Apple founder and chief executive Steve Jobs might seem like an unusual candidate to start a revolution in medicine, but don't tell that to your average general practitioner. After decades of struggling with poor and clunky proprietary applications that have cost billions to develop but still can't talk to each other, doctors and clinicians fed up with waiting for any progress on ¬e-health have started to take matters into their own hands – literally.
Underneath the avalanche of consumer marketing hype surrounding this year's launch of Apple's touch-driven iPad tablet computer, doctors and other healthcare professionals have emerged as a professional group that considers the device a no-brainer.
In recent months reports have abounded of doctors looking to Apple's latest portable gadget because of its ability to display imagery and patient records. Not requiring a keyboard is also an attraction.
Clinical reference software maker ¬Epocrates says it surveyed more than 350 clinicians, 20 per cent of whom indicated they were likely to purchase the device.
It's not hard to see why.
For at least the past 15 years, the use of computers in medicine has been constrained by devices that have proven too cumbersome to lug around, too small to meaningfully display imagery files such as x- rays and too slow to quickly deliver ¬patient information from networks.
Most Australian consulting rooms may now have a desktop or laptop computer but they are just as uniformly equipped with light boxes, which have remained steadfastly mounted to walls so that doctors can view diagnostic transparencies despite the availability of digital files.
Lit by a small fluorescent tube, the wall-mounted light box is a shining example of how clinicians cope when faced with a lack of interoperability between specialised medical systems and software to deal with a problem.
They stick with what they know will work and that can be viewed with the same degree of ease by others in the healthcare system. Handwritten notes may not ¬always be legible to the untrained eye but they can be photocopied, stapled and passed on with the patient as they cart their files between appointments.
If medical test results are missing or incomplete, more tests are ordered to fill in the gaps – at a total cost of billions of dollars a year.
But as the pressure on healthcare systems in Western economies increases from an ageing population and a shrinking funding base, such a scenario becomes clearly unsustainable.
In late 2006, then federal health minister and now Leader of the Opposition Tony Abbott was typically blunt about his view on the progress of e-health.
"There can come a time when the administrative side is so backward that the clinical side can suffer," Abbott said.
"I think some of us have been in that situation ... where the technology we use for delivery of services is extraordinary but the technology we use for recording those services is in an era of parchment and quill."
It wasn't the first time the exercise-loving former health minister had taken a blowtorch to Australia's health bureaucracy. A year earlier Abbott told an audience of health technology professionals and public servants that he was "sick of trials and studies and working groups".
He jabbed that e-health had produced more pilots than Qantas and demanded improvements for patients within 12 months.
More than five years after Abbott vented his frustrations, Australia is yet to commit serious funding to the roll-out of a national electronic health and medical records system, despite there being clear support for such a scheme from the states through the Council of Australian ¬Governments.
Expectations that funding for a national e-health system could flow this year reached a peak following the delivery of the landmark report of the National Health and Hospitals Reform Commission. Prime Minister Kevin Rudd had asked the commission to deliver a blueprint on how to cut through the maze of bureaucracy that continues to frustrate progress.
The report recommended that funding for health services should be tied to the adoption of e-health measures, as a means of driving systemic efficiencies, so that the savings could then be ploughed back into front-line services.
"The introduction of a person-controlled electronic health record for each Australian is one of the most important systemic opportunities to improve the quality and safety of healthcare, reduce waste and inefficiency, and improve continuity and health outcomes for patients," the NHHRC final report published in June 2009 said.
"Giving people better access to their own health information through a person-controlled electronic health record is also essential to promoting consumer participation, and supporting self-management and informed decision-making."
A critical first step to such reforms taking place was to be the introduction of unique health identifiers for virtually all Australians, a move that required legislative changes that would allow Medicare to ¬issue new numbers to almost every Australian from July.
However the proposed legislative changes have hit a speed bump following the major efforts by Canberra to take over hospital funding that generated frenetic political horse-trading as states lobbied to extract extra funding.
In the United States, where the iPad chalked up 1 million sales in its first month of availability, the Obama administration has committed about US$19 billion ($21.1 billion) to technology-driven health reforms.
That move saw Australia's biggest health software company, iSoft, immediately move to set up a US sales operation in an effort to break into a potentially giant market that could position the company as a global health player.
iSoft's executive chairman, Gary Cohen, has confirmed that his company is already trialling some of its products for both iPhones and iPads in anticipation of clinicians looking to embrace the mobile form factor.
"We've built a whole lot of new applications," Cohen says.
"Healthcare professionals need to have some process for those ¬devices. We have an innovation team working on those specifically at the moment.
"Healthcare professionals will revert to what's easy – a mouse is not easy but a touch-screen, voice recognition, simple input interfaces … will be much more reachable."
Influential Washington Post columnist Martha White has speculated that Steve Jobs's much-publicised recent illness, which led to a liver transplant, may have been a contributing factor in the iPad's clearly utilitarian design.
White wrote that it would be "no stretch to picture him watching doctors, nurses and orderlies peck away at a bevy of poorly designed, intermittently integrated and just plain ugly devices and thinking there had to be a better way."
Her hunch might have its merits given that the two other gorillas of Silicon Valley – Microsoft and Google – weighed heavily into the e-health debate in May 2008 to ¬offer consumers what both claim are ¬secure online facilities that can store their health information.
While there are still substantial privacy, security and regulatory concerns to overcome, the move by the two online ¬rivals is nonetheless regarded as a substantial shift in the market because it ¬offers consumers a way to take back control of information otherwise stored on paper or on incompatible systems.
In January this year Google announced it had struck a deal to integrate its personal health record service with Surescripts , a service that claims to be the largest electronic prescribing network in the US.
"Getting a current and past medication history assembled and ready in case of emergencies is one of the strongest value propositions for using an online personal health record," Google's vice-president of research and special projects, Alfred Spector , wrote on the company's official blog.
"Surescripts provides access to prescription benefit and history information on behalf of health insurance plans representing 65 per cent of patients in the US," Spector wrote.
Although Google's deal is aimed at making electronic medication information more readily available, there is still substantial debate within the health and computing sectors over how health data standards will be forged under the $US19 billion e-health mandate.
Vice-president of Microsoft's health solutions group, Peter Neupert, has not been shy in demanding that the government throw more than money at the problem by giving consumers access to their health records. "We need to think bigger," Neupert writes in his blog. He cautions that if the US wants to build "a platform for transforming care or creating a learning healthcare system … it must include connecting the last mile, which means incorporating the consumer and the home into the platform – by design."
An equally big issue is whether consumers will be prepared to trust their health information to big companies like Google and Microsoft given the obvious concern that sensitive data could leak out or be exploited for commercial purposes that could disadvantage some consumers .
One issue that has already flared is to what ends data garnered from the genetic testing of people who may carry hereditary illnesses might be used for insurance profiling if it becomes available. A chief concern is that insurers could seek to limit their exposure to groups of people who they feel are more likely to become seriously ill, a scenario that could result in the inequitable denial of policies from birth and costs forced onto the taxpayer.
Consumer research so far, perhaps unsurprisingly, seems to indicate that people are more comfortable with their health providers holding the keys to their health data rather than big technology companies like Google or Microsoft.
Whether such concerns will prevail over the ambitions of Silicon Valley remains to be seen. But chances are that this time next year your doctor will be typing your details into an iPad. MIS Australia
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