When sites offering medical advice first appeared on the World Wide Web few GPs believed that, within a decade, they would encounter patients who used the Internet to become specialists in a particular ailment. Before the arrival of the ‘informed patient’ the GP was expected to provide a diagnosis, then recommend a course of treatment. Today many patients believe they already have a diagnosis and merely wish to have it confirmed by a series of tests. The question is no longer ‘Doctor what is wrong with me?’ but ‘Doctor when can my treatment begin?’
While patient-facing ehealth systems have changed the relationship between the GP and patient, their impact on the hospital consultant has been small. The patient still relies on the consultant to carry out tests and, to a large degree, has to accept the treatment regime offered. However, a new wave of automation is subtly altering working practices within hospitals and changing the role of the consultant within the healthcare process.
A new generation of ehealth products and services, based on wireless and mobile technology, is putting diagnosis and treatment management into the hands of the patient. Companies such as CardGuard and Vitaphone are offering suites of wireless ehealth applications – which include blood pressure, heart rate and blood glucose monitoring – to patients with or without the support of a conventional healthcare provider.
Within the hospital itself wireless technology is being deployed to manage workflow and deliver new and innovative services to the patient. Wireless is a compelling platform for ehealth as it supports the rapid deployment of applications – sometimes using existing GSM networks. Applications such as SMS patient reminders provide immediate results, with the number of missed appointments falling as soon as the service is deployed. Others, such as wireless enabled dispensing carts, hold out the promise of costs savings when supporting infrastructure, such as electronic patient records, is in place. Whereas at present a skilled nurse might spend up to an hour on a typical ward round, an automated dispensing system would enable the same process to be carried out in half the time by a semi-skilled orderly.
The key barrier to adoption of many ehealth systems is no longer the limitations of the technology or the cost of equipment and software, but the health worker’s resistance to change. Nurses, clinicians and consultants are concerned that automation will impact on their careers and lead to job losses. Some of these fears are well founded, as governments, realising that healthcare costs are becoming an unsupportable burden on the rest of the economy, are desperately seeking ways to reduce expenditure.
