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THE APPLICATION OF ARTIFICAL INTELLIGENCE (AI) IN HIGHLY

INTELLIGENT HOSPITALS
Article · November 2021
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IJPHCS International Journal of Public Health and Clinical Sciences
Open Access: e-Journal e-ISSN : 2289-7577. Vol. 8:No. 6
November/December 2021
THE APPLICATION OF ARTIFICAL INTELLIGENCE (AI) IN

HIGHLY INTELLIGENT HOSPITALS
Nur Syarah Zulaikha MR 1,2, Nur Adibah S 1,2, Nurulain AB 1,2, *Aidalina M1
1
Department of Community Health, Faculty of Medicine, University Putra Malaysia.
2
Ministry of Health, Malaysia
*Corresponding author: Dr Aidalina Mahmud

Email:aidalina@upm.edu.my
ABSTRACT
Background: The utilisation of artificial intelligence (AI) in healthcare is being fundamental
in creating intelligent hospital. The realisation of data networking, emulation of human
cognition in the analysis, interpretation, and comprehension in delivering clinical and non-
clinical services is believed to improves overall healthcare services, patient satisfaction and
satisfying the health workforce. The aim of this article is to describe the current applications of
artificial intelligence in the healthcare services and gather available information and updates in
the evolution of intelligent hospital. Also, this article will describe the working process of AI-
integrated intelligent hospital looks like.
Materials and Methods: Review of relevant literature from online databases such as EBSCO,
Pub Med, Research Gate, Google Scholar, and Google search engine was done to collect the
information. This review's selected information was taken from academic journals, thesis,
official country reports, and news update using related keywords intelligent hospital, artificial
intelligence (AI), big data, hospital management, and smart hospital.
.
Results and Conclusion: Integration of AI into healthcare services in the hospitals hence
creating the intelligent hospitals, is the way to go. The benefits of having AI in intelligent
hospitals seem to outweigh the disadvantages. Integration of technology and science in the
healthcare delivery will reduce human-related error, improve patient satisfaction, assist
healthcare personnel in achieving better health results, and provide a better, safe, and efficient
healthcare services. It is highly recommended for healthcare professionals to be aware of and
be up to date with the development of AI technology in the healthcare setting and the pursuit
of creating and managing intelligent hospitals.
Keywords:
Intelligent hospital, artificial intelligence (AI), big data, hospital management, smart hospital
Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 1

1.0 Introduction
A hospital is defined as a "residential establishment which provides short-term and long-term
medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for
persons suffering or suspected to be suffering from a disease or injury and for the parturient. It
may or may not also provide services for ambulatory patients on an outpatient basis" (WHO,
1963). In the early times, a hospital is where ill individuals stay and were given medical
treatment and nursing care, until they recover and hopefully can be discharged home, healthy.
Management of the day-to-day activities in the hospitals were simple and straight forward.
Over the years as the patient load and the functions of the hospital increase, management of the
hospital became more complex. Many departments within a hospital interact with each other as
many illnesses of one patient were addressed simultaneously. In the 20th century, the
management of hospitals were so complex that the concept of Smart Hospitals emerged. Smart
hospitals consist of a combination of new clinical processes, highly digitised infrastructure, and
enhanced management systems. Examples of smart hospital are Bumrungrad Internal Hospital
in Thailand and Seoul National University Bundang Hospital (SNUBH) in South Korea. Over
the years, a new breed of hospitals emerged, which are even more sophisticated than smart
hospitals, and they are called Intelligent Hospitals. Intelligent hospitals integrate hospital
infrastructures, administration and clinical operation using AI in the healthcare services,
resulting in a seamless patient care environment (Frisch, 2014). Simply put, an intelligent
hospital is one that works better and smarter. It's better because it's resourceful, creative, and
perceptive about what patients and doctors need, and it is smarter because it is astute and
inventive when it comes to weaving together diverse technologies to enhance patient care.
The concept of the Intelligent Hospital places patient care at the centre of all operational
systems. The Intelligent Hospital brings together the architecture and design of the hospital
space, innovative technology, and best practices in healthcare to achieve optimal patient care.
The Intelligent Hospital also connects otherwise disparate clinical activities for more seamless
operations. By enabling more automatic exchanges of information, caregivers and staff can
provide detailed and effective patient care while equipping healthcare administrators with the
insights needed to improve protocols and policies that help increase efficiency and lower costs.
AI is defined as the algorithm study that enables machines to analyse and conduct cognitive
functions (Hashimoto et al., 2020). The advanced usage of artificial intelligence could imitate
human cognitive function such as analysing and making decision, knowledge representation,
vision and language, processing complex work and communication (Reddy et al., 2019). As for
major services in a hospital, they are the healthcare management, clinical decision support,
patient monitoring and care, and healthcare intervention (Reddy et al., 2019). Hence by
combining the AI and the major services in a hospital, the result is a seamless, uninterrupted,
safe care of the patients. The hospital intelligence components can be divided into clinical and
non-clinical services. The clinical services are services related to the diagnostic and therapeutic
interventions given to the patients (World Health Organization, 2018), while the non-clinical
services are the services that are not involved directly with the patients' diagnosis and treatment.
Non-clinical services include patient education services, facility operations, food services,
health information management, housekeeping & environmental services, human resources,
material or asset management and billing or financial aid (Jackson Purchase Medical Center,
2020). These two types of services are summarised in Table.1.

