Hospitals of the Future using Advanced Technologies

Hospitals of the Future using Advanced Technologies
Professor Rabee Mohamed Reffat
Professor of Architecture and Digital Technologies,
Architecture Department, Faculty of Engineering, Assiut University, Assiut, Egypt
Email: rabee.reffat@gmail.com
Abstract
Todays’ challenges and priorities are driving healthcare systems to forge innovative solutions to
manage the increasing expense and complex social burdens that increasing patients and
chronic disease rates bring. Advanced technology is being rapidly adopted in health care
facilities and is leading to changes in the way health care facilities are designed and built.
Implementing advanced technologies requires a great deal of planning and a specialized
construction expertise due to the requirements for accommodating sophisticated and advanced
equipment. One of the visions that can be utilized to address the above issues is the Hospital of
the Future that aims to transform health care to safe, cost effective, predictive, preventative,
evidence based, and participatory system. The Hospital of the Future concept is established to
share and accelerate development and findings related to technologies supporting future
healthcare needs. The purpose of the Hospital of the Future is to improve patient safety,
hospital design and interoperability. This paper addresses the concept of the Hospital of the
Future, its potential benefits and constraints. The paper presents the Digital Hospital
Framework developed by IBM as an approach to the utilization of the Hospital of the Future in
order to achieve healthy, safe, efficient and environmentally responsible health care facilities.
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1. Introduction
A hospital is unique building type in terms of the high level of complexity in circulation patterns,
constant use and diverse technical systems. A hospital delivers healthcare services to patients
who may stay in overnight accommodations or may visit briefly for specific care. New
advancements in radiology, aseptic germ theory, anesthetic surgery, and electronics and
communications made the former nursing care facility into a highly specialized workshop for
medical services. The hospital took on a new physical form, as a large dense building with many
specialized parts. The ability to provide extended 24 hour care with a high level of complexity of
medical services differentiates a hospital from other healthcare facilities. Successful hospital
planning must be measured over a long term, not just as an inviting and attractive new building
but as a structure that supports these intensive and demanding functions on a 24 hour/7 day
basis over what is often more than a 50 year useful life. Since the hospital is place dedicated to
health, its building must first be a healing, life-affirming space that plays an active role in
helping patients and their families return to health. Hospitals of the future will need to plan for
higher patient acuity, shorter stays, and must deal with aging patients and staff. Because of
their long term operational costs and long life cycle, hospitals have to be designed for improved
performance and work flow, and with a high degree of flexibility and adaptability for constant
change. With round the clock use and high occupancy, and the need for high capacity and
redundant building systems, a hospital is also a large energy consumer and a prime opportunity
for the benefits of green and sustainable design. The detailed architectural and interior design
philosophy of the future hospital needs to start with the feeling of hospitality, and of providing
a link to nature and the world beyond. The design of hospitals has to provide a safe,
comfortable environment, and reduce stress and confusion for patients, families, and staff. A
successful design will recognize the dimensions of life as well as the needs of efficient
operations and include art as well as technology. The design team needs from the outset to
plan for sustainable design and reduced energy usage, which in a building that operates
continuously is a major opportunity for lowering the carbon footprint of the service. To
maintain a feeling of wellbeing and positive support for the needs of people, the hospital must
also have clear, intuitive way finding and an easily understood layout (Sprow, 2012).
2. Designing Hospitals of the Future
The physical design of the hospital has significant implications for the ability of the hospital to
meet its goals for care that is safe, patient-centered, clinically effective and collaboratively
delivered. It also represents the physical manifestation of the hospital’s commitment to
environmental health and sustainability. There are factors that will be (to lesser and greater
extents), out of the hospital’s control as the future unfolds.
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Several studies have revealed hospital design characteristics that work for improving patient
safety and health care outcomes, and providing a supportive environment for hospital staff.
