Thursday, February 19, 2009

Healthcare in the Obama Information Age - a positive way forward

The way most doctors and health care professionals do their jobs has hardly changed over the past thirty to forty years. Contrast this with the enormous changes in, transport, manufacturing and telecommunications.

The combination of technological change, the demands of business and the rise of consumerism are causing radical changes in the way healthcare is practiced around the world. President Obama, with his promotion of information technology, broadband networks and electronic health records, is poised to accelerate these changes in health practices. They will be the 21st century’s equivalent of the public health initiatives of sanitation and nutrition which revolutionized healthcare in the twentieth century. Integration of online technologies will see doctors and patients working together using shared electronic health records with patients having much more say in their treatments. The development of widely available broadband networks and video mail will eventually bring electronically delivered healthcare into everyone’s home.

3 processes are underlying these dramatic changes across the health industry:

1. Evolution: The evolutionary processes are the new tools, the hardware and software of the computer industries; and changed business processes in healthcare. We need to substantially redesign many of the traditional processes used to practice medicine so that we can take advantage of the new available multimedia technologies. Technology, and in particular, Internet technology, is transforming the medical landscape. As a practicing physician, I no longer write any notes on paper – all my clinical work is electronically recorded. House staff attend rounds armed with a vast array of reference information stored in hand-held personal digital assistants. The iPod is their reception platform for lectures presented as podcasts and vodcasts.

2. Revolution: The revolutionary changes are easier access to information and knowledge on the Internet, leading to fundamental transformations are occurring in the area of healthcare delivery. Patients are increasingly expert in their own diseases and have more collaborative relationships with their doctors. The provision of clinical care is changing rapidly as information technologies become increasingly used and accepted, with a move away from episodic care to concentrating on continuity of care, especially for patients with chronic disease who will create the greatest disease burden in the future. Care is gradually moving away from a focus on the service provider to that of the informed individualized patient and from an individual provider approach to treatment to a team approach. Increasingly, less focus is placed on treating the illness and more is placed on wellness promotion and illness prevention. This is the model of “Information Age Healthcare.”

3. Devolution; The devolutionary changes will see organizations becoming more localized and less hierarchical. The world of healthcare will be flatter than it is now. Over the next fifty or so years large hospitals as we know them will reduce in number, leaving fewer centers of expertise staffed by super-specialist doctors and other health professionals. Healthcare will become a more distributed enterprise. We will be able to increasingly concentrate our scarce health resources on wellness promotion, instead of just the treatment of illness. There will be more resources available, for instance, to undertake the mass immunization campaigns that we need around the world.

Our health system has to meet the challenges contained in the crucially important report from the Committee on Quality Healthcare in America published by the Institute of Medicine. This influential report noted that “information technology must play a central role in the redesign of the healthcare system.” It is wonderful to see President Obama driving the current widely acknowledged broken US Health system in this direction and it is essential that he is strongly supported in this endeavor.

This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores.


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  2. I am all for the Information Age changes that are taking place. However, I have some concerns about a group of patients that may be left out of the evolution as you mention it.

    I have noticed that there is a group of patients between the ages of 50-65 that are not as familiar with how computers or the Internet works. Patients younger than this most likely have had significant exposure to this rapidly advancing technology either at work or in school. Patients older than this typically do not work and have additional time on their hands in order to learn the new technology. (excuse the generalization)

    But what about the middle group? I am noticing that this group has a higher percentage of people that have minimal computer knowledge. Sure, some can send email, but the majority do not know how to use search engines or even save files to their computer. These are the folks that print everything that they see on the Internet--Oh, the trees!

    Do we as a society need to step up to the plate and create educational experiences for this age group or others that lack the basic computer and Internet knowledge that will ultimately leave them behind? Jitterbug did it with cell phones. What is our role?

    Jonathan S. Ware, MD