Although equipped with incredibly advanced technologies, the modern hospital is still remarkably similar to those that existed decades, even centuries ago. A diverse set of patients are assigned to various wards based on acuity. A labor-intensive care model is carried out by a large and increasingly specialized workforce. Monitoring vitals requires frequent — and often disruptive — interactions with patients. It’s a complex choreography of patients, workers, and materials that haven’t changed much over the years.
We are now in an environment where new therapies and technologies, propelled by greater scientific knowledge, are progressing at an accelerated rate. As these continue to mature and become more integrated into the care delivery model, we can imagine what hospitals will look like in the future. This isn’t just an exercise of asking, “What if?” We need to answer some fundamental questions:
- What type of patients should be cared for in hospitals versus other settings?
- What mix of services should be provided in the hospital?
- What’s the right size and composition of the workforce?
Digital health is here. We need to push our thinking if we are going to reorganize hospital care in a way that’s better suited for a rapidly evolving environment.
Sicker patient mix
In the U.S., the average case mix index, a measure of admitted patients’ acuity, has climbed over the previous decade, from 1.59 to 1.96, according to the Centers for Medicare and Medicaid Services. The average length of stay has also been on the rise, with one analysis showing a 7% increase between pre-COVID 2020 and a comparable 2023 period. These trends have been driven by the shift of lower acuity care to ambulatory settings or prevented admissions due to better population health practices. These trends are expected to persist. Forecasts show hospital outpatient department volume up by 19%, ambulatory surgery centers up by 25%, home healthcare up by 15%, and inpatient volume mostly flat, declining 1% by 2029.
Hospital-at-home programs will contribute to rising CMI by diverting or shortening lower-acuity admissions. As CMS acknowledged during the COVID-19 pandemic, “treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.” Early adopters of this approach have reported strong clinical outcomes, although they have experienced challenges with the payment model and logistics.
As fewer patients get admitted to the hospital, a different mix of beds will be needed. Today, about 14% of hospital beds are critical care beds. We can expect this number to grow as med-surg and observation units make room for more, larger intensive care beds.
Automation allows professionals to focus on high-value tasks
One valuable lesson coming out of the COVID-19 pandemic was that the industry when driven by necessity, can move quickly. The widespread adoption of telehealth is the perfect example. As hospitals moved into crisis mode and policymakers instituted regulatory flexibilities, telehealth usage increased 63-fold during the early stages of the pandemic, and some say digital health advanced by what would have normally taken up to 10 years.
Building off that sense of urgency, there is an immense opportunity to harness technology and create a more efficient care delivery model. An estimated 40% of tasks performed by healthcare support staff and 33% of tasks performed by healthcare practitioners have the potential to be automated. This is promising news given the growing trend of staff burnout.
Artificial intelligence will certainly be used to automate time-intensive tasks. It is estimated that physicians can spend 34% to 55% of their time creating notes and reviewing medical records. To ease this burden, health systems like WellSpan Health are implementing natural language processing technology, while others, like Beth Israel Deaconess Medical Center, are piloting tools to improve search functions in the electronic health record. As generative AI solutions become more refined, we’ll see the technology further augment or even take over such tasks as clinical documentation, discharge planning, and medication reconciliation. Simultaneously, virtual nursing will become more common, further easing clinician workload.
AI-powered technology will also improve patient triaging and direction to the most appropriate site of care. For example, Johns Hopkins Medicine deployed a decision support platform that helps emergency room clinicians predict the patient’s risk of acute outcomes and recommends a triage level of care. We foresee rapid evolution in capabilities and degree of reliability of these types of platforms. They’ll be coupled with patient flow and operations automation platforms. Kansas City-based Saint Luke’s Health System utilizes a tool to help complete scheduling, decrease wait times, and make the overall care journey seamless.
Simpler tasks, such as finding or transporting materials, can be taken care of by robots. Cedars Sinai and ChristianaCare are testing robots and reportedly cut 33% of the time nurses spend during their shifts dropping off lab specimens or picking up supplies. The robots are estimated to be able to complete 200 delivery tasks a day by integrating with electronic health records and proactively anticipating needs. We foresee that a collaborative robot, coupled with real-time location tracking and an internet-of-things platform like the one being implemented at Houston Methodist, becoming widely used.
Ultimately, this will allow hospitals to adjust staffing levels and appropriately staff for the acuity census today. The remaining in-person staff will be focused on high-value tasks only humans can perform such as patient and family communication and administering drugs.
Patient experience: streamlined, connected, and thoughtful
Patients admitted to the hospital will have an increasingly digital, connected, and personalized experience. More consultations and rounding will be done virtually. A broader range of specialist consults will be conducted via pre-installed hardware consisting of screens and cameras in the patient room. Similarly, hybrid or virtual rounding, which grew in popularity during the COVID-19 pandemic as a way to reduce exposure, is a proven model to help ease the burden of in-person staffing, while including the patient’s family in the rounding. As streaming technology continues to improve, clinicians will be able to get a more accurate picture of patient status using traditional indicators such as skin hue or facial expressions, and leverage technology such as digital stethoscopes to perform remote check-ups that previously could only be done in person.
Patients will also be better cared for through passive, continuous monitoring. Enhanced sensor technology, coupled with better hospital networking and telecom capabilities, will allow for a wider array of vital signs, with higher volumes of data points, to be streamed to clinical teams, or even remotely. Temple University is piloting a sensor patch in the ICU, which provides continuous data to clinical staff on patient orientation, respiratory rate, and activity, and alerts them via the command center or mobile application if a patient is at risk for respiratory events, developing bed sores, or falls.
Diagnostic devices are installed in toilets to conduct automatic urinalysis, intelligent tracking with RFID for wandering patients like elders with dementia, and even pain levels are measured by interpreting facial expressions and pitch of voice. These technologies allow clinicians to care for a larger panel of patients by necessitating intervention only when alerted to and validating or intervening remotely, instead of the traditional way of rounding at periodic intervals, disruptively taking vital signs, and hoping the clinician is there at the same time an issue presents itself.
Coming online soon
The digital hospital is not as far away as we think. Technology advances at a consistently rapid pace and reluctance to implement new technologies in a clinical setting has been declining. Of course, there will be practical real-world challenges, such as interoperability, vendor management, and regulation, however, these changes should enhance the quality of care, reduce the total cost of care, and satisfaction for patients and clinicians alike. This has always been the case in healthcare and should be our driving force towards higher standards and new ways of working.