Yet, most new hospitals are not being built “safe by design.” Hospitals need to be designed to
safely accommodate fragile patients. Prominent threats to patient safety include medication
errors, patient falls, and errors made during patient transfers, which can be mitigated through
evidence-based design. Better lighting and reduced noise levels can help avoid distractions that
often lead to caregiver errors in the medication process. Decentralized nursing stations allow
nurses to better see and hear the patients under their care and observe changes in skin color
and breathing, as well as to prevent falls that occur when a patient is unobserved. Rooms that
are designed for the patient bed and bathroom entrance to be seen from the hallway also
enhance observation. Multi-acuity beds that reduce the number of transfers, or “hand-offs,” of
patients from one unit to another, in turn, reduce the opportunity for errors to occur. The
regulatory infrastructure can stifle design innovations meant to reduce the risk of patient
injury. Though multi-acuity beds that allow a patient to remain in the same bed while their care
level is stepped down from critical care to medical-surgical nursing may make sense, in some
states they do not meet state licensure stipulations regarding patient bed designations and
thereby are disqualified for reimbursement. Single-patient rooms may have the single most
important impact on patient safety. In addition to enhancing patient privacy, allowing for
confidential discussions and accommodating family members, single rooms help protect
patients’ health. Some of the prime principles to guide the design of the Hospital of the Future
include (TJC, 2008):
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Incorporate evidence-based design principles that improve patient safety, including
single rooms, decentralized nursing stations and noise-reducing materials, in hospital
construction
Address high-level priorities, such as infection control and emergency preparedness, in
hospital design and construction
Include clinicians, other staff, patients and families in the design process to maximize
opportunities to improve staff work flow and patient safety, and create patientcentered environments
Design flexibility into the building to allow for better adaption to the rapid cycle of
innovation in medicine and technology
Incorporate “green” principles in hospital design and construction.
3. The Hospital of the Future: Motivations and Ideas
The successful hospital of the future is one that efficiently delivers quality care and consistently
improves clinical outcomes. The model hospital of the future will adopt workflows, policies,
systems and solutions that optimize operational efficiencies. Integrating these disparate
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systems, it will leverage software applications to enable the collection, management and
analysis of patient and operational data. Armed with such actionable intelligence,
administrators and caregivers will be able to incrementally improve their performance. In so
doing, the hospital of the future will be able to deliver care faster, safeguard patient safety, and
empower more human resources to be applied at the point of care (Swisslog, 2014). Sprow
(2012) has identified some ideas driving the new hospital planning and design; some of which
have been selected and reorganized as shown in Table 1.
Table 1: Motivations and Ideas driving the hospitals of future (selected from Sprow, 2012)
Motivations
With more digital information being shared
around the hospital network, and the desire for
a patient visit which is as seamless and direct as
possible, hospitals are now looking beyond
departmental borders to think about how
patients make appointments, how they arrive at
the right location for their visit, and how clinical
and financial information is captured and
processed.
Wayfinding is more than signs. A stronger
management concern for the patient
experience, as part of a market share focus,
means that old systems such as endless
standard signs (and even worse, colored stripes
on the floor) are being replaced by more
information, more interactive systems.
Hospitals are routinely used for 50 years or
more – but at the same time individual rooms
may be changed or replaced after as few as
seven years, as clinical methods and equipment
change. The challenge is to plan for ease of use,
good wayfinding, high technology and a healing
environment, but without assuming that
specific rooms will remain unchanged for very
long.
Hospitals with functional older facilities, often
scattered on different floors or in different
wings, are finding that it makes sense to invest
in larger scale surgery facilities which are more
productive and more flexible.
Ideas
Providing service concierges to direct patients,
providing central registration points to capture
basic information for the database only once, and
using computer-assisted scheduling and
management systems that track patient arrival
times, length of wait, and final results.
Electronic kiosks, computerized direction systems,
and planning that is clear and modular, even
without signs, are the new tools in helping patients
and families navigate the hospital and to make it
more accessible to them
Hospitals are responding with an acceptance of
more generic and modular space. Today’s pediatric
exam room may later be part of a geriatric
cardiology unit, or a new imaging suite, or
relocated office functions in only a few years.
Often it is more flexible and efficient to build a
smaller number of larger but standardized rooms.
