UC Davis Medical Center

There is an old Chinese proverb that says, “When the winds of change blow, some people build walls, others build windmills.”  It’s a good reminder that every crisis presents not only challenges, but opportunities.

Change is always difficult, and nothing is quite as motivating for change as a crisis.

Since the pandemic started, dramatic choices and numerous opportunities have arisen in health care. The pandemic didn’t introduce digital health, but it certainly accelerated its adoption. Three of these changes are dramatically reshaping the health care landscape right now.

1. Creating ‘Hospitals of the Future’

One of the lessons of the pandemic is hospitals have to be more flexible in their ability to adapt to patient care needs.  The hospital of the future will have to deliver superior patient outcomes with increasingly sick patients and with greater provider efficiency while becoming more sustainable and keeping a focus on improving health, racial and gender equity.

At UC Davis Health, we’re building one of largest of these hospitals –at 1 million square feet and a $3.75 billion budget–with an opening date in 2030.  What will make it different, because of the pandemic, is that more 2/3 of the rooms will be acuity adaptable and can be converted into ICU rooms, if needed.

Future hospitals will have to be smarter, with AI-enabled technology helping providers even more– not artificial intelligence but “augmented” intelligence. It will be critical to deliver a better patient experience – closer to a hotel than the current noisy health care setting, which is not only more enjoyable, but stress reducing which improves healing.  It’s also going to have to be prepared to care primarily for higher acuity patients, as low acuity inpatient care will virtually disappear over the next decade. Those people who do require hospitalization will likely require longer stays for more complex surgeries or more aggressive treatments that can’t be delivered as an outpatient.

To balance the patient load regionally, academic medical centers like ours will have to work closely with community hospital partners, to increase the level and amount of care they provide locally, while we concentrate on patients that require more advanced services.  These kinds of partnerships are a different kind of triple win in health care, as they are better for patients (care closer to home), community hospitals (increased census) and regional academic medical centers (increased overall patient acuity using that facility to its highest purpose and revenue generation).

Another vision is designing hospitals and health systems to better address the social determinants of health. These inequalities have far too long put too many people at a higher risk of poor health and provide fewer opportunities for improving their quality of life. Our hospital is an Anchor Institution in the community, and now we’re amplifying greatly what we did before.  We’re working to lift up people in our surrounding neighborhoods, with job training, hiring locally, and pursuing local product sourcing, and volunteering locally to enhance the education of kids and to be part of charity driven community solutions like Habitat for Humanity.

We are doubling down on our core mission of health, and eliminating health disparities, and making sure our surrounding communities are treated with CLAS (culturally and linguistically appropriate services), have expanded access to needed health care and social services, and that we are capturing necessary demographics in our EMR so we can track and further address any implicit biases or unfair effects felt in underserved communities.

2. Reducing Provider Burnout with AI and Digital Health

Everyone seems to agree that digital and virtual health, remote-patient monitoring, home diagnostics, and other advances in connected health care will rapidly grow more sophisticated and expansive in the post-pandemic world. Deloitte’s global healthcare 2022 outlook says, “A collision of forces – a global pandemic of historic proportions; exponential advances in medical science; an explosion of digital technologies, data access, and analytics; informed and empowered consumers; and a movement from disease care to prevention and well-being – is proving to be the catalyst for the clinical, financial, and operational transformation that health care has long promised to the world.”

“Future hospitals will have to be smarter, with AI-enabled technology helping providers even more– not artificial intelligence but “augmented” intelligence”

One can hardly argue there’s a collision of forces for change unlike any to date.  Unfortunately, most technology changes to date are viewed as creating more work for health care providers, not less. A new unfiltered avalanche of data is certainly not helpful.  However, these many forces may, with the advent of AI-driven algorithms, finally deliver the long-awaited promise of taking over lower-value work, so providers are finally able to work at the top of their license – doing only those things which only they are able to do.

Multiple health systems connected through a digital nexus, with proactive AI suggestive capabilities, will be able to optimize the flow of patient data and watch far more than any single provider might. This can free up both patient and provider to have real conversations about health, enhancing the experience for both, and delivering even better outcomes with better costs, as this report notes.

While we’ve all heard about the explosion of virtual health, let’s put an accent on the new magnitude and increasing speed of it:  Since the pandemic started, providers have rapidly scaled multiple new offerings, and our industry is seeing 50 to 175 times the number of patients via these tools as compared to before.

While it’s likely the future of health care will be dominated by algorithms, this isn’t a bad thing.  Rather, like other industries, we’ll be able to move to care interventions by exception or clear indication. It’s antiquated how we treat patients, as if they needed regular visits like an auto mechanic for vehicle check-ups. This switch will be the equivalent of the patient’s ‘engine warning light’ indicating there’s an exception – something out of the ordinary – and a discussion with the care team is needed.

And, this switch will shift demand, reducing the appointment burden on care team, and the data and analysis burden of examining dozens of pages of records.  For example, the University of Colorado has eliminated its post-op visits, except when truly needed. Here at the University of California, we’re working to reduce, and hopefully eliminate, pre- and post-op in-person visits, replacing them with remote video visits that are more convenient for both patient and provider.

3. Patients’ Increasing Expectations

The driving force behind this increasing pace of change is that ultimately patients aren’t just patients.  They are also often daily consumers of multiple other services (health and non-healthcare related), and the vast majority of these services are now easy, convenient, consumer-centric and available via their phone or computer.

We have long looked at patients through the lens of “every person’s health journey is different,” and this is still true.  But patients are also citizens of the digital revolution and health care organizations have to acknowledge this fact and fine tune their services to elevate each patient’s encounter, creating a personalized health experience that not only meets their medical needs, but their consumer expectations.

As one example, research from Rock Health and Stanford Medicine found earlier this year that more than half of consumers are tracking their personal health stats with a digital wearable or mobile phone.  The overwhelming majority of these patients want their health care provider to ask them about their health data – yet most providers aren’t.  While not diagnostic, patients who are tracking their data about fertility cycles (the #1 reason), heart rates, sleep hours and exercise times are providing valuable discussion onramps for provider dialog about healthier lifestyles, irregularities, and better health care – while delivering a better patient experience at the same time.

Change is Coming – Faster Than Ever

Even before COVID-19, health care was increasingly becoming more personalized, “inside out”(tailored at the patient’s cellular or even gene level), and “always on” (integrated into people’s lives via internet of things including data acquisition and download, such as the AppleWatch EKG and pulse-oximetry modules.

Patients expect care to be available when and how it’s most convenient and safe for them. This includes virtual care, at-home prescription delivery, remote monitoring, digital diagnostics and decision support, and self-service applications.

Care-model innovations that can deliver a more effective and satisfying experience for both patients and clinicians might also help bend the cost curveWhile health care is the most change adverse industry in the country, technological disruption happens, no matter how hard you fight it or how little you want it. The winds of change are only growing stronger, so let us unfurl the sails and begin!