Home care will ease the burden on hospitals

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Kevin Smith is CEO of University Health Network


When it comes to technology, health care is far behind other industries. You can book a haircut and do your banking online, but it’s difficult to receive health care remotely. In a post-Covid era, we’ve realized that the next steps in the health care sector are to increase our reliance on digital technologies, and bring care out of the hospital and into the home.

In the current model, we have siloed systems—hospitals; primary care, or family medicine; and home care. In the future, I think we’ll see those integrated. I don’t know any patient who wants to stay in hospital, so I’d like to create a home care system robust enough that a patient could leave the hospital the day of their operation to recuperate at home. We know that hospitals are dangerous places to be, bacteria-wise. Your body is already used to the flora and fauna that exists in your home environment, making it a much less dangerous place to be.

In order to make home care the primary model of health care delivery, we need to develop more apps and tools that allow physicians and patients to accurately diagnose health conditions. My colleagues at UHN have developed an app called Medly, which determines the likelihood of heart failure before it happens. We can do more with that app than we can by bringing you into the hospital. In order to combat the two biggest burdens to our emergency rooms—chronic obstructive pulmonary disease (emphysema) and congestive heart failure—we’ll also need to create apps that can measure your weight, lung volume and strength to detect flare-ups.

Today, hospitals are designed around inpatient work, but tomorrow they could focus on ambulatory clinics. Imagine if you could be triaged by a nurse or doctor online instead of waiting five to six hours in a waiting room. If they determine you need to come to the hospital, you’ll tell them how long it will take you to get there, and they’ll send you a text before the doctor can see you. Otherwise, they can just call in a prescription to a nearby drugstore. The other piece of the puzzle is to build more advanced diagnostic centres in neighbourhoods so people don’t have to travel great distances to get an MRI or CT scan. Eventually, some of these diagnostics will become handheld—you could have your own ultrasound unit at home that attaches to your phone.

Increased home care means hospitals in the future will need to be smaller and more flexible—we may even be able to downsize the number of beds required for short hospital stays. We should be thinking about building hospitals with individual inpatient rooms, individual washrooms and an approach to infection control that prioritizes ultraviolet light: health care providers would ensure that their instruments pass through a disinfecting UV field before they go into a room. We also need to think about building more negative-pressure rooms to improve airflow, so that fresh air pipes into the room but doesn’t escape it. It would be irresponsible to build a new hospital today and not be considering those sorts of things.

A shift toward home care will lead to easy and efficient care for illnesses like emphysema and congestive heart failure, as well as chronic back pain and injury. I expect we could reduce the number of ER visits by as much as 30 per cent. By preventing emergencies before they even start, we can devote our existing hospital space to the people who really need it.


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