Science/Technology: Dotcom doctors

E-health -- the use of electronic processes and communication in healthcare -- is already well established in many parts of the world, providing facilities such as online health information and advice and electronic storage of patient records, and allowing patients, particularly in remote areas, more readily to consult health professionals. However, this remains a developing field, which is attracting increasing attention from major IT corporations:

Intel. Intel recently received market approval from the US Food and Drug Administration for its Health Guide, a device designed to permit home monitoring of health conditions, with a built-in camera and facilities that allow it to interface with other healthcare-related devices. Critics have pointed out that the Health Guide mostly carries out tasks that could be done with a standard computer, but Intel argues that it is significantly simpler to use, and is thus is more accessible to the elderly and other potentially excluded groups.
Microsoft. Microsoft recently announced a partnership with AT&T and Compuware subsidiary, Conisint, to help develop its HealthVault application: a centralised facility for storing patient health records, which Microsoft aims to make available to doctors and other healthcare providers.

Information sharing dilemmas

However, the success of initiatives such as HealthVault depends on hospitals, health services, insurance companies and other third parties being willing to communicate and store information using these applications -- which, in turn, requires opening their own information systems to external protocols. This raises political dilemmas as well as issues of compatibility, as the European Commission’s SOS project illustrates:

The SOS project aims to allow medical professionals in EU countries to access the records of patients they are treating from other member states.
It aims to use a bottom-up approach, building on existing technical systems and seeking to find specifications that allow interoperability.

While at a relatively early stage, the SOS project illustrates a number of difficulties e-health systems face:

Cost. First of all, large-scale e-health projects are extremely expensive. The SOS project’s budget of 23 million euros (36 million dollars) over three years is dwarfed by the cost of upgrades to UK National Health Service (NHS) computer systems, estimated at 12.4 billion pounds (24.9 billion dollars).
Trust. Such systems can only be used widely if patients and health professional trust them. In the United Kingdom, failings in major NHS IT projects in recent years, combined with other high profile cases of government bodies losing personal information, have undermined public trust in a way that will be difficult to reverse.
Compatibility. Issues of compatibility between health systems, even within the EU, will be difficult to overcome. Even if technical standards are established, issues such as institutional culture within health services and the logistics of translating records present an immense logistical challenge.

Outlook

Despite logistical, cultural and other issues, the use of IT to deliver healthcare services is likely to expand, particularly within individual countries and between member states of international organisations such as the EU. Nonetheless, e-health applications may well have their greatest potential in developing country contexts where medical services are sparse, distances large and access to some areas remote, and use of internet-based services -- particularly when delivered by mobile phone and other portable devices -- is increasing and has attracted growing donor attention. While they face a number of logistical challenges, including relatively old technology, lack of reliable internet connections and lack of staff trained to use facilities and services effectively, a number of international organisations and major donors, including the WHO and Gates Foundation recently have expressed a commitment to e-health.