2 ICT and Our Health Care Systems Today
Health care is an information-intensive domain, involving a diverse set of collaborating
service providers who need to access and exchange patient-related data. Many of
the inefficiencies and cost overruns experienced in health care systems around the
globe today are associated with a lack of access to relevant information. Common
examples of inefficiencies include: unnecessary duplication of laboratory work; cancellation
of scheduled treatments (e.g., surgery) because of missing data or prerequisites;
prescription of unnecessary or adverse drugs; low adherence to preventative
care guidelines, because the data is not available to generate alerts and reminders;
erroneous prioritization in waiting lists due to missing data; adverse events because of
missing counter-indications.
While ICT has played an important role in supporting financial and administrative
(“outside”) functions for the health care industry, these technologies have only recently
been introduced to support “inside” functions at the point of care. A recent
survey of the US Centre for Disease Control found that less than half of physicians
are using some form of electronic medical record (EMR) in 2009 (43.9%). With
20.5% using EMRs with basic functionality and only 6.3% using a fully functional
EMR [1]. Similar numbers are reported from Canada [2], while other industrialized
nations such as Australia, Denmark and the UK have significantly higher adoption
rates (78%-98%). Even in jurisdictions with high EMR adoption, systems are often
used as data silos, and data exchange over the Internet is lacking [3].
One of the major obstacles to Internet-based data exchange has been the difficulty
in defining shared health information interoperability standards, as well as the inertia
involved in marshalling political support to adopt cross-jurisdictional interoperability
infrastructures. Although investments in eHealth initiatives are growing, the benefits
to patient outcomes are not always apparent, if not clearly in doubt [4]. An increasing
number of industry observers are advocating that eHealth initiatives shift to become
The Smart Internet as a Catalyst for Health Care Reform 29
more consumer (patient) oriented. Some of these commentators have noted how
Internet services are profoundly changing evidence-based health care and contributing
to patient empowerment [5]. Neftel points to several recent studies showing that patients
are increasingly using the Internet as a tool for diagnosis, medical decision
support, preventative care and chronic disease management [6]. Siempos et al. have
shown that laypersons may reach correct diagnoses by using general Internet tools
such as Google [7], and Tang and Ng demonstrated that even professional physicians
can significantly improve their decision-making by using such services [8].
The Internet makes high-quality health care information accessible to patients and
care providers in an unprecedented way. However, it also contains a vast and rapidly
increasing amount of extraneous information. Using the Internet in the absence of
smart methods to customize the right information for a particular context has been
compared to drinking from a fire hydrant [5]. Alternatively, coming from the medical
domain, Neftel compares the current Internet with an individual who manifests the
savant syndrome – a condition that combines a narrow area of expertise or brilliance
in otherwise intellectually limited and often autistic persons [6]. He states that “the
savant syndrome of the Internet presents both doctors and patients with the same
problem, namely inflationary dilution by infinite abundance” and concludes that
medical expertise will continue to be needed to address this problem. Smart Internet
technologies enable us to codify and automate some of this expertise and, thus, provide
more effective uses of the Internet for health care services.