The COVID-19 pandemic has demonstrated the limits of our current healthcare infrastructure, the resilience of healthcare professionals, and the potential for rapid transformative change. The concept of a “Smart Hospital” has always been evolving but it is striking how different healthcare looks in the second half of 2021 than it did before 2020. Governments, hospitals, and health systems are looking for ways to better serve their communities. Financial pressures are challenging traditional ways of running hospitals. Despite the cash infusions into hospitals in 2020 and 2021, the American Hospital Association reports that US hospitals lost more than $320 billion in 2020 and are projected to lose between $53 and $122 billion in 2021. Reform and restructuring of healthcare institutions are underway in many of the world’s large economies.

In 2021, the revenues for global Smart Hospital products are estimated at $35 billion, rising to $83 billion in five years. This growth is driven by the medical needs of aging populations, rising consumer expectations for access to care, the necessity of cost containment, and global requirements to reduce carbon emissions. New hospital construction needs to anticipate climate change, decentralization of care delivery, and advances in medical science.

Required Technology for Smart Hospitals

One advantage of the Smart Hospital concept is its aspirational quality. A decade ago, it may have been visionary to imagine a “paperless” hospital. Today’s vision for a smart healthcare delivery system has more to work with, from AI-guided surgical robots to the collection of real-world evidence to create better diagnostics, treatments, and improved patient experiences. These technologies are here today, and the opportunities have never been more exciting. The Smart Hospital concept is a useful construct for planning advanced healthcare delivery systems.
In 2021, the following technologies are central to planning for this future:
  • Telehealth allowing virtual clinician visits and other ways to engage patients outside the facility, thus expanding the reach of the hospital enterprise geographically and improving the patient experience
  • Remote Monitoring, such as heart rhythms, oxygen saturation, blood glucose levels, and fall risk. This concept can even be applied to critical care, with centralized intensivists supporting multiple ICUs
  • Machine Learning and AI for diagnostic image analysis and simulation, surgical planning, surgical robotics, pharma robotics, care pathway analysis, and hospital resource optimization
  • Electronic Health Records are foundational to standardizing care plans, order sets, avoiding complications, improving outcomes, including data exchange with other care providers
  • Internet of Things (IoT) for tracking and controlling lights, HVAC, sensors, RFIDs for patients, guests, staff, and medical equipment
  • Cybersecurity to protect the institution and its community’s information resources from attacks and breaches
  • Eco-friendly building materials, supplies management, waste disposal, transportation, and power consumption

Beyond Certifications

Professional associations have defined models to benchmark progress towards achieving higher levels of capabilities within healthcare systems and environmentally responsible buildings. Two frameworks we describe below are from HIMSS and CHIME and can provide an independent assessment and certification of a hospital’s information technology program. These programs are useful but may not be sufficient for the new environment.

HIMSS Adoption Models

The Health Information and Management Systems Society (HIMSS) has created several models to assess the digital capabilities of hospitals and other health services organizations. The first of these models was the Electronic Medical Record Adoption Model (EMRAM), an 8-stage model beginning at zero with the least level of capability and the highest is stage 7. Relatively few hospitals have been certified at Level 7—approximately 50 worldwide—and fewer than 7% of US hospitals are at the top level. According to Becker’s Health IT, one-third of US hospitals have been validated at Level 6, one-third at level 5, and fewer than 6% of hospitals fall in the bottom 2 tiers.

The EMRAM model was initially oriented towards US hospitals and reflects the evolution of health IT adoption in the US although it is being used globally within the hospital IT community. Hospitals are finding it useful in countries such as China, with entirely different histories of health technology adoption. HIMSS reports that 42 hospitals in China are at Level 6, and 5 Chinese hospitals are at Level 7. The increased adoption of EMRs is encouraging because it means that many of the building blocks of healthcare IT are in place and can be leveraged as we transition into Smart Hospitals.

In addition to the EMRAM model for hospitals, HIMSS has published the Outpatient Electronic Medical Record Adoption Model (O-EMRAM), the Adoption Model for Analytics Maturity (AMAM), the Digital Imaging Adoption Model (DIAM), along with several others.

CHIME Digital Health “Most Wired” Program

The College of Health Information Management Executives (CHIME) was established in 1992 and is made up of senior IT leaders in provider organizations. They have more than 3,200 members, most of whom are from the US, with members from other countries as well. Their annual “Most Wired” program is based on a 47-page survey that provides a way for hospital IT departments to assess their capabilities. Based on their survey submissions hospitals are assigned a Level from 1 to 10, with Level 10 being the hardest to achieve.

Smart Building Certifications

For many communities, hospitals are one of the major employers and can be technically complex construction projects. Several certification programs can provide a framework for assessing different aspects of a new building, including:

Partnering for the Restructured Smart Hospital

No single organization has the expertise to build a Smart Hospital alone. Building a Smart Hospital requires multiple partners and a collaborative approach. We suggest using the following criteria to select potential partners in a Smart Hospital initiative:
  1. Adopt a Global Perspective: Leaders in the Smart Hospital movement work with hospitals in multiple countries and have trusted relationships with experts in different regions. We believe that there is strength in tapping experiences from around the world and that this diversity can lead to innovation in surprising ways. Companies, such as Keya Medical, that have formed relationships with over 1,000 hospitals in China and with leading medical institutions in the USA and the EU can bring a global perspective to Smart Hospital efforts that benefit all sides.
  2. Leverage Machine Learning Expertise: An essential element of every Smart Hospital initiative is an adaptable underlying technology infrastructure for managing the data and algorithms capable of medical device-level quality required for patient care and clinical research.
  3. Take a Collaborative Approach to R&D: The hospital of the future is also involved in the research, development, validation, and deployment of the next generations of diagnostics, therapeutics, and medical communications technology. Expertise in the design and execution of clinical trials, cohort selection, and outcomes analysis is required so that the hospital can share in the rewards from the successful creation of new clinical solutions.
Keya Medical has a strong commitment to collaborating with medical institutions globally to build the next generation of Smart Hospitals. We believe that health systems that are environmentally responsible, well-connected to the community, and work alongside clinicians to harness the power of machine learning will be best equipped to deliver improved healthcare.