Is e-health science fiction? Let me take you back some ninety years ago. A time when there was no such thing as a machine called a “computer”, let alone e-health. In the early twenties of last century Hugo Gernsback, a visionary publisher, introduced the term science fiction. Even now, the most prestigious award for science fiction novels is called the Hugo award. Gernsback also published a magazine called Radio News. In 1924 an interesting issue of this magazine appeared.
In this issue of Radio News Gernsback envisioned a future with: a Radio Doctor. A doctor you could access from your bed, throught the use of radio – which in those days was the equivalent of, let’s say, the iPad. Like today, technology was expected to change the face of healthcare and indeed, mankind.
And has it? We are here now, almost ninety years later, and where do we stand now? The digital age has brought us a lot, but can we honestly say information technology has had a massive impact on healthcare? We cannot imagine a world without the internet, surely, but has it changed the way the system works? No, it has not.We have to wait and see. We have to be patient.
And while we sit around waiting, circumstances change rapidly. The digital age provides tools for healthcare and especially for the most important player in the healthcare field: the patient. These tools empower patients or, in other words, they introduce e-patients.
The e-patient is here, right now. So, what about primary care, what about the GP? My name is Jaco van Duivenboden and I’mworking at the Dutch College of General Practitionerson topics such as e-health and GP informatics. I’d like to focus on who the e-patient is, what he or she does and what – based on developments in the Netherlands - this implies for the future of general practice.
First of all, who is this e-patient? One image that springs to mind is the young, male, highly educated, socially challenged person, in other words, the typical nerd. Of course, this is not the case.
Just as “the patient” could be anyone, an e-patient could be anyone. Definitions vary, but it is safe to say that an e-patient is a person who uses digital tools to manage his/her own health, in the broadest sense of the word. Of course, there are differences among age groups, sex and the manner in which e-patients use digital tools. The e in e-patient often refers to electronic, but we may as well define it as the empowered patient.
The rise of the e-patient should not come as a surprise. There is a shift happening. In the industrial age information was scarce, expensive, institutionally oriented and designed for consumption. This is true for healthcare as well. But: we’re living in the information age, where information is abundant, cheap, personal and designed for participation. And this might be happening to healthcare. A move from supply oriented healthcare towards more networked healthcare where digital tools support both patients and health care professionals in shared decision making.
So what does an e-patient actually do? What makes an e-patient?
The number one e-patient archetype is the e-patient consulting dr. Google. He finds health information online. On his (possible) illness, on medication, treatment options. A few years ago research showed that 50 to 70% of Dutch citizens visit Google before consulting their GP. And some e-patients use Google for more: to find information about you.
An e-patient uses information on the web, but in the last few years something else has grown far more important. Social media, such as Twitter, Facebook, Google+, are on the rise. In Europe 347 million users are member of one of these networks. An estimated 60% of e-patients are active on social platforms. They share healthcare experiences, discuss health topics and use the power of crowdsourcing. And – for some – even share their personal health data.
Of course, an e-patient is increasingly mobile and connected. Next year the majority of Internet traffic will be mobile. Besides having mobile Internet access, this offers patients a wide range of health oriented apps.
For example, in the Netherlands, an app was recently launched that – through a series of simple yes/no questions – assists patients in a very common decision: should I visit the doctor or not? A mobile phone becomes a medical device, a personal health record and a decision support tool.
So, with the e-patient here,what does this imply for general practice? In the Netherlands, e-patients and e-health are on the rise. Health care professionals are sometimes struggling with these developments and look for vision and direction. It is no longer a matter of why to use e-health. The question now is: how to use it in daily practice?
It is the view of the Dutch College of General Practitioners that the next few years will be years of “blended” primary care. Blended, because no patient or e-patient wants to rely on digital interaction alone. Blended, because physical, real life contact can be assisted and helped by digital means. It is mixing the best of both worlds.It’s not OR but AND. Such a concept is not enough. We need to overcome several important issues, in order for it to work. I’d like to stress three issues of special interest: (1) a change in attitude towards e-health (2) online security and indeed health care record security and (3) good access to the electronic health care record.
We’ve seen the why and the how, at least from a Dutch perspective. So what about the what? What are the critical components of an e-GP practice? In the Netherlands we focus on e-services, such as e-consultation, e-appointments and online prescription ordering. Chronic care is an area where e-patients will benefit the most from e-health. In the next few years online access to medical records – preferably assisted by the GP – will be more and more mainstream. Mobile computing is abundant and health apps are there: in the future you might prescribe “the best apps” to your patient, as well as use them yourself. For example, we’ve recently launched our own guidelines app for use in daily practice.
What can you do now, in daily practice, to be ready for an e-patient? It does not require you are online, mobile and connected 24/7. You do not need a Facebook or Twitter account. Though it might help. It does require you being informed, trained , transparant and involved. Be aware of what the digital age provides, both the possibilities and the threats. An e-patient will still need you. You could start as soon as you get back home and ask your patients a simple question: what do you want? The GP is the gatekeeper of most health care systems and therefore should be the first to embrace the e-patient. And that, is not science fiction.