What is a digital or ‘smart’ hospital? There is no universally agreed definition, but one thing that is clear is that the healthcare sector stands on the cusp of extraordinary change, with digital technology offering real solutions to tackling the healthcare challenges of today and tomorrow. The COVID-19 pandemic accelerated digital adoption, as it was critical for the NHS to accommodate virtual consultations, as well as track vaccines and the spread of the virus. As certain weaknesses in existing systems were highlighted, lessons learned from the pandemic mean that there is now a greater drive than ever to reach a more sophisticated level of digitalisation in healthcare.
For me, a ‘smart hospital’ is one that harnesses digital technologies as an enabler for all areas of healthcare provision – from telemedicine and how patient records are processed, to diagnosis, wearable technology, connected buildings, and more. This requires hospital design to evolve and become a more holistic process to deliver hospitals that are future-ready
Learning from a stand-out initiative in Greece
There are some outstanding examples starting to emerge internationally. Llewelyn Davies is involved as healthcare consultant in the design and construction of three state-of-the-art public hospitals in Greece, funded by the Stavros Niarchos Foundation’s (SNF) $750 m global SNF Health Initiative, and designed in collaboration with world-renowned architect Renzo Piano Building Workshop. The SNF General Hospitals of Komotini and Sparta, and the SNF University Pediatric Hospital of Thessaloniki, are all due for completion in 2025, and are setting a new standard for healthcare in Greece. They will bring to life a blueprint for the hospital of the future.
The vision for the hospitals is centered on a humanistic approach to design, paired with technology. A considerable budget has been allocated for the IT systems alone, with the hospitals aiming to achieve HIMSS (Healthcare Information and Management Systems Society) Level 3 at launch. HIMMS provides a defined framework to assessing services like electronic patient records, radiology, and laboratory systems based on a 0-7 rating. Level 7 signifies a totally paperless environment and a data-led hospital, which incorporates Electronic Medical Record (EMR) infrastructure, external health information exchange (HIE), data analytics, business management software, governance, disaster recovery, and privacy and security
Greek state’s goal
The Greek state has a goal of reaching Level 7 in the coming years for the three hospitals. This is in line with its commitment to the ‘H Cloud’, which entails migrating to an offsite-hosted data repository for electronic patient records. In the UK, fewer than a handful of hospitals are currently at level 7, with Great Ormond Street Hospital for Children in London, Alder Hey Children’s NHS Foundation Trust in Liverpool, and the Royal Free NHS Foundation Trust’s Chase Farm Hospital in North London, among the very first, and these are also helping to educate and motivate more widespread understanding of digital hospitals.
Reimagining how we approach design
With digital strategies and infrastructure at the heart of the hospital of the future, what are the implications for architects and designers? While digital technology is an enabler for change, the first step is changing attitudes. As an industry we are still building hospitals based on decades-old planning approaches and long-entrenched norms. There is bound to be a period of transition in the industry to encourage clients to buy into the vision, and make bold new choices, such as cutting down on consulting rooms. At the Our Hospital Project in Jersey, for instance, we integrated 10 digital booths for the consultants to meet with patients ‘virtually’, and the hospital has consequently been able to reduce the number of physical consultancy examination rooms by 20%. Similarly, hospitals can introduce sensors that measure how much of the time a room is occupied, which can help optimise scheduling efficiencies, to potentially reduce the number of examination rooms based on that intelligence.
Understanding ‘the power of digital’
As architects, the biggest issue for us is ensuring that the functional brief of the hospital has been written together with a consultant who understands the power of digital. For the SNF project,we are collaborating closely with strategic healthcare planners, Lexica, and international IT consultant, HCI Group, on the digital transformation roadmap, so that eventually the hospitals can become paperless administrations with all clinical services digitised.
When the Government pledged to deliver 48 new hospitals across England by 2030 as part of the ambitious New Hospital Programme (NHP), the Department of Health and Social Care stressed that healthcare infrastructure must go beyond ‘bricks and mortar’ to incorporate digital technologies and data ‘to provide better care to the public’. The funding roadblocks and delays that have stalled the programme have highlighted that the only way to deliver high-quality hospitals is to transform our approach to design to make hospitals smaller, smarter, more efficient, and ultimately cheaper to operate.
There is also tremendous scope to enhance the patient experience. We need to consider factors such as that fact that while younger generations are happy to scan a QR code via their smartphone, for example with their appointment details and directions, older people may prefer to interact with a real person. By designing new hospitals for the next generation, we must strike a balance between our hospitals being ‘smart’, and still providing a level of human contact, which cannot be replaced.
Automating time-consuming manual processes
Ensuring the right digital infrastructure can help to break down data silos, and open the door to automating burdensome and time-consuming manual administrative processes, so that staff can focus their efforts on what they do best – patient care. Such measures can also maximise available human resources at a time of staff shortages in healthcare. We need to look ‘outside the box’, and learn from evidence-based design from other countries – the SNF Health Initiative is a fantastic formula, and a ‘Template for Future Hospitals’ that we can replicate to deliver the vast programme of hospitals in the UK or elsewhere. The old way is no longer viable, sustainable, or affordable, but we now have an opportunity to effect exciting change for generations to come.
Moritz Spellenberg
Moritz Spellenberg is an architect with almost 20 years’ experience in the design and construction of complex healthcare projects. Having graduated from the University Stuttgart, he has developed a keen interest in both the humanistic and technical aspects of hospital architecture. Since 2018 he has led the healthcare expert team for the $750 m+ SNF Healthcare Initiative in Greece, which is scheduled to complete in 2025 with the delivery of three new hospitals, designed to the highest sustainability standards and level of innovation.