HealthManagement, Volume 18 - Issue 1, 2018

Future medicine, today's healthcare

Future medicine, today's healthcare

Is the “Smart Hospital” a chance for change?

Prof. Heinemann explains how futuristic and smart technologies that are used in preventive and diagnostic  healthcare, are embedded in a new digital professionalism and quality.

Artificial intelligence (AI) in diagnostic radiology, robots in nursing and operating theatres, augmented and virtual reality in surgery and medical training, 3D-printed skin, blockchain technology for clinical data exchange, modern and smart buildings, preventive healthcare via apps and wearables, at-home aftercare from a screen using interactive hospital cloud services such as telemedicine and high performance sensors, simulation techniques, cardiovascular risk prediction with deep learning, security & cyber crime prevention, gamification of patient care, and of course electronic medical records (EMR), automated pharmacy systems, fresh hospital design with real hospitality services, voice-command devices in patient rooms, integrated management systems focussing on patient satisfaction – all these and more in preventive and diagnostic healthcare, therapy and research are embedded in a new digital professionalism and quality. They describe at least some elements of what a smart hospital could look like. It may all sound a little like science fiction, but it is already far more science than fiction. right here, right now, we have access to a future that really works.

The emergence of a new kind of medicine, and shifting – albeit it slowly – legal conditions at European an national level (in Germany and not only here) have raised many hopes of better health and recovery, but also many concerns, fears even, about the dehumanisation of medicine, about transparent “datients” (data+patients) or even “drive-ins” for the sick, and about skilled medical staff becoming dispensable, not to mention the mainstream top's for today’s hospitals, like cost pressure, an ageing population and a shortage of practitioners and caregivers. Central to these developments, the three most important stakeholders in a hospital face the historic challenge of digital transformation, which cannot simply be delegated away to regulation or the market: doctors and nursing staff, patients and hospital managers today must rethink their relationship. Where there is risk, there is also opportunity, so is the smart hospital a chance for change, a new and trusting beginning?

It is certainly time for a new beginning: neither demigoddery nor Google-based self-treatment nor coldly calculated process optimisation is much use to a system that is clearly ailing economically and socially. A new beginning is a good thing anyway, and does not imply that whatever went before it was all bad. To the contrary, in fact: in Germany, measured patient satisfaction isoften higher than the apparent reputation of the hospital landscape (a declining number of some 1,900 hospitals,and 33 University clinics) would suggest.
and that satisfaction undoubtedly goes further than the patients’ delight at an unexpected flatscreen TV with Netflix in their hospital room. At any rate, if a systematic approach is taken to this new beginning, it is precisely smart hospitals – in theory – that offer a chance for – real! – change. As an integrated clinic concept, the smart hospital drives clinical excellence, patient centricity, strategic and operative effectiveness and efficiency with digital disruption in today’s and tomorrow’s clinics.

Clinical excellence – the best medicine for all
The digital transformation in medicine is primarily a scientific (research), economic (efficiency), legal (E-Health Act, EU-general data protection regulation), and social (data ethics) issue –not a purely technological one (a vast amount is already possible today).Andthemarketisbooming,theglobalhunt isonfor thenewdigitalhealthunicorns,thelawand societyare,toadegree,critically positive. and, as mentionedbefore,noteverythingisstilloutoftodays reach:within theboundaries ofwhatislegallypossible andsociallyacceptable,hybridoperating  theatres, imaging, andultramodern operating technologies are asrelevantasapatienexperiencethatisenhanced bynavigationsystemsbetter roomfacilities,oroptimisedaccesstoinformation.Manyoftheplayersinthe healthcare industry, like Siemens (D), GE Healthcare (USA), Samsung
(South Korea), Qualcomm Life Inc. (USA), athenahealth Inc. (USA), SAP (D) or Philips (NL), are offering increasingly sophisticated features and services around the smart hospital.

Digital disruption changes medicine intrinsically, but with it, not against it. Digital transformation makes medicineclearer,richer and,formedicalpractitioners inresearchandhealthcareprovision,future-proof.Data arenotthenewoiljustfor manyotherindustries, butalsoforthehealth industry.Heretoo,however,and hereofallplaces,qualitycounts:pulpdatain, pulp resultsout! ThePowerof Three-gooddata,smartuse, secureinternalaccess-startswithdata.Onlyclearly validated,annotatedandcurated  data canatbest assist evidence-based medicine,theycannotreplace it. AI+topradiologist= positivepatient  outcomeis thesuccessfulformula.Correlationforsuredoesnot implycausation.Andjustbecausitsayshealthappon thelabel, it doesnotmeanthatwhatcomesoutis healthmoreresearcisneedehere.Preciselyfor thatreason,it takesbothtypesof expertise, medical anddigital,togetthebesdata and,ultimately,the bestpossibleoutcomesforpatients.

