The Hospital Of The Future

Richard has a splendid story in today’s Pittsburgh Post-Gazette about the hospital of the future.  Appearing on the last day of his internship there, it’s a thought-provoking think piece about what the hospital of the future might look like.

IMG_1112I would expect communications technology to change hospitals, as it has changed law firms, retail stores, and just about every other business you can think of.  To me, the most interesting part of the piece was about the physical design of hospitals, and specifically how hospitals are striving to make their facilities more inviting and capable of being “branded.”  Rather than the institutional, brightly lit corridors most of us know, the new hospitals are warmer, gentler in their design and lighting, and chock full of things like gardens and coffee shops.  They’re bound to be less depressing than the sterile, wholly functional designs of the past.

In that respect, Richard’s article made me think of colleges, and how their focus has changed from the professor and the classroom and the curriculum to the posh student centers, rec centers, and health clubs that so many schools have built to attract more applicants.  We can bemoan the decline of serious scholarship on campus, but colleges clearly have recognized that they are competing for paying students and are willing to build what is needed to attract them.  As hospital systems become more competitive for patients — and in Columbus, we’ve got three gigantic ones duking it out — they’re bound to follow suit.

Pocket Hospitals

My doctor is a big believer in preventative medicine.  He’s also a bargain shopper.  Even though I have no symptoms of heart problems, he’s been after me to have a heart scan to perform “calcium scoring” and determine whether there are plaque deposits that might cause a problem in the future.  When he heard I could have the procedure performed for only $95, he really encouraged it.

IMG_1603So, yesterday morning I drove to the Ohio Health Westerville medical campus off Polaris Parkway on the north side of Columbus.  The facility is in one of those buildings you see around large cities throughout the nation — trim and brick, three stories, spread out, with lots of free parking.  I’d made a reservation, so I walked right in to a bright and spacious reception area, paid my $95, filled out a form, and was escorted to a room that featured one big piece of high technology equipment.  I stretched out on a platform without having to remove any clothing, a friendly technician attached a few electrodes underneath my shirt, and the machine then moved me back and forth through a spinning circular device and instructed me on when to hold my breath as x-ray pictures of my heart and lungs were taken.

There are ways to hold down health care costs, and this facility is one of them.  It’s in an area where land is cheap.  It offers a few services — I saw an emergency room, a surgery center, and the x-ray and scanning suite as I walked in — but doesn’t try to provide every form of care that a person might possibly need.  It competes with other providers, which helps to keep costs down.  In Columbus, there are dozens of these little pocket hospitals where you can go to have a scan, a colonoscopy, or arthroscopic surgery on your elbow, among other forms of routine health care activities.  The pocket hospitals employ hundreds of doctors, nurses, technicians, receptionists, and other staffers.

Yesterday the whole process took about 20 minutes from start to finish, and then I was out the door and headed to work.  It was cheap, easy, and convenient.  How often do you end up saying that after your encounters with the American health care system?

The Network Issue

Another area in which the Affordable Care Act will have an impact on health care in America is beginning to get some attention.  It has to do with the “provider networks” — that is, the collection of doctors, hospitals, and other health care facilities and personnel being offered by some of the new insurance plans.

The Affordable Care Act posed some difficult challenges for insurers.  Under the statute, they were required to include a number of new, mandatory forms of coverage in their health care plans.  That requirement, obviously, limited the ability of insurers to control the costs of particular plans by tailoring the kinds of care covered by those plans.  But the insurers still need to figure out a way to control costs, because their plans need to be competitively priced.

There aren’t a lot of remaining cost-control options. One is to tinker with things like co-payments and deductibles and increase the non-premium payments that the insureds must make when they use health care.  Another is to limit the networks to particular health care providers who, due to location or contractual agreement or some other consideration, are offering health care at lower prices than their competitors.

That’s the gist of an article in the Wall Street Journal by a cancer patient whose existing policy has been canceled and who can’t find a substitute policy that includes all of the providers that have given her the unique combination of care that has allowed her to beat the odds and survive.  It’s an indication of the kind of long-term effects that will play out over time, as the Affordable Care Act reshapes the health care market.  In the individual market, at least, Americans who are used to going to whichever doctor and hospital they choose may need to change their habits — and they probably won’t be very happy about it.

