How Technology and Computing Has Affected the Healthcare Industries
By Nina Benson, Katie Corbett, Corey Scamman
Introduction
The healthcare industry has an impact on virtually everybody. Between doctors, insurance companies, medications, and hospitals, everyone is reached. The advances that have been made in the healthcare industry as a result of computing have changed the way that doctors work and interact with their patients. Artificial intelligence has even found its way into healthcare, further advancing the way that hospitals are run. This increase of technology in healthcare has improved many aspects of the field, but there are still ethical concerns that must be investigated. The healthcare industry deals with life and death everyday meaning that their machines are doing the same. We must keep this in mind when designing machines to diagnose, treat, and care for patients as one mistake could cause someone’s life. Computing and technology has drastically altered the industry in many ways and continues to advance, forcing us to look at the costs and benefits of future research and technologies.
AI in healthcare
Artificial Intelligence is making its way into healthcare, helping increase efficiency and providing support to doctors and nurses. AI is being used to increase efficiency in scheduling, as seen at UC Health in Colorado, who is using an AI driven scheduling tool to optimize surgical schedules. The increase in schedule optimization allows for a higher throughput of patients which in one year increased the revenue for UC Health by $15M [1]. New York Presbyterian Hospital also used AI in a similar manner to reduce patient wait times by 50% which is a more intangible benefit to patients [1]. AI in general is being used to optimize hospitals to maximize efficiency and minimize costs. When AI optimization software is applied to all the hospitals nationwide, an even 5% improvement in optimization can unlock $100B in value per year. [4] Moving to more serious applications, deep learning methods have proven to be able to model drug toxicity levels and accurately read radiographs [1]. Additionally, AI can help diagnose patients and recommend treatments. IBM’s Watson Health software does exactly this, as it is trained to diagnose cancer patients and recommend treatments accordingly [1]. These softwares are trained on big data sets of patients for specific illnesses and use pattern recognition and machine learning to output diagnoses and treatments. Watson Health has already helped around 295,000 patients [2]. Now, this is not to say that AI will replace doctors in any sense. Rather, these AI tools are intended to support doctors and provide recommendations and attempt to speed up their work. Doctors still have the final decision to reject or accept any results the software outputs based on their expertise and knowledge.
They’re are many ethical concerns with AI in healthcare because we are dealing with the well being of people so mistakes can cost people their lives. As to whether an AI can make a mistake on a treatment and diagnosis and if so should they be responsible, we think that it is crucial not to remove the human element from the situation and that the AI shouldn’t be having that much control over the decision. It is possible that doctors can begin to rely too much on the software and become complacent and so we argue it is imperative for doctors to stay on top of their game. In regards to bias in scheduling algorithms in regards to certain patients getting seen before others, we again feel that there should be human oversight. Moving on to the thought experiment of what ideal AI in healthcare would look like in utopia, we think that it would something along the lines of what we would see in advanced science fiction and in space ships, software driven robots and machines that are able to accurately diagnose, treat, and successfully perform surgery on people. Even more so, the pod like objects in which you lay down in it for 10 minutes and emerge cured of any ailments. These outcomes certainly are an ideal outcome, and while this is in a utopia, things could easily take a turn for the worse. A simple malfunction, error, or system hack could turn a machine with a 100% cure rate into a machine with a 100% fatality rate, and if this were to happen collectively throughout society, this utopia would quickly become a dystopia.
Tablet Applications in Hospitals
Hospitals have been exploring ways to improve patient care using technology. Some have done so by decreasing wait times using artificial intelligence, as mentioned above. Other institutions pursue other methods such as providing a patient more access to their medical information.
Previous research has shown that a patient’s adherence to medical treatment regimens and patient satisfaction of care is heavily impacted by patient-practitioner relationship [3]. That being said, in a hospital setting, it is very difficult for patients and doctors to find opportunities to communicate due to logistical and time constraints and constant shift and scheduling changes. In fact, only 32% of hospitalized patients could even correctly name a single one of their hospital physicians [4]. In addition, health information technology has been primarily developed and given to doctors and other medical professionals, not the patients [5]. Patients aren’t even allowed the chance to read their medical charts at most institutions, even though they believe it will help them better follow and understand treatments. Keeping this information from patients makes them and their families feel uncertain and anxious [6]. Is it ethical to keep this information away from patients, especially since it pertains to them specifically?
