Many individuals experience anxiety and discomfort when visiting a doctor or hospital. This can affect more than simply their emotional well-being: Studies show that 20-25% of patients with high blood pressure are actually suffering White Coat Syndrome, a phenomenon where doctor- or clinical setting -related anxiety induces an acute increase in blood pressure. Using new technologies to provide healtcare in an informal community setting and having allied healthcare professionals provide the care may help to put more patients at ease. Leveraging community settings and less trained staff can also greatly improve access to care, especially for vulnerable populations who face barriers to accessing formal medical models of care (such as geographic distance or literacy problems) and can also reduce wait times.

Types of health.
Healthy
Health at risk/worried well
Unwell/sick
Chronically unwell
Palliative(end of life)

Lost of control

Healing Environments: What Design Factors Really Matter According to Patients? An Exploratory Analysis.
Although the methodological qual-ity of some of this research can be questioned, six themes with associated design characteristics (DCs) can be identified that may contribute to a healing environment for patients (College Bouw Zorginstellingen, 2008): spatial comfort, privacy, autonomy, sensory comfort, safety and security, and social comfort.

Healthcare is rapidly changing. This change is fueled by the availability of technology. This change is supported by two interdependent factors.

1. Decentralization.
2. Connectivity.

Challenges that pressure the current healthcare systems.
1. Managing the ubiquity of chronic illness.
2. Caring for an increasingly aging population.
3. The increasing cost of labour.
4. The adoption of new medical technologies.

Two common strategies to help address the growing strains on existing health systems.
1. Community-based healthcare.
2. Connected healthcare.

Shifting left: moving toward community-based healthcare.
Healthcare systems are shifting toward a more patient-centric care in comperrisson to the current situation where the patient will have to go to the care. This shift will result in new settings that could in setting like a patient's home, community health center, schools or workplaces, and many more locations convenient to citizens. But it could also take shape into mobile units that will move around the community.
Besides delivering care within the community, healthcare will start to provide services in the community that can affect health. Research has shown that social and environmental factors can effect a person's health and wellbeing. As a result of the increased person's health and wellbeing the need for healthcare downstream.

The shift left will have various benefits for not just patients but also providers and the health system itself that include the following:
Increased patient comfort and ease.
Individuals that visit a doctor of hospital often suffer from anxiety and discomfort. This can have negative influences on someones wellbeing. With the usage of new technology healthcare could be provided within a more informal setting to put patients more at ease.
More convenience and greater sense of independence and control.
With new technologies and alternative caregiving, patients could be able to manage their own health in collaboration with healthcare specialists. In this way individuals could increase their independences and control.

Better models for managing chronic conditions.
Community care is a more logical approach for chronic disease management and self-management because it allows for more continuous interventionsThere is a growing body of evidence that supports the positive impact of integrating traditional and community-based healthcare for management of integrating traditional and community-based healthcare for management of chronic conditions such as diabetes, hypertension, obesity and frailty in the elderly.

Improved health outcomes.
Researchers have studied community care and its integration with existing formal care resources, and have determined that, generally speaking, patients fare better when cared for outside of institutions (under non-acute conditions). Programs leveraging community-based care have been shown to help patients with congestive heart failure, asthma, diabetes and other conditions to reduce hospital readmissions/emergency visits, improve quality of life, decrease HbA and achieve other positive improvements to their health.

More compassionate end-of-life-care
Currently, most terminally ill and elderly patients pass away in a hospital. It would be much more compassionate to provide end-of-life care at home or in the community, which the majority of these patients have expressed as the preferred setting for their final moments.

Increased focus on prevention and proactive care.
Community care is often focused on early intervention in order to keep the population healthy. This may mean primary prevention (stopping you from getting sick in the first place) or secondary prevention (stopping chronic diseases from advancing to devastating complications).

Challenges.
Existing hospital- and physician-centric paradigm.
Current healthcare initiative usually take place within medical facilities, and the role of physicians is greatly emphasized. But it should revolve around patients. Within healthcare patients are the most important players. Therefor the system should be organized to meet demands of patients instead.

Complexity of care co-ordination.
To ensure that patients receive optimal care an integrated approach towards care is needed. This care co-ordination will depend upon the use of electronic medical records, electronic health record, secure communication tools and other technologies and will require protocols allowing the sharing of personal health information between provides within a patient's circle of care.

Availability of relevant and timely health information.
Healthcare is about communicating information and acting on that information. Therefor it is important to integrate data and communicate findings efficiently. This becomes more complex with concerns about data privacy and security. These factors should also be implemented into the work flow of caretakers and future technologies. Interoperability is key.

Connected healthcare

Achieving a connected healthcare ecosystem
The digitalization and connectedness of health system data is a major priority for health systems around the world. There are three key elements required to ensure access, collection and sharing of information across parties:
1. Electronic medical records (EMRS)
2. Consumer involvement
3. Data & analytics.

1. Role of electronic medical records in connected health.
A core system-level asset in connected health is the electronic medical record (EMR) maintained by healthcare providers, which allows primary care providers to capture and store patient information. Data elements within an EMR can include patient demographic information, diagnosis, lab results, medication, medical history and many others. Supporting solutions include clinical decision support systems (CDSS), computerized physicin order entry (CPOE), and specialized systems, such as picture archiving and communication system (PACS) for storage and access of medical images, and laboratory information management systems (LIMS) for use in laboratory settings. Health information exchanges (HIEs) or repositories bring together the plethora of provider-based digital health data sets to allow ubiquitous access to health information from different vendors, providers and sometimes patients, often across different locations. For HIEs to be effective, the software must follow specific standards that enable the communication between the constituent pieces of software.