Inasmart hospital,comprehensivclinicalexcellencemeansthatmedicineisenriched,notreplaced,by responsibly implemented digital possibilities. Doctors andnursingstaffarenotrenderedsuperfluous, quite theopposite,infact.Withtheirexpertiseandskills, theywillhavemoretimeandmoredigital resources withwhichtowork,agile,themselveshealthyand successful,forpatients,researchandothermeaningful uses.Inasmarthospital, theright solutions areavailable todoctorsandnursesinall thedifferent departments  andinstitutesandaredesigned  toincrease theirworkefficiency.Thepractitioners  inasmart hospitalwillhavemoretimefor goodconsultations, moretimetogointoindividual concerns,strengtheningthepatientsown competenciesandputting moreemphasis onacooperative relationship between doctorsandpatientsThat ismedical, notindustrial, healthcare.Thisiswherethechanceformedicalexcellencetosystematicallybemadeaccessible,in principle,toeverybody.inessence:best  medicalperformance  for all,withoutcompromisingthereasonable ideathatadditionalservicescostadditionalmoney.

PatienCentricityfosteringdignityisa dutyandasuccessfactor

Makinghumanitythefocal pointofeverythinga medicalinstitutioanditsstakeholdersthinkand doisthecentralmessage.Datasecurity/privacyand thehumanqualityofcarearekeyelementsofthat. Anewdigitalmaturityamongpatientsismorethan merelythinkablein thiscontext:moreresponsibility, moretransparency, moresecurity, andaboveall more qualityofcareinpatient  outcomesItalmostsounds toogoodtoever betrue.Butthechancesarereal and tangible. And,equally,itissimplyunacceptablethatthe averageconsumerinthedigital ageis somuchmore competentin selectingbest  prices,fashionstyles, playingcomplexvideogames, oraccessing(hopefully real) newsthaninwhatreally countsmostinlife: their health.Asmarthospitalinthis senseisalsoapromotionalplatform forlifelongpatient-learning toprevent disease and, ifnecessary, toenable patients tocooperatewithdoctors.

A smarthospital doesnotproducehealth; it creates theconditionsfor recoverywith integrity,empathy, medical excellence andgreatprofessionalism, andit partners  patientsin shapingtheirindividualpreventiveandrestorative  health regimens.This combinationofscalabilityandpersonalisationcanonlysucceed throughdigital transformation: it is difficult toimagine aneconomicallysuccessfulclinicwithscalableservices offeringindividualised medical excellence anyother way.Dignityisnotamarketablegood,butwithoutdigitallytransformedmanagementofthescarceresources andinnovativemedicine,thereisconstantinstitutional tension betweemarketandcompetitio(whether theclinicsareprivateorpublic).Theeconomically motivated goalofdischargingpatientsasquicklyas possiblemeetstheethicalgoaloftreatingpatientsas humanbeingswith dignity,because patientswantto recoverasquicklyaspossible.Thatiswhyanimportant  universitycliniclikeEssen,forinstanceisright tobealsothinking aboutthepatienexperienceand designingitsversionofthesmarthospitalaroundit.


Effectivenessandefficiencyagilehospitalmanagementisanempoweringstrategicandoperativedesign feature

Digital processes andacorrespondinculture of innovationpushcostdownaboveallunnecessary onesandcreateopportunitiesfor long-termeconomic successandgoodemploymentconditions(whichwill includeteamwork,developmentopportunities,optimal dutyrosters,andsecurity).Change,agility,innovation andtransformationclinicsalsooperatein anoften over-complexandimpenetrable"VUCAworld"(volatile, uncertain,complex,andambiguous)andshouldthereforeconstantlystriveto overcominternal,usually subjective, obstacles. There areundoubtedly objectivebarriersforthem toovercomaswell:thinkof theoftenverycolourful ITsystemsandtheirdifficult integrationandcompatibility,forexample.

I senoconvincingargumentsthatmodernagile managementmethods anddigitaltransformation issuesarenecessarilydiametricallyopposed toa morehumanistickindofmedicine.Onthecontrary,it isalsoandespeciallydowntohospitalmanagement asafacilitatortomakeameaningfulandsuccessful futureforpatients,caregivers  andtheother stakeholders,ataskthatishardto achieve withanaversionto innovationandneofeudalisticmanagement ofshortagesandshortcomings.Theseaspectsalone farexceed  whatisalreadynecessaryforthe digital managementofhospitalprocesses.Digitallyinspired medicalexcellenceandvalue-basedpatiencentricity willrequirelong-term heavyinvestment, whichfalls bothtothestateandthehospitalsthemselves.A smarthospitalalsosystematicallyusestheeconomic opportunitiesthatarisefromskillsandexperience  theassetsofitsoperationtogeneratestrategic advantages(egthroughcooperation),stimulateinno- vation(egthroughstart-ups),andcreate  newsources ofincome(newbusiness models).Cooperation with otherhealthindustrystakeholderslikepharmaceuticalscompanieswillalsosucceedbetteronanequal footing.

