Abstract
Hospitals are being transformed into healthcare ecosystems. The notion of housing the sick in isolated facilities is being replaced by the concept of a 'City of Health', an environment that promotes health and provides care at the place of living within the local community. This transformation was catalyzed by the COVID-19 pandemic, which highlighted the shortcomings of existing hospital facilities and accelerated the development of digital health and remote care to connect across diverse built environments. When healthcare systems were challenged to prevent contamination and control hospitals' occupancy, innovations in telemedicine technologies, robotics, and AI systems provided an alternative to remote care and home hospitalization. New hybrid models have evolved to integrate care pathways multiplied by the mode of delivery-physical or virtual-and the location of care-at the hospital, the community, or the patient home. Though hybrid models accelerate the flexibility of the healthcare system and provide personalized service through multiple options, the growing complexity challenges both the patient and the healthcare provider to control the operations and choose the best care pathway. We investigate the development of healthcare ecosystems in the use of telemedicine technologies for service innovation and integration of care between hospital and home, drawing on the case study of Sheba Medical Center and Sheba BEYOND, the first virtual hospital in Israel. We conclude by highlighting the potential for the development and use of Digital Twins in integrating the data of users, services, and environments to improve efficiency through real-time analytics and prediction models to support the design of the evolving healthcare ecosystem. © 2023 published by TU Delft OPEN Publishing on behalf of the authors. All rights reserved.