Author: Michael Emmerich
Published in: Autumn 2018 Edition of Ambulance Today Magazine
This Africa Quarterly editorial looks at the increasing demand for healthcare across the continent, and the pressures to reduce costs and show increases in value and patient care, including outcomes. Technology addresses key healthcare problems in developing economies and can also in turn add value. Small victories can lead to vast improvements.
Health systems are now rapidly developing and the Fourth Industrial Revolution in healthcare is upon us – wearable internet technology that will monitor our health in everyday life. Practitioners and patients can take full advantage of new and ubiquitous technologies. The smartphone in your pocket can open new avenues in healthcare.
Africa already uses technology to manage human resource constraints, such as text services that enable doctors to support Trained Birth Assistants at a distance. With rising economies and urbanization, noncommunicable diseases (NCDs) present new challenges to Africa’s emerging health systems. We believe that addressing Africa’s “dual-disease burden” of both NCDs and infectious diseases will require developing and adopting low-cost and high-quality medical systems that encourage people to manage their own health. Mobile technologies and new breakthroughs in customized care will help us succeed.
- Patrice Matchaba, Head of Global Health and Corporate Responsibility, Novartis – WEF AGM 2018
Those of us with many years’ experience in EMS have then been privileged (or cursed) to see significant changes across the board regarding equipment, patient care, protocols and drug therapies. Many of us have actively pushed for change and new equipment; be it about fluid therapy, bleeding control, pain management and airway management. At times we miss the most crucial approach to patient care neatly summed up by Hippocrates (400 BC approx.): Cure Sometimes. Treat Often. Comfort Always.
The classic approach to patient care has always been underpinned by the following:
• Arrive at a diagnosis by patient consultation and physical hands-on examination
• Confirm one’s diagnosis via various diagnostic devices
• Reaffirm one’s diagnosis by means of special investigations
Will technology change this approach, for better or for worse? Looking back at history, we see that not all new technologies have been readily accepted by the medical community. Many were viewed (/are viewed) with suspicion. In the 1930s some doctors doubted an X-ray image of the chest was as reliable as a physical examination. Devices threatened to replace the diagnostic expertise of the traditional doctor. Many doctors have valued their clinical experience over machine-produced information. Other technologies initially failed because doctors or patients found them impractical. The ECG was only useful when it became portable and reliable enough to be used at the patient’s bedside.
The entire patient/medical practitioner relationship is changing, as the patient has access to a wider range of medical information. Our patients are possibly smarter (maybe). Patients have access to more medical information with the result that, at times, they might be less trusting and prone to ask more questions of their medical practitioner. As practitioners we must be open to this new questioning patient and be willing to answer more questions than we did in the past.
Taking cognisance of all of the above: what is the healthcare practitioner to do?
There is an acknowledged gap in the “bench to bedside” cycle of medical discovery and its implementation in clinical practice, which can mean a gap of years changing “what we know” to “what we practice”. Hence the treatment of patients in an emergency setting should not only be concentrated on developing new technologies but must also involve proper training and skills development; medical talents needs to be honed. New technologies must always mandate new skill sets, protocols and procedures.
An area of import in medical development is patient information. The more patient information we have at hand, the more appropriate patient care can be rendered. Information and knowledge management is critical in helping with the decision-making process and thereby improving patient care.
Many medical practitioners believe that patients should take an active role in managing their own health information because it fosters personal responsibility and ownership, enabling both the patient and practitioner to track progress outside scheduled appointments and at times of a medical emergency.
Patient smart cards are a way to grapple with this issue of information. They will allow patients to upload their health records via a ash drive and carry their information with them in their wallet.
Information may be accessed through cloud-based storage and encrypted systems anywhere in the world or plugged into medical smart readers. Medical practitioners can update to cloud technology in real time and the patient’s own medical doctor can be alerted to changes in the cloud files. Ultimately, devices with communication and motion/health monitoring functions are expected to be implanted in the body. These changes are expected to help people manage their health more closely, and possibly allow medical practitioners to use this valuable data in emergencies.
Another key area where technology can aid is in having more information at our fingertips via a “differential” diagnosis or problem list, accessed via the cloud and linking to our patient and the further information we input. After reviewing the patient history and examination, the practitioner must then trawl his memory banks and innate knowledge base, or one may need to consult texts/online sources to check-up/confirm their thinking.
Cloud-based technology could aid us and speed up the confirmatory differential diagnosis. There is no doubt room for improvement in the current approach, with many practitioners currently relying on their tacit knowledge base at the frontline which, while mostly effective, is subject to human error. Once the differential diagnosis or problem list is drawn up, then a related treatment plan can be formulated, and treatment in the form of procedures and/or prescriptions for medications may be suggested by our cloud database.
We need to focus on leveraging the information we have and if we do not pay enough attention to building a basic infrastructure, we will be unable to make the Fourth Industrial Revolution a reality.
Emergency Medicine must continue its current academic trajectory, to keep pace with the challenges that technology brings to our patient care. If academic training lags behind the technology curve, our practitioners and therefore our patients will be the poorer. We must ensure that there is no technology/practitioner gap, as we continue to push the boundaries in improving our patient care.
The danger of technology is that it can make us lazy and reliant. It has become noticeable in certain areas of emergency medicine how our reliance on technology has allowed us to forget the three cornerstones of good medicine; diagnosis, confirmation and reaffirmation, of which the diagnosis and confirmation are reliant on us having a hands-on approach to our patients (which is becoming a dying art). Good solid diagnostic skills will always be an essential tool of medicine, especially emergency medicine – we forget this at our and our patients’ peril.