Table 1: Components of the Intelligent Hospital
Clinical Services Non-Clinical Services

1. Electronic Medical Record 1. Intelligent Infrastructures
2. Triaging Patient Management • Data Management
3. Patient Appointments / Registration • Smart Asset Management
4. Patient Management • Smart Building System
5. Doctor Management • Billing Management
6. Operation Theatre Management
7. Laboratory Management
8. Radiological Management
We are in the era of Industrial Revolution 4.0. The core of the Industrial Revolution 4.0 is the
adoption of AI methods. This revolution has affected all aspects of human activities and
medicine is one example. Medicine in turn, is the core business of hospitals. As the AI
technology continues to flourish in the medical treatment domain, there needs to be a parallel
growth in the hospital management domain.
The aim of this article is to describe clinical and non-clinical services in Intelligent Hospitals
and the role of AI in these services so that healthcare managers are kept abreast on the
contribution of AI in the hospital management.
2.0 Materials and Methods

Review of relevant literature from online databases such as EBSCO, Pub Med, Research Gate,
Google Scholar, and Google search engine was done to collect the information. This review's
selected information was taken from academic journals, thesis, official country reports, and
news update using related keywords intelligent hospital, artificial intelligence (AI), big data,
hospital management, and smart hospital..
3.0 Result
3.1. Clinical component of the intelligent hospital
3.1.1 Electronic Medical Record
Traditionally, medical records of patients were manually written in paper-based forms which
were then stored in medical record rooms. This old method of record-keeping had many
problems, among which is the damage of the records due to prolonged storage (Liang & Zhao,
2019). Retrieval of records and files was also problematic as the information stored were based
on the sequence of event experienced by the patients. Over the years, this manual record-
keeping practice was replaced by an electronic version, called the Electronic Medical Record
(EMR). Instead of writing manually, the health service provider can type or key in the