The Miracle Of Modern Medical Technology

Yesterday our family had urgent need of our American medical system . . . and boy, did it ever deliver!

In our case, the medical problem was a blockage caused by a large blood clot in the brain.  A skilled surgeon was able to use a new, less invasive procedure — one that has been in use at the hospital for only about six months — to follow the blood vessel up into the brain and use suction to dislodge and then safely remove the clot.  The entire procedure took less than an hour and left the blood vessel and brain tissue undisturbed.

Americans often complain about the cost of our health care system, but we also should boast, even more frequently, about the amazing quality of the care it provides.  In our case, the very recent technological advances permitted a result that is nothing short of miraculous — and it was a result that wasn’t reserved for royalty or the super-rich, but instead was available to a worried family that brought a loved one to a neighborhood hospital in Columbus, Ohio.  Where would we be if our hospitals were not striving to provide the best care imaginable?

Without lapsing into the political realm, I think it’s fair to say that our experience is one of the reasons why the Affordable Care Act is of concern to so many people.  Yesterday, when time was of the essence, we received the care we needed immediately, without having to cut through red tape or waiting to receive bureaucratic approvals.  I’d hate to think that things might change that would change that result — or, in some way, remove the incentives that our hospitals have to purchase and use the space-age technology that consistently delivers the modern medical miracles to which we’ve become so accustomed — and for which we are so grateful.

Video Cameras In The Delivery Room

From Pittsburgh comes a story about hospitals revisiting their policies on allowing video cameras in the delivery room.  In hospitals where filming is banned or limited, the stated reasons are to protect the privacy and safety of patients and employees.  There is also the suggestion that, if there are problems with the birth, hospitals and medical personnel would prefer that there be no video record of occurrences in the delivery room.

Some people strongly disagree with the restrictions on filming.  They cherish the video of the birth of their baby, watch it regularly, and like to be reminded of how their child looked at that amazing moment.  One of the people quoted in the article watches the video with their now-grown child.  For such people, documenting that life-changing moment is crucially important; they want to remain closely connected to that instant.  Because some people feel so strongly about it, I imagine that there will always be hospitals that allow video recording of the birth, notwithstanding privacy, safety, and potential liability concerns.

As for us, we didn’t film the birth of either of our boys.  I didn’t even think of it, really, and if I had considered it I would have decided not to do so.  I wanted to be in the moment during the births, not fussing with a camera.  I knew I would be so super-charged with adrenalin that I wouldn’t have been able to take a decent picture, anyway, and in any case I didn’t want to be separated from the event by a video camera, or anything else.  Looking at the birth through a video camera lens just would not have been the same.

Rejecting Robot Caregivers

Japan has a problem.  It has a rapidly aging population of senior citizens and not enough younger people to care for them (or for that matter to contribute to the social welfare programs that support them, but that’s another story).

Ri-Man

Japan had hoped that robots would be the answer.  They envisioned robots that would care for the elderly and staff nursing homes and hospitals.  They have developed robots like Ri-Man, which can lift and carry hobbled senior citizens, and robots to serve as guides in hospitals.  Manufacturers have sunk millions of dollars into efforts to develop such robots.  Now they have concluded that robots are too expensive and impractical — and, even more important, are unwanted by patients and unwelcome, even in robot-friendly Japan.  As one person plaintively said:  “We want humans caring for us, not machines.”

No one should be surprised by this reaction.  It is not just because Ri-Man and the other caregiving robots look like full-scale toys or embarrassing caricatures of the robot from The Day The Earth Stood Still.  Instead, the breathless and triumphal tone of the video introducing Ri-Man, below, demonstrates the disconnect between the views of the entrepreneurs and engineers developing the robots and the seniors who are supposed to be buying them.  Elder care isn’t about technological advances or new frontiers in the science of robotics.  Instead, it is about helping human beings who are failing and who seek companionship and comfort as they decline.  Having to rely only on robots for help would be sterile and depressing. 

The elderly want to know that there is some person who cares enough about them to help them and spend time with them.  Can anyone blame them for concluding that metal and plastic robots are no substitute for a meaningful human connection?