Digital Hospitals: Concept

 Digital Hospitals are they any different from hospitals as we know them? Just like any other experience of service industry can become user friendly and efficient, healthcare can be the same too. The reason healthcare needs to reach that state is that unlike other industry customer interactions, the customer here is usually in a distressed state and at such moments unable to express his needs. The concept of the digital hospital of the future is an utopian state wherein it is linked to wearable devices of users and is constantly monitoring the state of health of it's customer. It ensures medicines are taken on time and dose of medicine is automatically adjusted to the status of the monitored parameters. Preventive maintenance in the form of monitoring vital parameters and measuring levels of all measurable risk factors is done in customized packages. This to me makes Digital hospitals different from hospitals which practice medicine as we know as treating symptoms after they manifest. The new kind of hospital will anticipate risk and detect changes in health long before any symptoms manifest and action will be taken to prevent or minimize damage long before it affects the body. Home services, emergency tracking and door to needle golden hour will be automated. This is what is meant by making digital Hospitals compatible with Internet of Things or Internet of Medical Things (IoT or IoMT). 

 I think the Digital Hospitals of future have the potential to change the basic structure of hospitals, which may transform to service stations of the body for preventive maintenance and minor repairs. Minimally invasive day care procedures to remove or ablate pinpoint lesions before they grow will become the order of the day. Genetic labs will be used to detect high risk genes and modify or alter them to halt progressive disease. Rehabilitative medicine, physio and occupational therapy will be extensively offered on digital platforms with home gymnasiums being commonplace. 

 The flip side is that no touch medicine may dehumanize modern medicine more than at present. However it is quite possible that human bots which can sense mood changes and body language may actually fulfill the emotional needs of patients too. Thus this picture does not to my mind seem far fetched but before we reach there we have our present to look at and run our hospitals. 

 India is a large and diverse country and there is a huge inequality in geographical areas. The standard of healthcare and the quality of the same is very different even in the metros in private and public healthcare set ups. So to my mind we must work to create a standardized common digital platform to collect data across the healthcare spectrum in a common language. This data should be transformed into an individual health vault linked to Aadhar. For different populations depending on availability of resources both human and infrastructure this can be linked to interventions like nutritional, immunization and the National Disease Control programs and National programs on Climate Change and Human Health. 

 That Healthcare is not as safe as we think and believe it to be is a well known fact. In fact, the errors in healthcare leading to adverse events and death are often said to be greater than accidents and deaths attributable to vehicular accidents. Only deaths related to Cardiovascular diseases are more than those due to medical errors. On top of these are hospital acquired infections which create anti biotic resistance. Electronic Medical records can and should be used extensively to drive home quality. These should not be mere data entry tools but must be linked to ICD coding, Drug prescription and interactions and standard treatment protocols. They must provide analytics and must be linked to digital health data vaults. Standardization of the data to ensure clean data is very important in the Governments National Digital Health Mission is an important step in the right direction. 

 Challenge lies in implementation and there are two approaches, gradual incremental or compulsory no option approach. The biggest obstacle to this is the old timers and the busy doctor along with the challenge of shortage of nurses. We need to train para medical staff and motivate them by showing them the difference in terms of reduction of errors and clinical outcomes in a digital environment vs a manual system. The burden of time consumed in data entry and documentation is often the cause of dehumanization of medical care. A balance needs to be drawn and back end transcribers can help as a temporary stop gap solution for this problem. The example of use of person's with disabilities as data entry operators can be a solution worth considering. 

The woods are lovely, dark and deep,   

But I have promises to keep,   

And miles to go before I sleep,  

And miles to go before I sleep.

    So the journey of digitalization is a long arduous but difficult journey, with many obstacles and challenges to be faced but to ignore these will just leave us behind while we move from the practice of today's medical care to futuristic care where brick and mortar large hospitals as we know them will be relics of the past. Preventive healthcare and human body day care service repair and maintenance centers will be the hospitals of the future. 

Vispi Jokhi