Ripple: the personal media revolution for health

The Joneses: masters of
ripple [wikipedia]

Health IT is awash with predictions of the "next big thing" being one of any number of ICT-inspired leaps forward.


Some recent predictions from Vector blog seem quite likely to occur in the near future.  As Keeley Wray wrote in Vector blog, Advanced computing + healthcare = disruptive change.  "...healthcare has been a dinosaur when it comes to using advanced computational approaches.  But I think in the near future we will see measurable change." 


In Keeley's post, the big trends are visualisation, patient empowerment through open data, and knowledge engines providing the "smarts".

Whilst it is likely that any of the predicted trends for health + IT will be "disruptive" the biggest change will come through the impact that all these trends have by occurring simultaneously. Think perfect storm. We'll look into this after the jump.


Before diving in, a cautionary note: ICT enthusiasts like the idea of disruptive innovation, but within the health care sector this can be quite an inflammatory concept. So, let's be clear: we want to disrupt the delivery system, not the care outcome. 

The benefit of having more users in a network is well known - Metcalfe's law states that the network's value increases quadratically with the number of users, in economics this is called the Network Effect.
I'm going to steal a phrase - Ripple - to cover the effect of having a network effect on both supply and demand.

The best demonstration of ripple (and what gave me the idea) is a scene in the 2009 movie The Joneses. The Joneses (a marketing team) are congratulating themselves on the success of their strategy; Mr Jones points to the abundance of new purchased product, observing "ripple, ripple, ripple"

Health is experiencing ripple.


This ripple will see health move from a hospital- or delivery-centric approach to a community-wide, ICT supported care approach. This transformation is characterized by the personal media revolution:

1. information access is a basic 
   commodity, 
2. exchange and control of high‐level data by many autonomous 
   intermediaries and 
3. creation and consumption of personalized media

There are a number of simultaneous effects that are both cause and evidence of this ripple, I'll look at a few:

[wikipedia]

Data explosion: New sensors collecting massive data sets, and electronic versions of old data sources: Sensors are being developed that can spit medical-based data out at up to 10Mbps. Technology to achieve this is already under last-stage standardization procedures in the IEEE 802.15.6. In addition, what were once physical records - text and images - are becoming electronic. As the electronic versions become common place, static records become dynamic - Magnetic Resonance Images become Magnetic Resonance Videos (2D becomes 4D).


ICT containing the explosion: pervasive advanced computing to turn massive data into useful information. This was the driver of Keeley's post. The argument here is that high-powered computing (where ever it may come from) transforms the sea of data into manageable flows of information. Part of the  "advanced" computation is that massive computation power is a commodity resource. This is typically stated with a line that ends with "cloud" but part cloud is only one delivery mechanism: the nature of computing is that the wearable sensors of tomorrow, will have greater computation capacity than desktops of a generation ago.


The actual mechanics of the analysis are quite detailed, and involve as many types of algorithms as there are types of data to analyze - but the characteristic is that they will be pervasive, and turn the data flood into information.


ICT connections: ubiquitous high speed interconnects to join the data centres. The next piece of the puzzle is interconnecting the data source (explosion) with the data analysis (control). Without the interconnects, there is no network effect - just some techies with the latest and greatest toys. With interconnected data and computing, then the "cloud" effect is a sensible analogy. 


Network facilitators: open source everything allows fast innovation and empowerment
Open source data structures, such as the open architectures and open source electronic health records The open access data structures are one of several steps. Open app communities - such as openmhealth.org and the SMArt platform that provide a community and facilitate fast and networked innovation. Not broadband networked, but rather, a multiplier effect that as each innovation appears, it causes the ecology of health delivery to adopt best practice as quickly as possible.


Network multipliers: social media. Network enablers like social media may be (incorrectly) viewed as a broadcast effect. Twitter search terms #hcsm (health care social media) and variations on local versions - eg #hcsmanz for health care social media Australian and New Zealand certainly offer this. A nice effect of the hash-tag is that it is heirachichal - if you search on #hcsm, you'll get all the localized versions (#hcsmanz) too. Social media in health is certainly similar in this sense as social media in business or any other ICT area. That's the first part of the ripple - seeing what others have, and demanding it for yourself, promoting it for others.


But the next part if the ripple is becoming prevalent in health: the medium is becoming part of the system, not just a reflection of it. Social networking is growing to the point that it is providing a data course for clinical research - according to the Boston Children's Hospital. Health care is social.

User demand: the early adopters are adopting now. The outcome of this ICT revolution, is a rapid change in the way care is delivered: a system change. Currently, 7 percent of US physicians use videoconference to interact with patients, although this is predominantly psychiatrists and oncologists. In Europe 39% of hospitals provide tele-consultations services (mostly limited to clinician-to-clinician interaction, and only 4% of hospitals provide electronic access for patients to their records. This will change.

And the secondary effects of funding programs such as meaningful use are driving adoption of IT solutions, and hence IT staff. Skills shortages in critical Health-IT areas are beginning to be felt. (Healthcare IT news calls the shortage an IT talent war, which may be overly dramatic)

The application of antibiotics to medicine is often touted as a revolution. In reality, antibiotics gave a new tool that was gradually and meticulously adopted where it helped. Even now, almost 100 years later, there is no one true way for antibiotics -- some debate remains as to their appropriate use. But, in retrospect there was health before, and health after the application of penicillin and antibiotic technology. The same is true for ICT: we will eventually look back on a time when the internet-of-everything did not provide universal powerful understanding of measured and clinical data  to provide best practice evidence-based support. 

The personal media revolution is here in health, and these are exciting times indeed.