Towards the virtualization of healthcare

By Philips ∙ Featuring: Jeevan Gunaratnam ∙ Lead for Community Diagnostics and Director of the Independent Sector. Mar 2021 ∙ 5 min read

Services

Hospital operations

A few short years ago the idea of virtual healthcare was nascent. Compared to other industries, healthcare had initially resisted the off-premise and cloud shift, facing significant regulatory and systematic barriers around the world.

However, increasing connectivity, ageing populations, rising disease profiles and a new urgency for change, has necessitated and accelerated transformation. More emphasis is now being placed on what virtual principles and experiences healthcare can harness to ease the burden on operations and improve patient and staff experience.

Article at a glance

  • Virtual healthcare offers pressurized health systems a chance to expand access to care, cut operational costs and address bigger systematic challenges like bridging gaps between clinical departments.
  • Technology will begin to shape the physical design of the future hospital, how people interact with it, the activities it undertakes and what it looks like.
  •  The impact of COVID-19 on care models—how it accelerated the shift to virtual care by immediately altering how doctors and patients interacted, and reducing traffic inside hospitals.
  • Five of the key trends likely to inform healthcare’s virtualized future in the immediate and short term.

Clinical team participates in a virtual care telehealth appointment

Charting the growth of virtual care modes, new patient behaviors and the opportunity for out of hospital care

Before the COVID-19 outbreak, GP practices and hospital outpatients in the UK were providing around 400 million face-to-face appointments each year1, while planning to save ‘300 million trips’ for patients through more digital GP consultations.1 Telehealth in the US had surged with medical claims increasing by 624% from 2014 to 2018.1

The growth of virtual healthcare offers pressurized health systems a chance to expand access to healthcare, cut their operational costs and address bigger systematic challenges: reducing waste; cutting foot traffic into the hospital and patient length of stays; bridging gaps between siloed clinical departments; and, supporting staff and patient journeys.

According to a report by management consultancy, Deloitte: “Virtual care also has the capability to inform, personalize, accelerate, and augment care across the care delivery spectrum, from disease prevention to treatment to ongoing monitoring.”2 “It will enable simple collaboration and the sharing of data and insights across the complete circle of care. Taking the mystery out of care and treatment plans for the family and caregivers of patients, while maintaining privacy, becomes more effective in the virtual-care domain.”

Trends driving the virtual hospital of the future

Hospitals as buildings and service providers were designed to bring care under one roof; all in a single place so people would know where to go to when they were ill. Where do you go in a virtual future? Many of us are hard-wired to the concept of ‘hospital = care’, but as virtual care becomes integrated into processes and workflows, the very idea of the hospital - a place where care is delivered - changes quite dramatically. If healthcare becomes more virtual, then technology will begin to shape the physical design of the future hospital, how people interact with it, the activities it undertakes and what it looks like.

The hospital of the future is not a physical location with waiting rooms, beds and labs. It will be a network with nodes and connections. Technology will be the starting place of new spaces and will allow us to approach health and care in new ways.

Potentially, a virtual healthcare facility can reside anywhere - in your home, inside an old telephone box or in a public washroom. It is part of a wider healthcare delivery system. The hospital of the future is, then, not a physical location with waiting rooms, beds and labs. It will, instead, be a network with nodes and connections. Technology, in other words, will be the starting place of our new spaces and will allow us to approach health and care in new ways.

Healthcare will be accessible anywhere. A virtual healthcare experience will allow for continuous monitoring of patients anywhere, so that care is provided wherever and whenever it’s needed. This means retail-type outlets close to residential areas; specialist hubs, in-patient facilities, outpatient clinics and ambulatory facilities, all connected into a single network. In other words, technology won’t remove the hospital’s central role in care delivery. Instead, it will expand its reach beyond its own walls, to create a much bigger system, in which the hospital itself plays a less centralized role3. And in reaching that goal some key trends are accelerating change and addressing the operational challenges of hospitals.

Hospital disinfecting team

The global pandemic as a unique once in a century accelerant for virtualization

Cited as ‘the major disruptive event of the decade’4 and purported by some to be a ‘Black Swan Event’5 – the term popularized by former Wall Street trader, Nassim Nicholas Taleb in his book Fooled by Randomness - COVID-19 stalled the hospital’s revolving door and kickstarted a shift to virtual care by immediately altering the way doctors and patients interacted, and reducing traffic inside hospitals.

