Tuesday, 25 August 2009

A vision of the not so distant future

Dear Bloggers

I wanted to share my thoughts with you about how I envision the world of medical information technology will become in the next 10 to 20 years.

At present, we either write or type our medical notes. How quaint indeed. Humans have been using some form of paper for thousands of years. Papyrus was one of the earliest forms of writing material and before that, the Greeks wrote on tablets. We may indeed be going full circle in the electronic age with the tablet handheld. As you know, I love electronic gadgetry and although great inventions have been produced thus far, they are still in their infancy of development. Tablet computing is not a new thing but the size, capacity, user interface and general usability has been suboptimal for the needs of the modern physician. That may all be changing. There are rumours (and photos) indicating that Apple may be releasing a new tablet computer for next year!

I envision the day that a ward round at the bedside will involve voice recognition of the patient and the doctor by a hand held computer thereby giving a virtual transcript of the interview. With some artificial intelligence and fuzzy logic thrown in for good measure, the device could then organise the data into a structured format for the medical interview. It could then automatically list the previous medical history, social history etc, as the patient tells their story. Moreover, the computer could access the national database e.g. new UK system, to reveal the patient records in an instant.

Physical examination findings could either be recorded by the doctor through dictating the findings or by pressing selected boxes for positive or negative findings. Physical signs could then be added as a photographs or video from the built in camera.

By determining the history and hence, a list of symptoms, and the physical findings, the computer could then cross reference these symptoms and signs to a diagnostic database and provide options to the doctor for the mostly likely diagnoses and potential investigative and therapeutic options. If the doctor needs to brush up on some medical facts, the diagnoses could then be cross referenced to an EBM site such as UpToDate. Sounds like Star Trek right! Well, if you are a Trekky, in the original series, they came up with the 'mobile phone' device, memory cards, and video calls etc. Science fiction is tomorrows reality.

Such a system could provide a seamless, typing-less and paperless system that SPEEDS up patient care at the bedside rather than chaining the doctor to the PC work station or a pen and paper at the nursing desk.

With wifi being the standard technology being built in to the newest of devices, using an internal internet system (intranet) for use of secure information transfer with links to outside sites for cross referencing for diagnostic purposes, this would provide a state of the art system for patient care. PACS could also be utilised as could the ordering and checking of laboratory tests - these are already becoming a reality.

There is a new system coming to fruition that can provide fast transcription of dictations, for example, via the iPhone. However, there has been much criticism of late that such transcriptions rather than done by computer ( as advertised ) , are actually transcribed by people in centres based in other countries. This kind of technology , if it actually exists / works, is interesting but would be too slow for a ward round based system especially as sensitive information would be discussed and this should be kept confidential. Any system which could use dictation, transcription and to organise data would probably have to use artificial intelligence.

Computer technology has moved in leaps and bounds. Chips are getting smaller all the time, capacity is growing all the time and power consumption is decreasing and with the potential for new forms of batteries being produced that can charge instantly, and with such charging being across the air via magnetic waves or through direct contact without wall plugs. I can remember the large desktop computers that took minutes to boot up and crashed if you had too many programmes running simultaneously. The ZX spectrum comes endearingly to mind......Now we have laptops with consistency and reliability, fast multi-tasking and user interfaces that finally can be used with ease.

If we can get to the point when machines can have innate intelligence to be able to help humans in an intuitive and predictive way, then the above vision can become a reality.

But are we too far from that situation right now?

The best PDA around at the moment is the iPhone. Yes, I come back to this ingenious device. It has 3G and Wifi access, a camera and a pleasing user interface. It will not be too far off when specific medical software will be produced that will allow medical notes to be kept which can utilise the camera feature and will allow updating of such information on to a medical intranet database system. The iPhone can already utilise PACS data! It already has a dedicated UpToDate site and Skyscape has a multitude of medical books available which can cross reference to other books within the software package. All it takes is a little bit of cooperation and integration of the software packages to produce a system close to that I have described above.

Technology can set us free from the keyboard and paper. But, it has to be the right kind of technology. Many hospitals have the computer based patient notes, also referred to as Denshi Kalte. In my opinion, because data is kept sequestered in different areas of the database system (rather than fully integrated) with a poor implementation of the user interface, it can take a long time to enter information and to retrieve it. In fact, it can be slower and more labour intensive than using paper. Technology was supposed to be made to improve efficiency to make our lives easier, but the current medical software does not appear to achieve this objective. I can remember seeing 30 ward patients in a morning on my own and having written thorough paper notes for all of them. I can't see how the current situation with Denshi Kalte will allow anything near to that speed of input as compared to paper. Perhaps the next generation of computing will change that.....

With a portable computer in hand and the right software I think that we can get close to the idea above and set the doctors free to deal with patients rather than having to deal with the frustrations of copy and paste, trawling through old notes to find the needle in the haystack and where to find the histology report, that got put in the difficult to find tab system.

Things can only get better, but we must be prepared to change our technology to do so, but to change it in the right way.

Have a good week.

Kirk Out !