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

The research team, drawn from the University of Leipzig, the German Research Center for Artificial Intelligence, Charité in Berlin, SurgiTAIX AG, Vodafone’s Tech Innovation Center in Dresden and RPTU Kaiserslautern-Landau, conducted semi-structured interviews between August 2023 and May 2025. Participants came from clinical fields including anesthesiology, cardiology, internal medicine, pulmonology and sleep medicine, as well as from the medical technology and health IT sectors. Each interview lasted between 32 and 47 minutes, followed the COREQ reporting checklist for qualitative research, and was transcribed with OpenAI’s Whisper speech recognition system. For the analysis, the researchers used a combined deductive-inductive thematic approach, employing the Llama 3.1 8B Instruct language model to generate preliminary transcript summaries that were then manually reviewed and corrected against the original recordings. Five initial categories came from the interview guide itself, and three more emerged from the data.

The starting point of the study is a sobering diagnosis of the present. Even before 6G arrives, hospitals struggle with insufficient interoperability, fragmented IT systems and unreliable network coverage. Devices are frequently tethered by cables, data must often be moved by hand between incompatible systems, and documentation consumes time that clinical staff, working under chronic shortages, do not have. These problems matter because the demographic shift between patients and practitioners is intensifying, making efficiency gains from digital transformation not a luxury but a necessity. Remote health solutions, automation and artificial intelligence all depend on communication networks capable of moving massive data volumes in real time with guaranteed reliability.

Against that backdrop, the stakeholders’ expectations for 6G are strikingly concrete. They anticipate higher data rates, ultra-low latency, broader coverage, the capacity to connect vastly more devices simultaneously, enhanced encryption and lower energy consumption. In practical terms, they envision real-time transmission of vital signs, imaging data and other medical information supporting live consultations, remote diagnostics and tele-supervision in operating rooms and emergency departments. Continuous home-based monitoring could accelerate clinical decision-making and improve patient safety. They also see 6G as a driver of workflow optimization: standardized device communication, mobile ward rounds, integrated patient and equipment tracking, and automated documentation assisted by large language models. Improved connectivity, they argue, is essential for efficient hospital operations and optimal resource allocation.

The study drilled into three specific use cases. The first involves artificial heart systems such as mobile ventricular assist devices, where stakeholders demand maximum fail-safety, reliable alarms and stable data transmission supported by proactive network monitoring and seamless coverage beyond hospital walls. They stressed transparency with patients about network stability and ensuring emergency connectivity with ambulance services, but flagged unresolved liability questions when automated systems fail. The second covers augmented and virtual reality applications, viewed positively for training and surgical support, though participants worried about distraction and information overload in daily practice. The third is smart hospital tracking: asset and material tracking drew broad enthusiasm for efficiency gains, patient tracking was deemed useful in specific scenarios such as surgical logistics, fall prevention and dementia care, but staff tracking was predominantly regarded critically, touching a raw nerve about surveillance in the workplace.

The concerns expressed were equally pointed. Data protection and privacy emerged as the single most critical challenge, encompassing fears of data misuse, cyberattacks and ambiguous patient consent for data use, along with skepticism about centralized data storage. Some participants found the European GDPR overly restrictive for medical innovation, while others defended strict local data handling and access controls. Responsibility and liability in the context of increasing automation and AI-supported decision-making remain unsolved, and stakeholders called for a clear framework defining who is accountable when technical malfunctions occur. There was also anxiety about technological dependency itself: if practitioners lose the skills to treat patients without technical assistance systems, any system shutdown could degrade care quality. Manual backup procedures, paradoxically, were seen as necessary to sustain trust in automated ones.

Acceptance, the study found, is deeply individual and hinges less on the technology itself than on perceived usefulness and honest communication of benefits. Reactions ranged from outright rejection to enthusiastic adoption, largely determined by reliability. Key barriers included limited transparency, poor communication and restrictive regulation, with misinformation amplifying uncertainty. Notably, many interviewees worried more about user errors caused by complex, unintuitive interfaces than about external cyberattacks, particularly under staff shortage and time pressure. This led to a strong emphasis on intuitive system design, redundancy for monitoring and diagnostic systems, and graceful degradation that preserves essential functionality during failures. Stakeholders also prioritized low latency over raw bandwidth for timing-critical scenarios such as remote surgery and remote control, and demanded deterministic, real-time communication with immediate alerts and automated emergency responses during network outages.

Synthesizing these findings, the authors derived five recommendations for technology providers. Interoperability comes first: open interfaces, shared data models and transparent standards are needed to end redundant documentation and proprietary lock-in. Second, network coverage and reliability are prerequisites for everything else, including robust connectivity in rural areas where telemedicine is growing; as one participant put it, the infrastructure must guarantee a stable and fast connection outside major cities. Third, awareness and trust must be actively built through transparent, comprehensible information about functionality, limitations and risks, coupled with clear explanations of system behavior during failures. Fourth, usability must be a central design criterion, adaptable to varying levels of technical proficiency. Fifth, technological performance must be balanced against sustainable energy use, because, as one technical stakeholder observed, it would be impractical if every device required an additional power bank. Continuous real-time monitoring can drain battery-powered sensors, so power-aware scheduling must be weighed against clinical needs for uninterrupted data transmission.

Ultimately, the study frames the hospital of the future not as a hyper-connected machine but as a resilient, people-centered ecosystem in which technology serves as an enabler of care. The authors emphasize that purely technical performance metrics, such as higher data rates or lower latency, only matter when they solve real clinical problems. The introduction of 6G should be understood as a co-evolutionary process between technology and healthcare practice, requiring ongoing dialog and co-design; as one physician put it, clinical users should develop more IT skills while IT developers should spend more time in clinics. The researchers acknowledge limitations: the LLM-assisted analysis saved less time than expected due to validation overhead, demographic characteristics were not systematically collected, and all interviews took place within the German healthcare system, which may limit transferability. Future work should adopt a multicentric, international scope and extend beyond the hospital to general practitioners and emergency medical services. But the core message stands: if engineers want 6G to transform medicine, they must start listening to medicine now, while the standard is still being written.

Subject of Research: Stakeholder perspectives on 6G technology requirements for healthcare and future hospitals

Article Title: Anticipating the hospital of the future: stakeholder perspectives on 6G technology requirements in health care

Article References: Schatz, A., Rüb, M., Hegermann, H., Hiddemann, M., Wieschebrock, D., Stegemann, D., Herbst, J., Lipps, C., Möllenhoff, C., Petzold, T., Irmer, R., Köhler, F., Rockstroh, M., Pabst, T., Neumuth, T., Schotten, H. D., & Treskatsch, S. (2026). Anticipating the hospital of the future: stakeholder perspectives on 6G technology requirements in health care. International Journal of Computer Assisted Radiology and Surgery. https://doi.org/10.1007/s11548-026-03776-z

Image Credits: AI Generated

DOI: 10.1007/s11548-026-03776-z

Keywords: 6G, smart hospitals, healthcare, interoperability, telemedicine, clinical workflows, data protection, network reliability, medical technology, artificial intelligence, remote monitoring, standardization