Medical appointments went online, workers began remote work, equipment monitoring was adopted, elected procedures were delayed or cancelled. Remote monitoring technologies such as telemonitoring, telemedicine, mobile monitoring all grew at speed. Telehealth adoption rates lagged around 11% in January 2020 in the US—but spiked amid the coronavirus pandemic to 36% in August 2020.6

The revolving door of the hospital was already a big problem before COVID-19. In 2018, there were an estimated 142 million visits to emergency rooms in the US, up from 100 million in 2008.7 The pandemic highlighted that hospitals are too overloaded: covering too many different clinical specialties, accepting a wide spread of low-to-high acuity patients.

Jeevan Gunaratnam, a former NHS Director, who is now Director of Independent Sector & Community Diagnostics at Philips explains the issue further: “The bandwidth for hospitals to plan was reduced to zero during COVID-19. Patients also stopped going to hospital, delaying procedures, clinical work and elective procedures and staff were were quickly redeployed as part of the COVID-19 response.”

Jeevan Gunaratnam continues: “A lot of healthcare’s needs could be addressed without ever stepping foot inside a hospital. And if you do that across the board, you have reduced traffic inside the hospital and can reconfigure that hospital to deliver higher value care - more complex care and procedures that really add value.”

The use of virtual health technology for screening, monitoring, and e-visits, as well as the patient’s preference to stay away from the hospital during the pandemic, offered a glimpse of healthcare’s future. Could more healthcare be delivered virtually or elsewhere? Will healthcare as a result become more decentralized? Experts see a future determined by which clinical services make sense for a hospital and the speed of innovation around new care models that allow more space and ‘bandwidth’ for hospitals to focus on acute care. This inevitably drives a shift to models for out of hospital care as much as on-site care.

Stuart Wilders, Marketing Operations Manager for Solutions at Philips explains: “Separating patients out represents a new streamlining opportunity for healthcare. For a long time, hospitals have been accessible to everyone. There is a strong case for pinpointing the activities that don’t necessarily need to happen inside a hospital and shifting their provision to out of hospital care. If you do that across the board, you will reduce traffic inside the hospital and can reconfigure that hospital to deliver the more complex care and procedures that really add value. Patients also won’t have to travel great distances for diagnostics. Ultimately, this model supports the health providers in being better able to spread resources, knowledge and learning across the geography.”

Patient participating in a telehealth visit

Jeevan Gunaratnam, a former NHS Director, who is now Director of Independent Sector & Community Diagnostics at Philips, identifies five of the key trends likely to inform healthcare’s virtualized future in the immediate and short term:

Trend 1: Virtual monitoring and maintenance


How hospitals maintain their vast and sweeping technology investments into the future while under continued operational pressures is a challenge. Hospitals still rely heavily on highly technical diagnostic equipment to diagnose and form treatment plans for patients. Digital and virtual tools exist to troubleshoot, problem-solve and remotely diagnose and fix failing equipment to keep diagnostic equipment online.

Trend 2: Patients shifting to more self-diagnosis


Virtually, there is a lot patients can do to track their own health and stay out of hospital in the first place. Patients are more emboldened by their growing understanding of their own health and are now more immersed in their own healthcare.


“Home-based medical technology can help curtail costs and improve quality of life – by tracking relevant health data, integrating it with other data sources such as electronic medical records, and translating the combined data into actionable insights,” says Henk van Houten,8 CTO of Philips. “This can encourage patients to take an active role in managing their disease, while enabling care professionals to support them in a more targeted way.”

Trend 3: Developing innovative telehealth care models


Virtual care will mean more outpatient care, through physical spaces where telehealth services can be delivered. For example, Philips has partnered with the US Department of Veterans Affairs (VA), The American Legion and Veterans of Foreign Wars (VFW) to bring telehealth to remote parts of the US through the ATLAS Program,9 bringing care to Veterans through non-traditional locations such as retail health, community and university environments. Inside the hospital, innovation around telehealth delivery models can support access to care outside the hospital. The monitoring of high-acuity patients through command centers or ‘eye in the sky’ technologies has potential to reach beyond the hospital walls at scale. In the US, Mercy Virtual is a four-story hospital with no beds,10 which provides 24/7 telemedicine for patients remotely, either at their own homes or other Mercy facilities, around the clock.

