The longer-term effect of Healthcare Informatics on clinical practice and education.

Introduction

From a pure informatics perspective, clinical medicine is the application of proven treatments to described conditions. This is analogous to believing that an orchestra is a means of giving sound to the composer’s score. This logic implies that computer programs capable of reading music will revolutionise classical music.

While the impact of ICT on clinical medicine has been minimal, it has not been zero. Extrapolating from what has already occurred may give a better indication of what will happen in the future than assuming that, because something is technologically possible and sociologically desirable, the detail of implementation will take care of itself.

Three developments will have a major role in redefining clinical medicine:

1. The internet and the dissemination of medical knowledge.

It is still too early to assess the impact the internet will have, but it is already apparent that the dissemination of medical knowledge is a double-edged sword. On the one hand, it allows patients to take a more active and constructive part in the management of their own treatment, which is particularly advantageous in chronic diseases. On the other hand, some patients are becoming less compliant and utilising more clinical time to discuss inappropriate or unproven treatments. These two situations require different responses and different terminology. The term Expert Patient refers to the former, while the latter is an example of Google-Informed Patient Syndrome (GIPS).

2. The ubiquity of information technology:

Processing power (often measured in million instructions per second, or MIPS) and data storage capacity has grown exponentially for a generation. While computer applications have in the past increased in complexity and simply consumed more computer resource, there is evidence that this will not continue for much longer. The result of exponential grown in computer resource, without a corresponding grown in demand, will be that processing power and data storage will become so cheap as to effectively be free.

As electronic health records become widely used, a huge amount of clinical significant data will be collected. Much medical knowledge has been obtained through extrapolating from sampling techniques and randomised control trials. With vast amounts of data available, much more rapid, accurate and detailed Total Population Studies (TPS) may soon supersede these. While this will lead to an explosion in the amount of clinical research available, it will have other effects too.

When diagnoses are recorded in centralised electronic patient record systems, epidemics could be monitored in real-time and rapid interventions considered. It will also be possible to measure the quality of the traditional clinical skills of history taking and physical examination. This may allow professional proficiency to be formally recognised and may reverse the decline in emphasis given to these skills in undergraduate education.

3. Practitioner's need for knowledge:

At present, primary medical research is published and analysed by academic specialists, who disseminate the knowledge through secondary research, teaching, conference presentations and textbooks, and this process takes time. Non-academic practitioners will face both supply-side and demand-side pressure. The explosion in the amount of clinical research available creates a huge supply; the internet makes this directly available to patients who then demand a response from their doctor before the information can be digested and disseminated through the traditional channels.

What may be needed is a more focussed approach to the evaluation and dissemination of new research, based not on the interests of leading academics but on providing practitioners with the knowledge tools needed to manage the expectations of the patients in the waiting room. To some extent this is what the UK's National Institute for Clinical Excellence (NICE) is doing at present. As this tend develops a new kind of physician may emerge. A specialist who constantly evaluates clinical practice and, in conjunction with colleagues, develops guidelines of other clinicians it follow. Well a metaphysician means something completely different, but perhaps such a role will come to be called that of a metaclinician.

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Copyright (c)Roy Johnston, Peter Millard, 2005, for e-version; content is author's copyright,