Hospital medicine and the future of smart care

People often overestimate what will happen in the next two years and underestimate what will happen in ten. – Bill Gates

The COVID-19 pandemic set in motion a series of innovations catalyzing the digital transformation of the health care landscape.

Telemedicine use exploded over the last 12 months to the point that it has almost become ubiquitous. With that, we saw a rapid proliferation of wearables and remote patient monitoring devices. Thanks to virtual care, care delivery is no longer strictly dependent on having onsite specialists, and care itself is not confined to the boundaries of hospitals or doctors’ offices anymore.

Dr. Sareer Zia

We saw the formation of the digital front door and the emergence of new virtual care sites like virtual urgent care, virtual home health, virtual office visits, virtual hospital at home that allowed clinical care to be delivered safely outside the boundaries of hospitals. Nonclinical public places like gyms, schools, and community centers were being transformed into virtual health care portals that brought care closer to the people.

Inside the hospital, we saw a fusion of traditional inpatient care and virtual care. Onsite hospital teams embraced telemedicine during the pandemic for various reasons; to conserve personal protective equipment (PPE), limit exposure, boost care capacity, improve access to specialists at distant sites, and bring family memberse to “webside” who cannot be at a patient’s bedside.

In clinical trials as well, virtual care is a welcome change. According to one survey¹, most trial participants favored the use of telehealth services for clinical trials, as these helped them stay engaged, compliant, monitored, and on track while remaining at home. Furthermore, we are seeing the integration of artificial intelligence (AI) into telehealth, whether it is to aid physicians in clinical decision-making or to generate reminders to help patients with chronic disease management. However, this integration is only beginning to scratch the surface of the combination of two technologies’ real potential.

What’s next?

Based on these trends, it should be no surprise that digital health will become a vital sign for health care organizations.

The next 12 to 24 months will set new standards for digital health and play a significant role in defining the next generation of virtual care. There are projections that global health care industry revenues will exceed $2.6 trillion by 2025, with AI and telehealth playing a prominent role in this growth.² According to estimates, telehealth itself will be a $175 billion market by 2026 and approximately one in three patient encounters will go virtual.^3,4 Moreover, virtual care will continue to make exciting transformations, helping to make quality care accessible to everyone in innovative ways. For example, the University of Cincinnati has recently developed a pilot project using a drone equipped with video technology, artificial intelligence, sensors, and first aid kits to go to hard-to-reach areas to deliver care via telemedicine.⁵

Smart hospitals

In coming years, we can expect the integration of AI, augmented reality (AR), and virtual reality (VR) into telemedicine at lightning speed – and at a much larger scale – that will enable surgeons from different parts of the globe to perform procedures remotely and more precisely.

AI is already gaining traction in different fields within health care – whether it’s predicting length of stay in the ICU, or assisting in triage decisions, or reading radiological images, to name just a few. The Mayo Clinic is using AI and computer-aided decision-making tools to predict the risk of surgery and potential post-op complications, which could allow even better collaboration between medical and surgical teams. We hear about the “X-ray” vision offered to proceduralists using HoloLens – mixed reality smartglasses – a technology that enables them to perform procedures more precisely. Others project that there will be more sensors and voice recognition tools in the OR that will be used to gather data to develop intelligent algorithms, and to build a safety net for interventionalists that can notify them of potential hazards or accidental sterile field breaches. The insights gained will be used to create best practices and even allow some procedures to be performed outside the traditional OR setting.

Additionally, we are seeing the development of “smart” patient rooms. For example, one health system in Florida is working on deploying Amazon Alexa in 2,500 patient rooms to allow patients to connect more easily to their care team members. In the not-so-distant future, smart hospitals with smart patient rooms and smart ORs equipped with telemedicine, AI, AR, mixed reality, and computer-aided decision-making tools will no longer be an exception.

Smart homes for smart care

Smart homes with technologies like gas detectors, movement sensors, and sleep sensors will continue to evolve. According to one estimate, the global smart home health care market was $8.7 billion in 2019, and is expected to be $96.2 billion by 2030.⁶

Smart technologies will have applications in fall detection and prevention, evaluation of self-administration of medicine, sleep rhythm monitoring, air quality monitoring for the detection of abnormal gas levels, and identification of things like carbon monoxide poisoning or food spoilage. In coming years, expect to see more virtual medical homes and digital health care complexes. Patients, from the convenience of their homes, might be able to connect to a suite of caregivers, all working collaboratively to provide more coordinated, effective care. The “hospital at home” model that started with six hospitals has already grown to over 100 hospitals across 29 states. The shift from onsite specialists to onscreen specialists will continue, providing greater access to specialized services.

With these emerging trends, it can be anticipated that much acute care will be provided to patients outside the hospital – either under the hospital at home model, via drone technology using telemedicine, through smart devices in smart homes, or via wearables and artificial intelligence. Hence, hospitals’ configuration in the future will be much different and more compact than currently, and many hospitals will be reserved for trauma patients, casualties of natural disasters, higher acuity diseases requiring complex procedures, and other emergencies.

The role of hospitalists has evolved over the years and is still evolving. It should be no surprise if, in the future, we work alongside a digital hospitalist twin to provide better and more personalized care to our patients. Change is uncomfortable but it is inevitable. When COVID hit, we were forced to find innovative ways to deliver care to our patients. One thing is for certain: post-pandemic (AD, or After Disease) we are not going back to a Before COVID (BC) state in terms of virtual care. With the new dawn of digital era, the crucial questions to address will be: What will the future role of a hospitalist look like? How can we leverage technology and embrace our flexibility to adapt to these trends? How can we apply the lessons learned during the pandemic to propel hospital medicine into the future? And is it time to rethink our role and even reclassify ourselves – from hospitalists to Acute Care Experts (ACE) or Primary Acute Care Physicians?

Dr. Zia is a hospitalist, physician advisor, and founder of Virtual Hospitalist – a telemedicine company with a 360-degree care model for hospital patients.