One hospital, New York Presbyterian in New York City has developed tablet applications for patients to hopefully decrease these feelings and increase information sharing. The idea behind this application was to allow patients to be more in control of their care [6]. It was to be used on Apple iPads and built off of their custom personal health record Web portal. Access to information is only available after user authentication, to ensure privacy. Through this application patients had access to information such as their care providers, such as nurses and doctors, what medications they were currently and previously on, and how those medications were administered. The information could be updated in real time. This information was displayed in an easy to understand user interface, an example of which can be seen in Figure 3.
Figure 3 above shows that a care provider’s name, role, and image is shown to the patient. A list of medications, their dosages, frequency, and last dose is also shown to the patient. This application simply and clearly provides patients with the information related to their care.
The hospital initially tested this application by providing the tablets with the application to five patients in the cardiology step-down unit. They were all physically and mentally capable of using a tablet application. These five patients had never used a personal health record before this. A survey of the participants after using the application revealed that they were generally satisfied with the care received at the hospital. All participants felt the application improved their satisfaction and made them feel more engaged. One participant said “If I’m monitoring what’s going on, my care team will treat me better, because they know that I know what’s going on. There will be more honesty and better service.” [6] All patients also said the application was useful and helped them feel more at ease seeing the information told to them confirmed in writing [6].
This was the first case study of a hospital providing patients with a tablet application with the intention of improving a patient’s engagement in their medical care [6]. New York Presbyterian claims that after surveying the patients using the application this is a useful tool for providing information to patients. But that doesn’t mean the concept is perfect and that it doesn’t raise any concerns.
Patients are not the only ones that see the effects of this application. Hospitals and the care providers would also experience changes. Hospitals want their patients to be satisfied and have a good opinion of their facilities. This will ensure they recommend the hospital to friends and family members and will come back if they need any other medical care. Also, if patients complain about the hospital not providing them with adequate care or information, that will have negative repercussions on the institution. Doctors and nurses will now also have more eyes on them and their actions. Patients will be able to spot mistakes or if their care providers do not listen to their wishes. These medical professionals may also now have to more thoroughly explain their medical decisions to the patients. This is good for the patients because they have a better understanding of their care, but this takes time away from the doctor or nurse to spend with other patients. It also may interfere with their ability to provide the best care if the patient disagrees with their course of treatment. Downstream, this could also possibly lead to more malpractice suits against doctors if patients have better access to their medical information.
Other concerns include the privacy of confidential medical information. Who exactly are the authorized users able to access the application and a patient’s information? Their family? Just the patient? How is this determined and how can it be ensured only the correct people have access. In addition, what if errors lead to patients being able to access other patients’ information? How will this be avoided and handled? Who is liable if confidential medical information falls into the wrong hands? Similarly, how secure is user authentication for those determined to be authorized users? Will there be multi factor authentication? How often are user credentials used to log in? Additionally, how secure is the application from external attacks? Does this application open up a pathway for malicious hackers to access the larger medical information database for the hospital?
Differently, how does the hospital determine who is physically and mentally capable of having access to their medical information through this application? Can doctors just choose randomly if they want their patients to have access to this information? Their needs to be clear and medically sound guidelines as to what conditions keep a patient from being eligible for this application.
The best case scenario looks like the following. This application is a secure interface for patients of the hospital to use to have access to the information of their care. They will know who their doctors and nurses are and what their names are. They will know the specific medications they are on, the dosages they are being given, and when they have received a dose. This will improve patient care by making the patients feel more in control of their care and more involved with their health. It will also help them feel more connected with their medical staff. Specific guidelines would be inplace to determine who can get access to the application. Also, patients could add immediate family members and child patients could have their parents as authorized users.