Creating generic operating theatres, directly
adjacent to highly flexible operative units which
can function flexibly as pre-operative holding for
ambulatory patients and recovery for ambulatory
surgery and for inpatient. Rooms and recovery
beds are grouped in clusters, so that staffing can
follow peaks and valleys in the work load through
the day. Surgical rooms are designed for multispecialty use as needed, with very few dedicated
rooms. Operating theatres are also being rebuilt to
include facilities for minimal-access surgery and
telemedicine, with more flexible ceiling-mounted
utility booms, and new generation lights which
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Often the Emergency Department is the
marketing front door and the starting point for
a high percentage of patient admissions, and
hospitals are very concerned about making it
both more productive and more responsive to
patient concerns.
integrate efficient and flexible LED lighting, video
cameras and flat-screen technology. New hybrid
operating theatres blur the distinction between
surgical and imaging functions and design
requirements.
One common approach is the single room
treatment concept, which provides a large number
of private treatment rooms so that each patient
and their family are usually taken directly to one
room for all of their treatment. Triage steps are
minimized, and much of the admission process can
be done directly in the room. The result is a patient
experience of being seen and attended to almost
immediately, rather than the typical story of being
held in the waiting room for long periods of time.
Satisfaction is much higher and flexible generic
rooms can adapt easily to changes in utilization.
Reducing the need for waiting room space allows
for more functional space.
4. Advanced Technologies Shaping Hospitals of the Future
Regardless of ongoing technology revolution, the visible and physical design of hospitals has
changed less than one might imagine over the past decades. With a significant influx of new
patients, and an aging existing hospital infrastructure, it is appropriate for health care leaders
to think carefully about the next generation of hospitals. So, thinking about the hospital of the
future includes patient-centered care, flexible space and evidence-based design which make
great sense and should be pursued with vigor. These three themes typically dominate the
discussions of the hospital of the future. Three other concepts also might be worth careful
contemplation: the connected, service and value enterprises. The unifying theme is using
clinical and information technology better, faster and smarter to integrate and make those
three concepts come alive. In other words, advances in technology drive the hospital of the
future as follows (Montagnolo, 2013):
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The Connected Enterprise: clinical care devices, information systems, workflow systems,
and patient and family communication systems should integrate more seamlessly in
both time and space. Numerous technological advances may help push this concept. For
example, new sensor technologies will provide more real-time and mobile monitoring.
Instead of a nurse taking a patient’s blood pressure and pulse periodically, a mobile
sensor monitors those vital signs continuously. And instead of a patient checking his or
her blood glucose, a portable sensor monitors it continuously. When changes happen,
the information becomes available in real time to the entire care team. Further,
telepresence robots already can help extend the reach of care teams so that all
members are able to interact in real time with patients. The mindset shaping the
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hospital of the future should be better integrated space, technology and processes all
focused on seamless communication during, rather than following, care delivery.
The Service Enterprise: The hospital of the future must treat service as a central
principle and embed it in all the workflows throughout the enterprise, from delivering
meals to transplanting organs. Great service relies on helping staff do their jobs
effectively and efficiently; consistently delivering the desired outcome; and treating
patients in a manner that acknowledges their humanness, not simply their biological
status. The hospital of the futures solves this by tackling issues such as patient alarms.
The Value Enterprise: Hospitals must acquire clinical and information technology to
create the value enterprise. They must improve outcomes and the patient experience
while creating cost-efficiencies that help the masses and the government to afford care.
Adopting new clinical or information technologies, and using existing clinical or
information technologies can make a difference right now. Moving imaging closer in
time and space to where it is most urgently needed, for example, would improve
outcomes. If imaging and real-time data analytics are combined, unnecessary or
redundant imaging studies will be eliminated.
Todays’ challenges and priorities are driving healthcare systems to forge innovative solutions to
manage the increasing expense and complex social burdens that increasing patients and
chronic disease rates bring. In both developed and emerging economies, the healthcare
infrastructure is transforming to address the steady rise in both healthcare demand and costs.
In emerging economies such as those in China, India, the Middle East and Latin America, stateof-the-art hospitals and medical centers are being built or retrofitted to meet these challenges.