information or data of the patients into the computer, and the relevant systems can then store
these information and data in a digital storage unit. The EMR not only saves on floor space in
record-keeping, but also enable data retrieval from the medical records faster and more
efficient.
More recently, the performance of EMR has gone up a notch higher, with the integration of AI
into the system. In the intelligent hospital, the already existing information and data of the
patients pertaining to sociodemographic characteristics, medical history, birth history,
immunisation status, family history, and risky behaviors assessment from all their visits, can
now be analysed by the AI. This personal medical analysis by AI is carried out by using detailed
algorithms that can recognise patterns of disease occurrence and patient's characteristics, and
then predict the risks of hereditary disease of that patient or if there is an amplified risk of
chronic disease in that patient (Hamet & Tremblay, 2017). Therefore, this AI-integrated EMR
is a vital tool for tailored medical care for the patient, because it can analyse massive amount
of data, then make hypotheses, inferences, calculations, and suggestion based on collective
information. These activities can be done in the prevention, detection and management of the
disease in that patient, hence the provision of appropriate measures to him/her, and ultimately
increases the clinical value and reduce health cost of the patient (Hamet & Tremblay, 2017,
Hashimoto et al., 2020).
3.1.2 Triaging Patient Management
In an intelligent hospital, AI plays a very important role in the Emergency Department (ED).
Studies have shown that AI-based tools for predicting many aspects of medicine, including risk
stratification, diagnosis, and treatment choice are especially helpful in patient triage in crowded
ED (Farahmand et al., 2017). A study conducted in Tehran in 2015 showed that AI-based triage
model could accelerate triaging and patient risk stratification in hectic ED condition
(Farahmand et al., 2017). Using AI integrated EMR, the analysis will be based on patient
previous history and current complaints working as helpful tool in assisting other medical staff
from doing mistake in triaging level. In Rwanda, two million users were benefited from the AI
based telemedicines services trial which acts as triage advisor, managing physician
appointments, medical tests and prescription (Burki, 2019).
3.1.3 Patient appointment
To ensure seamless care in an intelligent hospital, the smoothness of patient's flow throughout
the hospital should begin with an efficient appointment system. The traditional ways of getting
a date to see a doctor by way of calling the clinic or hospital, or by personally coming to the
hospital, are inconvenient and inefficient. In an intelligent hospital, setting an appointment for
the patient is easy and quick, as AI is integrated into the patient appointment system. The system
would then read personal patient data and preferences, and then analyse and predict the optimal
doctor-patient matches (Liang & Zhao, 2019).
Another advantage of using AI in the appointment system is that we can predict no-show
attendance to hospital by using AI predictor. The predictor should feature patient-specific data
such as patient age, gender, nationality, geographic region, and the 12-month historical rate of
no- show for each patient (no-Show-rate) (AlMuhaideb et al., 2019). Based on the prediction,
the time slot can be backed-up by another patient with the condition that they are aware they

are second in line. This application would significantly reduce the wasting of human resources
volume, underutilisation of expensive healthcare resources, and lessen barrier to patient access.
3.1.4 Patient management
The crux of a hospital role is in the patient management, which mostly involves nursing care.
If the nursing care is inadequate, it may jeopardise the quality of care and patient safety.
Artificial intelligence applications in inpatient management may just be the required solution
to this problem. For example, the patient would be placed in a smart bed that can monitor the
patient's weight, has an automatic side-rail which would ensure the safety of the patients, and
also integrated with nurse-call platform linked with radio-frequency identification (RFID) for
better communication (Frisch, 2014). Radiofrequency identification (RFID) comprise mainly
of tags (linked to patients) and tag readers (linked to respective nurse). It can provide better and
faster medical services since medical staff can immediately get real-time data about the patients,
especially during critical patient call and alerts (Álvarez López et al., 2018).
In a conventional hospital, patient bedside vital sign monitoring is done at certain intervals
which might leave them at risk for unknown sudden complications such as shocks, cardiac
arrest, respiratory failure, or others. However, AI can assist in vital sign monitoring. For
example, telemetry method such as bed sensor pads provides as another choice for automatic
vital sign collection. The AI would interpret data and alert the staff by sending alert and data to
receiver end (mobile, tablet, computer), resulting in faster intervention to prevent potential
complications (Frisch, 2014). Another contribution of AI in patient management is in
preventing medication error. The bed monitoring system can be linked with medication
prescription and an alert is sent via RFID if there is any wrong prescription or delay in
administering (Álvarez López et al., 2018).
3.1.5 Doctor Management
AI can assist physicians in making a better clinical judgement based on AI integrated EMR
(Jiang et al., 2017). AI can also assist in providing specific tools to support physicians' diagnosis
and rehabilitation planning (Spyropoulos, 2000). Another specific strength of AI-based systems
is the capability to collect and analyse big data and bring to clinical deductions such as
predicting disease; help the physician in evaluating cancer risk or evaluating the cardiovascular
and strokes risks in an individual. AI can also help predict a rare illness that the physician often
overlooked (Ahuja, 2019). AI can support physicians by helping in diagnosing diseases by
utilising complex algorithms with aggregated published clinical research, imaging results from
millions of patients, thousands of biomarkers, and millions of physician's notes from EMRs
(Ahuja, 2019).
AI can also analyse and assist physicians in deciding for best pharmacotherapy such as the best
possible antibiotic for the patient or whether these particular patients already develop antibiotic
resistance during previous admission (Jiang et al., 2017). Through time, AI-based system will
always be improvised and underwent continuous active feedback and tuning from the physician
(Hashimoto et al., 2020).

3.1.6 Operation Theatre Management
By assimilating AI into operation room system, a hybrid operation room (OR) can be
established. A hybrid OR can support various high-technology surgical techniques including
the minimally invasive surgical approach and robotic surgical device, endoscopic devices,
lights, video cameras, insufflators, and scopes (Frisch, 2014). As illustrated earlier, the RFID
in a hybrid OR can help in enhancing patient safety. For example, by using RFID-coupled
instruments and RFID-coupled surgical sponge for item counts throughout surgery, confirming
that surgical devices are preserved within the surgical field. Then, automatic documentation of
the surgical procedure in the patient EMR, serving a precise depiction and better cost
calculation of the surgical events (Frisch, 2014).
Another application of AI in a hybrid OR is computer vision (CV), which is defined as a visual

understanding by computers, where the computers are able to "see" and interpret the content of
digital pictures such as photographs and videos. The use of CV applications in surgery are
increasing, along with visual data demand in surgery. For example, many surgical instruments
such as laparoscopic, endoscopic, and robotic camera systems now have very large data storage
abilities and many surgeons are opting for operations recording or doing a live recording for
education, and research purposes (Hashimoto et al., 2020).
3.1.7 Pathological Specimen Management (Laboratory)
In a conventional hospital, sometimes laboratory results may be conveyed late to the treating
physicians, and so the patient's treatment could not be started in a timely manner. These delays
may be associated with the lack of trained laboratory personnel or insufficient equipment. In an
intelligent hospital which utilises AI in its system, can avoid such problems. Integration of AI
into the reporting system can create a real-time link alert to the respective physicians. If these
alerts are generated when potentially hazardous result was detected, the early intervention can
be started for the patient (Frisch, 2014). Again, AI in the form of RFID plays a significant role
in the laboratory services. The RFID can be used to track inventory such as reagents and kits.
The RFID would send and alert to laboratory personnel if the inventories are almost depleted
in supply.
Another role of AI in the pathology laboratory is in the visual examination of biospecimen

which are fixed on the glass specimen slides. The conventional method of examining the
biospecimen is dependent upon pathologist's skills and is subject to the level of fatigue of the
pathologist. However, an AI-integrated system has been shown to be able examine sample
slides accurately, and without fatigue (Ahuja, 2019).
3.1.8 Radiology department
In an intelligent hospital which utilises AI in radiology, big data in the form of radiological
imaging can be analysed quickly, and meaningful insights can be extracted from the analysis.
Images in the form of x-rays, ultrasonography, computed tomography (CT), and magnetic
resonance imaging (MRI) often hold large amounts of complex data that can be difficult and
time-consuming to be interpreted manually. However, AI algorithms in radiology can assist in
this interpretation, for quick diagnosis and timely decision-making process (Ahuja, 2019). The
AI algorithms can also help in disease patterns identification and classification from images,
subsequently allowing the radiologist to recommend care pathways in the patient's care (Ahuja,

