First it was Tony Blair, and now it’s Barack Obama. They both see IT as the ‘step-change’ technology that could revolutionise healthcare. Many industries have transformed themselves by investing heavily in IT and completely changed the way they do business. They have recouped their investment many times over and now couldn’t really envisage working in the old ways. But, for some reason, healthcare seems difficult to do.
There are many barriers (well-rehearsed elsewhere) and some of these appear to strike at the heart of the values and beliefs held dear by patients and doctors alike. A quick look at the Hippocratic Oath (or its many, modern equivalents) is instructive:
- ‘All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.’ (The Hippocratic Oath, classical version)
- ‘I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.’
Many worry about making electronic, records that are traditionally kept as hard copies in files. This would make them potentially widely available. There is general doubt about the ability of organisations, and especially public bodies, to keep records confidential. And what if the information was corrupted or inaccurate? How could patients challenge errors once ’embedded’ electronically?
In reality, with the improvement in security in IT there is probably less risk now with electronic notes as compared with paper ones. And, electronic transactions should enhance safety by, for example, preventing legibility errors. Ironically then, electronic solutions should help promote the ideals of the Hippocratic Oath, but this has not been well communicated by the IT industry that frequently doesn’t have physicians in the most senior leadership positions.
These two objections, though common, are not, I maintain, the principal concerns to doctors. This is evidenced by the fact that in some areas doctors take up IT solutions with alacrity. PACS is one such area. This is Picture Archiving and Communication. Simply, the ability to look at medical images easily and to transmit them effortlessly. X-ray films are now a thing of the past. As soon as doctors saw the systems, they loved them.
No, to me, a more fundamental challenge is proposed by IT and that is it attacks the central raison d’être of doctors, which is their knowledge. If everyone has access to the same information, why would you need to consult an expensive professional? So, the successful physician will have to become skilled at discussion and negotiation, not skills widely held by doctors nor well taught at medical school.
Another barrier is the lack of consumer-responsiveness in medicine. There is little opportunity for patients (who by definition may be in a vulnerable position), to shop around for a doctor or hospital with good IT systems. So the IT systems must produce benefits for the professionals, at least until the consumers actually demand it.