Future medicine, today's healthcare

Is the “Smart Hospital” a chance for change?

Prof. Heinemann explains how futuristic and smart technologies that are used in preventive and diagnostic  healthcare, are embedded in a new digital professionalism and quality.

Artificial intelligence (AI) in diagnostic radiology, robots in nursing and operating theatres, augmented and virtual reality in surgery and medical training, 3D-printed skin, blockchain technology for clinical data exchange, modern and smart buildings, preventive healthcare via apps and wearables, at-home aftercare from a screen using interactive hospital cloud services such as telemedicine and high performance sensors, simulation techniques, cardiovascular risk prediction with deep learning, security & cyber crime prevention, gamification of patient care, and of course electronic medical records (EMR), automated pharmacy systems, fresh hospital design with real hospitality services, voice-command devices in patient rooms, integrated management systems focussing on patient satisfaction – all these and more in preventive and diagnostic healthcare, therapy and research are embedded in a new digital professionalism and quality. They describe at least some elements of what a smart hospital could look like. It may all sound a little like science fiction, but it is already far more science than fiction. right here, right now, we have access to a future that really works.

The emergence of a new kind of medicine, and shifting – albeit it slowly – legal conditions at European an national level (in Germany and not only here) have raised many hopes of better health and recovery, but also many concerns, fears even, about the dehumanisation of medicine, about transparent “datients” (data+patients) or even “drive-ins” for the sick, and about skilled medical staff becoming dispensable, not to mention the mainstream top's for today’s hospitals, like cost pressure, an ageing population and a shortage of practitioners and caregivers. Central to these developments, the three most important stakeholders in a hospital face the historic challenge of digital transformation, which cannot simply be delegated away to regulation or the market: doctors and nursing staff, patients and hospital managers today must rethink their relationship. Where there is risk, there is also opportunity, so is the smart hospital a chance for change, a new and trusting beginning?

It is certainly time for a new beginning: neither demigoddery nor Google-based self-treatment nor coldly calculated process optimisation is much use to a system that is clearly ailing economically and socially. A new beginning is a good thing anyway, and does not imply that whatever went before it was all bad. To the contrary, in fact: in Germany, measured patient satisfaction isoften higher than the apparent reputation of the hospital landscape (a declining number of some 1,900 hospitals,and 33 University clinics) would suggest.
and that satisfaction undoubtedly goes further than the patients’ delight at an unexpected flatscreen TV with Netflix in their hospital room. At any rate, if a systematic approach is taken to this new beginning, it is precisely smart hospitals – in theory – that offer a chance for – real! – change. As an integrated clinic concept, the smart hospital drives clinical excellence, patient centricity, strategic and operative effectiveness and efficiency with digital disruption in today’s and tomorrow’s clinics.

Clinical excellence – the best medicine for all
The digital transformation in medicine is primarily a scientific (research), economic (efficiency), legal (E-Health Act, EU-general data protection regulation), and social (data ethics) issue –not a purely technological one (a vast amount is already possible today).Andthemarketisbooming,theglobalhunt isonfor thenewdigitalhealthunicorns,thelawand societyare,toadegree,“critically positive”. and, as mentionedbefore,noteverythingisstilloutoftoday’s reach:within theboundaries ofwhatislegallypossible andsociallyacceptable,hybridoperating  theatres, imaging, andultramodern operating technologies are asrelevantasapatient experiencethatisenhanced bynavigationsystems, better roomfacilities,oroptimisedaccesstoinformation.Manyoftheplayersinthe healthcare industry, like Siemens (D), GE Healthcare (USA), Samsung
(South Korea), Qualcomm Life Inc. (USA), athenahealth Inc. (USA), SAP (D) or Philips (NL), are offering increasingly sophisticated features and services around the smart hospital.