2. Role of the consumer in connected health.
From the perspective of the citizen, the building blocks of connected health include digital health technologies such as:

Personal health records (PHRs)
Patient portals
Mobile health and medical apps
Communication tools and social networks
Wearable technologies and sensors

These consumer digital health technologies consist of tools used outside of traditional medical settings, leveraging data found in the formal healthcare system (for example. in the EMR), to increase engagement with a person's circle of care, in order to better track and manage their health. These technologies also carry the potential to redefine how a patient's formal healthcare team can seamlessly keep abreast of their patient's health status, and work together proactively to keep them healthy. For example, in the near future, the concept of scheduling an annual check-up will be outdated.

3. Data and data analytics become central figures in a connected health paradigm.
Digitized medical data is a tremendous asset and vital currency for connected healtcare. With the onslaught of new consumer digital health tools and devices, there is now an abundance of unstructured, patient-generated health data available, in addition to existing, more structured health-related data. This includes health history, lifestyle choices and other information-created, recorded, gathered, or inferred by or from patients or their designees (that is, care partners or those who assist them) to help address a health concern. Further still, a flood of other molecular, genomic, environmental, behavioural and social/contextual data is more available and accessible than ever before. When combined, these data sets form the basis of "Big Data" in healthcare, so called not only for its sheer volume but also for its complexity, diversity and the speed at which it grows. Data analytics brings it all together, completing the connected health ecosystem. Analytics, and the applications that make the data actionable, will ultimately transform healthcare by enabling decisions to be made by each of the members in the full circle of care around an individual.(MacIntosh, 2015)


Smaller and more complex hospitals.
Leading hospitals will be expected to focus on high-value and highly complex services and to become highly efficient organizations, without requiring high activity volumes. Noncomplex services will be shifted from leading hospitals to other healthcare providers, which should provide these routine care interventions at lower costs with a workforce mix and technologies that represent a lower average cost than at the leading hospitals. Leading hospitals will become less capacity-based and more results-oriented as organizations, implementing process improvement to reduce waste and increase value to patients and payers. They will share results and best practices, generating benchmarks for other healthcare providers.

New scope of services.
Leading hospitals will embrace new services such as personalized medicine and genome-based diagnosis, with a broader scope of services.

Leading hospitals will provide complex services to referred patients and also manage the provision of acute services in a catchment area.

Leading hospitals will not be defined by the physical structures and will be organized so they deliver services at different locations. Leading hospitals will adjust to become smaller in terms of physical resources due to fewer inpatient processes, smaller equipment and fewer patients on-site. Leading hospitals will reduce their physical resources on the main site, such as ward areas, and will use distributed facilities to get closer geographically to patients, with processes covering not only on-site activities but also home care and providing services at facilities shared with other levels of care. The size of wards, rehabilitation areas and A&E departments will be adapted to new flows of patients, and resources will be more flexible (suitable for different uses) rather than for a fixed purpose or specialty. In combination, the leading hospital will deliver care at different locations with virtual and flexible, multidisciplinary and process-oriented teams.

Integrated care and process-oriented teams.
Leading hospitals will be organized into process-oriented teams and seek to create integrated care models (either virtually or merging companies). The design of the hospital organization will consider the whole network of provision structuring disease or process-oriented teams, the scope of which extends beyond the hospital facilities. The hospital's role will be not only coordinating but orchestrating services. In order to do that, hospital professionals will share clinical knowledge with other levels of care and providers in the network. Hospital physicians and managers will consider the whole healthcare provision network as their area of influence and will develop and will develop an active role for the care management and improvement, not only within the hospital but also for other providers in the network. In order to manage this healthcare network efficiently. leading hospitals will push forward integrated care models to create either a single integrated care organization (merging entities) or a virtual integrated care organization (a multiple entity organization with a joint governance body).

Connected hospital.
Improvement of the patient experience will lead to connected hospitals where case managers will reach out to coordinate care for patients at home. In the next 15 years, patients will spend less time at hospital and on healthcare premises. Improving the patient experience will demand the introduction between patients and hospital professionals. Information technologies will be used to predict needs, personalize healthcare processes and treatments and follow up and connect with patients wherever they are, using virtual consultation, not only one-to-one but also between a team and patient. Hospital professionals will also become mediators of relevant and personalized information to patients. As remote health management services will become widespread, citizens will use mobile apps, sensors, medical devices to monitor and improve their health and well-being. there will be a wide range of such devices and apps, covering different age and socioeconomic groups in the population almost equally, though there will be different levels of adoption depending on each patient's willingness to communicate remotely and receive directions, support and monitoring. These patients taking a more active role in the design of hospital services and participating in activities to redesign care processes sos patients' needs and views are considered.

Patient-centered innovation.
Leading hospitals will systematically redesign the service experience with innovation to become really patient centered. Hospital services will need to evolve along with clinical knowledge and also with clinical knowledge and also with patient's expectations, systematically evaluating and improving patients' experience and quality of services. Leading hospitals' innovation will promote the establishment of collaborations with other healthcare providers and industry to discover, ideate and prototype new services and new ways of providing services to patients. Patients' involvement in the redesign of healthcare services will be promoted and their perceptions of health services will be consistently evaluated for quality improvement. Innovation activities will not be limited to a small group of practitioners but will extend to most healthcare professionals, and skills and competencies in innovation will be included in the curriculum of different professional career plans.(Ribera, Antoja, Rosenmöller, & Borrás, 2016).

There is a lot of research and innovation being done in the field of medicine and healthcare. As a species we try to survive as long as possible on this planet. Globally many breakthroughs are being made to improve human health. With innovation not slowing down any time soon it is worth the investigation of what the future developments in healthcare and medicine will be. Below is a video visualising research done by the Economist showing what the future of healthcare and medicine will look like. In my opinion there are seven elements which are very important for healthcare and medicine, these are: