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The Internet as the New Industrial Revolution: Implications for Healthcare

Posted Oct 17 2012 12:00am

Pathology Informatics 2012, the most important pathology conference of the year, was held on October 9-12 in Chicago at the Hyatt Regency. All of the PowerPoint slides for the lectures synched with audio have been posted and are available online (see: Full Schedule ). Click on any of the lecture titles to launch the presentation. In this and subsequent notes, I will frequently link to this rich set of lectures to support some of the new ideas that have been germinating in my mind post-conference. --BAF

I had to turn to the Wikipedia for a concise definition of the industrial revolution that was referred to in a recent article describing the Internet as the modern analogue of it (see: Industrial Revolution ). Here it is:

The Industrial Revolution was a period from 1750 to 1850 where changes in agriculture, manufacturing, mining, transportation, and technology had a profound effect on the social, economic and cultural conditions of the times. It began in the United Kingdom, then subsequently spread throughout Western Europe, North America, Japan, and eventually the rest of the world. The Industrial Revolution marks a major turning point in history; almost every aspect of daily life was influenced in some way. Most notably, average income and population began to exhibit unprecedented sustained growth...."For the first time in history, the living standards of the masses of ordinary people have begun to undergo sustained growth ... Nothing remotely like this economic behavior has happened before".

Here's the link to the article that caught my eye and below is an excerpt from that it (see: The Internet Revolution is the New Industrial Revolution ):

In the mid-90s, ARPANet was transformed from a military safety net to the civilian Internet that has become such an integral part of our lives, bringing with it change not only technological, but societal and epic in scope....The Internet is bringing a revolution along with it. Access to information combined with global supply and demand is reshaping established conventions and destroying old world definitions....The very definition of ‘success’ is now drastically changing. It once meant a “keeping up with the Joneses” lifestyle your neighbors would be envious of; now it’s about making personal, intimate choices about how to live your life....Anyone now has the opportunity to monetize their skills, from the full-time worker looking for additional income to the once hobbyist building their very own business....As we engage in a century where everyone is not only a global citizen, but a valuable “Brand in Waiting,” we begin to understand that the Internet Revolution IS in fact the Industrial Revolution of our time....It’s the return of personal choice and personal definitions of value, as we increasingly define ourselves by the work we produce rather than being defined only by the work available.

We all understand that the effects of the Internet/Web are ubiquitous. The technology affects nearly everyone and everything in very fundamental ways. It's inescapable. I personally spend perhaps four hours per day working on web-enabled email, writing these blog notes, and searching for information with Google. But let's turn our attention to a physician working in a large, complex hospital. On the one hand, such physicians are now demanding that they be allowed to access the hospital EHR with their smart phones or tablets. On the other hand, we have hospitals today spending hundreds of millions of dollars installing EHRs running on local servers that are the rough equivalent of "mainframe computers" in a former era. Dr. Paul Chang commented in his lecture at PI-2012 that healthcare is the only industry in the U.S. that "solves" its computer problems by using a single, monolithic, inflexible EHR system rather than a set of specialized servers connected on a network (see: Digital Revolution in Radiology ). With this more advanced computer architecture, the user submits a query to the network and the response is assembled using information from the most appropriate, specialized systems.

Hospital executives are also passively resisting the exchange of clinical information with HIEs because they view it as proprietary to their hospital. They resist cloud computing on the basis that it is too risky and because their favored EHR vendors are committed to older technology (see: Relevance of the Cloud for Lab Computing ). Hospital executives are providing patients access to their own medical information via patient portals primarily because it is required by Phase II of the HITECH act with financial penalties for not cooperating rather than because it's a key element in customer service (see: Relevance of Meaningful Use Rules for Lab ProfessionalsPatient Portals For Laboratory Results: Conundrums and Care ).

Simply put, the Internet "Industrial Revolution" will swamp much of the outdated IT that is being deployed and healthcare will be no exception. One person quipped to me during PI-2012 conference that the Epic EHR will be "gone" in ten years. This is clearly impossible but there is no question in my mind that the company will be seriously challenged in upcoming years by more innovative HIT choices. Companies will spring up that offer better EHR services for much less money based on modern technologies and processes. This has always been the modus operandi in healthcare IT.

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