Digital disruption changes medicine intrinsically, but with it, not against it. Digital transformation makes medicineclearer,richer and,formedicalpractitioners inresearchandhealthcareprovision,future-proof.Data arenotthe“newoil”justfor manyotherindustries, butalsoforthehealth industry.Heretoo,however,and hereofallplaces,qualitycounts:pulpdatain, pulp resultsout! ThePowerof Three-gooddata,smartuse, secureinternalaccess-startswithdata.Onlyclearly validated,annotatedandcurated  data canatbest assist evidence-based medicine,theycannotreplace it. “AI+topradiologist= positivepatient  outcome”is thesuccessfulformula.Correlationforsuredoesnot implycausation.Andjustbecause itsays“healthapp” on thelabel, it doesnotmeanthatwhatcomesoutis health– moreresearch isneeded here.Preciselyfor thatreason,it takesbothtypesof expertise, medical anddigital,togetthebest data and,ultimately,the bestpossibleoutcomesforpatients.

Inasmart hospital,comprehensive clinicalexcellencemeansthatmedicineisenriched,notreplaced,by responsibly implemented digital possibilities. Doctors andnursingstaffarenotrenderedsuperfluous, quite theopposite,infact.Withtheirexpertiseandskills, theywillhavemoretimeandmoredigital resources withwhichtowork,agile,themselveshealthyand successful,forpatients,researchandothermeaningful uses.Inasmarthospital, theright solutions areavailable todoctorsandnursesinall thedifferent departments  andinstitutesandaredesigned  toincrease theirworkefficiency.Thepractitioners  inasmart hospitalwillhavemoretimefor goodconsultations, moretimetogointoindividual concerns,strengtheningthepatient’sown competenciesandputting moreemphasis onacooperative relationship between doctorsandpatients. That ismedical, notindustrial, healthcare.Thisiswherethechanceformedicalexcellencetosystematicallybemadeaccessible,in principle,toeverybody.inessence:best  medicalperformance  for all,withoutcompromisingthereasonable ideathatadditionalservicescostadditionalmoney.

Patient Centricity–fosteringdignityisa dutyandasuccessfactor

Makinghumanitythefocal pointofeverythinga medicalinstitution anditsstakeholdersthinkand doisthecentralmessage.Datasecurity/privacyand thehumanqualityofcarearekeyelementsofthat. Anewdigitalmaturityamongpatientsismorethan merelythinkablein thiscontext:moreresponsibility, moretransparency, moresecurity, andaboveall more qualityofcareinpatient  outcomes. Italmostsounds toogoodtoever betrue.Butthechancesarereal and tangible. And,equally,itissimplyunacceptablethatthe averageconsumerinthedigital ageis somuchmore competentin selectingbest  prices,fashionstyles, playingcomplexvideogames, oraccessing(hopefully real) newsthaninwhatreally countsmostinlife: their health.Asmarthospitalinthis senseisalsoapromotionalplatform forlifelongpatient-learning toprevent disease and, ifnecessary, toenable patients tocooperatewithdoctors.

A smarthospital doesnotproducehealth; it creates theconditionsfor recoverywith integrity,empathy, medical excellence andgreatprofessionalism, andit partners  patientsin shapingtheirindividualpreventiveandrestorative  health regimens.This combinationofscalabilityandpersonalisationcanonlysucceed throughdigital transformation: it is difficult toimagine aneconomicallysuccessfulclinicwithscalableservices offeringindividualised medical excellence anyother way.Dignityisnotamarketablegood,butwithoutdigitallytransformedmanagementofthescarceresources andinnovativemedicine,thereisconstantinstitutional tension between marketandcompetition (whether theclinicsareprivateorpublic).Theeconomically motivated goalofdischargingpatientsasquicklyas possiblemeetstheethicalgoaloftreatingpatientsas humanbeingswith dignity,because patientswantto recoverasquicklyaspossible.Thatiswhyanimportant  universitycliniclikeEssen,forinstance, isright tobealsothinking aboutthepatient experienceand designingitsversionofthesmarthospitalaroundit.

