The Future of Healthcare Technology

Telemedicine

Telemedicine is the delivery of healthcare services through remote technologies such as videoconferencing, remote monitoring, and electronic health records. This technology is particularly useful in rural areas where access to healthcare providers can be limited. Patients can consult with their healthcare provider from the comfort of their own homes, reducing the need for travel and improving access to care. Telemedicine is also beneficial for patients with chronic conditions who need regular monitoring but don't want to visit the doctor's office frequently.

Wearable Devices

Wearable devices such as smartwatches and fitness trackers are becoming increasingly popular for tracking health metrics such as heart rate, steps taken, and sleep patterns. This technology can help patients monitor their health and provide valuable data to their healthcare provider for analysis. Wearable devices can also be used to alert patients to potential health issues, such as an elevated heart rate, and prompt them to seek medical attention.

Artificial Intelligence

Artificial intelligence (AI) is being used in healthcare to improve the accuracy of diagnoses and to identify potential health issues before they become more serious. AI algorithms can analyze vast amounts of data to identify patterns and provide insights that human healthcare providers may not have noticed. For example, AI can be used to identify early warning signs of diseases such as cancer and to develop personalized treatment plans based on a patient's unique health data.

Blockchain Technology

Blockchain technology is being used in healthcare to improve the security and transparency of patient data. With blockchain, patient data can be stored in a secure, decentralized ledger that is accessible only to authorized parties. This helps to prevent unauthorized access to sensitive patient information and ensures that the data is accurate and up-to-date. Blockchain technology is also being used to improve supply chain management in the healthcare industry, making it easier to track the origin and distribution of medical products.

Technical factors

Healthcare is just a market for technology where consumers such as hospitals are happy to pay enormous amounts of money, particularly for prestige equipment, such as PET and MRI scanners and linear accelerators.

Accelerated cost savings

Technology automates and extends things that previously had to be done by people. Before infusion pumps, nurses had to give injections every so often; the infusion pump technology automated that. Now the nurse’s time is freed up for other activities, and if the manufacturer has used technology in the production of the infusion pump – as they surely will have – they can reduce the cost of production for exactly the same reasons. Some plastic moulding process will make millions of infusion pumps as easily as it makes one; once one infusion pump has been programmed in software, it costs essentially nothing to program them all. This virtuous circle of using technology to make technology ensures prices drop, market share increases, and profit margins increase, which in turn allows the manufacturer to invest in more cunning production and distribution technologies.

However, what is important to notice is that these benefits do not accrue to custom or rare problems that cannot be mass-produced. This means that a technology like an MRI scanner that can scan anyone equally well is going to be much more popular than a technology that has to be customized to a particular patient’s conditions.

Personal healthcare

Already, the assumptions of mass production are changing. For example, today’s 3D printers are capable of making objects of any shape; they are slightly less efficient than standard mass production, but the costs of custom objects of certain sorts has been lowered significantly. It is now possible to custom make titanium implants the right shape and size to fit. Going further, it is widely envisaged that custom drugs will be manufactured, customized to the patient’s disease and genetic makeup. While this seems to be enormously beneficial to patients, there are dangers. For example, a customized drug may be very effective, but its side effects will be unique to the patient too, and therefore harder to diagnose and manage.

Personal healthcare has an interesting technological imperative. If we can personalize healthcare, we get population-sized markets: instead of selling to clinicians, manufacturers can sell to individuals – a market 1000s of times larger.

Big data

Patients generate huge amounts of information – patient records – from X-rays to blood test results. Replacing paper with computerized summaries makes patient care easier and more efficient. In the future the quantity of information will increase dramatically because of genomics (and the huge genomics of our symbiotic bacteria) and personalized medicine, and as more patient data is collected, more insights will become available.

If computers collect data on patient illness, treatments and outcomes, one automatically obtains valuable information on the effectiveness of those treatments, or relations between side effects and patient characteristics across whole populations. Huge amounts of data will be collected, hence the name big data. Once the infrastructures have been set up, the incremental cost of adding one new patient will be essentially nothing, and this economy of scale will drive further technical developments. Epidemiologists will benefit enormously, but the benefits to individuals are less obvious, except in the long run from big data’s contribution to the progress of medical science more generally.