To deliver the highest quality care to meet the needs of their communities, integrated health
systems are leading in the transformation of healthcare, migrating from its traditional focus on
acute care episodes toward providing more coordinated, patient centered care. Fundamental
to this transformation is the digital infrastructure (known as information and communications
technology – ICT), that enables information sharing among healthcare providers, payers and
patients. However, deployment of such technologies within the industry has been slow and
uneven across various areas of hospital operations. Automation of hospital administrative
processes, such as patient registration, admission, and discharge is relatively widespread. Yet
fully digital hospitals that run the gamut of clinical applications and advanced hospital
information systems interconnected by a robust and reliable infrastructure are exceptions
rather than the rule. Digital hospitals, whether newly-built or existing operations retrofitted
with the latest digital information technology, promise to boost efficiency and quality through
better integration with all sources of care. They are enabling deployment of eHealth systems
that provide online information, disease management, remote monitoring and telemedicine
services that can extend the reach of scarce medical resources and expertise. Digital hospitals
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provide faster and safer throughput of patients, creating more capacity through process
efficiencies, while containing costs. Examples of benefits include (IBM, 2013):
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Improved patient outcomes, as measured by reduced length of hospital stay,
readmission rates and other key metrics
Safer, healthier, green environments and medical workplaces that help attract worldclass medical talent
Improved consumer service and patient satisfaction
Decreased documentation and administration effort, while increasing staff satisfaction
Broad improvements in healthcare access, quality, safety and sustainability
Improved operational efficiencies and decreased capital expenditures
A digital hospital is one that implements a comprehensive, pervasive IT infrastructure to enable
clinical and administrative workflow and communications as well as process and quality
improvements. It expands those process improvements beyond the hospital’s four walls and
into the community, providing connectivity and collaboration with physician offices and other
remote healthcare organizations and even extending its digital reach into patient homes and
emergency medical services. In a digital hospital, various advanced technologies, such as critical
medical devices, intelligent information systems, facility control systems, automated transport
systems, location-based services and sensors, and digital communication tools, provide a fully
integrated set of applications and services that improve staff productivity, hospital operations,
process quality, patient safety, and overall patient experience. The digital hospital journey can
begin with one or more change initiatives, each representing a different set of circumstances
and considerations. A number of potential changes that could initiate the digital hospital
journey are shown in Figure 1. Regardless of the starting point, the guiding principles are the
same: functional integration is critical, as is the innovative use of information systems; process
redesign that maximizes the value of IT-enabled process improvements is also essential; and a
strong partnership with technology suppliers is a key to long-term success. Organization
commitment, sound planning, effective implementation management, and end-user
commitment to the technologies are all vital to a successful journey (Duffy and Holland, 2009).
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Figure 1: The IBM Digital Hospital Framework: An approach to the Hospital of the Future (Duffy
and Holland, 2009)
Digital hospitals are complex ecosystems with hundreds of clinical and business processes made
up of thousands of sub-processes. When properly integrated, these processes should
seamlessly unite patients, clinicians, staff, assets and information throughout the hospital,
delivering the right information and resources at the right time to the point of care. Essential to
this integration are the ICT that interconnects all aspects of care delivery and administration.
New hospitals take an average of three to five years to build, while existing hospitals that are
retrofitted with the prerequisite pervasive, medical grade networks and multi-modal digital
communications can take as long as five to ten years to completely modernize. In addition to
digital medical devices and continuously available high-speed networking infrastructure,
hospitals must reengineer business processes to create paperless automated workflows.
Electronic medical records, including Computerized Physician Order Entry (CPOE) and access to
medical imaging, must be integrated seamlessly, while the decomposition, redesign and
planning of clinical and business processes must start early in the cycle, even before the
specification and selection of technology. Whether planning the development of new acute
care and ambulatory facilities or modernizing aging technology infrastructure of existing
hospitals, healthcare executives and their boards must endorse the big picture, understanding
how departments interact within an enterprise and how different facilities across diverse care
settings must work in a coordinated health system. Understanding the dependencies and
relationships between various IT programs and initiatives can help healthcare decision makers
cope with the complexity of the numerous solutions and choices available to them. For
example, implementing an electronic health record system that allows laboratory results and
diagnostic images to be viewed at the bedside may require upgrades to the wired and wireless
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network infrastructure and changes to enterprise storage capacity. Real-time location tracking
technologies, including infrared and radio frequency identification (RFID) might have a dual use;
improving clinical care by reducing time to locate equipment or implementing a closed-loop
medication management system while supporting the tracking of assets in order to optimize
asset capital requirements. The framework illustrated in Figure 1 represents the various
categories and components of IT networks and storage and electronic health records and care
orchestration systems and the like can help executives understand how the IT elements in the
framework relate to their larger strategic objectives (IBM, 2013).
