I recently had the privilege to present at the inaugural TedMed Sydney event held on April 20 2013 at the University of Sydney. This was a satellite event for the larger TedMed event being run in Washington DC. It was a particularly exciting as I was speaking back at my old Alma Mater, I studied medicine at the University of Sydney. To make it even more special I was speaking in the same session as Professor Martin Tattersall. Professor Tattersall is a legendary physician at the Royal Prince Alfred Hospital where I trained. He is recognized for his clinical skills and his humanity. He was the oncologist who looked after my mother during her 2-year battle with lung cancer, and I will never forget the kindness he showed her and us during that time.
The problem with TED talks is that the go very quickly. I had prepared a speech, but on the day the adrenaline kicks in and the clock ticks down, and I suspect I may have missed a few of the salient points I wanted to say. So below I have my prepared notes, which I hope emphasise the point I wanted to make. When the video becomes available I will post it too, so you can compare the two.
The Art and Science of Digital Medicine
Dr George Margelis
I love gadgets, I am unashamedly a geek. My first Personal Computer was back in 1981, a Sinclair ZX81, since then I have gone through multiple iterations, and today I have 3 computers and 2 tablets on my desk with 3 redundant internet connections. So as you can see I am not a Luddite.
Today, to paraphrase Marc Antony in Shakespeare’s Julius Caesar, I have come not to praise technology, but to bury it.
Over the last decades many entrenched myths have developed about technology and healthcare. They are based on good intentions, and a common desire to do the right thing. However the net effect has been wasted money, wasted energy, and wasted opportunity. But that is not the worst of it. The real problem is that people who we could have helped, if we had done it right, were not being helped. We were breaching the very basis of the Hippocratic oath, First do no harm. We thought we were doing the right thing, but in practice we weren’t.
The first myth is that technology will save the healthcare system. We have heard that it will save the healthcare system billions of dollars, prevent thousands of medical errors, solve the challenge of chronic disease, and even stop childhood obesity. Because, as my technology colleagues have told me, these are just the fault of a flawed healthcare system run by greedy doctors and poorly managed patients, all of which can be solved by the right app on their phone.
They are Wrong. Healthcare is a complex endeavor, balancing human physiology, psychology, sociology and economics. Technology is a powerful tool we can use to effect many aspects of healthcare, but ultimately healthcare is a very personal endeavor. No app or device alone will change that. In fact, technology has the potential to amplify our problems in a way humans just cannot. For the technologists their desire to simplify everything to data flows is their greatest weakness.
The second myth is that the development of new technology, that is new gadgets that we see being released on a regular basis will drive innovation in healthcare. New tablets, phones, sensors, imaging devices will lead to innovation. Again wrong. Innovation in healthcare is very different to invention. Each new gadget, is a new invention. It is only an innovation when someone does something better with it. A faster chip, a better screen, a new program are all great inventions, but until someone takes that capability and delivers a healthcare outcome using it, it is just another shiny bauble by the bedside.
The gadgets are not our enemy, they are our tools. As with any tools, in the hands of the right person they can make beautiful art, and in the wrong hands they can create havoc. It is our responsibility as the healing profession to ensure they are used well. The challenge we face is that the technology for gathering information has overtaken our capability to utilize it. It is up to us to speed that up, and at the same time simplify it. We hear about big data, it is up to us to turn it into good data.
That is where you come in. The doctors, nurses, allied health workers, medical administrators. You need to identify the problems, and use the gadgets to make the improvements. You need to take charge, and stop believing that the latest device will solve your problems, because the people who make that gadget have no idea what your problems are
However, it is not all about the doctor. The greatest change in healthcare is the rise of the E-Patient. The E has many meanings. Empowerment is the key to better healthcare, so the Empowered Patient is one of those meanings. The key to power in the past has been access to knowledge. For centuries locked away in medical libraries and arcane journals that knowledge has now been freed by the power of electronics. So the Electronic Patient is another meaning, because thanks to the internet and the computers that have made the world’s knowledge available via the press of the button the doctor can no longer hide behind their shield of knowledge. Again, the electronics is but a tool. The real innovation is in people making that knowledge available and accessing that knowledge, and using it to improve their health. A journal article in itself will not make anyone healthier, but accessing it and changing your actions based on that evidence will. Technology can make the knowledge more accessible, but like the proverbial horse to water, it can’t make you drink from the fountain of knowledge. Education can, so the third E is for the Educated patient. Not in the classic K-12 sense, but in health literacy. No doubt the two are related, but unless we ensure the health literacy of our population is improved all our efforts in healthcare reform will be wasted.
The E-Patient along with the E-Doctor and the E-Health system can change healthcare. By combining the art and science of medicine with the art and science of technology we can develop solutions to our healthcare problems. Separately medicine and technology cannot. Each can make a difference, but when combined, with a deep understanding of what we want to achieve, the potential is limitless.
To do this we need to develop a clinically focused innovation model that combines the two. Doctors need to understand technology, and technologists need to understand healthcare. We need to make sure we are working towards a common goal, healthier and happier patients. To do this we need to collaborate. This sounds simple enough, but we come from very different worlds. For us to collaborate, we must first cohabitate. We need to bring technologists into our domain, the hospital, the clinic, the labs. We need to introduce them to who we work with, our patients and their families.
They need to understand how we work, how we think, and how we accept that sometimes, despite our best intentions, we can’t solve all the problems. The art of medicine is as much to know when to stop, as it is to keep going.
In technology there is only one direction, forward. We can learn from that, and develop the burning desire to continuously improve what we do. We can learn to measure more, analyse more, think more before and after we act.
At the intersection of doctor, patient and computers lies the brave new world of digital medicine. It is our responsibility to take charge of it and mold it into a tool that can deliver on the triple aim: Improve the patient experience of care, improve the health of populations, and reduce the per capita cost of healthcare. We can’t do it alone, but we can lead it, and it is our responsibility to do so.