Doctors without corridors: the Rise of the Digital Hospital

Introduction

The Covid pandemic has changed so many facets of our lives especially in the way we work with the advent of remote working. Allied to this were the requirements during the pandemic to keep non-Covid patients away from hospital as much as possible lest they too succumb to the virus. The intersection of the ability to work remotely and treat patients remotely heralded a paradigm shift in how hospitals treat patients. No longer confined to the walled garden of the hospital, many patients can be treated and monitored remotely in the comfort of their own homes.

Hospitals without walls

The pandemic has been a catalyst in advancing the concept of the “hospital without walls”. A hospital connected to its patients in a digital ecosystem of “internet of things” (IOT) smart devices, electronic medical records (EMR) and telehealth. These advances have encountered many obstacles and unfortunately still do. The lack of an EMR in every hospital is the most significant hurdle. Its nigh on impossible to offer a telemedicine consultation to a patient in their home when their paper chart is buried in medical records in the hospital. Digital poverty whereby some patients have no access to or skills in IOT enabled devices or smartphones is another barrier to mass adoption. And finally the ever present and increasing threat of cybersecurity breaches. A stark case of this was a cyber attack in Germany in September 2020 that sadly resulted in the death of a patient.

Overcoming Obstacles

Despite so many obstacles in its way the concept of the digital hospital is still gaining traction. The pandemic forced the hand of a lot of healthcare institutions. Overnight, clinicians went from face-to-face consultations to phone, text or video-call consultations. Patients loved it because they could remain in the comfort of their home. A survey of 10,000 patients in London conducted by Imperial College London found patients wanted more not less digital health. The entire digital consultation lends itself well to the EMR, since all artefacts from the consultation are inherently digital being in a text, voice or video format.

The Next Advances: The Doctor Will Zoom You Now

IOT devices will become more prevalent. Some analysts predict that there will be 27 billion IOT devices by 2025. Hospitals and health care providers will move towards exploiting these devices where appropriate and available for the patients treatment. Ireland has already taken nascent steps in this direction with the policy of “Stay Left — Shift Left” indoctrinated by Martin Curley in the HSE.

Another interesting aspect is that the hospital can scale out in the number of clinicians it has available. These clinicians do not necessarily have to be in the hospital or even employed directly by the hospital. Consider Mulk Healthcare in the Middle East, an E-Hospital that allows patients to present via a downloadable app. The patients can be anywhere in the world and so too can the clinicians. Granted there are some limits to type of treatments that will be available here but it does herald a significant departure from traditional in-person medicine.

Patients have a part to play too in advancing this paradigm shift. Incentivised by being able to remain at home during their convalescence they will become more and more tech savvy.

Conclusion

So does this sound the death knell for the hospital as we know it? In a word no. For complex patients and procedures — may still require hands-on human expertise. However as a more efficient means to run an effective hospital it could be a panacea for waiting lists. The number of bed days and the staff that support these bed days could be reduced dramatically if the majority of patients could be monitored and supported from their home.