Auditing the Smart Hospital

Hospitals may be the most complex organizations in the world. They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals. The desire for stability is undercut by epidemics, changes in treatment, and a suffocating regulatory environment.

But help is on the way. Leading hospitals now are in the midst of a digital transformation leading to an era of “smart hospitals,” a $21 billion market in North America promising to deliver unparalleled integration and improvements in all aspects of healthcare.

A battleground for innovation lies in the information technology and telecommunications (ICT) networks forming the hospital infrastructure. IoT (“Internet of Things”) sensors monitoring an army of connected devices will provide a continuous stream of data on everything from the temperature of patient rooms to which doors are locked or unlocked.

The location of every patient, caregiver, technician, nursing staff, and even guests will be known at all times. Electricity and power consumption will be optimized, as lights and air conditioning will go on and off depending on whether anyone is in the room.

Interoperability of data and real-time services will link together regional smart hospitals to skilled nursing facilities, supplies, transportation, clinics, specialty hospitals, and patient homes.

More than 60 percent of patients believe that virtual care is more convenient than face-to-face care. Home monitoring of patients linked to connected devices and wearable sensors for respiratory therapy and other conditions will be supported by on-demand portals in case of discomfort.

Comprehensive patient management solutions in hospitals will rely upon services such as tele-ultrasound, tele-radiology, tele-pathology, and tele-acquisition of patients. Artificial intelligence (AI) clinical decision support tools will speed up services and become welcome friends of tired staff. Clinical insights will be available on mobile devices, at the bedside, in acute care, and in the home, including imaging information.

This advanced underlying ICT infrastructure will rely upon interoperability of all connected systems and the data they are using. The smart hospital will be efficient in its use of supplies and resources. Asset tracking, inventory control, maintenance operations, patient flow tracking, and provisioning of hospital staff will be directed by algorithms, particularly in emergencies. Real-time analytics continuously will be collected and recorded.

Combined with the ocean of other data being processed, patient management will be a completely visible process, displayed on decision support dashboards. For any operational function within the hospital, management will be able to view real-time flow management of all processes. This will allow for the development of performance analytics and the application of AI to operations.

Complex services such as genomic analysis and customized therapy unique for each patient will become commonplace. According to Edgar van Zoelen and Angus Cameron of Philips Healthcare, patient concierge services, financial management, patient education, and shared care decision-making will allow the patient will enjoy a sense of being at the center of care, as all touch points between them and staff will be monitored and queued up.

Ultimately, clinical outcomes will improve and the smart hospital will develop capabilities for even greater transformation and change, because automated systems are easier to change than the habits of persons.

Auditing the Smart Hospital

Every move of every hospital employee, including doctors, will be recorded. Every pill given, treatment administered, conference and consultation engaged in, resource used, and invoice submitted will be recorded. The amount of time spent with a patient will be known exactly because the locations of all staff and patients will be tracked using IoT sensors and radio-sensitive wrist bands. The lazy employee who spends too much time in the coffee shop will be spotted by the algorithms that are kept busy dispatching resources to problem areas.

In auditing, one of the greatest rejection reasons of all time, the champion standing high above any other reason for stiffing the healthcare provider, is medical necessity. A test, a procedure, a drug, a piece of durable medical equipment (DME) – all must pass the medical necessity test. Most of us in the auditing community have gone through lengthy hearings in which minimally trained auditors argue against a doctor, despite their years of advanced training, that medical necessity simply was not present, and so they are not going to get paid.

But if medical necessity decisions are going to be made by giant and incomprehensible automated medical systems driven by AI, then who is more credible: a narrowminded and captious bean-counter, or an AI relying on vast amounts of knowledge and experience? And who is going to argue about face time with patients when everything is recorded? Remember, it is not the doctor or their staff who will be formulating and submitting the bills to the payor. Instead, it will be the smart hospital itself, and the AI directing it.

Just as the business-as-usual in many hospitals will be swept away and replaced by a far more advanced and efficient system, so too will the current auditing techniques and the entire process itself crumble from obsolescence.

The profit-driven auditors of today will become as relevant as the country doctor who made their rounds through the countryside on their horse and buggy in the 19th century.