Building on H&HN's April cover story titled "More Than a Building," I would like to project what hospitals may well morph into going forward. While there is remarkable pressure on short-term, major challenges such as transitioning to a value-based system and lowering costs, as the feature article delved into, there is another exciting opportunity long-term. It's part of the radical rebooting of medicine.
Just think about cloud computing. It really didn't get legs until 2008 when Amazon Web Services was initiated. With so much of our data storage offloaded to the cloud, it's hard to remember how storage was managed before these massive server farms became available. Now think of how quickly patients could be relieved from hospitalizations when there is digital monitoring technology that fully supports this capability.
Progressively, with inexpensive, remote, real-time, continuous and comprehensive patient monitoring, the need for regular hospital rooms will decrease. Just as there has been a big switch from in-hospital stays to outpatient procedures over recent decades, the next change will be a major uptick in home monitoring. With the average U.S. hospital room at $4,500-plus and the high risk of nosocomial infection and other hospital-induced morbidity, the forces to induce this emigration from hospitals are well-anchored. But we didn't have the technology to do this until now. In the coming years, I expect the strategy of home monitoring with biosensors, smartphone labs and imaging to be fully validated and gain immense appeal by consumers who would unquestionably prefer to stay in their own homes with this as a viable option.
While operating rooms, intensive care units, procedure rooms, emergency departments, medical imaging and lab functions likely will still exist at the hospital, most other functions will be taken out. However, the trade-off will be the inundation of data, such as all vital signs for blood pressure, heart rhythm, blood oxygen saturation and temperature coming from each patient. Surely there will be algorithms to filter and process such immense data streams, and alarms preset that notify health care professionals when appropriate.
The big question is: Where will all the data go, and how will it be handled downstream in the best interest of patients? Will this all be centralized? Or will there be local data centers that are part of the new hospital complex where the data are monitored 24/7? The appeal of the latter is the improvement to continuity of care. The health system knows the patient, provides longitudinal follow-up, and is an integral part of the community. This complements and transcends what is in a database, with whatever predictive analytics and machine learning that will be increasingly factored into information resources in the future. And when the patient needs care — whether in the ED, ICU or medical imaging department — the digitized data center hospital is ready to swing into action.
Robin Cook's recent medical sci-fi thriller Cell portrayed a medical data center with hundreds of physicians and nurses working four-hour shifts to stay alert and able to virtually connect with any patient at any moment when necessary. While this scenario is a bit unlikely, the concept of a health system data center needs careful thought and design. Medicine is quickly becoming a data science. Our hospitals of the future can capitalize on that remarkable transformation.
Eric Topol, M.D., is chief academic officer at Scripps Health and a practicing cardiologist with Scripps Clinic. He is also chief medical adviser to AT&T. Follow him on Twitter at @erictopol.