Central to all healthcare systems is the notion of the hospital. Are these remnants of industrial-age or can they be rethought and refreshed for the post-industrial and information world we are likely to inhabit for some time? Foucault spoke of the birth of the clinic (hospital); I will write about its demise.
The logic of hospitals has a lot to do with aggregation of technologies and brains. It is easier to move the patient to the hospital where integrated systems kick in and provide care, than to have all that expertise go to the patient. That paradigm is getting tired, but yet our thinking is still hospital-oriented. What is the way out?
Evolution of artificial intelligence systems, for instance, points to the possibility of remote locations having access to clinical brains, either embedded in portable diagnostic technologies, or through distributed intelligent systems, or even more mundanely at the end of a telephone. Perhaps it will take time to be comfortable with robotic surgeons, but remote manipulation of robotic surgical equipment is not inconceivable in daily use.
A rather interesting book from the early 1970s, by Maxmen, The Post-Physician Era, offered thinking about the direction of travel. While getting many things wrong — we still don’t have shopping malls on the moon, he did, given the thinking of the day, accurately identify AI as a challenge to human diagnosis, and saw the obsolescence of the pharmacist through robotic dispensing.
The overall forces at work here are the migration of specialist human knowledge into devices and into software, that can be used by less-skilled people (i.e. not necessarily clinical professionals). Self-diagnostic testing kits are just a primitive example. Roll the clock forward with electronic health records, Web 2+.whatever, and advances in materials science, etc, and we have a constellation of factors which form a new pattern for healthcare service delivery.
And when will we build the last hospital?
It takes perhaps 3-5 years to plan a hospital and a couple to build one. It is also critical in the design to take into consideration the evolution of use, changing demography, etc, to perhaps 20 years into the future. I think by 2025 we will acknowledge that the existing hospital infrastructure should not be replaced, but slowly wound down as useful clinical environments. Given the average useful lifespan of anything from 25 to 100 years, we need to be thinking the thoughts about the last hospital within the next 5 to 7 years. There are, no doubt, hospitals in the early planning stages, that when built will be instantly obsolete.