Figure 2: The IBM Digital Hospital Framework: An approach to the Hospital of the Future (IBM,
2013)
Some of the potential benefits of the highly efficient Digital Hospital are that hospitals will be
equipped to handle twice as many patients with a higher level of care and safety without increasing
hospital or staff size. It can track patients, staff and assets anywhere and at any time in the hospital.
Advanced Technologies will facilitate the link of diverse and complex processes to save time, money
and effort while greatly improving outcomes and the patient experience. Wireless technologies
such as hand-held communications devices and smartphones that track patients and resources are
already transforming the healthcare environment. Real-time location services tracks medical assets,
equipment, patients, and staff to help improve asset utilization and improve overall patient safety
and quality of care.
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On the other hand, deploying new or enhanced technology in any environment can be a very
difficult task. This is more difficult in the healthcare environment that is composed of wide and
diverse stakeholders. Thacker (2011) introduced a set of the best practices that should be
incorporated into the proposed technology and its implementation process which will greatly
enhance the chances of success. This set of best practices includes:
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Gathering and developing the comprehensive requirements of stakeholders
Documenting the existing processes before developing the requirements
Selecting and developing systems with integration in mind
Selecting and developing systems that are flexible and can be expanded to meet new
requirements
Developing systems that focus on providing accurate and actionable data and outcomes to
all stakeholders
5. Conclusion
For the hospitals of the future, it is most important is to focus on a planning process leading to
form not on designing an architectural idea first. It is also critical to think in terms of an open
system of planning in which variables such as required services, anticipated volume,
operational and staffing assumptions and building system decisions could all be adjusted and
tuned as needed while keeping in mind the basic goal of a high quality, low upkeep, flexible and
expandable hospital concept which can be an expression of a new hospital type for world use.
Helping clinicians and caregivers become more efficient in the hospital of the future should be
as important as purely improving patient outcomes because clinician efficiency allows room for
concentrating behaviors and time on new areas of value. Better patient outcomes for
individuals and better population health for communities become the ultimate benefit of the
virtuous circle of continuous improvement. In hospitals that embrace the concepts of patient
centered care and support the development of their workforce, no one should be neglected.
The application of digital technologies will extend the reach of hospital care into the community
and into the home and will potentially help to achieve for healthy, safe, efficient and
environmentally responsible hospitals using the digital hospital framework and its associated
advanced technologies t. The hospital of the future may one day be defined by its intellectual
property rather than its physical facility.
6. References
1. Duffy, J. and Holland, M., 2009, The Digital Hospital of Tomorrow: The Time Has Come Today, Health
Industry Insights #HI216948.
2. IBM, 2013, The digital hospital evolution Creating a framework for the healthcare system of the
future, IBM Global Business Services, White Paper, GBW03203-USEN-01.
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3. Montagnolo, A. 2013, The Hospital of Tomorrow, Trustee, (July-August, 2013), pp. 25-26.
4. Sprow, R., 2012, Planning Hospitals of the Future, In G. D. Kunders (ed.), Designing Hospitals of the
Future, Prism Publications.
5. Swisslog, 2014, Hospital of the Future: Critical steps to improve clinical outcomes, cut costs, improve
safety and meet the challenges of the future today, Swisslog Healthcare Solutions,
www.swisslog.com/healthcare
6. TJC (The Joint Commission), 2008, Health Care at the Crossroads: Guiding Principles for the
Development of the Hospital of the Future.
7. Thaker, T., 2011, Perspective on Deploying Hospital Technology, Philips Healthcare Consulting,
Philips, The Netherlands.
8. Ulrich, R. and Zimring, C., 2004, The Role of the Physical Environment in the Hospital of the 21st
Century: A Once-in a-Lifetime Opportunity, Report to the Center for Health Design for the Designing
the 21st Century Hospital Project, funded by the Robert Wood Johnson Foundation.
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