care outside the facility allows patients to have a comfortable environment while reducing infection rates, saving money and improving treatment.

Personalized medical care with greater precision

For this to become a reality, primary care and family support need to be improved. Kaiser Medical Group presents a broad vision of "integrated care", which offers hospital visitors a wide range of options, from its website to information centres to emergency medical centres, which will be cheaper and more convenient for some minor illnesses, disease management and prevention, and social issues that contribute to the rise of unhealthiness. "If we take the inpatient approach to care for a comatose diabetic, that's a failure of our system." Bernard Tyson, owner of Caesars Healthcare, said. He blamed the overpayment of hospitalizations because the support of the healthcare's profit model encouraged more people to opt for hospitalization.

Banner Medical Center, a large non-profit health system in the United States, operates 28 hospitals and a number of specialized institutions across 6 states. Its tele-icu project is supported by equipment, procedures and software from the Dutch medical technology company Philips. Although the center is headquartered in Phoenix, it manages the care of critically ill patients, perhaps thousands of miles away, and under its "Intensive Mobility Care Program," patients can leave the hospital earlier.

Patients are still under constant observation and care at home and can communicate with doctors or nurses at any time via video. After completing initial research trials with Philips, Banner Medical Center believes that such a telehealth program could reduce hospital attendance by nearly half and reduce expenses by a third.

As a result, the experience may be more convenient and comfortable for patients who still need to be hospitalized. Hospitals operate more like transits in modern airports and luxury hotels, with patients registering on their phones, completing blood and urine tests on their own, and pushing information to the phones of patients or their relatives. For scheduled visits, algorithms can help patients decide which tests need to be done before they leave home, optimize the protocol for receiving tests, and record the results directly in the patient's electronic file.

Healthcare professionals have long understood the fact that the environmental impacts patients are exposed to, such as recovery time and success rates. Some places favor brand-new, white and pale facilities; others need to be decorated in color, with some shells and some classical music playing. The latter setting can be seen at Caesars Medical's Manhattan Beach Medical Office in Los Angeles, while yoga and cooking classes are being planned for patients. In Stockholm, the new Karolinska University Medical School features artwork worth SEK 118 million (US$13.2 million) and large areas of glass to maximize light exposure, all to aid treatment.

Medical director Annika Tibell said it would be more tranquil than a traditional city hospital, replacing flickering alarms and loud-talking people, each with a small buzzer. While these may seem luxurious, they will recover more slowly if the patient is unable to maintain a good night's sleep. Some hospitals have more than 70 decibels of noise at night, which is equivalent to the sound of a vacuum cleaner.

But for hospitals, the main change is still happening behind the scenes. In Baltimore, Johns Hopkins Hospital was inspired by NASA to build a "control center" to manage its admissions. Surrounded by 22 beeping flat-screen TVs, live video streaming and many phones, 24-hour on-call, headset-equipped medical personnel observe the 1,100 beds. GE Healthcare is a medical technology company that helps mix, filter, and visualize data streams, even including information such as weather, in new ways. Procedures help healthcare workers anticipate needs to make better decisions, alerting them when beds are about to reach their upper limits, and shifting bed planning from empirical skills to scientific management. Patients at some nearby facilities do not have to be present when they need specialist help, and the control center keeps in touch with them. The leader, Jim Scheulen, said the goal is to maximize the number of patients who can access Hopkins expertise.

In the future, there will no longer be any more important work indicators for patients to be checked only between breaks, or nurses will stay at the bedside of intensive care, real-time data streams from medical devices or wearable devices will go directly to the control center, and supercomputers will observe whether they need medical staff. Doctors in control centers, or even at home, can be virtually present around the patient via the swipe of the touch screen. These reforms will not only make hospitals safer or more efficient, but will also allow medical staff to keep real-time and complete records of patients' conditions.