Hospital as a Platform: API-First Healthcare Ecosystems Where AI Agents Coordinate Multi-Institutional Care Pathways

Abstract

The traditional hospital model is increasingly strained by fragmentation, workforce shortages, and rising chronic disease burdens. This narrative review and conceptual framework proposes redefining hospitals as modular nodes within API-first digital platforms. Drawing on platform economics (Uber/Airbnb analogies), HL7 FHIR interoperability standards, and emerging agentic AI capabilities, the article introduces the Hospital-as-a-Platform model. In this architecture, autonomous AI agents orchestrate dynamic, patient-centric care chains across multiple institutions, enabling seamless coordination, optimized resource utilization, and continuity beyond institutional boundaries. Managerial implications include revenue diversification through platform participation, while applications encompass revolutionized global health tourism via algorithmically matched cross-border pathways. By 2035, hospitals are envisioned as hybrid physical-digital platforms, where physical infrastructure supports high-acuity needs and AI-driven orchestration handles the majority of coordination. The framework offers a strategic blueprint for healthcare leaders to transition toward resilient, ecosystem-centric delivery systems.