Forecast of e-health development in the next five years

Predictions for the main developments in e-health over the next five years: cloud, modularity, genetics, and networking.

John D. Halamka, MD, MS, is a professor of medicine at Harvard Medical School, CIO of BIDMC, president of the New England Healthcare Exchange Network, and co-chair of the National HIT Standards Committee. Here are his predictions for major eHealth developments over the next five years:

Electronic health records in the cloud

Doctors are good at diagnosing and treating diseases, but they are not good at hosting servers, managing databases and enforcing government-issued data protection rules. They are unwilling to pay for expensive hardware and software, and cloud computing can quickly realize electronic health records.

Cloud computing stores data and programs on centralized servers rather than in the doctor's office. It requires new security engineering approaches to protect against malware, denial of service and sophisticated hacker attacks that could compromise private medical information. It also solves other problems, such as enabling complex software to be scaled up and maintained in the clinician's office without any technical involvement.

In the short term, regulatory requirements will drive the rise of "private clouds", but given the huge commercial potential of hosting electronic records for more than 500,000 U.S. physicians, commercial cloud providers are likely to develop secure hosting solutions. While serving as CIO of Beth Israel Deaconess Medical Center (BIDMC) in Boston, John D. Halamuka moved infrastructure and applications to the hospital's private cloud, cutting the cost of implementing electronic health records in half.

Modular software unleashes creativity

Cloud-based software combined with tablets will usher in a wave of software innovation. Currently, innovation in health IT relies heavily on the development progress of a few large vendors who sell $100 million hospital systems to hospitals. In the future, electronic health records will become increasingly modular, just like the online app stores that let consumers download games or programs for their phones. Imagine a cool new app that gives diabetics a dashboard that shows their daily blood sugar readings and sounds the alarm if they are not managing their disease well. Today's doctors must wait for their medical center's sole vendor to develop such an app. In the near future, modular software will allow doctors and patients to tap into the creativity of thousands of entrepreneurs.

Computer hardware will also accelerate the new ecosystem of innovation and bring it to the patient bedside. More than 1,000 clinicians in our hospital have used their own funds to purchase tablets such as iPads and Samsung Galaxy Tabs. Although developed for ordinary consumers, tablets have proven to be ideal computing devices for doctors as well: they weigh less than a pound, have a battery life of 12 hours (or a shift), can be dropped from five feet without much damage, and can be wiped down with disinfectant.

Genomes lead to information for prescription drugs

It took nearly $3 billion and more than 10 years of effort to sequence the first human genome in 2003. Today, a person's entire DNA sequence can be determined for less than $10,000 and in about a week. I was one of the first 10 people to be sequenced (through the Personal Genome Project), and I can say that there is still a big gap between understanding a person's DNA and being able to use it to make a difference. For most people, DNA still doesn't tell us much.

That will change sooner than many expect. Researchers are already working on new ways to store a person's genomic data in electronic health records and speed up diagnostics, for example by predicting in advance the chance that a person will develop diabetes. Treatments will be more effective because your DNA can be compared to that of thousands, or even millions, of other patients. Rather than just prescribing medications, doctors will be able to use your DNA to write "genomic information prescriptions," tailored educational materials that describe the risks, evidence and likelihood that a treatment will work for you.

Network interconnection and sharing

Many people assume that doctors will constantly share data with each other to coordinate treatments, conduct research, or track disease outbreaks. The reality is that only a handful of hospitals and cities in the United States are able to securely exchange health records, and even fewer have the financial means to do so. However, over the next few years, new standards for secure data email between providers will be integrated into electronic medical records. The use of fax machines will gradually decrease, and patients will expect that every time they see a new doctor or visit a new hospital, their health records will follow them.

Will there be one giant database containing all of our health records? Will there be a single network connecting insurance companies, doctors, and patients? This is unlikely, given privacy concerns. Instead, we think cities, states, and regions will develop regional data exchanges. Just as the Internet has many email service providers and many Internet service providers, there will be many private and public "Health Information Service Providers" that can exchange data with each other. This will create a national health information network made up of a federation of subnetworks.

In my parents’ generation, doctors were considered essentially infallible, and medical records belonged to the doctors and were only accessible to them. Today, the availability of trusted medical knowledge and electronic records on the Internet allows doctors and patients to view the same data, and shared decision making is increasingly common. Research shows that shared decision making between doctors and patients often leads to better outcomes. An engaged patient is also less likely to allege misconduct by the doctor and sue.

New payment models will pay doctors for maintaining patient health, not for ordering a test or performing a procedure. This emphasis on early intervention will lead to the rise of connected devices in the home, such as blood pressure cuffs, blood glucose meters, and bathroom scales that wirelessly transmit data to the clinician's office and the patient's personal health record. Remote consultations in the home will become more common. It's getting closer. Fifty years ago, doctors came to your home and tried to make you better. Today, we've shortened the office visit time to prescribe a prescription to treat an illness. Home monitoring and telemedicine will take us back to a bygone era of health.

Now, the golden age of e-medicine is dawning. U.S. healthcare currently accounts for 18% of GDP, which is undermining America's position in the world market. Health care information technology can bend the cost curve by ensuring that patients get the right care at the right time (not too little or too much) and by improving quality, safety, and efficiency. Although health care reform has proven controversial in Washington, health care reform is widely accepted. With $27 billion in federal stimulus, the urgent need for change, and collaboration between government, insurers, and providers, we will usher in an e-future for health care.