2019). In addition, seamless AI component within the imaging workflow would reduce errors
and achieve earlier diagnosis even with minimal manual input (Hosny et al., 2018). Another
crucial role of the AI algorithm is its ability to detect rare imaging presentation and suggest
them to the radiologist (Hosny et al., 2018), which otherwise may be missed by physicians.
3.2 Non-clinical component
A hospital is never stagnant, so the design and infrastructure of a well-run hospital should have
intelligence embedded into it. Intelligent hospital infrastructures will enable it to detect any
potential issues, giving management of valuable insights to respond accordingly while at the
same time providing built-in protection against mechanical and human errors.
3.2.1 Data management
'Big Data' is the large amounts of a variety of data generated at a rapid rate. In the healthcare
industry, various sources for big data include hospital records, medical records of patients,
results of medical examinations, and devices that are a part of the internet of things (IoT). This
data requires proper management and analysis to derive meaningful information. Healthcare
data management is the process of acquiring, examining, and maintaining records of patients to
offer quality treatment and other healthcare-related services to the end-users. The application
of AI is introduced in healthcare data management. It uses sophisticated algorithms and
techniques such as machine learning and deep learning to process medical data and perform
various healthcare-related decision-making processes. Machine learning is a subset of AI which
allows a machine to automatically learn from past data without programming explicitly.
Machine learning algorithms resemble human intelligence that may detect trends in actions and
construct their reasoning. On the other hand, deep learning is a type of machine learning subset
of artificial intelligence. Machine learning is about computers being able to think and act with
less human intervention; deep learning is about computers learning to think using structures
modelled on the human brain.
In the setting of an intelligent hospital, the most common application of traditional machine
learning is precision medicine – predicting what treatment protocols are likely to succeed on a
patient based on various patient attributes and the treatment context (Lee et al, 2018). The great
majority of machine learning and precision medicine applications require a training dataset for
which the outcome variable (e.g., the onset of disease) is known; this is called supervised
learning. The most complex forms of machine learning involve deep learning. A typical
application of deep learning in healthcare is recognising potentially cancerous lesions in
radiology images (Fakoor et al., 2013). Deep learning is increasingly being applied to
radiomics, or the detection of clinically relevant features in imaging data beyond what can be
perceived by the human eye (Vial et al., 2018). Both radiomics and deep learning are most
found in oncology-oriented image analysis. Their combination appears to promise greater
accuracy in diagnosis than the previous generation of automated tools for image analysis,
known as computer-aided detection or CAD. At the patient level, the AI model has been to
predict if and in which facility the patient will book an appointment (Piccialliet al.,2020). In the
year 2017/18, close to 120 million outpatient appointments were scheduled in England. During
the same year, one in 20 outpatient appointments in England were not attended (6.7%), and
some estimated this to cost the NHS around £1bn (NHS Englad, 2018). From an operational
point of view, missed appointments are a waste of resources in already overstretched services

and contribute to longer waiting times for all patients. It could also be a missed opportunity for
an individual patient to receive a diagnosis or timely care and treatment.
A growing number of machine learning models can now assess the individual risk of a patient
missing an appointment. Several of these are US examples, including a large study attempting
to predict patient no-shows across a range of clinical specialities in this study, the researchers
developed a series of risk models for patient No-Show/Late cancellation across a range of adult
specialities and found that the risk factors for patient no-shows across the different clinics are
different (Ding et al.,2018). Similarly, a study by Nelson et al. (2019) demonstrates that state-
of-the-art predictive models of non-attendance can be derived from relatively modest datasets.
Based on routinely recorded, easily accessible attendance variables, enabling institutions to
build effective models without substantial modification of their data streams and without the
necessity and potential information governance risk of pooling data across multiple
environments.
3.2.2. Smart Asset Management
Hospital inventory on assets needs regular updates and is time-consuming in traditional hospital
management. However, the combination of IoT and radio frequency identification (RFID) in
hospital asset tracking and management can introduce accurate and updated hospital items. The
stored data helps for the speed and quality of hospital inventory management. Thus, enhanced
serviced provider. Figure 1, showed how the RFID and IoT work in asset tracking and
management. The assets are provided with the RFID tag, which consists of a chip with asset
identification. The usage of radio-frequency electromagnetic enables the hospital staff to track
the locations of the assets in hospitals. In the system depicted below, the hospital staff reader
devices will receive the radio waves from the RFID tags and transfer the command to activate
the RFID tag. Once activated, it will resend the asset information to the reader devices. These
technologies also protect the movable asset from loss and theft because the RFID tag
authorisation is sent in the IoT system and alert notification is informing to the security officer
about potential theft (Boris, 2018).

