Information technology (IT) is rapidly changing the face of modern medicine. Its proponents have long touted the potential benefits of IT in terms of the quality and efficiency of healthcare. Yet along with these advances in IT come various new challenges. The scope of this field is vast, rapidly developing, and well beyond comprehensive discussion in this brief overview. Nevertheless, it is an area that could fundamentally change the practice of medicine and the relationship between doctors and patients. IT in healthcare extends well beyond its most obvious manifestation, the internet.
It consists of an enormously diverse set of technologies for transmitting and managing health information for use by doctors, other healthcare providers, patients, payers, researchers and various other stakeholders with an interest in healthcare. Today, the internet is the dominant medium for obtaining all types of information. Patients are increasingly consulting the internet about their health needs, both before and after consulting with their doctor. They are also able to participate in virtual online communities that offer support and advice.
This is changing the nature of the doctor-patient relationship. [1] An historically paternalistic approach has evolved into a partnership as patients are increasingly informed about their condition (though not always correctly). The internet has also changed the way doctors access information and communicate with their peers. Just two decades ago, a doctor wanting to answer a clinical query would have to make his way to the library, search through the gargantuan volumes of Index Medicus, locate the relevant journal article and then make a photocopy.
Today, an online search via Pub Med or a range of other search engines and databases can produce an answer within seconds. Nearly all medical journals can be accessed online. The digital revolution has other obvious benefits for the medical profession. Rural or isolated family practitioners can email digital files of complex ECGs or radiographs to their specialist colleagues for assistance with rapid interpretation. The internet has also influenced how doctors learn, with many Continuing Medical Education (CME) programmes having an online component including ‘webinars’ or virtual seminars.
Advances in IT have also changed the way research findings are communicated, with a number of traditional publishing outlets offering rapid online publication to expedite the dissemination of the latest medical breakthroughs. Smart phone and tablet apps have enabled new means of collecting data for clinical trials and disease surveillance. [2] The healthcare industry is evolving to address the explosion in the use of the internet.
Many governments are funding telemedicine and online health services that have dramatically reduced the burden on family practitioners for common ailments. In the UK, 60% of the more than 350,000 web inquiries every month are completed within the service and don’t require further attention. [3] Patient web portals or intranets enable primary care and preventative service providers to remotely monitor weight, blood glucose level or peak flow in patients with heart failure, diabetes, and asthma, respectively, saving time and costs.
Aside from the internet, one of the most important developments in medical IT which is likely to have a profound impact on the daily work of doctors and other healthcare providers is the electronic health record (EHR). At its core, the EHR consists of four main functionalities. These include the collection and storage of patient data, the supply of that information on request to healthcare providers, computerized physician-order entry (for example, requests for laboratory tests, imaging or medications), and computerized clinical decision support.
The availability of the EHR at, or near, to the point of care has been demonstrated to increase adherence to guidelines and to reduce rates of medication errors. [4] Despite the exciting prospects heralded by advances in medical IT, very real concerns remain relating to the privacy of patient information, the expenditure of implementing new IT systems, and the ethics surrounding the use of new social media. Guidelines are urgently needed for the appropriate use of social networks and other online behavior by doctors.
There are also worries about the quality of online health information accessed by patients. A recent global survey found that only a quarter of people checked the reliability of health information they found online by looking at the credibility of the source. [5] Finally, the advent of the world wide web has presented real challenges to national regulations regarding the online advertising and sale of medication. [6] There is no doubt that rapid advances in IT are translating into radical changes in how medicine is practiced.
However, along with the prospects of improved efficiencies and safer clinical practice, there are a host of wider ramifications that must be taken into account to ensure that advances in IT do not inadvertently compromise overall patient wellbeing. In this regard, the time honored maxim ‘Primum non nocere’ (first do no harm) remains in good stead. Ultimately, no technological development will ever be able to replace the value of a face-to-face consultation with an empathetic and competent healthcare professional.