Alternatively, the worst case scenario involving this application would mean the application is not secure, meaning there are many ways to get to the backend database through the application. There is no user authentication to access the patient’s medical information. Additionally, there is no system as to who gets the application. Instead of offering to all who fit certain preset guidelines, doctors get to choose if their patients get the opportunity to use the application. This would cause problems since doctors could purposely withhold this resource for their own gain, not in the best interest of the patient.
One way to ensure the worst case scenario doesn’t occur is to, in advance, only allow the application on devices provided by the hospital. This will help improve security. Also, the guidelines to determine which patients qualify for the application are already in place and available.
A way to improve the worst case scenario after-the-fact is to temporarily take down the application and take the time to audit the security protocols to ensure that only the people that should be authorized users are ones and then increase security. Also the hospital should take responsibility for the mistake. It was their job to keep the information secure and confidential, the liability should not fall on the patient or their family. They will also take the time while the application is down to prepare rules as to which patients get access to their information. All those who qualify should get the application.
In order to ensure applications such as the one being implemented at New York Presbyterian, proper authentication for application access, such as multi factor authentication or biometric authentication, should be implemented. Patients should also be able to say who can have access to their information. They should have the opportunity to allow spouses or parents and children access with their own specific log in credentials. Additionally, general guidelines should exist to ensure the proper patients receive the application. This should not be done at a discretion of the doctor alone. This could lead to bias or improper withholding of the information. This will also ensure a patient who is not allowed access to the application, or that patient’s family, can be shown why that is the case.
The application piloted by New York Presbyterian has the potential to be an invaluable technological tool to increase the quality of a patient’s care at a hospital. It can give patients more control over their care and make them feel more involved. But, the application needs to be implemented ethically. Medical information needs to remain secure and be available to all who medically qualify.
Telemedicine
Telemedicine is a recent development in the healthcare industry where doctors and patients can meet face to face without having to go to an actual hospital. Telemedicine companies such as, Doctor on Demand and CareClix, allow patients to get almost a full exam without having to leave home [7]. In theory this could seem to make it more difficult to help a patient, but 90% of common conditions seen at urgent care facilities can be treated via telemedicine [7]. Hospitals are then benefited by keeping non-emergent cases out and keeping people who could spread infections away from others healing. However, we must wonder, does telemedicine pose a risk to the quality of care patients are receiving? It also leads to concerns of misdiagnosis as the patient isn’t in front of a doctor and therefore the doctor is unable to physically check on their patient. These questions limit the amount that telemedicine is able to do while still giving patients the best care possible. These companies must also come up with a plan if a misdiagnosis were to occur as who whose fault it is. Those that choose to make an appointment via telemedicine must understand the risks that come along. With this said, doctors making a diagnosis must also take responsibility for their diagnosis and determining when it is time to tell a patient they must come to a hospital. However, these concerns don’t overshadow the success that has been seen as a result. Telemedicine has increased accessibility of medical care to those who can’t easily make it to an urgent care facility and are available beyond normal business hours, allowing more people to be helped. [7]
Conclusion
Computing and technology drastically altered the healthcare industry. It changed how patients are diagnosed, inpatient care at hospitals, and how people see doctors. The future is relatively unknown in the healthcare field as technology continues to progress. This progress comes with concerns that must be investigated as our research continues, however. Researchers must remember that the patient is the most important part of a hospital and their care should not be given up for a more efficient system. The balance between efficiency and putting the patient first is what doctors and scientists must be constantly working together to achieve. For example, this increase in technology has lead to concerns regarding patient information’s privacy and accuracy. The amount of information hospitals have access to means that we must ensure that the technology is continued to be used ethically. In addition, the room for error that comes with a machine poses questions of responsibility. Physicians always have the final say, but with the increase in technology it must be ensured that they do not become too comfortable with the lives of patients in the hands of machines. However, the progress that has been made in terms of efficiency and research is not something that should be overlooked even in light of the valid concerns that are at hand. The medical field has forever been changed by the introduction of technology and will only continue to develop.
References
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