WASHINGTON Emerging technologies ranging from wireless networks to ubiquitous nanoscale sensors promise to transform medicine, including the way new hospitals are designed.
As the United States plays catch-up with Europe on deployment of new medical technologies and the issues they raise, U.S. companies seeking new markets are targeting medical electronics as the next big opportunity. Some have even tapped physicians to be their "chief medical officer."
Still, not everyone is sold on the idea that technology alone can save lives and reduce suffering. Behind the scenes, some physicians at a recent medical technology conference here wondered whether new technologies represented little more than expensive add-ons that would do little to improve health care while fattening the bottom lines of technology companies.
"More toys being thrown at chronic diseases?" asked one cardiologist. Others worry that technology applied to existing hospital procedures would add to workloads rather than reduce them.
Proponents said the shift to medical electronics would also require changes in U.S. health-care policies to ease the transition and hold down soaring medical costs.
Either way, the growing availability of new wireless and sensor technologies seems certain to influence how hospitals are organized and the way health care is delivered, experts at the "Emerging Technologies and Healthcare Innovations Congress" said.
The trend has already begun as cell phones and PDAs become commonplace in hospital corridors. Now, medical technologists are bracing for the next wave as technology infrastructures are built into new hospitals. "This next decade is going to be relatively disruptive" as new technologies come online, said Kevin Fickenscher, national director for clinical transformation with CSC Global Healthcare Group (San Francisco).
These concerns have prompted hospital architects to consider how to redesign hospitals for the short term as new technologies are introduced and what the hospital of the future would look like. Designers must also take into account the changing roles of hospitals as the U.S. population ages and emergency rooms generate more admissions.
"Emergency rooms used to be the back door of hospitals," said Steven Goe, a health-care consultant and former head of Scripps Hospital in San Diego. "Now they are the front door." Evolving medical requirements have created "hospitals without beds and comprehensive outpatient centers," he said.
Another design consideration for the digital hospital is attempting to "de-tether" nurses and doctors from central nursing stations, giving health care workers greater mobility and more time with patients, Fickenscher said.
As a result, hospital designers are moving away from the pyramid and grid floor plans of the past as wireless technologies take hold. Craig Semingson, a hospital designer with HDR Architecture (Pasadena, Calif.) said wireless technologies are transforming the way future hospitals will be designed.
Semingson said the standard hospital grid could be divided into three concentric wireless zones so that floor plans wouldn't exceed the range of wireless networks.
Another proposal calls for dividing the grid into four adjacent "spheres of activity or care" linked by wireless technologies and a center area. Bringing wireless technologies closer to health care users could yield greater efficiencies, he added, noting that each extra 10 feet of distance translates into 10 percent less health care delivered.
"The hospitals of the future," Goe said, "need to be designed based on how care is provided, not by how the hospital is reimbursed."
Experts predicted physicians would also become "informaticists" as they adapt and learn how to use patient data collected by sensors like heart and blood glucose monitors and delivered by wireless networks.
Local-area networks based on optical fiber and emerging ultrawideband technologies are expected to geometrically increase the amount of patient data being delivered to nurses and doctors, said Thomas Jones, Oracle Corp.'s chief medical officer. Enabling technologies include enhanced biomedical, genome and clinical databases, Internet-scale operating systems and a host of electronics technologies, including multithreaded computers with "smart memory" and increased storage capacity through holographic data storage systems and three-dimensional chips.
Jones said European countries have already invested heavily in "smart-memory" technology for more flexible multithreaded computing.
Network equipment makers are meanwhile touting wireless networks as a way to increase remote patient monitoring and other efficiencies. As with many areas of the technology, a single standard is scarce. "There are no standards in terms of frequency and reliability," said Kathryn McTighe, Cisco Systems Inc.'s health care practice director.
The worst-case scenario has happened, McTighe said, when an interference problem caused by a nearby cell phone caused a patient's artificial heart to stop beating.
The short-term solution to knitting together disparate medical technologies is better middleware, Jones and McTighe agreed. Speedier deployment of broadband technologies would also help, said Fickenscher, adding that applications like remote patient monitoring are a more-legitimate broadband application than video entertainment.
Others see advances in sensor technologies and the ability to connect doctors with sensor data as key. Molly Joel Coye, founder of the San Francisco-based Health Technology Center, said several new monitoring devices could soon be approved by the Food and Drug Administration, including heart and glucose monitors. These early sensors could eventually pave the way to "sensor agents" that could use networks to help maintain a patient's glucose level, Coye said.
Coye's center lobbies for more medical technologies on the premise that operating hospitals over the last decade has changed dramatically as costs soar and the shortage of nurses and other hospital workers worsens. Technology could help fill the gap, Coye said.
But critics warn that new technologies can't simply be thrown at these problems without creating more work and less efficiency. "Workplace redesign" is needed, Fickenscher said, to determine how new technologies would affect hospital operations from the emergency room to admissions.