Hospitals teamed up and hired doctors as technology changed healthcare delivery.

If one word could be used to describe changes in the local healthcare scene over the past 25 years, it would be expansion.

Expansion of hospital systems. Expansion of physical footprints. Expansion in the scope of healthcare delivery. Expansion in knowledge.

Twenty-five years ago, Doctors, Grant, Riverside and St. Ann's all were independent hospitals. Children's Hospital took up a relatively small portion of real estate along Livingston Avenue. Ohio State University Hospital occupied space that is dwarfed by the current medical center complex.

Mercy and St. Anthony hospitals served populations on the south and east sides of Columbus, respectively.

Today, Doctors, Grant and Riverside all bear the name of their corporate parent, OhioHealth. St. Ann's is part of the Mount Carmel Health System.

St. Anthony now is Ohio State University Hospital East. Mercy became Columbus Community Hospital in 2001, then closed the same year due to financial problems.

Now occupied by Select Specialty Hospital, the building at 1403 S. High also will house a 55-bed addiction treatment center this fall. Maryhaven will operate the center to try to meet the desperate need for addiction detox and recovery brought about by central Ohio's growing opioid crisis.

Locally, hospital growth has included the opening of hospitals within hospitals, specializing in heart and vascular conditions, cancer, neuroscience and orthopedics. Construction is a constant.

Neighborhood health centers, freestanding emergency rooms and specialty clinics sprout up regularly on the central Ohio landscape. And, in addition to growth around the I-270 Outerbelt, hospital systems continue their push into contiguous counties and beyond. Some of the larger ones have a presence in dozens of Ohio counties and affiliate with other systems, such as Cleveland Clinic.

The explosion of mergers and acquisitions has its origin in part due to managed care and changes in third-party reimbursement that began in the 1990s.

By consolidating, “hospitals found they had better negotiating power, and were able to lower costs and benefit from efficiencies through elimination of duplicative services,” says Jeff Klingler, president and CEO of the Central Ohio Hospital Council. And increased market share helps the corporate bottom line.

Besides physical and corporate hospital expansion, several other developments have marked the last 25 years in the central Ohio healthcare sector.

Patients and doctors alike aren't to blame if they have trouble keeping up with the dizzying pace of technology advancement, which seems to change overnight.

Some of the more notable developments:

Electronic medical records give providers access to the same information, which has the potential to eliminate cumbersome paperwork, duplication and mistakes.

Smartphones seem to get smarter every day. With them, doctors can look at images, consult with peers and use specialized software to help them with clinical decision-making. Columbus-based CrossChx even allows people to securely store medical history, prescriptions and other information on their phones using a downloadable app.

Telemedicine and telepsychiatry can bridge gaps and help meet healthcare needs among underserved populations, as well as allow physicians to collaborate across the miles.

The ubiquitous tracker, once used primarily for fitness, now runs the gamut. Patients can monitor myriad conditions, including mood, pain, migraines, water consumption, heart rhythm, ovulation, and autoimmune disorder symptoms.

More and more physician-practice websites feature portals, where patients can view test results, receive reminders and schedule appointments.

Then there are changes on the business side.

“Where have you gone, Marcus Welby?” is a refrain that comes to mind for Tim Maglione, a 24-year veteran of the Ohio State Medical Association. Maglione is referring to the disappearance of the sole practitioner running his or her business independently from top to bottom.

In the last 25 years, the number of physicians who are employed by hospital systems has grown exponentially. Most choose that route because it frees them from many of the administrative burdens that have come with managed care. It also can provide access to a larger network of specialists, technology and expertise.

The administrative “hassle factor” also has spawned businesses designed to help physicians deal with the hurdles they may face with reimbursement and other issues. Founded in 2008, Columbus-based CoverMyMeds electronically automates the prior authorization process for medications by working with electronic health record systems, health plans, pharmacy systems and providers. Earlier this year, the company entered into an agreement with McKesson Corporation to be acquired for $1.1 billion.

On the other end of the ownership spectrum have been attempts by physicians to own and operate specialty hospitals. An orthopedic hospital was built in New Albany over opposition; legislation passed at the federal level prohibits any further such physician-owned hospitals, Maglione says.

And groundbreaking new technologies push the frontiers of medicine.

Researchers at The Ohio State University Wexner Medical Center and OSU's College of Engineering recently developed a nanochip that uses a small electrical current to deliver new DNA or RNA into living skin cells, “reprogramming” them and giving them a new function. Known as Tissue Nanotransfection (TNT), the technology can generate any cell type of interest for treatment within the patient's own body. It may be used some day to repair injured tissue or restore function of aging tissue, including organs, blood vessels and nerve cells.

Elsewhere, bioprinting uses inkjet printer technology to produce different cells types, which could eventually be used to produce organ tissue. Researchers are working with kidney and liver tissue, skin, bones and cartilage, as well as the networks of blood vessels to keep body parts alive.

Where we get medical care is also different. It has expanded from the doctor's office to the neighborhood grocery store and pharmacy. It's another way the sector is reaching out directly to consumers.

Also in the last couple of decades, several hospitals have added on to their names, typically to reflect corporate ownership or sponsorship as well as prominent benefactors. Some examples: Bing, McConnell, Nationwide, Ross, Solove and Wexner.

Laurie Allen is a freelance writer.

Our look-back stories in 10 key sectors show the only constant of the past quarter century has been tremendous growth and change.