Preaching new roles for IT and Internet in a patient-centred health religion

Brussels 24 November 2000As the second keynote lecturer at the MedNet 2000 Conference, Dr. Ilias Iakovidis from the start admitted to feel like a TV-evangelist since his talk would be more about religion than about science. Responsible for the planning and the monitoring of research in the area of health telematics within the European Commission, the speaker indeed expressed his vision for a citizen centred care which should pay full attention to prevention and the establishment of collaborative environments. The European dream is to create continuity through shared care, but not limited from doctor to doctor. The circle has to enclose health care professionals, providers, trusted third parties, researchers, public authorities, patients, and epidemiologists.

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For the last 6 years, the medical sector has been concerned with the wiring of different points of care, including the home and working space. Standalone clinical systems are gradually being replaced by alternatives that are wired enterprise-wide. The electronic health record (EHR) more and more is getting part of an Intranet network. However, as Dr. Iakovidis stressed, the health care sector lags behind in the field of Information and Communication Technology (ICT) for a number of reasons, but mainly because for companies, this is not a normal market due to the fact that the best not always wins. To get a clearer picture of the needs and directions in this multi-faceted health care universe, the speaker tried to outline the specific situation of each party involved, namely health care providers, decision makers, industry suppliers, and consumers.

Starting with the providers, including doctors, nurses, and other care takers, Dr. Iakovidis referred to the Eurobarometer report of May 2000 that studied the number and use of PCs in general practitioners' (GP) offices. It stated for example that 60 percent of the Belgian physicians have a PC but they do not use it for medical records. A 1997 study, carried out in the United Kingdom, already had shown that GPs apply IT for patient management but that there were almost no full medical records available. Unfortunately, this data is not used by the authorities, according to the speaker. In addition, it was found that very few providers do messaging with their patients. Physicians tend to have a greater belief in and earn more revenue from face-to-face visits. Yet, both in the USA and Finland, doctors are already being paid for telework.

Dr. Iakovidis equally mentioned the big hype about voice recognition for data input, decision support systems, the electronic medical record, and portable devices. Several newly approved projects in the European Commission deal with these developments. In the meanwhile, providers are calling for simple mobility. Nonetheless, we should be aware that no physician will use e-mail unless it saves time elsewhere. This fact demonstrates that user acceptance is a multi-dimensional phenomenon in which technology does not answer all the questions. In any case, ICT should not come between the doctor and the patient. This made the speaker tackle one of his most favourite issues, which is the deplorable human-computer interaction. The three priorities in health care are speed, speed and SPEED. As a result, ICT tools should be driven by the user and not the other way round but the problem is as much a legal as an organisational and technological one.

As for the decision makers, they reserve the smallest amount of money for IT in health care from all of the sectors. Yet, they are the easiest to convince to spend more, because they also are the first to benefit from structured health data in order to take decisions based on accurate statistic information. Why is there so little IT funding available for health care, Dr. Iakovidis wondered. Probably, since decision makers always work with yesterday's problem. They simply are not willing to provide any money for something that will be ready only in five years. If put before the choice between a questionnaire or clinical trial, decision makers prefer the latter one.

At last, best practices are starting to develop in some countries. Dr. Iakovidis mentioned Denmark where a national EHR strategy was set up in 1996 with the first positive results now emerging. Different country, different approach in France where GPs only would get paid if they used e-mail before the 1998 deadline. In 2000, only 50 percent of the GPs apply electronic messaging so the project finalising has been postponed but it still is an excellent initiative. Novel concepts need time to get implemented, but the decision makers have the power to set up an environment for experienced doctors, researchers and companies. The four parties have to sit together and sign their agreement. As for the procurement, Dr. Iakovidis stated that there may never be any money reserved in the health care budget for IT. Traditionally, it is always somebody else's money, left over in development or research, to finance promising pilot projects in hospital information technology.

Ironically, if some money finally is available, hospital staff immediately tends to create a group of advisors, which consists of computer experts only. This usually results in a nice technological paper which hardly responds to what the hospital actually needs. Hospital information systems however are only one part of the story. Suppliers from industry need to be aware that there is also home care, patient monitoring, and telemedicine for which applications have to be developed. Dr. Iakovidis' intuition is that the market that does not need reimbursement will be very big in the future, for instance patients who need ECG or weight data, etc. Upcoming e-commerce initiatives will require support from trusted third parties for claim management, application service provider solutions, information processing, and so on.

The speaker anticipated that the estimated market shares for drugs delivery, diagnostic requests, and discharge lettering are bound to grow spectacularly. A new business model soon will emerge for specialised companies to serve as application service providers in order to ensure secure and anonymous data transmission to meet the laws of confidentiality in health care. To date, this industry is very fragmented. EHR product reselling is quite difficult because everybody works differently. Already 4 companies in this field went bankrupt in Belgium alone and market consolidation, which started in 1996 in Norway is now happening in Belgium.

If we talk patients, we ought to realise that we are all health consumers and take up this role from time to time. Dr. Iakovidis explained several studies in the USA have tried to outline the profile of people who search for health care information on the Internet. Northern Europe is following the trends in the United States with 18 months delay. Very few home and telemonitoring care projects have been tested clinically. American pilots for heart, diabetic and pulmonary diseases have been evaluated. These usually rely on very simple systems, like palmtop and GSM to connect with the clinician's workstation. The amount of data that can be measured non-invasively is quite incredible. Dr. Iakovidis indicated that for this type of projects, a call for proposals has been launched by Andreas Xamberis in the health programme's key action 4 of the Fifth Framework Programme.

In conclusion, the speaker forecast that by 2005, everybody will dispose of a mobile phone and diabetes will be measured without punching blood. The biggest value will be the education of the patients, who will be able to learn about their disease through tailored and personalised information. Today, some cultures still treat confidentiality as an excuse for not doing the things you don't want to do as a patient, because you don't really care much. Other ones instead are allergic towards a unique ID. Still, Dr. Iakovidis expected that people will put their health data on the Internet if they can benefit from it and will not mind that the information is integrated and linked to create a virtual record.

At present, about 80 companies in the United States are making business of the electronic health record. As such, the personal health record might even combine the clinical data with the patient's own personal notes in the future. The collaboration between physician and patient will happen via a relation of trust. In this partnership, health care through mobile devices represents an important aspect as will the networking of physicians with hospitals. In the years to come, wireless technology and video-connection with UMTS will play a vital role. Dr. Iakovidis insisted that doctors use computers because they do more then they have to with regard to demographic research. Thus, they try to overcome the slow pace of the national policies. If you want to learn more about Dr. Iakovidis' visionary philosophy, we invite you to read the VMW May 2000 article IT acceptance in health care can only succeed via magically balanced developer-decision maker-user triangle.


Leslie Versweyveld

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