Hospital at home: Why a communication platform is key

• The Hospitals in the Home (HiTH) care model is well established in several countries and has proven benefits for health systems and patients
• Lack of access to reliable and high bandwidth internet connectivity could be a barrier to reaching those communities who would benefit most
• This cutting-edge communications platform should be offered “as-a-service” and must encompass multiple connectivity options to overcome the challenges of underserved communities

The Hospitals in the Home (HiTH) care model is not a new concept. A version of HiTH was introduced in France as early as the 1950s, and since then, the model has become well-established in countries such as Australia, the UK, Canada, Israel, Spain, the US, and others.¹ For instance, in Australia alone, over 595,000 days of hospital-at-home care were provided in 2017 – 2018, accounting for more than 5% of acute care bed days.²

The aim of the HiTH model is to address capacity issues within healthcare services, drive efficiencies, reduce costs, and improve patient experience by moving care from the hospital to the home, all of which have been demonstrated in practice. Advantages seen include reduced risk of hospital-acquired infections, more efficient triage, and optimal utilization of scarce resources such as hospital beds and equipment. Multiple studies and pilots have demonstrated cost savings ranging from 20% – 40% compared to inpatient care, attributed to factors such as shorter hospital stays, fewer diagnostic tests, and reduced sedative medication usage.³

Research also indicates that patients receiving hospital at-home care experience a 26% lower risk of readmission and reduced long-term care admissions compared to those receiving in-hospital care. Furthermore, they exhibit lower levels of depression and anxiety, along with higher overall satisfaction.⁴

IIn addition to the proven advantages of the HiTH model, the potential benefits are particularly promising for underserved populations, including rural residents, low-income individuals, and the elderly. In America, for example, a staggering 80% of individuals residing rurally remain medically underserved.⁵ A hospital at-home model offers a viable solution to provide high-level hospital care to rural communities and to significantly mitigate the risk of hospital-associated complications among older people.

Patients enrolled in HiTH programs can benefit through continuous monitoring from their care team, facilitated by a blend of in-person and video visits, as well as ongoing biometric monitoring through telehealth technologies. Technological advancements like artificial intelligence (AI) powered monitoring and data processing, digital health platforms, and connected devices further enhance the feasibility of hospital at home programs that can provide hospital level care.

While the benefits, and potential benefits, of the HiTH care model, are clear, providing a viable experience requires paying attention to non-medical, intangible challenges associated with moving hospital care into the home. Consideration must be given to factors such as patient eligibility and education, staff training, and necessary adjustments to home environments.

Perhaps the most crucial component is the ability to have effective healthcare communication. Serving as the cornerstone to successfully moving care from the hospital in the home, dependable connectivity plays a pivotal role in the timely and accurate exchange of information among healthcare professionals. Access to digital tools and a good internet connection are essential to enable the delivery of high-quality care. Different services will require a varying degree of connectivity:

• Telehealth/telemedicine: Enabling virtual sessions between the patient and physician(s) to review the patient’s health, vital signs, data, diagnostics, etc in real time – a reliable, jitter-free connection is required to deliver high-quality video streams.
• Telemetry: Connecting several medical devices to automatically monitor and upload patients’ vital signs and symptoms and transmit real-time data to the central hospital database – requires the ability to support multiple device and sensor connections in a finite space without negatively impacting network performance.
• Testing: Non-invasive testing, such as endoscopy (a procedure whereby a pill-sized camera is fed into the bowel to detect signs of cancer) – requires high bandwidth and connectivity with minimal delay for high-definition imagery and synchronizing user movements with device imagery.

Treatment: Alternate therapy for conditions such as chronic pain or anxiety delivered using augmented reality (AR)/virtual reality (VR) that is easier for caregivers to implement – requires high bandwidth and low latency connectivity.

Additionally, without the necessary connectivity requirements, the emergence of a “digital divide” could exacerbate existing disparities in healthcare. Unfortunately, the very segments poised to benefit most from the HiTH model — rural communities, low-income individuals, and the elderly — often lack stable, secure, and high-bandwidth connectivity at home due to physical connection or affordability issues. Even in a high-income country such as the US, approximately one in five households lacks internet connectivity with 18% citing affordability as a barrier.⁶

A disruptive and dedicated communication platform is critical to address this as it facilitates the expansion of hospital at home technology. Rural and low-income communities need seamless wireless connectivity for multiple devices to facilitate HD video conferencing and enable real-time exchange of large datasets.