Social media, patient power, mobile health and education

Stopping people going to hospital in the first place and empowering people to care for themselves and their families is something computers are already doing well. But as patients are empowered, is their new-found knowledge helpful or unrealistically raising their expectations? Today, the internet is problematic, as there is no consistent way anyone can distinguish snake oil from sense, how patients can distinguish reasonable treatment from misguided hope – there will always be a lot of solutions hunting for the patient’s money. Technical solutions to this problem include providing accredited high-quality information; cultural solutions include improving education. When somebody has a knee injury at 40 this should not be the first time they encounter the bewildering amount of variable information and social media on the internet! Their management of their condition – whatever it is – would be much improved if they had been exposed to sensible strategies since preschool.

Dramatic, transformational integration of technologies

There is not space here to fully explore the vast range of likely and significant technological breakthroughs. Consider nanohealth, brain implants, artificial organs, networked sensors, genomics, exoskeletons ... just a few of the potentially transformative developments already under way. Some of these technologies are going to transform our whole approach to illness and health – in the same way that the nineteenth century development of anaesthetics changed society’s moral approach to pain. Pain and suffering used to be inevitable; now we like to think we have a right to painless procedures – and in turn this has influenced everything, from our treatment of patients to our treatment of animals (why should animals suffer? is a very modern question). New technologies, like nanohealth, are going to have ethical implications that will be hard to anticipate. Sometimes ethical issues will be hard to negotiate because they will be apparent only after somebody has got things working and already has a business-driven perspective.

Security, privacy and monitoring

In a world beset with major security concerns (like terrorism) it is inevitable that all technologies, even in those healthcare, will be aligned with national priorities. For example, taking patients’ fingerprints and other biomedical identifiers will become easier (perhaps driven by consumer finance, such as credit card security); and, as it becomes easier, gathering data for state security will happen as a side-effect of routine clinical practice. The state will be able to identify illegal immigrants and outlaws and others; the current notion of patient confidentiality will be eroded in a way that will be impossible for clinicians to control.

Today we may think this would be objectionable, but it is salutary to remember that we happily divulge all sorts of personal information during our use of mobile phones, credit cards, as well as during our use of the internet. We unthinkingly sacrifice our privacy because of the huge convenience of buying stuff on the internet. It seems to make losing our identities a trivial price to pay. When considering future healthcare trends we can expect similar trade-offs; it will be easy to slide into levels of surveillance we do not now like, falling for it because of the healthcare benefits we want. Surveillance is not the only downside of course – paying data rights owners; paying software licenses; signing off responsibilities for insurance liabilities – all happen, and are often signed off without sufficient thought.

It is increasingly trivial to collect data about patients and the quality of patient care. This information can be aggregated and help discover variation in treatment and outcomes, and hence help improve quality – which is good. On the other hand, data inevitably distances the manager from the patient as an individual: perhaps the fundamental notions of patient care will lose out to organizational or state concerns, because cost management and security, not care, becomes to be the point of the information.

Health 2.0

There are many areas where the scale and unit profits of the healthcare market will drive technical developments. Collectively, this technology-driven progress in healthcare is sometimes called Health 2.0, to distinguish it from what we are doing now – Health 1.0. While Health 2.0 is exciting, it is sobering to realize that perhaps it is just the start of an upgrade path: Health 2.0 will have problems we solve with Health 3.1, and in turn that will develop into Health 4 or whatever. While it seems obvious technology will continually advance, it is going to be harder to ensure that each iteration of technology satisfactorily achieves what it claims to achieve, without having to be fixed up and upgraded soon after.

