1) Hospital-at-home models are moving from pilot programs to scalable care pathways. What structural, clinical, and policy-level changes are required to make remote acute care a mainstream alternative rather than a supplementary service?
Dr. César Morcillo Serra: For hospital-at-home models to become a mainstream alternative, structural, clinical, and policy-level transformations must converge. Structurally, health systems need integrated digital infrastructures that allow seamless data sharing across acute, community, and social care. Clinically, clear eligibility criteria, standardised care pathways, and escalation protocols are essential to ensure safety comparable to inpatient settings. From a policy perspective, hospital-at-home should be formally recognised as acute care, not an adjunct service, with aligned accreditation, reimbursement, and liability frameworks. Without explicit regulatory recognition and operational clarity, these models risk remaining marginal, rather than becoming a core component of modern healthcare delivery.
2) How can healthcare systems ensure robust clinical governance, patient safety, and accountability when care is delivered outside traditional hospital environments?
Dr. César Morcillo Serra: Delivering acute care at home requires governance models that are as rigorous as those within hospital walls. This starts with clearly defined clinical accountability, robust protocols, and continuous monitoring supported by digital tools. Standardised escalation pathways, audit mechanisms, and outcome measurement, including safety events and patient-reported outcomes, are critical. Governance must also extend to the home environment itself, assessing social, cognitive, and logistical factors that impact risk. Crucially, transparency in decision-making, documentation, and communication with patients and families underpins trust. When governance frameworks are intentionally designed, hospital-at-home can match, and in some cases exceed, traditional inpatient safety standards.
3) With the rapid expansion of remote monitoring tools, AI platforms, and digital health solutions, what are the biggest interoperability challenges, and how can organizations avoid fragmented care delivery?
Aline Noizet: The rapid expansion of digital health is hindered by three primary interoperability challenges: the persistence of isolated data silos, the disruption of established workflows, and a lack of coordination between key actors. To avoid fragmented care delivery, organizations must intentionally fit digital solutions into existing care pathways and user journeys to ensure they are intuitive rather than disruptive. Success requires aligning all stakeholders around a clear, central problem and prioritizing platform compatibility to bridge silos, ultimately creating a seamless, unified experience for both clinicians and patients.
4) How can AI-driven predictive analytics be effectively leveraged in hospital-at-home models to enable early intervention while minimizing alert fatigue among clinicians?
Aline Noizet: AI-driven predictive analytics can strengthen hospital-at-home models by transforming continuous remote monitoring data into early actionable insights. By detecting subtle physiological changes before symptoms worsen, AI enables earlier intervention and helps prevent avoidable deterioration. To be effective, these systems must be designed to support clinical workflows. Minimizing alert fatigue requires personalized thresholds tailored to each patient’s baseline, combined with intelligent prioritization such as color-coded risk stratification to distinguish urgent issues from low-priority ones. Predictive insights should be embedded directly into existing clinical workflows and surfaced through a single, unified interface.
5) What operational and workflow changes are necessary to transition care from hospital to home while maintaining efficiency and preventing clinician burnout?
Dr. César Morcillo Serra: Transitioning care from hospital to home fundamentally reshapes clinical workflows. Success depends on redesign rather than simple transfer of existing processes. Multidisciplinary teams require clear role definitions, supported by digital coordination tools and streamlined documentation. Asynchronous monitoring, proactive outreach, and well-defined handoffs reduce unnecessary workload and cognitive burden. Equally important is protecting clinician wellbeing by avoiding always-on expectations and ensuring predictable rotas and escalation support. Hospital-at-home should not rely on informal heroics but on sustainable operating models. When workflows prioritise clarity, automation, and team-based care, efficiency improves while preserving professional satisfaction.
6) As care becomes increasingly technology-mediated, how can providers preserve empathy, trust, and meaningful patient-clinician relationships in a virtual-first environment?
Dr Céline Orhond: Preserving empathy and trust starts with how we design the care organization, not with the tools themselves. Hospital-at-home must be co-designed with patients and be truly patient-centric. Focusing on patient experience is essential to ensure patient engagement because staying at home can be reassuring but also anxiety-provoking.