 

Effectivenessandefficiency– agilehospitalmanagementisanempoweringstrategicandoperativedesign feature

Digital processes andacorresponding culture of innovationpushcosts down– aboveallunnecessary ones–andcreateopportunitiesfor long-termeconomic successandgoodemploymentconditions(whichwill includeteamwork,developmentopportunities,optimal dutyrosters,andsecurity).Change,agility,innovation andtransformation–clinicsalsooperatein anoften over-complexandimpenetrable"VUCAworld"(volatile, uncertain,complex,andambiguous)andshouldthereforeconstantlystriveto overcome internal,usually subjective, obstacles. There areundoubtedly objectivebarriersforthem toovercome aswell:thinkof theoftenverycolourful ITsystemsandtheirdifficult integrationandcompatibility,forexample.

I see noconvincingargumentsthatmodernagile managementmethods anddigitaltransformation issuesarenecessarilydiametricallyopposed toa morehumanistickindofmedicine.Onthecontrary,it isalsoandespeciallydowntohospitalmanagement asafacilitatortomakeameaningfulandsuccessful futureforpatients,caregivers  andtheother stakeholders,ataskthatishardto achieve withanaversionto innovationandneofeudalisticmanagement ofshortagesandshortcomings.Theseaspectsalone farexceed  whatisalreadynecessaryforthe digital managementofhospitalprocesses.Digitallyinspired medicalexcellenceandvalue-basedpatient centricity willrequirelong-term heavyinvestment, whichfalls bothtothestateandthehospitalsthemselves.A smarthospitalalsosystematicallyusestheeconomic opportunitiesthatarisefromskillsandexperience  – theassets–ofitsoperationtogeneratestrategic advantages(egthroughcooperation),stimulateinno- vation(egthroughstart-ups),andcreate  newsources ofincome(newbusiness models).Cooperation with otherhealthindustrystakeholderslikepharmaceuticalscompanieswillalsosucceedbetteronanequal footing.

MarketresearchFuture(2018)  isforecastingfor 2023 a62-billionUSdollarglobalmarketforsmart hospitals, with asubstantial growth rate ofsome  25 percent between2017and2023 –itisamarketof global quality, andmanycountriesaremuchfurther thanGermany(intheUSA,80 percentofaround 5,000 clinics already haveelectronic health records; inthe UK,inSouthKoreaandAustralia,examplesof moreadvanced smarthospitalapproachesexist).Not least,however,smartbusinesselementscanalsobring significantbenefitsto thefundingstructureofthe (smart)hospital.

Naturally,legalcertainty remains amajorconcern, not onlyinGermany.Whatsappdiagnosesmaysuit manypatients’lifestyle,but theinfrastructureis unregulated –there areno(agile!) standards.That said,theimpetusisessentiallyonnationalandlocal government  totakeswiftandconsistentactionwhen itcomestoregulations–theclinicscanonlystandby andsupportthemwiththearguments.

Inthissense,itisperhaps–alittletoo– daringto see inthemuchdiscussedandindeedcontroversial – ambitious–versionof the smarthospitalachance foranewandtrustingbeginninginthesense outlined above.And yet there still seems to meto begood reasontodoso.Neitheranaversiontoinnovationnor recklessnesswill help,soperhapsthe“smarthospital” isanambitious ideaonsensible middle-ground. At the same time, the term itself does  not reflect the full agenda. Ultimately, asmart hospital isonethat nolongerhasthe shortcomingsofclinicstoday. And allthe stakeholdersstand to benefitfromthat,which iswhyitisagoodthingthat at leastsomeclinicsare ontheirway transformingto smarthospitals.

Key Points

• The “Smart Hospital” is a chance for change: as an integrated clinic concept, the smart hospital drives clinical excellence, patient centricity, strategic and operative effectiveness and efficiency with digital disruption in today’s and tomorrow’s clinics
• Clinical excellence – the best medicine for all
• Patient Centricity – fostering dignity is a duty and a success factor
• Effectiveness and efficiency – agile hospital management is an empowering strategic and operative design feature.