Figure 1: A smart networking of RFID and IoT for hospital asset tracking and
management (Source: Boris, 2018)
These technologies overcome manual asset tracking, which is a slow process and subject to
human errors. They can also automate routine tasks such as reporting on hospital equipment
utilisation and maintaining the supply of drugs and other hospital inventory. Data from these
activities enable the hospital manager to accurately forecast the demand for healthcare services
in that hospital.
3.2.3 Smart building system
An intelligent hospital depends on AI for the technical aspect of building management, such as
power and climate regulation system, ventilation system, temperature sensors, medical gas
supply, automated door locked system, smart operation room and management system (ENISA,
2016). The application of AI in the hospital building enables managers to make timely and good
decisions in terms of energy optimisation because of the availability and accessibility of real-
time data (SD Global, 2020).
3.2.4 Billing management
Most hospitals using EMR would send the discharge information to the medical coder in the
finance department. This medical coder would calculate the bill using the visit information,
procedures, laboratory sampling, and medication prescription from the EMR (Seibert, 2020).
This billing process may be subjected to human error as the diagnosis coding to charge the
patients are often done manually by humans. However, in an intelligent hospital setting, the use
of AI may prevent the error from happening. Figure 2 showed the interconnected systems in
the non-clinical services of the intelligent hospital.

Figure 2: The interconnected system in non-clinical services of an intelligent hospital
3.3 Real-life examples of Intelligent Hospitals in Asia
Intelligent hospital concept is gradually gaining interest and acceptance globally. Many
hospitals are adopting and adapting AI technology in their work processes. In Asia, several
countries have begun using AI in their hospitals and can be regarded as becoming intelligent
hospitals.
In Malaysia, a hospital called Hospital Sungai Buloh, Malaysia's main hospital specifically
allocated for COVID-19 treatment, recently received assistance from a private company called
Huawei Cloud. Huawei Cloud and its partners' key cloud services, such as cloud-network
synergy, big data, and artificial intelligence, are used in the AI cloud auto detection solution. It
allows for early detection and diagnosis, allowing hospitals to quickly identify contaminated
individuals for early quarantine and treatment. This new technology involves an AI system that
has been "trained" to analyse more than 4,000 verified CT-scan images. Consequently, the
system can analyse hundreds of CT-scan images within seconds to detect lesions accurately and
make the diagnosis in just one minute. As a result, doctors can identify infected patients very
quickly and receive early treatment and be quarantined immediately (Alzahrin Alias, n.d.).
In Singapore, the Tan Tock Seng Hospital, co-developed inpatient falls prevention program
called PreSAGE. PreSAGE is a smart bed-exit prediction that requires minimal nursing
intervention. The system was trained with 12,000 hours of real patient thermal data and thermal
sensing, so that it could trigger an alarm whenever a positive bed-exit is predicted. The system
is automatically disarmed when the nurse is at the bedside and rearmed when the patient was
left alone. Post-deployment studies show that the system has 99.7% sensitivity and 100%
specificity. For this innovation, this hospital won The Outstanding ICT Innovation category for
HIMSS-Elsevier Digital Healthcare Awards in 2019 (HIMSS, 2020).
In Thailand, the Bumrungrad Internal Hospital is the world number one Medical Tourism
Hospital, and the first recipient of the Joint Commission International (JCI) accreditation in
Asia. Bumrungrad hospital has adopted five main medical technologies: AI or Big Data,

