From analogue to digital patients – or how to avoid being trapped in the ‘mash-up’

If I didn’t know from all the media coverage that the digital switchover was taking place in London today, then I would only have to look over my back fence into Crystal Palace Park to see them preparing for the laser show tonight at the Crystal Palace Tower.  It explains the weeks of helicopters hovering overhead at least, unless that was just our local criminal fraternity again, trying to escape the Met’s laser beams.

Some people are not happy about this milestone event in broadcasting history.  Take the  elderly woman whose son is quoted in the Evening Standard as saying: “Mum woke up to NO channels on TV this morning. She’s so angry with the digital switchover thing.” So, despite the promise of more channels and a stronger signal, more than a few will be bereft without their helping of Eastenders tonight.  And quite a few will be puzzled that that old trick of rubbing the back of the remote control to breathe life into those old ‘I must remember to replace them’ batteries is not working as it has done for years.

Healthcare is also going ‘digital’ but this ain’t no press-a-button easy peasy switchover type of event.  Nor will it garner the plaudits or be celebrated in the same way.  But the impact will be as momentous if not more so in terms of the impact on our lives and our deaths.

Digital healthcare is defined by Warwick Medical School as (take a deep breath first):

‘Digital healthcare concerns the development of interconnected health systems to promote the use and advancement of smart devices, new technologies, analysis techniques and communication media to help professionals and patients manage illness, enhance the performance of patient monitoring devices, improve clinical education, manage healthcare risks and promote wellbeing.’

In every conceivable way the patient’s experience in the future will be influenced by the march of the digital and it will manifest itself in many different forms: the application of medicines and treatment such as smart pills; the use of imaging and other technologies to diagnose and monitor our condition; the way in which data about our health and the way we use health systems is stored and can be used by ourselves and others whether for care or for research; online systems to aid clinical decision-making; not to mention the use of telemedicine or telecare  (take the Guardian poll here) to help better manage our condition at home and at work; the simple use of social media to connect, network find and share knowledge and experience in ways that were unthought of not so long ago or; the technology and information systems wrapped around personalised medicine.

No, this isn’t an easy switch-over but one great ‘mash-up’ of innovations.

The opportunities and potential benefits are clearly huge.  But there is also a risk that some patients will be left disenfranchised by the digital divide for one reason or another – an issue that the Society for Participatory Medicine in the US is taking up very forcefully  (see also its blog with none other than Ben Goldacre featuring in its latest post).  I am not sure that we have even begun to grapple with this agenda in the whole in the UK and I am thinking of ways we might go about it so please let me know if you have ideas.

In reading their materials I came across this rather energising interview with one of the leading lights in the Society, Dave deBronkart.  e-Dave as he is known, lays out some good foundations for changing the paradigm by which we consider the future patient in the digital age: giving people license to seek and be armed with information; using new media to enable patients to form communities including aggregating their views on what works and doesn’t; changing the language we use about all aspects of care (I liked his take that we should use ‘achievement’ instead of ‘adherence’ when talking about medicines); partnership and shared care (of course).  The opportunities for changing the old hierarchies seemed achievable once again on reading his words.

At the same time, swept along in this fervor as we are, there is also something about the need to hold onto the ‘personal’ to human contact.  It was not long ago that my Dad told me of a visit he paid to his new local hospital.  Instead of receptionists and people to guide, this state-of-the-art facility had an electronic sign-posting system for patients arriving for their appointments.  All very good, as even he admitted.  And very efficient.  But the triumph of the impersonal over the personal made his experience just that little less human.


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