It is just a matter of time that pathologists too will recognize the value of wireless connectivity, coordinating care, analytical tools for diagnosis and management and closer follow up, all enabled through mobile computing and digital pathology.
At the rate technology has changed everything else in our lives, by now we should have the equivalent of tricorders in our smartphones—instant access to our health statistics collected by sensors in our clothes and pulled into our individual health history in the cloud. We should be able to Skype our physician, text our pharmacist, and get both a blood sugar measurement and an MRI at Starbucks while waiting for a grande latte.
Except for the MRI part, all of that is doable today. Thanks to the big stick provided by the Affordable Care Act in the US, some healthcare organizations are pushing more aggressive use of network bandwidth and cloud technology:
- Monitoring patients’ health more proactively with networked devices, ranging from wirelessly networked medicine bottle lids to worn or embedded sensors that report back on vital signs;
- Coordinating care with the help of analytic tools in the cloud and a wealth of individual and collective patient data; and
- Connecting physicians directly with patients over PCs or mobile devices for between-appointment follow-ups.
Those things can’t be pulled off without cloud technology, whether it’s hosted internally in a health organization’s data center or elsewhere. But ask any random sampling of physicians, technologists, and health industry observers. They’ll tell you technology isn't restraining the next big paradigm shift in health care. The bandwidth is willing.
“It’s less about the technology holding the industry back, and more about the reimbursement model for healthcare,” says Kenneth Kleinberg, senior director of research and insights at The Advisory Board Company, a global healthcare research, technology, and consulting firm. “Quality hasn't been rewarded, physicians don’t have incentives to share data, and patients are freaked out about privacy. Healthcare isn't a system—it’s a bunch of individual entities looking out for themselves. Just adding more bandwidth to a broken system doesn't work.”
Real technological change in health care requires changing the “work culture” of health organizations and people’s confidence in health IT systems, says Harry Kim, senior director of Hewlett-Packard’s healthcare group. But other complex (and heavily regulated) businesses have embraced change long ago. Citing ATMs, Kim says, “If we can trust our money to a machine, we can do it with healthcare.”
That’s why health organizations are looking outside of their industry for inspiration. “The companies bringing the biggest changes to medicine today are companies like Cisco, EMC, Apple, and Microsoft,” says Dr. Elliot Fishman, Director of Diagnostic Imaging and Body CT at Johns Hopkins Medical Center. Technology from the consumer sector (such as mobile devices and apps, cloud computing, and even gaming) is seeping into the healthcare field and being seized upon by care providers to improve the connection between physician, patient, and data.
To get an idea of how bandwidth can change medicine, we talked to people on the front lines of medical technology at two of the most well-known hospital systems in the US: Johns Hopkins and the University of Maryland Medical Center. We also caught up with technology and digital health service providers. What we got was a snapshot of organizations that are already working to transform medical care with networked technology, while trying to overcome organizational inertia to make it happen.
Driven by data
The first wave of change that healthcare organizations have dealt with (or are still dealing with) is what Kim calls the “digitization of sick care.” Nearly 80 percent of healthcare is dealing with chronic illness. To improve care for patients with chronic health problems, health providers need to be able to effectively monitor and capture the right data from them, pull it back into electronic medical records, and make it available to both patients and physicians to act upon.
The problem is that many health record systems weren't built to handle those tasks. Healthcare systems have had electronic health records for decades; the problem is the systems lack standardization. These carry with them the sorts of software and schema hangovers that plague every data integration project.
“At Hopkins, it started a long time ago with a longitudinal patient record that pulled in from all our systems,” says Stephanie L. Reel, Vice Provost of Johns Hopkins University, Vice President of Information Services at Johns Hopkins Medicine, and CIO for both the university and hospital. The system acts as a repository for information from all of the hospital systems’ various health systems.
“But in spite of the fact that I think we've done a good job over the last 25 years, we've now realized we didn't,” Reel says. The effort required to get all of the data normalized from each of the systems was “too expensive, cumbersome, and not always possible.”
So Hopkins is replacing its homegrown system with one from Epic, a hosted system with a single, patient-centric database. Reel says that when it’s implemented, the system will “give each patient control over his or her own records.” Patients finally gain complete access. Since it’s a single integrated system, all of an individual's data is there for each caregiver—their allergies, test results, medications, etc. Epic's portal can even be accessed through mobile apps for Apple iOS and Android devices.
Epic's Canto electronic medical record app for iPad.
But on top of that, the data will also be used to mine information on how well different courses of care worked for patients. This should help tailor care based on patients' own conditions and the outcomes of people with similar cases. “You can look at a population base that has benefited from treatment,” Reel said. “We can learn from our own cases, but also if done appropriately, can learn from interventions elsewhere. This gives us the opportunity to do personalized medicine—based on previous cases, we can be able to predict when patient will benefit from one type of intervention or another—or, from their genetic makeup, might be able to decide if treatment won’t help.”
BYOD medicine
Physicians aren’t waiting for their central IT departments to achieve the nirvana of centralized healthcare data. They’re finding their own ways to get access to the information they need, when they need it—pushing health providers to build Web portals and other applications that give them access to medical records anywhere. One of the most visible signs of change is the adoption of the iPad and other mobile devices by physicians.
Thanks to more reliable and more widely available wireless bandwidth, the iPad has become an essential tool for clinicians. Last October, the Department of Veterans Affairs moved to open up its network so that doctors could use their own mobile devices. While other health systems have been slow to officially adopt the iPad and other devices, John Kornak, Director of Telehealth at the University of Maryland Medical Center says, “A BYOD (bring your own device) mentality is starting to take shape among physicians, and more mobile apps are starting to find their way into use.”
Kornak says that there is a strong push from doctors to find mobile apps that make it easier and more seamless for them to connect to health data such as charts and radiology images. “Physicians are telling us if we don’t have [the apps they need], we need to have a development partner and build it ourselves. They're really urging us to not focus on what the standards are—we need to be open to any devices on market, and keep them in mind when building solutions.”
One of the most obvious applications for the high-resolution screen of the latest iPad is displaying medical imagery. By pulling up images from CT scans and MRI scans on their iPads, Hopkins’ Dr. Fishman says surgeons now use the iPad to explain procedures to patients more effectively. “Doctors can look at their cases in real time. Now my clinicians are looking at the information I generate as it’s created. They can pull down CT slices in 2 seconds. It’s very fast and interactive. They can bring the image to the bedside or in the office.”
That mobility and ease of access pays off in another way: time. “When you speak to surgeons at Hopkins,” says Fishman, “they say that they save about an hour of time each day from using the iPad. And that’s a big deal—instead of going home when their kids are asleep, they get home when their kids are awake.” Fishman says he’s been at the beach and on airplanes and has been able to look at radiology images for consults.
That power doesn’t just come from the digitization of raw information, though. It only works, Fishman says, when the networking piece becomes transparent. “The end-user experience has to be that it just happens," he says, "not typing 20 codes in for access and hoping that it works.”
Read more.
Sean Gallagher / Sean is Ars Technica's IT Editor. A former Navy officer, systems administrator, and network systems integrator with 20 years of IT journalism experience, he lives and works in Baltimore, Maryland.
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