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Smart enough? Technology-proof hospitals – UPDATE


Stephane Vermeulen, director healthcare design for VK Architects & Engineers, recently addressed a conference on the smart hospital, a new tendency which will greatly impact the way future hospitals are designed and built.

Stephane Vermeulen, your lecture treated the smart hospital, and especially how hospital infrastructure is to cope with future technology. What technology are you referring to?

It’s a wide range of applications and research that will soon have its impact on our healthcare facilities. They include existing technologies that constantly evolve, such as medical imaging devices and robotics. But the actual revolution is to be expected from genetics and the digitalisation of care, including e- and m-Health. Even though these domains are still in their infancy, it’s foreseeable that they will advance very quickly in the near future. Just look at the boost of health apps and wearables these past couple of years.

ICT is not new in hospitals.

Far from it. Nowadays, it’s impossible to imagine care without ICT. Nevertheless, 90% of all current data has been created in the last 2 years, causing a true data explosion. These data are ever more personal and the technology ever more social. However, having the data is not enough. The most important question is: how do we use these data to their fullest potential? At the moment, that last aspect leaves much to be desired.

90% of all current data has been created in the last 2 years, causing a true data explosion.

What needs to be done to unfold the full potential?

The true potential of data can only be unfolded in combination with other data. It’s the correlations and relationships between data that give insight. In healthcare, the sharing of data is still in its infancy. Firstly, the Electronic Health Record takes forever to really take off. Secondly, big data analysis poses many questions which are still left unanswered. The combination of the EHR, m-Health and big data analysis has great potential for future medicine, as is being stated by many studies and institutions. According to OECD, big data analysis is a real game changer in healthcare, accelerating knowledge development and innovation. PwC issued a study that stated mHealth could already save 100 billion euro’s in the EU’s care spending. Another study estimates that by the end of 2017, half of all smartphone users worldwide will have installed health apps on their phone. A treasure trove of data that has its use on an individual basis, even more when combined with the EHR. But imagine the research possibilities when all of these data could be combined. However, for that full potential we need all three elements. Sadly enough, the care sector, care policy, knowledge centers and industry are still not attuned to one another. As a result, at this moment, many legal, technical, financial and policy obstacles are still not resolved.

Surely, in the last 100 years, medicine has undergone several technological advances. How are the technological advances you refer to different?

Absolutely right, medicine is constantly evolving. However, the technological advances of the past 100 years mostly targeted higher survival rates and lengthening lives despite disease. In other words, the focus was on healing. However, the new domains such as genetics – which has become much cheaper these last few years – will enable us to focus on individual, targeted prevention, especially in combination with the digital possibilities. This totally new approach has the potential to profoundly change the practise of medicine and the infrastructure in which it is practised.

Individual, targeted prevention has the potential to profoundly change the practise of medicine and the infrastructure in which it is practised.

Shifting the focus from repairing to monitoring.

Exactly. From a patient’s point of view, health data from genomics research, mHealth and the EHR enable him or her to monitor their wellbeing and health on a daily basis. When a doctor’s consult is needed, maybe through telemedicine, the health data can possibly lead to a faster diagnosis. And as prevention also would imply that any disorder or disease is detected in its earlier stages, this would reduce the need for heavy medical interventions, resulting in shorter recovery times.
The hospital as we know it will still function as a place for healing, but not in its current form. With fewer heavy medical interventions and shorter recovery times, bed occupation will drop. Prevention and telemedicine will also reduce the number of hospital consults, so the consultation areas will need less space. In other words, the targeted prevention will impact the hospital building in its largest areas, being consultation areas, outpatient and inpatient departments.
The focus on monitoring will entail a new development : virtual clinics, as all of these data will have to be monitored. So we are looking at new infrastructure, solely used for monitoring patients from a distance. And in case you think I am looking 30 years into the future: virtual clinics already exist. In the US, Mercy Virtual employs 300 healthcare professionals who monitor patients in 38 hospitals.

Financially not the best news for hospital managements : they’re looking at new investments.

Actually, any hospital at some point undergoes renovation and reorganisation projects, and often more than once. The point is to handle it smartly. You know, “smart hospital” does not just regard technology. It concerns the overall approach of the infrastructure and the processes it houses. Far too often, hospital managements handle renovation or reorganisation projects department per department, or a floor at a time. Renovation and reorganisation has to be looked at campus-wide and in the long run. I know time is money, but time not spent to thoroughly consider the entire situation and all opportunities, can easily cost you more money.
And looking at it from a wider angle, prevention will save society at large many millions in the healthcare budget, which is under pressure as it is.

“Smart hospital” does not just regard technology. It concerns the overall approach of the infrastructure and the processes it houses.

How about new hospitals? How can they be prepared for this evolution?

VK Architects & Engineers strives for a maximum of flexibility. Designing with modular grids allows us to realise buildings that are highly adaptable with a minimum of costs. And in Charleroi, we are realising the first European hospital based on the layers model. Looking at it with a real-estate mind, we have split the campus in several sections: the hot floor, the factory for logistics, the office for administration and consultations, and the hotel and motel for hospitalisation. Each of these sections has a different life cycle and different investment costs. Future adaptations or renovations will only impact that specific section. A refreshing approach that won us the international architecture competition.

Surely, these solutions are not offered solely by the healthcare designer?

Obviously not. Our designs and projects are the result of close collaboration and constant deliberation with our clients. We advise hospital managements to invest much time in charting their processes and strategy. The better and more informed the brief, the more efficiently the healthcare designer can propose design solutions for the individual situation. Invest in a master plan and take your time for programming. It may cost a bit more, but the return will be higher in the end. Remember, during the entire life cycle cost of a hospital, the design cost is a mere fraction compared to the operational costs. It’s better to invest wisely in that fraction, to make sure the rest is put to the best possible use.