MarketresearchFuture(2018)  isforecastingfor 2023 a62-billionUSdollarglobalmarketforsmart hospitals, with asubstantial growth rate ofsome  25 percent between2017and2023 itisamarketof global quality, andmanycountriesaremuchfurther thanGermany(intheUSA,80 percentofaround 5,000 clinics already haveelectronic health records; inthe UK,inSouthKoreaandAustralia,examplesof moreadvancesmarthospitalapproachesexist).Not least,however,smartbusinesselementscanalsobring significantbenefitsto thefundingstructureofthe (smart)hospital.

aturally,legalcertainty remains amajorconcern, not onlyinGermany.Whatsappdiagnosesmaysuit manypatientslifestyle,but theinfrastructureis unregulated there areno(agile!) standards.That said,theimpetusisessentiallyonnationalandlocal government  totakeswiftandconsistentactionwhen itcomestoregulationstheclinicscanonlystandby andsupportthemwiththearguments.

Inthissense,itisperhapsalittletoo daringto see inthemuchdiscussedandindeedcontroversia ambitiousversionof the smarthospitalachance foranewandtrustingbeginninginthesense outlined above.And yet there still seems to meto begood reasontodoso.Neitheranaversiontoinnovationnor recklessnesswill help,soperhapsthesmarthospitalisanambitious ideaonsensible middle-ground. At the same time, the term itself does  not reflect the full agenda. Ultimately, asmart hospital isonethat nolongerhasthe shortcomingsofclinicstoday. And allthe stakeholdersstand to benefitfromthat,which iswhyitisagoodthingthat at leastsomeclinicsare ontheirway transformingto smarthospitals.

Key Points

  • The “Smart Hospital” is a chance for change: as an integrated clinic concept, the smart hospital drives clinical excellence, patient centricity, strategic and operative effectiveness and efficiency with digital disruption in today’s and tomorrow’s clinics
  • Clinical excellence – the best medicine for all
  • Patient Centricity – fostering dignity is a duty and a success factor
  • Effectiveness and efficiency – agile hospital management is an empowering strategic and operative design feature.


Forsting, Michael (2017) Hot Topics: Machine learning will change medicine, in:  Journal of Nuclear Medicine, doi:10.2967/jnumed.117.190397


Heinemann, S./Miggelbrink, R. (2011) Medizinethik r Ärzte und Manager, in: Thielscher, C. (Hrsg.): Medizinökonomie, Wiesbaden, p. 107-144

Market Research Future (2018) Smart Hospital Market Research Report- Global Forecast 2023, Pune


Ryan Poplin, Avinash Vaidyanathan Varadarajan, Katy Blumer, Yun Liu, Mike McConnell, Greg Corrado, Lily Peng, Dale Webster (2017) Predicting Cardiovascular Risk Factors from Retinal Fundus Photographs using

Deep Learning, Arxiv. arXiv:1708.09843


Weng Stephen F., Reps Jenna, Kai Joe, Garibaldi Jonathan M., Qureshi Nadeem (2017) Can machine- learning improve cardiovascular risk prediction using routine clinical data?, in PLOSone. journal.pone.0174944

Related Articles

In healthcare patients are not consumers with the economic power they have in other markets, but the arguments for patient involvement... Read more

Founded in the same year as the NHS and celebrating its 70th birthday in 2018, the UK charity Music in Hospitals & Care continues... Read more

An interview with Dr. Umesh Prabhu.  Leading NHS medical director, Dr. Umesh Prabhu on what a hospital can do to improve... Read more

Related IssueArticles

H e a l t h c a r e e x p e r t s a r o u n d t he g l o b e we... Read more

Top Quote from Blog: How can the Internet of Things and people help improve our health, wellbeing and quality of life? "While... Read more

A snapshot on the future of healthcare. Read more

robotics, Radiology, Healthcare, Medicine, telemedicine, Nursing, EMR, patient care, augmented reality, patient satisfaction, virtual reality, wearables, medical training, electronic medical records, hospital design, Artificial Intelligence, smart technologies, clinical excellence, future healthcare, Health technology, future medicine, Smart Hospital, Stefan Heinemann, health robotics, Artificial Intelligence in diagnostic radiology, robots in nursing, blockchain technology, smart buildings, preventive healthcare, at-home aftercare, interactive hospital cloud services, cardiovascular risk prediction, deep learniny, cyber crime prevention, gamification, automated pharmacy systems, voice-command devices, diagnostic healthcare, Patient Centricity Prof. Heinemann explains how futuristic and smart technologies that are used in preventive and diagnostic healthcare, are embedded in a new digital professionalism and quality.

No comment

Please login to leave a comment...