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Boston Hospitals Embrace Technology. The Real Estate Impact Isn’t So Clear.

Innovation and congestion are changing how Boston tackles healthcare.

Rendering of the new clinical tower at Boston Children's Hospital

“The conversation we’re having is how to improve the patient journey and bring down costs," said Carla Small, Boston Children’s Hospital executive director of innovation and operational effectiveness. 

Overcrowding in emergency rooms and congestion on city streets have many Boston hospitals treating patients closer to their homes in ambulatory care facilities. Boston Children’s is taking it a step further through technology and an on-site startup accelerator. 

The hospital uses voice technology and online portals to direct patients, based on their symptoms, to the best treatment option before they even speak with a doctor. Sometimes that solution means grabbing a bottle of Tylenol instead of making an appointment to see a doctor. 

“We’re focused on digital solutions to reduce the emphasis on brick-and-mortar,” said Small, who is speaking at Bisnow’s National Healthcare New England event May 30 at the Westin Boston Waterfront. “But brick-and-mortar will always be so central to who we are.”

The hospital began experimenting with voice technology through Amazon’s Alexa device three years ago. Last month, Boston Children’s became one of six organizations to launch a HIPAA-compliant skill on Alexa. The top-ranked pediatric hospital is now able to use the device as a hands-free discharge tool. 

There are also apps to allow voice technology in clinical rooms, the Intensive Care Unit and the operating room. Voice technology startups have even discovered ways to utilize biomarkers and detect cardiac disorders. 

“There are a number of exciting things happening in voice,” Small said. “We think it’s transformative.”


Boston Children’s also has a 70-person team working at an on-site startup accelerator to innovate practices and procedures at the hospital and around the world. A partnership with GE Healthcare will now put a Boston Children’s algorithm in GE radiology devices and enable radiologists who didn’t specialize in pediatrics to better understand a brain scan of a toddler.

While there are plenty of accelerators in Greater Boston, Small said it made more sense to open one at the hospital. Clinicians are so busy with their day job treating patients that it was important to bring the entrepreneurial side of healthcare innovation as close to campus as possible. 

“We worked hard to not reinvent the wheel and even work with an existing incubator, but most of our staff can’t quit their day jobs,” Small said. “We have to go where they are and help move the idea forward.”

Hospitals are also going where patients are, which is partially driven by the traffic congestion headache Boston has become. 

Ambulatory facilities away from a main hospital campus are more popular than ever and provide a convenient, affordable option to some services at bigger hospitals. The number of retail clinics, typically staffed with nurse practitioners, almost tripled in Massachusetts from 20 in 2010 to 57 in 2018, according to a Massachusetts Health Policy Commission report. The number of urgent care clinics went from 18 to 145 across the state in the same period.  

Emergency room visits at a hospital typically cost just under $900, and patients are usually charged a $118 copayment, according to the MHPC report. An urgent care clinic visit costs about $150 with a $33 copay. Retail clinic visits cost $69 with a $20 copay. 

Hospitals see the savings and are pushing more services out of the main campus in crowded downtown Boston and into suburban outpatient facilities of their own. 

The Spaulding Rehabilitation Network includes 24 outpatient centers across eastern Massachusetts. While Spaulding patients will still be directed to the provider's hospitals in Charlestown, Cambridge or on Cape Cod for surgical procedures and initial rehab, Spaulding's suburban outpatient facilities are available for more convenient treatment later in the recovery process.

“They’re not all on Boston Harbor like our Charlestown location, but we’ve tried to build in as many of the same accessibility features as we’ve built new sites and renovated or expanded older ones,” Partners Continuing Care & Spaulding Rehabilitation Network President David Storto said.

Rendering of Massachusetts General Hospital's planned expansion

Dana-Farber Cancer Institute also has an outpatient network, including plans for a 34K SF oncology and hematology outfit at Patriot Place in Foxborough and a 140K SF treatment center at Chestnut Hill’s Life Time Center, formerly the Atrium Mall.

Diagnoses, first-round trials and surgeries will still take place at the Dana-Farber’s Longwood Medical Area campus, but other treatments can take place closer to home. 

“If you’re coming all the way from Maine and New Hampshire, the Longwood Medical Area and its traffic congestion can give anxiety, which is already there because of a cancer diagnosis,” said Wendy Gettleman, Dana-Farber Cancer Institute vice president of facilities management and real estate.  

It is still too early to see if tech innovation and a push toward ambulatory care are having real estate ramifications for Boston’s biggest hospitals. Based on the plans moving through the Boston Planning & Development Agency, hospitals still have plenty of confidence in their ability to conduct business in the city. Massachusetts General Hospital has plans for a $1B expansion, and Boston Children’s is underway with its own $1B expansion at its Longwood campus. 

But the networks also recognize there are plenty of treatments and procedures that can be moved away from the city’s busiest healthcare hubs to the benefit of patients and providers. 

“The whole arc of care involves both virtual care, brick-and-mortar care and a holistic view of how to treat patients,” Small said. 

Hear more from Small, Storto and Gettleman at Bisnow’s National Healthcare New England event May 30 at the Westin Boston Waterfront.