As part of its National Health IT Week program, HIMSS presented a webinar this week exploring the advent of what it calls the "Smart Communities-Cities Movement."

Healthcare suddenly finds itself amid a paradigm shift, where a profusion of real-time clinical and social health data, broadband connectivity, personal devices, sensors, apps, digital therapeutics and more are transforming delivery away from acute care settings and into the larger community.

It's a fundamental change that's only going to be more pronounced in the years ahead as the demands of consumerism and value-based care, combined with ongoing advances in always-on technology, maintain the momentum toward new models of care.

"How healthcare is organized will be drastically different because of technology," said Dr. Chris Gibbons, founder and CEO of The Greystone Group, during the HIMSS session – which is now on-demand and explores how providers and federal, state and local policymakers are changing the way they think about the internet of things and connected health tools as they focus on population health management.

The prevalence (if not ubiquity) of broadband, combined with fast-advancing robotics, ingestible technologies and wearable sensors as thin and lightweight as temporary tattoos – to name just a few recent innovations – are set to transform "medical services, public health, social services. wellness" and more, said Gibbons — to say nothing of completely reshaping the patient experience.

Smart technology – "embedded chips that can detect automatically and react appropriately without human interaction," or digital health tools that "have the processing power embedded right in them" – are already making their presence felt.

And as these AI-enabled IoT networks proliferate across communities and entire cities, the result will be "real-time delivery of automated health services, anywhere the person is located in the community," said Gibbons.

In this near future, "there is no place these people are not connected," he explained. "They do not need to be in a hospital. You can really envision the delivery of automated services – public health services, social services – anywhere to the person in the community.

"Digital technologies and smart care approaches will transform healthcare organizations far beyond the practice of medicine, yet they will also provide significant opportunities to improve population health," he added.

And not a moment too soon, said Dr. Asif Dhar, chief health informatics officer at Deloitte.

The main drivers of cost in the U.S. – and they are astronomical costs – are for chronic disease and addiction: health issues that exist outside of the hospital setting and thus need to be tackled in the community at large.

The U.S. spent $327 billion on diabetes management in 2017, Dhar said. The total spending on addiction, and all its ancillary costs, is likely to exceed $740 billion. These massive expenditures on behavior-based illness could be avoided, to say nothing of the actual human cost: "more than 42 percent of cancers are deemed to be preventable if we had different behaviors."

The establishment of an online health community around a specific health issue (weight loss, for example), scaled up by deploying custom apps, incorporating gamification and "nudging" for motivation and combining "digital sidewalks" for virtual community meetings, are one way forward.

"Communities are major players in the future of healthcare," he said. "The coming together of exponential technologies, behavioral science, biology and clinical medicine in order to develop and shape communities, hubs and conditions (will) dramatically reduce costs and improve wellness and longevity."

These smart health communities should have five key elements, Dhar explained. They should 1) empower proactive health and wellbeing management; 2) foster a sense of community and wellbeing; 3) be enabled by digital technology and behavioral science; 4) meaningfully use data to improve outcomes; 5) enable new, innovative ecosystems.

Leave it to a place like Portland, Oregon, to already be modeling what these new ecosystems can look like.

Skip Newberry, president and CEO of the Technology Association of Oregon, has been overseeing some intriguing innovations in connected health there, working to develop a "culture of consumer success" – he favors that to the term "consumerization," since it has some connotations that make some healthcare stakeholders bristle – enabled by widely dispersed technologies across the city.

Initiatives such as Smart City PDX, for example, are deploying leading-edge technologies to help its citizens, especially underserved communities.

It starts with small pilots, learns from them, and then scales up. It uses existing budget money to maintain sustainability. 

Among its projects are an open data program, an urban data lake, air quality sensor deployments and solar-powered smart kiosks for disaster preparedness called PREPHubs, designed to operate off-grid while offering power, communication and first aid supplies.

The aim, said Newberry, is to "take the built environment and make it more connected: device to device, and also human to device."

So far, one key area of progress has been on social determinants of health, such as homelessness and food security: "One thing we've been focused on is trying to bridge the gap between government, community organizations and residents," he said.