Trend 4: Innovating out of hospital care solutions


As the need for access to quality healthcare goes up, so too will the pressure to reduce discretionary hospital visits and ease the burden further on the system. This could mean hospitals partnering to bring healthcare closer to people through satellite hubs or diagnostic centers and removing a costly part of their operations. The fact that the NHS in England spends around £2 billion per year delivering imaging services,11 further highlights the scale of diagnostics requirements and the need to structurally embed out of hospital care.

Trend 5: Servicing the pro-consumer patient with a blend of virtual services and physical experiences


Patient demand for speed and convenience — removing friction from the healthcare experience — will drive new players and services towards addressing recurring pain points. A rising ‘Uberization’ to address gaps in primary care services, transportation, patient scheduling and homecare is one example. Could everything from healthcare insurance, payments, transportation, social care and wellness all be open to faster, more convenient and accessible virtualization? Can my lab results be sent via smartphone within minutes of leaving a medical center? Can my health records be integrated across platforms, accessible across devices and freely exchangeable?


“Eventually, our virtual healthcare landscape will be different and focus on better, more efficient and effective care, while saving hospitals on foot traffic and operational expenses,” notes a report by PwC.12

A virtual future relies on people and care


The opportunities and adoption of virtual care are clear and here to stay. And yet, a virtual future will still rely on the personal touch. Nothing changes one simple fact: that healthcare is a people business and caring is core to the moral imperative of quality healthcare delivery. Even with rapid digital transformation, the human experience of in-person care, face-to-face contact, and human empathy still underpins healthcare’s moral objective. You can’t remove ‘care’ from healthcare’s future: it is tightly woven into the human story.

You can’t remove ‘care’ from healthcare’s future: it is tightly woven into the human story.

And the human touch - working alongside new innovative technologies to solve operational challenges - will steer technology to where it can make the biggest difference to people’s lives. Challenges, of course, lie on the road to a more virtual future. The surgeon and writer, Atul Gawende, has observed this ongoing friction writing that: “Medicine is a complex adaptive system: it is made up of many interconnected, multilayered parts, and it is meant to evolve with time and changing conditions. Software is not. It is complex, but it does not adapt. That is the heart of the problem for its users, us humans.”12

A virtual future for healthcare is limitless in possibility: faster data transmissions, better services, AI-enabled predictive capabilities, robotics, precision medicine, 3-D printing, augmented reality/virtual reality, genomics and more. And yet, no virtual future of healthcare nor the realisation of the Quadruple Aim can exist without the power of people. Automation, robotics and virtual environments - all need the guidance of clinical experts with deep knowledge and understanding of the application, its intended goals and the desired outcomes.

Article

Towards the virtualization of healthcare

Featuring

Jeevan Gunaratna, Lead for Community Diagnostics and Director of the Independent Sector, Philips

Jeevan Gunaratnam

Lead for Community Diagnostics and Director of the Independent Sector

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Footnotes
 

[1] The NHS Long Term Plan, June 2019, www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf
[2] Deloitte, ‘Covid-19: virtual care is here to stay’, www2.deloitte.com/content/dam/Deloitte/ca/Documents/life-sciences-health-care/ca-covid-19-digital-health-and-virtual-care-aoda-en.pdf
[3] McKinsey, ‘The Role of the Smart Hospital’, www.mckinsey.com/industries/healthcare/our-insights/finding-the-future-of-care-provision-the-role-of-smart-hospitals
[4] Deloitte, ‘Digital transformation and COVID-19’, www2.deloitte.com/us/en/insights/topics/digital-transformation/digital-transformation-COVID-19.html [5]corporatefinanceinstitute.com/resources/knowledge/finance/black-swan-event/
[6] Business Insider, ‘The Digital Health Ecosystem’ www.businessinsider.com/digital-health-ecosystem?international=true&r=US&IR=T
[7] National center for statistics, emergency department visits www.cdc.gov/nchs/fastats/emergency-department.htm
[8] Philips Innovation Matters, ‘Six Ways Healthcare Will Move into Our Homes’, www.philips.com/a-w/about/news/archive/blogs/innovation-matters/2020/20200623-six-ways-healthcare-will-move-into-our-homes.html
[9] Philips, ATLAS, www.usa.philips.com/healthcare/government/our-approach/partnerships-and-collaborations/atlas
[10] CNN, ‘The $52 million Hospital Without Any Beds’ money.cnn.com/2016/09/12/technology/mercy-hospital-virtual-care/index.html
[11] NHS, Transforming imaging services in England: a national strategy for imaging networks
[12] The New Yorker, ‘Why Doctors Hate Their Computers’, www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

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