Question

I need some help with these questions. What are the most significant influences shaping the current and future healthcare information technology landscapes in the United States? Please explain your rationale.

Answer 1

Healthcare changes dramatically because of technological developments, from anesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy. Future technological innovation is going to keep transforming healthcare, yet while technologies (new drugs and treatments, new devices, new social media support for healthcare, etc) will drive innovation, human factors will remain one of the stable limitations of breakthroughs. No predictions can satisfy everybody; instead, this article explores fragments of the future to see how to think more clearly about how to get where we want to go.

Technology does not have an agenda of helping healthcare, however much we might like to focus on benefits. It develops because of miniaturization, lowering costs of production, and so on, not because it makes people well, but rather because it can find ways of making money and reinvesting it

There are many futures to plan for. As soon as we get to our future, there will be another – and we will increasingly be seeing partially-completed solutions superseded by even better ideas. Today we might be thinking we just need to computerize all patient records, but before we’ve finished doing that some fancy new technology will change what we want to do or how we should do it. For the foreseeable future, we will have to live with fragmented and partially working technologies.

Technical factors

Healthcare is just a market for technology where consumers such as hospitals are happy to pay enormous amounts of money, particularly for prestige equipment, such as PET and MRI scanners and linear accelerators.

Accelerated cost savings

Technology automates and extends things that previously had to be done by people. Before infusion pumps, nurses had to give injections every so often; the infusion pump technology automated that. Now the nurse’s time is freed up for other activities, and if the manufacturer has used technology in the production of the infusion pump – as they surely will have – they can reduce the cost of production for exactly the same reasons. Some plastic moulding process will make millions of infusion pumps as easily as it makes one; once one infusion pump has been programmed in software, it costs essentially nothing to program them all. This virtuous circle of using technology to make technology ensures prices drop, market share increases, and profit margins increase, which in turn allows the manufacturer to invest in more cunning production and distribution technologies.

However, what is important to notice is that these benefits do not accrue to custom or rare problems that cannot be mass-produced. This means that a technology like an MRI scanner that can scan anyone equally well is going to be much more popular than a technology that has to be customized to a particular patient’s conditions.

Personal healthcare

Already, the assumptions of mass production are changing. For example, today’s 3D printers are capable of making objects of any shape; they are slightly less efficient than standard mass production, but the costs of custom objects of certain sorts has been lowered significantly. It is now possible to custom make titanium implants the right shape and size to fit. Going further, it is widely envisaged that custom drugs will be manufactured, customized to the patient’s disease and genetic makeup. While this seems to be enormously beneficial to patients, there are dangers. For example, a customized drug may be very effective, but its side effects will be unique to the patient too, and therefore harder to diagnose and manage.

Big data

Patients generate huge amounts of information – patient records – from X-rays to blood test results. Replacing paper with computerized summaries makes patient care easier and more efficient. In the future the quantity of information will increase dramatically because of genomics (and the huge genomics of our symbiotic bacteria) and personalized medicine, and as more patient data is collected, more insights will become available.

Social media, patient power, mobile health and education

Stopping people going to hospital in the first place and empowering people to care for themselves and their families is something computers are already doing well. But as patients are empowered, is their new-found knowledge helpful or unrealistically raising their expectations? Today, the internet is problematic, as there is no consistent way anyone can distinguish snake oil from sense, how patients can distinguish reasonable treatment from misguided hope – there will always be a lot of solutions hunting for the patient’s money. Technical solutions to this problem include providing accredited high-quality information; cultural solutions include improving education

Security, privacy and monitoring

In a world beset with major security concerns (like terrorism) it is inevitable that all technologies, even in those healthcare, will be aligned with national priorities. For example, taking patients’ fingerprints and other biomedical identifiers will become easier (perhaps driven by consumer finance, such as credit card security); and, as it becomes easier, gathering data for state security will happen as a side-effect of routine clinical practice.