Unfortunately, few manufacturers stay in business selling us perfect solutions; they stay in business by selling us something to keep us consuming: a service, something to rent, a disposable product, a product that wears out, or a product that goes obsolete. Certainly Health 2.0 will lead inexorably to more developments, whatever they will be. The danger is that it will make us eager to upgrade before we have even realized the promised benefits of Health 2.0. Somehow, we need to work with manufacturers to align their interests of staying in business with our interests of having a predictable and stable life. We might do that by distinguishing infrastructure, which is provided about once, with consumables that are provided regularly. This is the economic model of infusion pumps: you buy an infusion pump once, but the giving sets are replaced after each infusion. Over time, the manufacturer makes more profit on the easily reproduced plastic tubing than the complex pump, and everyone is happy.

In some areas, the consumables will be information itself. This costs nothing to reproduce, but people own it and want to make a return on their investment. Thus patient data will be owned so that its owners – rarely the patients! – can make money from it. Information is stored in computers in data formats, and often these are proprietary: the format of a patient data system belongs to the manufacturer. This leads to the danger that the patient data is inaccessible except on the terms the manufacturer imposes. It may be costly to convert it into other formats, say to upgrade to a different manufacturer’s systems. Worse, if a manufacturer goes bust, some data may be lost. This is a very real problem, as our inability to use data on paper tape, cards, cassette tapes, magnetic tape, VHS tapes – none of them very old technologies – and so forth, testifies. A desirable technological trend, then, in fact a trend that bucks the trend to date, has to be the assurance that data remains accessible and usable over long periods of time – at least a 100 years, which is way longer than any electronic technology!

Hacking and open health

Healthcare sensors can be readily bought off the internet, and it is easy for technically-minded people today to build sophisticated equipment (to hack) to collect and analyse any personal or clinical data using their own computers. Credit-card sized computers like Arduinos and a few biomedical sensors cost about the same as a drug prescription!

Some individuals are already obsessed with collecting as much health-related data as they possibly can about themselves – it is not just people will illnesses, but people who want to lead healthier lifestyles or be better athletes. If these people upload their data and contribute to aggregated data, they are contributing to citizen health – just like open science,5 except tackling healthcare problems. At its simplest, they would be contributing to epidemiological studies; at its best, they would be helping build databases and web systems that other people can find their medical conditions in, and hence find support communities. Many patients end up with more time on their hands than they expected, and this is how some choose to use their time: solving their own problems and helping others.

Hacking is not restricted to patients: a doctor using a laryngoscope has the choice of paying commercial prices for a video recorder (e.g., to record images to send to an ENT specialist), or more conveniently recording the video on their iPhone – about a 1,000 times cheaper.

The point is, technology is empowering people to do what they want to do, and in the future patients are going to take some of the initiative away from professional healthcare, particularly for diagnosis, chronic illnesses, and lifestyle advice.

Technology is diverse and surprising

These are some of some powerful technological drivers, and it is hard to draw a line under the discussion. We have not discussed many technologies that are both critical and exciting such as nanohealth, personalized healthcare, mobile health, telehealth and so on – the beginnings of all of these are already available and in use in first adopter places. What the brief discussion illustrates is the diversity, the rapid pervasiveness, and the complex trade-offs of future technologies.

Bridging future gaps

The science fiction author William Gibson says the future has already happened – we just don’t know where. All the ideas we discuss in this article about the future have happened.

From considering technological drivers, we now turn to human futures. We believe these will be more stable and less likely to change, but will raise increasingly unexpected interactions with the new technologies. In areas like human error this is alarming, for if we believe that technology improves – why else would we adopt it? – then, as human error will still occur, the error must even more surely be due to the humans involved, not the improved technologies which were intended to design out error. In other words, the irresistible drive to adopt improved technology may exacerbate our management of human error. The economic drivers that push technologies have vested interests in promoting benefits and belittling problems. And healthcare has no end of problems: we all want and expect better care, costs are rising and performance is declining; living longer, and living with chronic illness, are other problems. Healthcare staff are over-worked and under-resourced... it is hard to imagine technology changing that. On the contrary, many technologies (take MRI scanners, heart implants) are very expensive, and buying into them will exacerbate financial pressures.

Safety, security and regulation

In the future there will remain an enduring distinction between safety and security. In healthcare these mean different things: safety is about patient and staff safety – basically, following Hippocrates first do no harm – and security is about controlling access, in particular so that intruders, rogue patients and staff cannot get inappropriate patient access, whether that is informational access or physical access.

