Will new health care technology bring a utopia or dystopia?

It’s easy to get carried away with the continual promise of better health care through technology. From the IBM Watson super computer to vending machines that dispense pharmaceuticals, we are likely on the cusp of a new wave of technology that will vastly change the way we deliver health care. Whether that is for better or worse is up for debate.

The public largely buys into the dream of transformation through technology. Even with all the questions raised about problems with electronic health records, for example, surveys still show substantial public support. Are we even aware of what the trade-offs are?

Richard Alvarez, President and CEO of Canada Health Infoway, told an audience this morning that the next big thing will be personal health monitors, easily accessible devices that can be picked up at department stores like Walmart.

Speaking at Longwood’s Breakfast with the Chiefs alongside Dr. Jennifer Zelmer, vice-president of clinical adoption and innovation at Canada Health Infoway, the two argued that technology can be a case of the good, the bad and the ugly. Not surprisingly given the speakers, the presentation got specific on the good and much more vague on the bad and the ugly.

Canada Health Infoway is an independent not-for-profit corporation created by Canada’s First Ministers in 2001, and funded by the Government of Canada. CHI has a mandate to work with governments, health care stakeholders and the technology industry to “improve access to health information for better care.”

After enthusing about personal health monitors, Alvarez pondered who would pay for these items, harkening back to a quote they began the session with from futurist William Gibson – “the future is already here, it’s just not very evenly distributed.” What role does government play in levelling that playing field?

Richard Alvarez, President and CEO of Canada Health Infoway

The speakers highlighted the ability of technology to make health care more accessible to remote communities, especially ones that face difficulties recruiting specialists. Zelmer specifically made the claim that Telehealth saves Canadian patients from driving 47 million kilometres at an estimated cost of $55 million. The opportunities are certainly much broader. Alvarez said with digital scanning it was possible for pathologists to work out of a single center in Canada. It was interesting that none of the audience members picked up on the implications of this – if it could all be done out of a single center, what’s to say that this center even had to be in Canada? That should be enough to make any pathologist nervous.

Alavarez and Zelmer suggest that the “bad” constitutes issues around privacy, patient safety, workflow and scope of practice. It is interesting that neither raised the issue of control, especially when technology makes health care much less geographic specific.

Does whoever controls the technological portal control the system? With the temptation to off-shore our health care system, what happens if the source country decides not to sell these services any longer, or cannot recruit sufficient professionals to meet our needs? What happens if there is another buyer willing to pay more for limited resources? What is the contingency when the technology fails, as it often does? What happens when new technologies replace the old,  is there sufficient benefit to warrant these costly transformations? We all know about new patented drugs that do very little different from generics. Are we likely to witness a similar pattern with costly high technology?

Like last spring’s presentation on IBM Watson, no costs were ever put forward, although Alvarez and Zelmer have suggested savings in the billions as a result of existing advanced technologies. Should we not be asking what is the cost-benefit of new technology, and does it promote appropriate use, especially when the provider needs to recoup their substantial investments?

Previously in Diablogue we noted a Duke University study that showed doctors who owned advanced diagnostic imaging technology were far more likely to use it, raising questions about appropriate use and overall cost to the system.

Alvarez admits there is a lot of technology already out there, but we could be doing a better job at how we use it.

Recognizing the black eye that Ontario’s e-Health scandal delivered to promoters of information technology, Alvarez frankly admitted they are no longer using the term e-health, instead preferring to talk about digital health information. If public buy-in is as high as Alvarez and Zelmer say it is – 92 per cent support electronic health records – why the need to beat a retreat on the language?

Promoters of new technology are always quick to make impressive promises, but Canadians should be wary without evidence to support it. We know that 41 per cent of Canadians already have electronic health records. Where are the outcomes?

We should be also asking about the broader questions that new technologies raise, including what the future of health care professionals will be in a universe where a computer is effectively doing primary care diagnosis, when remote technologies make it possible to offshore services, or even what constitutes public health care when new private technologies enter the home?

The future may be now, but are we entering into a utopia or a dystopia?

Stay tuned.

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