Hospitals will be 'rare exception': What healthcare will look like in 100 years

Healthcare is advancing more swiftly by the year with new technologies, treatment options and artificial intelligence models hitting hospitals across the world.

With the acceleration of advancements, it is hard to imagine how the industry will change. While some believe racial equity challenges might remain, others expect personalized care by genomics to be the standard and that there will be medications that will prevent disease before it takes root.

Becker's asked eight leaders to speculate on what healthcare might look like in 2123:

Tony Ambrozie. Senior Vice President and Chief Digital and Information Officer of Baptist Health South Florida (Coral Gables): One hundred years is a very long time to predict anything given the exponential rate of developments in technology, bioengineering and medicine. But I think we will see a number of trends that will probably happen in the next 50 years or less:

— Healthcare and well-being will be personalized to the extreme, driven by personal genomics as well as continuous and comprehensive real-time monitoring based on a variety of sensors, worn or implanted, as well as fixed diagnostics devices in homes and other locations.

— AI will, based on the real-time data, diagnose anomalies and afflictions and provide and continuously adjust treatments.

— A variety of diseases, including cancer, will either be avoided altogether through gene therapy or treated and cured through biomedication.

— Surgeries, if required, will be performed by AI-enabled robots.

— Hospitals will be the rare exception and not the norm for care.

All these trends combined will lead, I strongly believe, to much longer and of higher quality life spans for humans.

Scott Arnold. Executive Vice President and CIO of Tampa (Fla.) General Hospital: In our near future, I expect AI will continue to play an assistive role on clinical and administrative fronts like it does today, but even better. For clinicians, AI used properly should support quicker decisions for clinical diagnosis and treatment by summarizing data in milliseconds and replacing the lag that exists for hunting and gathering data, reviewing data, making sense of data and narrowing possible diagnosis and treatment tracts for human consideration.

I don't expect AI will replace humans in the process, rather it will maintain an assistive role. In healthcare, humans play an important role in knowledge, critical thinking, intuition, treatment empathy and understanding. AI has the potential to create additional capacity for humans in a high-demand environment — that is value.

Atul Butte, MD, PhD. Chief Data Scientist at University of California Health (Oakland): One hundred years ago, the 1923 Nobel Prize in physiology or medicine was awarded to Dr. Frederick Grant Banting and professor John James Richard Macleod for the discovery of insulin. So now imagine how far medicine would seem to have been unrecognizably transformed in the subsequent 100 years, if one were present in those days for that significant, lifesaving discovery. In other words, medicine in 2123 will likely be barely recognizable to us.

Surely we will have more medicines and medical devices to use. We will certainly have medicines that target proteins and DNA in ways we can't imagine today. … I'm imagining magical "scalpels" for tomorrow's genomic surgeons, to fix things in utero or in cancer. I am also guessing we will have more medicines to compensate for our environment: drugs that protect our lungs from airborne pollutants and drugs that protect our organs from chronically ingested and imbibed toxins.

We will be measuring much more from patients (think about serum proteins and molecules, circulating DNA, sugars and fats), and measuring those components much more frequently. If so many people today are already thinking about continuous glucose monitoring even before they have diabetes, imagine how many molecules we will want to measure continuously in 100 years. Networks of clinical data sharing will exist to help share the very best medical care practices, so that more care providers can see how to provide care in unfamiliar cases.

Anthony Chang, MD. Chief Intelligence and Innovation Officer of Children's Hospital of Orange County (Orange, Calif.): In 2123, healthcare will be about the convergence of historically separated paradigms: 

1. Healthcare and artificial intelligence will involve advanced AI tools, such as deep reinforcement learning, routinely embedded within most if not all aspects of healthcare so there are no longer discussions about AI in healthcare.

2. Health delivery and clinical research will be intertwined with deployment of health digital twins so "researchers" will be more reliant on real-world data and experience versus the current structured randomized controlled trials that have become obsolete.