Security means stopping bad people doing bad things. If a bank loses money to fraud, this is not unexpected – we all know there are plenty of bad people around who want to get at our money. It follows that it is the bank’s responsibility to provide security.

Safety means stopping good people doing bad things. If a nurse is involved in an untoward incident, this is neither normal nor expected. It is easy, then, to think the good nurse has gone bad and therefore they are to blame – this is the conventional bad apple approach to safety. Indeed, if a good nurse has gone bad, this is a serious betrayal of our high regard of the nurse, which makes things even worse. The bad apple theory is very appealing: getting rid of this bad nurse appears to solve the problem.

In short: security is seen as an organizational responsibility (e.g., the bank’s or the hospital’s), whereas safety is seen as the individual’s responsibility (e.g., the nurse’s). Technology improves things that generate return on investment (security, speed, efficiency, scale and reach) and safety will not do that while users are scapegoated.

Moreover, safety is hard to assess up-front, unlike simple claims for low price, speed or efficiency. Unless regulation requires safety to be assured, we would expect safety to take second place. We therefore anticipate an increasing debate between safety concerns on the one hand and regulatory burden on the other. Since currently the regulatory burden for technology is negligible, certainly compared to the rigors of pharmaceutical development, much could be gained by strengthening regulation. We suggest careful attention needs to be paid to statutory regulation. To avoid hasty regulation that is ineffective or rapidly obsolete, we need to think very clearly. Today there is a lively debate about regulating computer technology; some say (for example) mobile apps should be more tightly regulated; others say that rigorous protocols (such as randomized controlled trials) take so long the technologies will be obsolete once there is formal evidence one way or the other.

Solving the right problems

Conventional patient records are paper records in folders in cabinets. Many patients have extensive patient records, lab results and so on, and even more patients have patient records that are in many places – in hospitals they have visited, consultant’s offices, general practices, and so on. They are rarely all together where the patient is, often they get lost or duplicated, and sometimes destroyed by fire or floods. Many healthcare providers have trucks shipping patient records around their areas.

The obvious thing to do is to computerize all the records, and then use networks to ensure they are always available wherever they are needed. Looking at records on a screen is simpler than wading through piles of paper. Since computers already work, all we need to do is set up a program to scan or type up all the existing paper records. Job done!

Unfortunately this obvious solution creates new problems.

When a clinician examines a patient, they want to refer to the relevant parts of the patient’s medical history. If we have simply computerized the patient records, all we have done is made the large, scattered piles of paper into something that can be viewed on a computer screen, but now the clinician can only view one window at a time, and they may easily lose the big picture. Information may be scrolled off the screen, or be concealed behind pop-ups. In fact, we have merely swapped the unusability of piles of paper for the unusability of a user interface.

While we are very familiar with the ways that paper records can fail, unfortunately we are much less familiar with the ways that computerized records are hard to use and may mislead us.

Tom Landauer’s book The Trouble with Computers makes the insightful point that computers are enormously successful in areas where there is commonality that can be computerized — banking, communications, stock control, office documents, email are all good examples.6 Areas where they have been less successful are those where success depends on the human element. My bank account works just like your bank account, so computerizing either of our accounts is the same as computerizing everyone’s. But my patient records are different to yours. The computerization of my records does not help computerize yours or anyone else’s. Well, that is not quite true. Computerizing my records helps computerize yours, but when those records are used, we and the healthcare professionals using them will have different problems. As the healthcare computer systems scale up to handle more patients, the usability problems get compounded – in contrast, as bank accounts are scaled up, things become more uniform and easier to automate successfully. (Banks also have a very different approach to problems; a British bank does not have to handle my Russian currency or it can charge me exorbitant rates, but a hospital that ignored my X rays would be negligent.)

In healthcare, we have to pay more attention to the broad context of how information is used.

