Introduction

The current healthcare system is often compared to the 19th-century cottage industry. The US healthcare delivery system is described as expensive, fragmented, highly decentralized and poorly organized. Why has a sector that can be traced back to the medieval era still be so inefficient? How is Information and Communication Technology (ICT) driving the sector towards better care through prevention? What are the key challenges faced by the sector today?

I come from a healthcare background and I have always been interested in the influence ICT has on healthcare. This blog aims to provide an insight into this complex sector and analyze how ICT is changing the healthcare sector.

Healthcare Information Technology: The Push and Pull

There has been significant progress in developing and evaluating computer applications aimed at improving personal health and healthcare and this often referred to as “medical informatics”: the intersection of information technology (IT) and medicine. By focusing on healthcare that is predictive, preventive, personalized and participatory (P4 medicine) new frontiers in Healthcare Information Technology (HIT) are emerging. However, the road to successful implementation of IT has been challenging, with strong factors pushing it up the path of progress while simultaneously pulling it down.

The Push for HIT

“Prevention is Quality. Prevention lowers cost”. The healthcare sector will save trillions of dollars if healthcare is made convenient while simultaneously improving quality and lowering cost. While this sounds difficult, it is not an impossible task. According to Robert Pearl during his speech at the 8th Annual American Health Care Congress, sending secure email to physicians and getting almost immediate diagnosis increases productivity by $28,000/year. Only a few minutes are required to make initial medical assessment and there is no need to meet the physician in person. In areas such as dermatology, 70% of the patients received care almost immediately because of sending information safely and securely via internet.

Another emerging sector in HIT is mobile apps. This sector aims to better connect medical professionals with patients and decrease the divide between patient, doctors and nurses. The technology also aims to improve the flow of information among the medical community by allowing doctors and nurses in the same health institution to communicate efficiently and provide the right medical treatment at the right time.

Hurdles faced by HIT

The barriers to shifting healthcare to a predictive and preventive system includes costs, technical issues, system interoperability, concerns about privacy and confidentiality, and lack of a well-trained clinical informatics workforce to lead the process.

While there is an increased demand for HIT, its development has been rather slow. Evaluation by means of randomized controlled trials (RCT) has not yet provided any major indications of improved patient outcomes or cost effectiveness. The evaluation technique adopted has a severely negative impact on the progress of information as clinical information technology is not comparable to a drug and cannot be evaluated using randomized controls. The major drawbacks to using RCT is cost and difficulty related to external validity. Further, a negative result from such trails do not provide any constructive feedback as it does not help us understand the effects of the clinical system or help us build better ones in the future.

In conclusion, HIT is a disruptive technology that has the potential to steer the healthcare system towards the path of success if IT and healthcare are able to more easily merge to form one cohesive sector.

References:

http://www.youtube.com/watch?v=Ws37ra7FIg

Dr. Robert Pearl's speech at the 8th Annual American Health Care Congress

http://www.bmj.com/content/316/7149/1959

The article “Evaluating information technology in health care: barriers and challenges” evaluates the issues faced by clinical informatics

http://medicalcenter.osu.edu/about

http://medicalcenter.osu.edu/aboutus/personalized_health_care_stories/Pages/index.aspx

Impact of ICT on healthcare

ICT is not a novel technology; it is a continuous improvement of computing and communication. The combination of ICT and Healthcare has ushered in a new field called “e-health” that impacts each and everyone of us: payers, providers, practitioners and patients.

E-health is the “a concerted effort undertaken by leaders in health care and hi-tech industries to fully harness the benefits available through convergence of the Internet and healthcare”. This emerging sector aims to address three main communication networks. The “Business to Consumer“ (B2C) section aims to improve the interaction of consumers with the system, the “Business to Business” (B2B) aims to enhance the institution-to-institution transmission of data and the “Consumer to Consumer” (C2C) explores new possibilities of peer-to-peer communication. 

The reasons why e-health is revolutionizing the healthcare system is because it is easy-to-use, exciting and entertaining. The NHS Direct in the UK provides advice on health and medical problems via internet and telephone. WebMD provides online group discussions with medical experts. CyberDocs offer “virtual house call” with board-certified physicians for $50 -$100 a session and the demand for these services are ever increasing. One system which is still under development assists men with enlarged prostates to make an informed decision on whether to watch and wait or take recourse to medication and surgery. Another interesting application uses automated computer interviews as well as multimedia presentations to help patients choose treatment options for deep-vein thrombosis.

Kaiser Permanente has spent over $2 billion to move all of its operations onto the Internet and has created a computerized patient record. This has allowed all 361 of its clinics and hospitals and every physician, nurse, and dentist in these hospitals communicate with one another and with patients. Members can also use the system to search online for health information, obtain advice from nurses and pharmacists, request an appointment, or join an online discussion group.

But what are the drawbacks? Is it good to allow consumers access to information? Are the consumers using the information made available efficiently? The information available online is many a time incomplete and this often leads to misdiagnosis and panic for the consumers. Many argue that this free access to information will lead to adverse selection. Consumers will generally choose high-quality providers based on the performance review and this will unfairly penalize healthcare providers and organizations that treat high-risk patients. This might discourage surgeons from operating on high-risk patients.

Thus, while ICT promises to make access to quality healthcare easier and more cost effective the drawbacks discussed above remain to be addressed.

References:

http://www.medscape.com/viewarticle/415047_2I

In the article “How the Internet Is Transforming the Physician-Patient Relationship” James G. Anderson provides a detailed analysis of the impact e-medicine has on patients and physicians.

https://tspace.library.utoronto.ca/html/1807/4615/jmir.html