Genomics, Robotics, Scientific Wellness and Telemedicine to raise their care standards
(Techsauce Team, 2019). The AI technology used is the pharmacy robots that has complete
packaging, storage, and dispensing system using a barcode, which can lower complexity and
avoiding over-reliance on memory (Techsauce Team, 2019). The hospital also has mobile
applications that can find patients' favourite doctors, schedule appointments, as well as enable
patients to communicate with their doctors, be reminded for appointments, purchase online
packages, and experience virtual navigation of the Bumrungrad International Hospital
(Bumrungrad International Hospital, 2018). Additionally, the Faculty of Medicine,
Chulalongkorn University together with Bumrungrad Hospital, Thailand also won an
Outstanding ICT Innovation award from HIMSS-Elsevier Digital Healthcare Award 2019 for
their Deep Learning for Automated Classification of Tuberculosis-Related Chest X-Ray
(DAC4TB). The award-winning innovation was a technology specifically created for resource-
limited and non-hospital settings that have no internet connection. The technology can interpret
as many as two chest x-ray images per second, or 100,000 chest x-ray images in less than a day,
when it would take over five months if done manually (HIMSS, 2020).
Another award-winning AI innovation in hospitals hailed from India. The Nanavati Super
Specialty Hospital won "Outstanding ICT Achievement for Operational Efficiency
Enhancement" in the discharge process of inpatients that enable real-time monitoring of the
inpatient discharge process. This AI-based project monitors and updates vacant beds status, the
bed under discharge, and scheduled discharge list, therefore providing an overview in planning
and allocating beds for patients (HIMSS, 2020).
In Taiwan, the National Taiwan University Hospital (NTUH) collaborated with the company,
Acer, to develop an AI-assisted diagnosis software for diabetic retinopathy. The AI program
was trained in deep learning techniques, using colour fundus photography to analyse the
severity of diabetic retinopathy. The accuracy of this program was noted to be over 95%, which
is very close to the accuracy of the interpretation by retinologist (Acer, Taiwan University
Hospital Develop Ophthalmic AI Based Diagnostic Software, n.d.).
The hospital with the highest level of AI technology achievement is the Seoul National
University Bundang Hospital (SNUBH) in South Korea. Their digitised hospital journey began
in 2003 using a homegrown EHR system and paperless medical records and was accredited as
Stage 7 EMRAM in 2010. The Clinical Data Warehouse (CDW), health information exchange,
and closed-loop medication administration (CLMA) use RFID barcode technologies to manage
the pharmacy, medication administration, and blood bank. The barcode enablement system
ensured patient safety with an RFID wristband containing patient information, conveniently
tracking real-time patient data, and cross-checking patient data with medical orders. This
consequently decreased the incident of patient safety related to medication (Yoo et al., 2016).
4.0 Discussion
The advantages and challenges of intelligent hospitals are discussed in the following section.
Based on the description of the AI used in a potential intelligent hospital setting in the preceding
paragraphs, there are several advantages of the concept of AI and intelligent hospitals. The first
is that, the application of intelligent hospital is likely to enable the bridging between clinical

and non-clinical services to engage with problems and solutions for ageing population care,
limited human resources in healthcare, and improved access to healthcare (Chen et al., 2012).
The bridging between clinical and non-clinical services significantly affects how patients
experience the entire hospital care (Berry et al., 2018). The application of AI technologies in
the hospital is continuously evolving by time. According to Berry et al. (2018), the delivery of
both clinical and non-clinical must be aligned to give optimal patient care.
Secondly, the AI system can also extract and gather useful information about large patient
populations, which assists public health disease surveillance and public health measures (Jiang
et al., 2017). AI usage can also improve patient care as the application can perform healthcare
tasks such as diagnosis and treatment recommendations, patient engagement and adherence,
and administrative activities (Davenport & Kalakota, 2019). Thus, this will encourage healthy
behavioural changes among patients, enable early detection of diseases, promote robotic
surgery and rehabilitation, and help with the ageing or terminally ill patient through a humanoid
robot (PWC Global, 2017).
Thirdly, the socio-economic impact of AI in healthcare reported in the European health system
showed that the AI could save 400,000 lives annually, 200 billion Euros in annual saving and
1.8 billion hours freed up every year, equivalent to having 500,000 additional full-time
healthcare professionals (Biundo et al., 2020). Therefore, the intelligent hospital realisation is
highly likely to improve the socio-economic status.
On the other hand, there are several challenges in the use of AI and the concept of intelligent
hospitals. Firstly, the current weakness in the usage of AI in managing health data is still
fragmented. The public and private sector partnership in healthcare governance is beneficial in
sharing the biomedical data across the field. However, the gap that is still needed to be discussed
regarding the evolutions of AI. The gap involves automated medical coding and capturing AI-
based information, healthcare data management and data governance, patient privacy and
confidentiality and health information management (HIM) workforce training and education
(Stanfill & Marc, 2019).
Secondly, the working group on the development of an intelligent hospital involves diverse
professionals including clinicians, manufacturers, regulators, public policy and civil rights
organisations to lead the healthcare AI (Donovan, 2019). With such a large group, the
stakeholders' opinions can vary in the creation of an intelligent hospital (Laï et al., 2020). There
may
Thirdly, to enable the formation of an intelligent hospital, the overall costs may be very high.
It includes spending on tags, software, RFID infrastructure maintenance and personnel training
and third-party consultant involvement (Frisch, 2014). This highly intelligent technology also
comes with high maintenance cost and high electrical usage.
Fourthly, the use of RFID tags may influence medical equipment, such as defibrillators and
pacemakers (Boris, 2018). Sometimes defective equipment, such as a faulty sensor can emit
radio-frequency signals that affect the signal transmission process. The RFID system itself may
also cause electromagnetic intrusion (EMI) to other healthcare devices and systems, causing
system error (Frisch, 2014). Furthermore, diligence testing and evaluation of this system must
be enforced to ensure patient safety.

