Previous pieces in this series have mentioned an outlook for cancer treatment, molecular diagnostics, regenerative medicine, bioinformatics, gene therapy, astute physicians, precision drugs, telemedicine, minimally invasive and non-invasive surgery, microrobots inside the body, and nanoscopy.  All of these are, or could be, disruptive innovations in how Americans receive healthcare.  All of these also are among health’s last line of defense.  The front line is personal behavior.

Medicine has never been the chief determinant of health; rather that state depends on things like diet and exercise, hygiene, smoking cessation, wearing seatbelts and motorcycle helmets, and risk avoidance.  While medical innovation seems to change in a nanosecond, behavioral change moves slowly, thus guaranteeing a continuing role for hospitals.

The hospital of the future, however, may not closely resemble the typical “community hospital” of today.  Community hospitals, as arose under the 1946 Hill-Burton Act, gave federal support to community groups for non-profit hospital construction.  This provided central locations for patients to come and physicians to practice, while the hospital itself furnished beds, labs, food services, laundry, nursing, and management.  Communication which held everything together were the telephone and postal mail.

While handling complex, chronic diseases still holds a rationale for community hospitals, aging demographics, declining reimbursements, and a slipping away of profitable in-patient procedures to out-patient clinics financially undermine the almost seventy year old business model.  This resembles what the personal glucometer did to diabetes management a generation ago.  Patients could track their blood sugar without going to their endocrinologist’s office.  Today’s telemedicine allows cancer patients undergoing chemotherapy the possibility of being doctor-evaluated over an internet connection rather than sitting in an ER next to a person with contagious influenza.  Many scenarios portend the future hospital being a distributed network of various out-patient clinics, distance monitoring with home nursing, 3-D printing labs for personalized drugs and prosthetics, computational medical units within sequencing capability and tissue repositories, and advanced smartphone imaging, all spoking out from a hub of information management, perhaps with a trauma center for old times’ sake.

While a distributed network may take a while to overtake the community hospital model, a nearer term vision may be the traditional institution with ever more automation and robotic systems.  The University of California at San Francisco’s Mission Bay Hospital opened in early 2015 with twenty five robots servicing one floor for things like food service and laundry delivery, automated room sanitizers, and moving patients on gurneys.  Some of this technology comes from the Navy’s Nimitz-class “autonomous” aircraft carrier program which flies drone fighters, and uses every conceivable engineering approach to reduce the vessel’s crew from 6,000 to 600.

Competition between hospitals may drive some of these changes, but there also is competition between hospitals and retail healthcare providers like Walmart, Walgreens, CVS and others.  Walmart may or may not reach the goal one of its executive stated, of being the largest healthcare provider in the US by 2020.   In any case, innovation is accelerating at an ever-accelerating pace.

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