In the long term, it serves a dual purpose by also facilitating innovation in the HiTH model through advanced novel applications including:

• Automated treatment responses: Insulin pumps monitoring blood glucose levels and automatically dispensing insulin
• AI-powered screening: To measure patient biomarkers such as facial expressions or voice to screen for mental illness
• AR/VR enabled remote procedures: Treatments and procedures performed by paramedics with aid from hospital-based physicians and enabled by AR/VR equipped glasses/devices

Currently, options for accessible connectivity are limited, but progress is being made. While wireline internet remains the primary method of home broadband deployment, wireless broadband is increasingly viable. 5G wireless networks boast steadily increasing download and upload speeds, with averages above 100 Mbps in both urban and rural areas.⁷ However, this technology is subject to weather conditions and requires a direct line of sight to the tower.

Another disruptive technology, Low Earth Orbit (LEO) satellites, is rapidly advancing. Companies like SpaceX continue to expand Starlink Internet service, with plans to deploy 42,000 satellites. With median download speeds of around 79 Mbps and upload speeds of 10 Mbps, Starlink offers a compelling alternative where cable and fiber access networks are absent.⁸

Despite these advances, the reality is that no single connectivity solution suits every HiTH location. For the successful implementation of the HiTH model, secure, reliable, and scalable connectivity is crucial. A disruptive and dedicated communications platform solution provided “as-a-service” by a trusted third party, should ideally incorporate the following components:

1. Intelligent Home Gateway:

• Rugged, secure, and intelligent system supporting various technologies (5G, LTE, Wi-Fi, LEO, etc.)
• Auto-connects to the best available network for optimal bandwidth
• Integrates seamlessly with personal/local area network (PAN/LAN) devices using Bluetooth, Zigbee, etc. (e.g., wearables, bed monitors)

2. Robust and Redundant Network:

• Bundles a variety of communication networks such as fixed wireless, LEO from multiple operators (e.g., Verizon, AT&T, T-Mobile, Starlink) for wider coverage and redundancy
• Can potentially utilize a Mobile Virtual Network Operator (MVNO) structure for a unified, hardened broadband connection

3. Zero-Trust Network Security:

• End-to-end encryption protects sensitive patient data (at rest, in transit, in the cloud) through multiple security protocols (e.g., VPNs)
• Implements strict access controls based on defined permissions and protocols (e.g., Identity and Access Management – IAM)

4. Network Operations Center (NOC):

• State-of-the-art facility with 24/7 monitoring and troubleshooting to ensure uninterrupted network availability
• Proactive problem-solving for network and device issues

5. AI/Machine Learning-Powered Intelligent Network:

• Continuously monitors and selects the best available network for high-fidelity connections
• Dynamically adjusts bandwidth based on application and device needs
• Self-corrects for maximum uptime and conducts root-cause analysis for faster issue resolution

6. Coverage Mapping Tool:

• Up-to-date, interactive geographic information system (GIS) system utilizing national broadband maps
• Provides precise coverage details and available network speeds by provider for any location, aiding in program feasibility assessment

7. User Interface and application programming interface (API):

A set of APIs for seamless integration with other applications and interfaces for a user-friendly experience

Cloud-based platform with an intuitive graphic user interface (GUI) offering dashboards for management, provisioning, billing, and network monitoring

Although the concept of creating a healthcare-focused communications platform to help move hospital care into the home is not entirely novel, there are limited examples of such network offerings. Around 2005, Qualcomm attempted to establish a healthcare-focused cellular network service named LifeComm, which unfortunately did not gain traction due to timing and other factors.⁹

Google Fi, the consumer-focused cellular service from Google, incorporates some of the described elements. For instance, Google Fi operates as an MVNO with data service based on two underlying networks – T-Mobile and U.S. Cellular – and utilizes public Wi-Fi networks when available. Google Fi-compatible devices automatically detect the best available network and seamlessly switch connections for optimal connectivity. Moreover, Google Fi offers an interactive coverage map displaying available coverage and services at specific locations, and it encrypts data using a virtual private network (VPN) whenever connected to a network.¹⁰

In the public safety domain, examples of MVNOs created to support mission-critical services can be found. For instance, ASTRID, the specialist telecom operator for Belgian emergency and security services, launched Blue Light Mobile – a mobile broadband service leveraging multiple commercial networks in Belgium and neighboring countries to ensure optimal coverage.¹¹

The hospital in the home (HiTH) care model is a crucial initiative with the potential to significantly benefit healthcare systems by addressing capacity issues, driving efficiencies, and improving the patient experience. However, for this initiative to succeed and expand, the critical component of connectivity needs to be addressed. Advancements in technology present a renewed opportunity to develop a disruptive and dedicated HiTH communications platform that would not only extend access to underserved populations lacking reliable broadband at home but also serve as a catalyst for innovation and further expansion of the HiTH model.