To build trust, we need clear, transparent communication, time to explain choices and dedicated contact points for patients and relatives (chat, phone number…). Reassuring patients' relatives is key too as the burden is important for them.
Simple digital tools, like patient portals and AI assistants can help answer questions in real time and reduce friction.
Another crucial point is monitoring vital signs continuously, because it’s a good way to reassure patients and their relatives when the results are explained.
Ensuring fluid communication between at home professionals and hospital professionals is essential; it ensures that all the professionals work together, share the same procedures and communicate easily. It builds patients’ trust in the system.
7) What strategies can ensure strong patient engagement, adherence, and satisfaction, particularly among elderly populations or those with limited digital literacy?
Dr Céline Orhond: Strong engagement means treating patients as true partners in the design and day-to-day use of remote care. That includes co-building pathways with patients and their representatives from the start and testing tools with all types of patients, including those with low digital literacy.
In my experience, many older people have relatives to help them and time to engage; the real risk is for socially vulnerable patients who are alone, around 20% in many programmes, from the USA to France.
We need very simple, ux friendly interfaces, clear instructions and alternatives for those who struggle with technology: an organization dedicated to proactively helping patients with special needs. AI and technology must save time for professionals, so they can devote more attention to patients with special needs.
Furthermore, providers need to focus on continuous feedback like satisfaction questionnaires and real time indicators of use.
8) Hospital-at-home models risk widening disparities due to unequal access to technology and connectivity. How can healthcare systems design inclusive and equitable remote care frameworks?
Aline Noizet: Healthcare systems must build equity into remote care design from the beginning. This starts with selecting technologies that are simple, intuitive, and accessible across diverse patient populations. Devices should support multilingual interfaces, intuitive ergonomics, and function reliably even in low-connectivity environments, particularly in rural or underserved regions where internet access remains limited. Inclusive design also requires actively involving healthcare professionals, patients, and caregivers in the development process to ensure solutions reflect real clinical and patient needs. Beyond deployment, organizations should establish continuous feedback loops to identify usability barriers, monitor adoption across demographic groups, and adapt rapidly when gaps emerge.
9) With sensitive health data being transmitted from patients’ homes, what are the emerging cybersecurity risks, and how can organizations build patient-centric, trust-driven data protection frameworks?
Dr Céline Orhond: For patients, cybersecurity is first a question of trust, not of technical standards. Many will never read a security policy, but they will remember whether someone took time to explain what happens to their data and who is responsible for protecting it.
We need to focus on 3 priorities: first systematically informing patients and caregivers at onboarding about data flows and access with practical advice; this is a public health objective, just like digital and health literacy for all citizens. Secondly, embedding privacy by design by collecting only what is necessary and allowing patients to easily view and change their preferences. And finally, making governance visible with a clear data protection contact and transparent communication about incidents and patient feedback.
10) What reimbursement structures and payer models are necessary to sustainably support hospital-at-home programs, particularly across diverse healthcare systems?
Dr. César Morcillo Serra: Sustainable hospital-at-home programmes depend on reimbursement models that recognise value rather than location. Payment structures must reflect avoided admissions, reduced complications, and improved patient experience, rather than fee-for-service encounters alone. Bundled payments or episode-based models are often better suited, provided they include clear quality and safety metrics. In mixed or fragmented systems, alignment between payers, providers, and regulators is essential to prevent incentives that favour inpatient care by default. Without reimbursement parity and long-term predictability, hospital-at-home risks becoming innovation theatre rather than a viable, scalable model of care.
11) What digital and operational infrastructure investments are critical to scaling hospital-at-home programs without compromising care quality?
Aline Noizet: Scaling hospital-at-home requires strong digital and operational infrastructure working in parallel. On the digital side, interoperable platforms are essential to enable seamless data exchange across different remote monitoring tools, hospital systems, and EHRs. These platforms must be supported by secure connectivity, standardized data flows, and workflows that allow clinicians to access information efficiently. Operationally, healthcare systems need standardized care pathways and multidisciplinary teams trained to interpret data, manage escalation protocols, and deliver coordinated care and follow-up. Equally important is the physical infrastructure that supports care outside hospital walls: rapid device deployment, technical troubleshooting, home support logistics, and clear emergency protocols for patient transport or in-person intervention.