This is the concern of User Centered Design (UCD), which Landauer describes well. The ideas have been taken up in international standards. In particular, healthcare technologies must be developed using UCD processes, such as ISO Standard 62366 etc.7 One of the most important features of the standards is that they make clear that new technologies are not going to be perfect and need to be tested and improved to better match how people actually use them.

UCD is essential in the battle against information overload and the law of unintended consequences. Technology is introduced to solve a problem or to improve performance, but this then changes people’s behaviour and new problems may emerge.

Originally, email seemed like a wonderful idea – it is cheap, fast, saves paper, and so on. But we are victims of its very success: now people have so many emails that they are overloaded (it is hard to prioritize), to say nothing of spam and phishing, flames and people sending irrelevant or erroneous emails to thousands of recipients. It is now possible for an ill-conceived email to waste thousands of hours when it is send to many staff. Emails are a recognized and growing problem; but the same trend is affecting test results, patient records, drug-drug interaction reports. For all of these reasonable tasks it seems obvious they should be computerized, but doing so often results in increasing amounts of low-level information that can distract people from doing their real job.

UCD helps because it emphasizes that no innovation is ever finished: we have to see how it is used, and continually improve it. Email, and the rest, have a way to go, and UCD promotes that at each step we should be user-centred (driven by the needs of users and what they are trying to do) rather than technology-centred.

Unfortunately, technology creates new users. Computers need technicians and managers, and these users also contribute to the UCD improvement cycle. However if we are not very careful, the management of the technology gets a life of its own that takes a higher priority that delivering improved patient care. When investments are made, the experts are consulted – but now the experts appear to be the technologists rather than the healthcare professionals or even the patients. This can cause many problems.

Systems that are under-performing and hence need improving often induce workarounds by their users. For example, passwords may not work very well, so nurses find ways to get on with their jobs regardless. Unfortunately the people the other side of the computers just see the systems apparently working; they do not see the workarounds or the unintended risks nurses may be creating as they get things to work. When the system is improved, the workarounds are not considered sufficiently, and the new system may have unanticipated problems that even workarounds cannot overcome.

The science (rigor) dream (unqualified success) gap

X-rays were discovered by Wilhelm Röntgen in 1895 and immediately recognized as having huge potential for healthcare. Only a few years later, one of Thomas Edison’s assistants, Clarence Dally, who had been enamoured with the potential of X-rays died, of cancer because he had been experimenting with them every day.

Healthcare technology has been transforming the medical industry for several years now. With advancements in technology, the healthcare sector has become more efficient, accessible and cost-effective. Healthcare technology involves the use of innovative and cutting-edge technologies to improve the overall quality of patient care, reduce medical errors and increase patient satisfaction.

Another major advancement in healthcare technology has been the development of telemedicine. With the increasing use of smartphones and mobile devices, telemedicine has become a popular way for patients to receive medical care from the comfort of their own homes. Telemedicine allows patients to have virtual consultations with their healthcare providers, which eliminates the need for in-person visits, saving time and reducing the risk of exposure to illness.

Medical imaging technology has also made significant advances, allowing doctors to diagnose and treat conditions with greater precision. This includes the use of CT scans, MRI scans, X-rays and PET scans. These technologies have revolutionized the way doctors diagnose and treat diseases, making the process faster and more accurate.

One of the most significant changes in healthcare technology has been the transition from paper records to electronic health records (EHRs). EHRs allow doctors and healthcare providers to store and access patient information in a secure and centralized manner. This not only improves patient care but also reduces the risk of medical errors, as all of a patient’s medical history is easily accessible.

Artificial intelligence (AI) is another exciting area of healthcare technology. AI has the potential to greatly improve patient care by automating various tasks such as diagnosing diseases and predicting patient outcomes. For example, AI algorithms can be used to analyze large amounts of medical data to help doctors make more accurate diagnoses.

In conclusion, healthcare technology is rapidly advancing and transforming the way healthcare is delivered. From telemedicine to wearable devices, AI to blockchain, these technologies are improving access to care, reducing costs, and improving patient outcomes. As technology continues to evolve, we can expect to see even more exciting developments in the healthcare industry in the years to come.