Sunday, December 9, 2007

Limits of Technology, Internet - Medicine Doesn't Run on Internet Time

The world now runs on Internet time.

Andy Grove, founder of Intel

Clinical medicine doesn’t run on Internet time. Health care needs are so intimate, strong, varied, and diverse with so many permutations and combinations that personal care has yet and may never yield completely to the Internet or to be dramatically improved by it.

My skepticism makes me one of a diminishing few. Others think the Internet will transform medicine. To explain how this might happen , IT professionals use the term “Killer Apps.” A Killer App, short for Killer Application, refers to any computer application of power, originality, or market reach that turns the world upside down.

Prime examples of killer apps include the Internet and Google. The latest example may be the laptop itself. If you’ve been following the news lately, you’ve no doubt heard of Nicholas Negroponte. He’s founder and chairman of the One Laptop per Child non-profit association.

Negropante believes dirt-cheap laptop computers, distributed to illiterate children in the developing world, will be a world-wide boon to education and a blessing to mankind. In the health care realm, some believe universal laptops, in the hands of Internet savvy clinicians, may revolutionize medicine But, in a foreword to Unleashing the Killer App, Negroponte cautions Internet applications are often simultaneously understated and over-hyped..

You can appreciate his comment about understatement when you consider the hoopla about electronic medicine. Consider EMRs, EHRs, e-prescribing, telemedicine, and clinical monitoring of patients with chronic disease. Yet, for most doctors not much as changed in the clinical trenches. The most evident change in clinical medicine has been CT and MRI scanning. Internists have voted these computer-guided imaging devices as the number #1 clinical innovation over the last 20 years.

As far as hype goes, we have yet to see the clinical fruits of the computer-assisted stem cell revolution, individualized treatment of disease based on genomic analysis, diagnostic support systems, applications of predictive modeling on clinical practice, or even the much touted consumer health care sites such as WebMD or Revolution Health, Most so called killer apps, in the form of sophisticated algorithms, has been applied to streamlining managerial monitoring and “tiering” of clinicians. Until the killer apps have a more direct application to clinical medicine itself, I shall remain skeptical.

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