3. Precision medicine and population health will be an intimate dyad so both are carefully monitored with both genetic profiles including pharmacogenomic information and social determinants of health so there is a global health learning system.

4. Human-centered healthcare and virtual health will be deployed to maintain the human-to-human touch in medicine, and concomitantly healthcare will be primarily delivered via extended reality to improve the quality of the experience.

5. Healthcare and medical care will be mainly focused on preventive physical and mental health due to advances in AI and emerging technologies and will no longer be concentrated only on the delivery of acute medical care.

John Halamka, MD. President of Mayo Clinic Platform (Rochester, Minn.): One hundred years from now, every human will be fully sequenced at birth and a care journey will be laid out looking at all the probabilities from phenotype, genotype and lifestyle. Rather than treat disease, we will prevent disease. Not only will longevity increase, but the number of quality years of life will markedly increase. We will democratize access to this kind of knowledge and care via extensive use of automation so it will be available to most humans on the planet.

Christopher Longhurst, MD. Chief Medical Officer and Chief Digital Officer of UC San Diego Health: Healthcare advancements 100 years from now will have eclipsed the pace of the progress that has taken place over the past 100 years. Considering the changes we are seeing right now, I predict all routine healthcare will be personalized to an individual's unique genetics, proteomics and environment by an AI co-pilot that is constantly monitoring physiologic status through implanted wearables and circulating nanosensors.

Many cancers will be detected at an unthinkably early stage by real-time molecular diagnostics and curable through tailored therapies. Advancements in regenerative medicine will extend the average lifespan through cellular regeneration and tissue engineering. However, arriving at this future nirvana and closing healthcare disparities will require a laser focus on the ethics and equity of data science and digital health.

Gary Small, MD. Behavioral Health Physician-in-Chief at Hackensack Meridian Health (Edison, N.J.): I think there will always be a need for people who are trained in specialty, but they'll be more educators, and consultants and the computers and the primary doctors will take care of tomorrow, but that kind of gets us into the area of healthcare in general. These same principles will hold true in medical care in general, where there'll be more remote care. There'll be more reliance on technology.

Now, if you want to fast-forward to 100 years from now, I think it's going to be even more exciting and in some ways, a bit scary. Because of artificial intelligence, right? It may eventually be where you have an avatar therapist right in your living room talking to you and helping you. And you won't have to wait for 15 minutes to get an hour with them at the end of the week. You could just pull that person up a moment in terms of the technology.

Airica Steed, EdD, RN. CEO of MetroHealth (Cleveland): One hundred years from now our biggest concern will be the same as it is today, ensuring everyone, regardless of their skin color, ethnicity, economic status, who they love, or where they live has access to the highest quality of care. Advances in technology can help us accomplish this goal by supporting our efforts to expand healthcare access, zero out the death gap and better target treatments to the needs of individual patients. We do need to be vigilant in ensuring new advances are implemented equitably and are used to eradicate healthcare disparities not exacerbate them. Unfortunately, in this last century we did not see nearly enough progress in this area, but I believe the alarm has been sounded and we now have the momentum necessary to better utilize technology to achieve equity for all. My ultimate hope is we will not be talking about health equity in 100 years because it is no longer a problem.

Artificial intelligence, including intelligent automation, has a significant role to play in improving healthcare but AI cannot replace people. We need to be intentional in how we implement automation in all its forms so that the outcomes lead to better patient care and better patient access without reducing interpersonal connection or damaging doctor-patient relationships.

Look at how virtual care was transformed by COVID-19. We will have to balance the benefits of both moving forward. We need to ensure the human touch continues because of its effectiveness in improving overall patient care, but virtual medicine can augment and enhance treatment. It can also improve access, allowing individuals in rural communities or people who face transportation barriers to take further advantage of all available medical services. Being intentional about how we implement and utilize virtual care moving forward will help us take full advantage of its positive benefits while preserving in-person treatment as a central component of medical care.

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