Thursday, October 21, 2010

What precisely is meant by medicine "going digital"?

We have an intuitive sense of what is meant by those urging medicine to "go digital." It seems to refer to modernizing, becoming more flexible, and basically following the path of modern computing and information technology.

Is it useful to think more rigorously than this hazy conception, without necessarily reading a special report from The Economist (excellent though it may be)?

Digital information is special because it can be transmitted to and instantiated within any number of devices that are now cheap and portable. The information is can be located at several places at once, and can travel instantly and cheaply. Lord Harold Samuel was talking about more than property when he said "The three things that matter in property: Location, location, location."

It's a truism that modern medicine is largely a testament to the power of knowledge. As we say at SUNY Upstate, "Knowing changes everything." Indeed, patients seek doctors because of their expertise, knowing full well that the pharmacist can find the drug, the nurse practitioner can deliver the shot, and even a physician's assistant can perform surgeries, as long as someone is around who KNOWS what's going on.

Once that knowledge leaves that physicians head, it empowers more an more people to help the patient. Most importantly, it helps the patient help themselves. The more places medical knowledge can be, the more powerful it can be, and the healthier we can be. Thomas Goetz, in his book The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, is not the only person urging doctors to repeat themselves, so that the knowledge stays with the patient longer. Requests for medicine to "go digital" need to be heard not as nagging demands from petulant or arrogant technophiles, but pleas for doctors to maximize the rigors of their training.

Naturally, there are risks to disseminated information. For sure, the patient armed with a dossier of internet factoids presents more problems than solutions. But this is precisely why doctors must take an active role in developing ways to disseminate and manage information safely. As the generators and stewards of this knowledge, doctors are uniquely suited to mediating the virtually ubiquitous potential influence of their knowledge.* The temptation exists to hide behind a duty to privacy, and to defend this in the sacred language of the doctor-patient relationship and the art of medicine.

I believe it is particularly incumbent on medical students to explore developments in the use of information technology to safely digitize medicine, and a modern medical education would be lacking without helping emerging doctors to "go digital."

* My favorite information technology of the moment is Indivo, a platform for a Personally Controlled Health Records that is employed in diverse settings, including Children's Hospital Boston.

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