Lastly, even though AI application would significantly make many tasks more manageable,
there are ethical concerns associated with it (Hamet & Tremblay, 2017). Privacy issue in the AI
integration system cannot be overlooked since it is associated with patient confidentiality.
Privacy-associated legislation needs to be revisited and revised so that AI and its impact on data
privacy would be mutual from patient and healthcare perspective (Ahuja, 2019).
This review has some limitations. This review is descriptive in nature. There is no known recent
comprehensive systematic review on intelligent hospital to date, and many AI technologies in
healthcare still need further research before it can be fully implemented.
4.1 Conclusion
Integration of artificial intelligence into healthcare services in the hospitals hence creating the
intelligent hospitals, is the way to go. The benefits of having AI in intelligent hospitals seem to
outweigh the disadvantages. Integration of technology and science in the healthcare delivery
will reduce human-related error, improve patient satisfaction, assist healthcare personnel in
achieving better health results, and provide a better, safe, and efficient healthcare services. It is
highly recommended for healthcare professionals to be aware of and be up to date with the
development of AI technology in the healthcare setting and the pursuit of creating and managing
intelligent hospitals.
Acknowledgement
This review is a project done for the completion of the Master of Public Health programme.
The authors would like to acknowledge Universiti Putra Malaysia for their institutional support.
Declaration
The authors have no conflict of interest to declare.
Authors contribution
Author 1: information gathering, preparation and editing of the manuscript
Author 4: final review of the manuscript and final editing

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THE APPLICATION OF ARTIFICAL INTELLIGENCE (AI) IN HIGHLY

Article · November 2021

Nur Adibah Shaharul Aidalina Mahmud

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THE APPLICATION OF ARTIFICAL INTELLIGENCE (AI) IN

*Corresponding author: Dr Aidalina Mahmud

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 1

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 2

Table 1: Components of the Intelligent Hospital

Clinical Services Non-Clinical Services

2.0 Materials and Methods

3.1. Clinical component of the intelligent hospital

3.1.1 Electronic Medical Record

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 3

3.1.2 Triaging Patient Management

3.1.3 Patient appointment

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 4

3.1.4 Patient management

3.1.5 Doctor Management

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 5

3.1.6 Operation Theatre Management

Another application of AI in a hybrid OR is computer vision (CV), which is defined as a visual

3.1.7 Pathological Specimen Management (Laboratory)

Another role of AI in the pathology laboratory is in the visual examination of biospecimen

3.1.8 Radiology department

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 6

3.2 Non-clinical component

3.2.1 Data management

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 7

3.2.2. Smart Asset Management

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 8

3.2.4 Billing management

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 9

Figure 2: The interconnected system in non-clinical services of an intelligent hospital

3.3 Real-life examples of Intelligent Hospitals in Asia

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 10

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 11

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 12

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 13

Bumrungrad International Hospital. (2018). Bumrungrad Application l Bumrungrad Hospital.

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 14

practices: Opportunities and challenges. Conference on Human Factors in Computing

Donovan, F. (2019). Healthcare Artificial Intelligence Group Forms to Set Standards.

Frisch, P. (2014). What is An Intelligent Hospital. IEEE Pulse, 5(6), 10–15.

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 15

SD Global. (2020). SD Global | Malaysia's Smart Hospital | IoT | Artificial Intelligence.

Spyropoulos, C. D. (2000). AI planning and scheduling in the medical hospital environment.

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 16

Stanfill, M. H., & Marc, D. T. (2019). Health Information Management: Implications of

Techsauce Team. (2019, October). Bumrungrad moves forward implementing medical

WHO. (1963). Expert Committee on Health Statistics. In World Health Organization

Nur Syarah Zulaikha Mr, Nur Adibah S, Nurulain Ab, Aidalina M 17

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