By Peggy Salvatore
My grandmother was born in 1896. The ice man delivered big blocks of ice through a little ice door in the kitchen where my great-grandfather moved the ice into the family icebox. My great-grandmother, fresh from birthing my grandmother upstairs in a quiet room attended by the family physician and a neighbor, heard the clopping of horse hooves pull away from her back door as the ice man dragged his freight to the next home while she held her infant daughter.
My grandmother was the first born of 13; she was the last of the 13 to die in 2002 surrounded by electronic, beeping equipment confirming that her heart had stopped after 105 years of continuous beating. No matter what else ailed her throughout the years, old Doc Hahn who visited her in the big living room and sat next to her on the “couch” told her, “Mamie, you’ve got a strong heart.”
Her three remaining children, 7 grandchildren and 8 great-grandchildren arrived for her funeral in motorized transportation. After her funeral, we gathered at a restaurant where food was prepared in kitchens with large, walk-in refrigerators holding fresh fish caught days before in places as far away as Maine and Vancouver.
After that same baby was laid in her final resting place two centuries later, her grandchildren pulled out their cell phones to tell their employers they’d be back at their desks later that day.
Only 105 Years Later
My grandmother lived only 105 years. In that span, she went from gas lighted fixtures to the computer age. Never in the history of man had huge leaps in technology taken our species that far in so short a period of time. Read Alvin Toffler’s 1970 bestseller Future Shock to get a sense of the compression of history. Today, scientists tell us the first human who will live to be 500 years old is already born. When I view history through my grandmother’s eyes, it doesn’t seem impossible.
In fact, when I think about the pace of progress, it doesn’t seem that surreal. It’s almost a yawn.
What was sci-fi in the late 1960s is merely everyday life today. So, why not a lifespan of 500 years?
What Does All This Have to Do with Health IT?
For my readers of Health System Ed blog, more importantly, why do I mention it here in the place where we talk about health information technology policy and related issues?
This blog began as a place where I could think out loud to explore the promise of health information technology as a way to make healthcare equal, accessible and affordable for all. I have believed since the mid-90s, and continue to believe, that technology is the great equalizer.
As I (re) start writing a book on the topic of health IT that has been growing mold in my computer, it is becoming increasingly clear that already we have partially arrived where I originally envisioned the future to be five years ago. The real story of health and technology is beyond that near horizon of universal, secure electronic patient records. Now, it reaches as far as the eye can see.
Increasingly, it is the interface of wearable and assistive technology with the electronic patient record systems where real vitality begins.
Disc brakes on a space shuttle
We still need to build and repair the technology that runs the system today. Electronic patient record systems still go down and leave health care practitioners working “blind”. It is still nearly impossible for your dentist to know anything about the rest of your physical health without personally asking you for your history, getting permission, and faxing your medical records across town. Your psychiatrist or psychologist who is treating you and possibly prescribing drugs faces the same limitation as your dentist.
From the perspective of what is possible with state of the art medicine circa 2015, the electronic patient record system seems almost barbaric. But our legal and regulatory systems, the limits of budgets and patient engagement and much, much more all figure into the system we are locked into today.
At the same time, we are beginning to build those large vessels – both literally and figuratively – fit for grand adventures that will take us to far horizons. Here, in my little corner of the world, I am expanding the definition of health information technology to include all the technology that informs leaps in human health and wellbeing.
To get anywhere meaningful, we need the full picture from a high level. Spending time, money and resources on health-related technology requires that view expand to take in all the current advances that will impact what we think of today as the interface of man and machine. When we think of the interface of man and machine under the rubric of “health information technology,” our imagination is limited to the computer on the desk of your primary caregiver’s receptionist.
On one hand, it seems superfluous and even careless to think about the leaps in genetic medicine, as well as the potential of assistive and wearable technology, when most healthcare providers can’t meet Stage 2 Meaningful Use attestation requirements. But in reality, without considering the state of the art, we will spend money foolishly as the technology leaps out ahead of our plodding efforts at putting a laptop in the lap of every HCP.
I don’t pretend to have any answers. But it is becoming increasingly clear as we reflect on the way the health information infrastructure is being constructed, that we start asking some bigger questions so we stop throwing money at projects that can’t do what they are intended to do.
The danger in controlling and regulating the details of the implementation of health IT is that we end up planning for disc brakes on a space shuttle. Our society and its component businesses are financing an infrastructure that serves the needs of people who live to be 100 in a time when babies are born who will live to see 2515.
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