At the beginning of the 2nd decade of the 21st century I would like to share some thoughts with you on my idea about the goals of HIT.
We have grown in many aspects and very rapidly so during the last decade. We rarely spoke, outside a relatively small group of specialists and promoters, about EHRs in 2000. Broadband connections were a relative rarity. Computers’ power was identical to the power of the better smartphones nowadays, which contain 800 Mhz processors. Cellphones were for calling and messaging, not for monitoring, diagnosis and data collection. Social networks were hardly visible on our horizon and spread of information through the internet on a mass scale was just taking shape. It’s only in the second half of the past decade that the empowerment of the citizen through communication and knowledge sharing, Web 2.0, started. It took a couple of years longer for the start of a similar process of empowerment to happen to the patient.
This decade has a very different starting point. Broadband is becoming a basic commodity in the Western World. Cellphones have overtaken the entire globe and are already making a huge social and economic difference. EHRs are actively being implemented in a growing number of countries around the world, not only the west. Newly developed technology and newly agreed standards have become the starting point for the build-up of developing countries, which puts the western world in a somewhat backward position, the disadvantage of an early start.
Why do we use technology? In my view we use technology to make life more efficient, to make work more efficient and to bring us comfort, but also economic benefit. That is exactly the same with HIT. We use it to make hospitals and any cure or care provider work more efficiently; to bring clinician-patient relationships to a different level of participation and, relative, equality; to make certain physical burdens in life more bearable, by helping us to adhere to essential medication, to assist us in our chronic diseases or physical limitations; to maintain our independence as long as possible by monitoring, by adjusting our daily environment; but also to make our lives more comfortable.
Developing countries show us, in a way, where to go. The OpenEMR project in Africa, the telemedicine connections between Africa and India, the way cellphones are used in countries like India but also in Africa. In the western world social networks are becoming more and more important and research shows their positive effects.
However, even with the very large numbers, those who actively use and enjoy these innovations are a minority. Facebook has over 50 million users, on a global population of over 6 billion just a drop. Twitter has become the community hype of the last year, but the numbers are low, compared once again to the global population. Cellphones have a far greater impact. Broadband and wireless are now available to enormous groups of people. Access to information has become standard for a growing majority in the western world, but is rapidly becoming available in the developing countries as well. And desperate efforts to contain it like you see in certain Asian countries prove that this development cannot be stopped anymore.
What should we do with this new starting point? First bring awareness to (potential) users. Awareness of the benefit and comfort it can bring. Therefore there is a necessity to find ways to educate. Not the youngest of our peoples, they already grow up embedded in an IT world. We will have to target the user generations before them to help them to realize the benefits of IT and the long-term consequences, both in comfort and support. And of course the economic benefits should and will be a major argument. Stimulating the use of home appliances will make them more efficient and therefore create economic benefits. Being able to self care when you have diabetes with the help of IT will make your life more comfortable, will make you less dependent of third party services, will economize your life as well as the health industry, as many physicians and nurses will be able to spend their time on other people who can not, or at least less be helped by IT.
However, we still have a long way to go, both at the level of the citizen in general and the professional communities in special. Unfortunately we use polls like the Google one (Connecting with Physicians Online) that suddenly show a certain popularity again in the past few day; they do not give a correct impression from reality. I said it before, there is a problem with numbers.
86%of physicians have used the Internet to gather health, medical, or prescription drug information.
83% Rely more on the Internet than in the past for clinical practice.
Well, it was 86% of just 411 physicians, who were all interviewed over the internet, so already active users. This number is certainly not representative for the whole group of thousands of physicians cross the US.
The patient is becoming more and more information driven. Again, the numbers presented by certain polls are certainly not representative for the population at large, but they show a growing trend that will rapidly become more important in the coming decade. And access to information will change, and in a number of instances is already changing the provider-patient relationship. However for the patient to have access to valid information we will have to look at a number of aspects. To find valid information information on prescription (Ix) will be a great tool. But also the EHR can and will be an important basis to be actively used by the patient for the search of health information relevant to their situation. Therefore an EHR must be fully, immediate and actively accessible by the patient, to give him the complete medical and health information about himself. Only that way he can use it to find valid information to assist him in his communication with his caregiver. And only then he will have the complete context to compare to, and enhance with, his own experiences, his ODL.
The growth of smartphone applications linked to health will initially have a high gadget and fun factor. But advertised properly they will help the younger part of our population to start to take parts of their health into their own hands. And their example will help the elderly to adopt these technologies as well, the way our grandparents are now using Facebook and Skype to communicate with their grandchildren. And once devices become more unobtrusive and even wearable, the adoption will rapidly increase. The advantage will be gigantic in any way from comfort and ease of life to the economic benefits of health institutions.
And I can’t even imagine what the latest innovations like SixthSense will do to our lives and to society.
In 2009 we celebrated the 5th anniversary of ICMCC. One of our initial focuses was awareness. The term compunetics was developed to address the social, societal and ethical issues of ICT. Chris Gibbons, member of the ICMCC advisory board, was instrumental in finalizing that definition and has taken, correctly, the concept a step further by creating the term populomics:
it specifically focuses on the integration of medical and social sciences to foster the elucidation of the biophysicologic and molecular mechanisms that under gird socioenvironmentally determined outcomes among populations.
M.C. Gibbons, Populomics, Medical and Care Compunetics 5, 2008, 265-268
Awareness is still our main goal, as awareness leads to empowerment. However, to raise awareness we will have to connect all possible dots for only then the use of HIT will become meaningful. And in my view EHRs are the ideal platform to gather all that information as well as the experience of both kinds of users, patients and providers, paving the way for what my friend Amir Hannan called the Partnership of Trust.
Lodewijk Bos
