The study, conducted by Neda Hoseini Abforosh, Hasan Abolghasem Gorji, and Naser Derakhshani of Iran University of Medical Sciences, set out to clarify the criteria and standards needed to guide the design, implementation, evaluation, and management of smart hospitals. The researchers followed the well-established scoping review framework developed by Arksey and O’Malley, a methodology designed to map the breadth of literature on a topic and identify key concepts and gaps rather than answer a single narrow clinical question. Their search spanned five major databases: PubMed, Scopus, Web of Science, Embase, and ProQuest, covering publications from 2000 through 2024.

The scale of the initial search illustrates just how rapidly this field has grown. The team identified 3,676 publications over the twenty-four-year window, a testament to the explosion of interest in digital transformation within healthcare. After rigorous screening against eligibility criteria, only 43 papers made the final cut. To be included, studies had to focus specifically on standards and requirements for smart hospital design, implementation, evaluation, or management. That steep attrition rate, from nearly four thousand records to fewer than fifty relevant papers, tells its own story: despite enormous enthusiasm, the literature on formal smart hospital standards remains surprisingly thin and fragmented.

From those 43 papers, the researchers distilled six main themes encompassing 29 sub-themes, a framework they describe as the essential DNA of the smart hospital. The first theme, Smart Technological Infrastructure, contains five sub-themes and covers the foundational digital backbone of any intelligent facility: computing systems, networks, interoperability, and the data platforms on which everything else depends. Without robust and seamlessly connected infrastructure, even the most sophisticated clinical applications cannot function reliably. The emphasis on interoperability reflects a long-standing pain point in health informatics, where electronic health records, health management information systems, and integrated hospital information systems often fail to communicate with one another, creating data silos that undermine the very intelligence a smart hospital is meant to deliver.

The second and largest theme, Smart Services Delivery and Patient Interaction, comprises eight sub-themes and shifts the focus from technology itself to how technology transforms care. This domain captures the ways patients actually experience a smart hospital: telemedicine consultations, remote monitoring, mobile health applications, automated appointment and triage systems, and personalized care pathways driven by data analytics. It also encompasses the clinical side, including AI-assisted diagnostics and decision support tools that augment rather than replace clinicians. The prominence of this theme in the review underscores a crucial point that experts in health services research have long emphasized: a smart hospital is not defined by the quantity of gadgets it owns but by whether those technologies measurably improve the patient journey and clinical outcomes.

The third theme, Operational Management and Administration, includes three sub-themes addressing the managerial machinery behind the scenes. Smart hospitals generate enormous volumes of operational data, from bed occupancy and staffing levels to supply chain movements and equipment utilization. The review highlights standards for using this data to optimize resource allocation, streamline workflows, and support evidence-based administrative decisions. Radio frequency identification technology, for example, enables real-time tracking of assets, medications, and even patients through hospital corridors, reducing losses and errors. Building information modeling, known as BIM, extends this intelligence into the physical plant, allowing facility managers to simulate and manage complex building systems with unprecedented precision.

The fourth theme, Regulatory and Maturity, contains four sub-themes and addresses one of the most underappreciated dimensions of the field: governance. The review points to frameworks such as the Joint Commission of Taiwan’s Smart Healthcare Standard, or JCT-SHS, as examples of formal certification schemes that grade hospitals on their digital maturity. Maturity models allow institutions to assess where they stand on the continuum from conventional to fully intelligent operations and to chart a realistic roadmap for progress. The researchers note that regulatory structures are essential for accountability, ensuring that claims of smartness can be independently verified rather than self-declared. This matters for policymakers and investors alike, who need trustworthy benchmarks before committing resources to large-scale digital transformation projects.

The fifth theme, Safety Infrastructure, spans three sub-themes and confronts the risks that come with connectivity. A hospital saturated with networked devices is a hospital with an expanded attack surface for cyberattacks, and healthcare has become one of the most targeted sectors for ransomware and data breaches. The review emphasizes standards for cybersecurity, data privacy, and patient safety safeguards as non-negotiable components of smart hospital design. Safety in this context extends beyond digital threats to include the reliability of AI-driven clinical tools and the resilience of systems on which life-critical functions depend. The authors’ inclusion of safety as a standalone pillar signals a maturing understanding that intelligence without security is a liability rather than an asset.

The sixth theme, Smart Buildings and Environmental Infrastructure, comprises six sub-themes and grounds the digital hospital in its physical reality. Smart hospitals require intelligent heating, ventilation, and air conditioning systems that respond dynamically to occupancy and infection control needs, energy management systems that reduce costs and carbon footprints, and sensor-rich environments that monitor everything from air quality to asset location. This theme reflects a holistic vision in which the building itself is an active participant in care delivery, not merely a container for technology. The researchers argue that integrating all six themes is essential for a comprehensive, multi-dimensional understanding of smart hospital standards, warning that partial approaches that focus on technology alone will fall short.

Perhaps the most consequential message of the review lies in its framing of smart hospitals as complex health-system transformations rather than simple technology upgrades. The authors conclude that technological advancement is inseparable from organisational, human, infrastructural, regulatory, and managerial capacities. A hospital cannot simply purchase intelligence; it must cultivate the workforce skills, governance structures, cultural readiness, and financial models that allow digital tools to take root. The findings offer practical insights for policymakers, hospital managers, healthcare administrators, and investors seeking informed decision-making in the development, implementation, and assessment of smart hospitals, and the authors suggest that applying these standards could ultimately contribute to the evolution of healthcare systems globally. As hospitals worldwide continue their digital march, this framework provides something the field has conspicuously lacked: a shared map of what smart truly means.

Subject of Research: Standards and indicators for smart hospital design, implementation, evaluation, and management

Article Title: Crafting the DNA of smart hospitals: decoding standards and indicators through a scoping review

Article References: Hoseini Abforosh, N., Gorji, H. A., & Derakhshani, N. (2026). Crafting the DNA of smart hospitals: decoding standards and indicators through a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15747-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15747-w

Keywords: smart hospitals, scoping review, health informatics, digital transformation, interoperability, artificial intelligence, Internet of Things, healthcare standards, hospital management, cybersecurity, smart buildings, telemedicine