Editor's Choice

Can IT lead to radical redesign of health care?

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7449.0-f (Published 13 May 2004) Cite this as: BMJ 2004;328:0-f
  1. Richard Smith, editor (rsmith{at}bmj.com)

    Most of the large sectors of the economy have seen radical reinvention in the past 25 years. Consider air transport: low cost airlines are making bigger profits than traditional airlines. Consider telecommunications: distance is dead, or at least dying, and everybody (apart from me) has a mobile phone. Even higher education has changed, with a threefold increase in young people going to university. Health, in contrast and despite seeming to be in a state of permanent revolution, has not changed so fundamentally. But the perfusion of high quality information technology (IT) into the heart of health care should lead to radical redesign.

    One of the characteristics of being in the old world (or paradigm) is that it's almost impossible to imagine the new one. Nevertheless, it's fun to try—and this theme issue on electronic communication and health care provides clues.

    The first development is that patients have access to the same information, knowledge, and guidelines as clinicians. This has happened to some degree, but we have much further to go with the mass of patients finding the information, being helped to make sense of it, and most importantly acting on it. Sometimes people will manage their own problems but they will also get help from patients' organisations—often through the web but sometimes in person.

    Access to professional services will also be through the web. Again this is beginning with NHS Direct, but soon almost every encounter might start this way, with patients being advised that they don't need care, being referred to patients' organisations, or passed directly to a clinician. Increasingly that clinician may be not a doctor but a nurse or other healthcare worker supported by excellent technology that will provide instant access to knowledge and pathways to manage the patient.

    Doctors too will be supported by technology that will feel helpful to them but constantly guide their management of patients. Many consultations will happen via the internet (as is already the case for some doctors), and the patients' electronic biographies (not just records) may contain every last fact about them, including all that they eat and the exercise they take. Sensors placed in their clothing and houses will feed the biographies.

    Every step in health care will be recorded, allowing better management of both the patient and the system but also the generation of new knowledge through data mining. Every cost will also be known.

    As this theme issue makes clear, the limiting step in moving to the new world is less the technology and much more the human aspects. But good technology will change us and health care.

    If you'd like to discuss further the ideas raised in this theme issue, then join our experimental webchat at 11 am London time (British Summer Time) on Thursday 20 May. Go to http://quest.bmj.com/chat a few minutes before it starts to register and read the rules.

    To receive Editor's choice by email each week subscribe via our website: bmj.com/cgi/customalert

    View Abstract