12) How does remote care reshape collaboration between physicians, nurses, caregivers, and allied health professionals, and what best practices can enhance coordinated care delivery?
Dr Céline Orhond: Remote care pushes us to move from doctor centred models to truly team based care where home workers, hospital professionals, physicians, nurses and other professionals collaborate as equal decision-makers. It’s a more horizontal way of working where trust is central.
Care procedures need to be co-built and standardized. They must be easily accessible, respected and followed. Everyone needs to agree on them and to know what they have to do, when and how.
Communication must be structured : a shared EHR to ensure that everyone access and complete the same real time information, regular multidisciplinary reviews including home based teams and digital tools designed to support coordination rather than add complexity.
13) Given the variability in regulatory frameworks across regions, how can standardization be achieved to ensure consistent quality and safety in hospital-at-home services?
Dr. César Morcillo Serra: While regulatory frameworks vary widely across regions, standardisation can be achieved through shared clinical principles rather than identical rules. International consensus on minimum safety requirements, governance standards, data protection, and quality indicators would provide a common foundation. Professional societies and international health bodies can play a key role in defining these benchmarks, enabling local adaptation without compromising quality. Importantly, regulation should focus on outcomes and processes rather than prescribing specific technologies. Standardisation built around safety, accountability, and patient experience allows innovation to flourish while ensuring consistency across borders.
14) Looking ahead, how do you envision the balance between in-hospital and home-based care evolving, and what role will emerging technologies such as virtual wards, IoT, and digital twins play?
Aline Noizet: Healthcare is moving toward a hybrid model in which hospitals focus more and more on high-acuity interventions, complex procedures, and critical care, while a growing share of monitoring, recovery, and chronic disease management shifts into the home. Hospital-at-home will become a core extension of care delivery rather than a parallel model. Emerging technologies will accelerate this transition. IoT devices will continuously capture real-world patient data and digital twins will allow clinicians to simulate treatment pathways on virtual patients to personalize care and anticipate deterioration. Agentic AI will further support this model by acting as a digital care assistant for both patients and caregivers, reinforcing adherence.
Closing Question for all panellists:
What is one critical barrier that must be addressed in the next 2–3 years to unlock the full potential of hospital-at-home models—and who should take the lead in solving it?
Cesar: The most critical barrier to unlock the full potential of hospital-at-home in the next two to three years is cultural, not technological. Many systems still equate safety and quality exclusively with physical hospital environments. Overcoming this requires strong clinical leadership, supported by policymakers, to redefine what “acute care” means in a digital era. Clinicians must trust the model, patients must understand it, and organisations must embed it as standard practice. Leadership from healthcare professionals, grounded in evidence, outcomes, and patient experience, will be decisive in shifting mindsets and sustaining momentum.
Aline: The most critical barrier is the lack of a permanent, standardized reimbursement framework. To unlock the full potential of hospital-at-home models, governments and payers must take the lead by establishing clear billing codes specifically adjusted for remote care. These frameworks must recognize healthcare professionals time and the underlying digital infrastructure, moving beyond temporary pilot status to become a foundational part of the care pathway. Without this financial clarity, health systems cannot sustainably scale, making permanent, value-based payment models essential to integrating home-based care into the mainstream.
Céline: From my perspective, the critical barrier is organisational : we’re not yet able to organise care around the patient and to remove the existing silos between the healthcare professionals, whatever their profession and their status. Mentalities have changed, patients don’t want to stay in hospital if it’s not absolutely necessary and the cost of hospital care forces us to rethink the idea that inpatient care is always the best option. Furthermore, all countries face a shortage of professionals. All that obliges us to redesign patient pathways and cooperation between professionals. We need to invest seriously in shared information systems, time for coordination and change management, not only new devices.
