The future of health IT is everywhere (at least, intimations of it). Keeping up with it is not easy. I found the post discussed here a while ago in Dr. Bill Crounse's blog at Microsoft. It's called Unified Communications: The Next BIG Thing in Healthcare. I have a bunch of these posts that are partly done, and I'm trying to work through the backlog. There's interesting stuff here.
Healthcare is a communication intensive business. Good communication has a profound effect on the quality and safety of patient care. Communication also has a huge bearing on patient satisfaction. Yet historically, the options for how we communicate with each other in the healthcare industry have been somewhat limited. We are hampered by an industry that has far too long relied on old fashioned telephone, paging, fax, and mail (both postal and interoffice); not exactly the most contemporary communication infrastructure.
This makes me realize how spoiled I am working at one of the top academic health centers. Email is the ubiquitous communications medium here, but we also use MSN Messenger (replete with voice, video, file transfer, and application sharing); Skype (which can do many of the same things); blogs, wikis, and integrated Sakai-based collaboration and communication environments; issue tracking and project management software; and of course all this is in addition to our enterprise and departmental IT and telecommunications systems. Did I mention clunky old pagers, which most of us avoid, opting instead for text messaging each other's cell phones when we need to.
To get more radical, we can use Adobe Connect, and we have some cool cross-campus videoconferencing systems. We can also skip out to the Moonwinks Cafe if we need to, though that's a bit against the rules. OK, back over to Bill.
Today’s progressive businesses use a wide variety of tools and technologies to facilitate communication. Communication can be synchronous or asynchronous depending on the urgency or context of the message. Information can be relayed and exchanged by instant message, e-mail, telephone (including voice over IP), audio conferencing, or video conferencing. In addition, the concept of “presence” in communication technologies now allows us to know ahead of time if someone is available to receive a message or take a call. It also lets us set up rules on how, when, where, and on what devices we want to be contacted.
Wow! I never realized before we were a progressive business; for an IT geek, this place can feel pretty glacial at times. But I know it isn't, when I be objective about it all.
Bill is touching on the core divides of computer-supported cooperative work (CSCW) here. Traditionally (since the early 1990's, that is; it's a new field) it's been divided into a quadrant, with the two dimensions being time and place. Email is different time/different place (DT/DP), as is text messaging. Audio- or videoconferencing and instant messaging are same time/different place (ST/DP). Different time/same place (DT/SP) examples are harder to come by, because there are so many cheaper alternatives to information technology. A group whiteboard, for example. But enterprise systems often are used as DT/SP systems, for example in a hospital setting where it is important to convey information from one work shift to the next. The information can also be viewed DT/DP, but it's very useful to the next shift coming into a single location.
Same time/same place (ST/SP) examples include situations where a document is projected in a meeting, the editing application is shared between two or more workstations, and the meeting attendees can work collaboratively to edit the document.
Bill's point about "presence" is an indication that ST/DP technologies are becoming smarter, incorporating look-ahead features to conserve attention and energy - vital in a situation of chronic information overload. Another evolutionary change he hasn't mentioned is the emergence of a new kind of ST/SP, one that is a cognitive overlay on ST/DP. An example of this is Second Life, which offers a meeting venue in which ST/SP is emulated in a virtual world. Telepresence-based surgery is another example. Laparoscopic surgery is an example of virtual ST/DP CSCW, where the "place" is at a scale several orders of magnitude smaller than that of the surgeon, who on her scale is in the same place as the patient. So we can see that CSCW is evolving along with the information technologies that support it.
So let’s extend all that into the typical healthcare setting. No longer am I restricted to the telephone for communicating with colleagues or patients. Depending on the nature of the message, where I am and what I’m doing, I can decide to use either a synchronous or asynchronous mode of communication. No more waiting on hold or playing phone tag on the telephone. Furthermore, as communication technology converges to the computer and is increasingly facilitated by the Net, my choice of device is no longer restricted either. My office telephone, Smartphone, Pocket-PC, laptop, Tablet-PC or desktop PC will all be able to do the job for me whether it’s an instant message, e-mail, voice, or video communication that is required.
This technology will also have a profound effect on the way we conduct meetings and do training in the future. The use of multi-media web conferencing and interactive e-learning technologies will absolutely explode in healthcare as we increasingly communicate electronically in the office and at home for grand rounds presentations, staff training, patient education, and more. Finally, advances in speech recognition and the incorporation of speech recognition technology into unified communications, will open up new vistas for securely accessing patient information and relaying clinical orders.
Speech recognition is out of my ken at present, but with Second Life adding voice capabilities I've got hold of a decent headset with noise-cancelling microphone, so I'm going to be playing with it soon.
Bill's article is definitely worth your time. He does an excellent job of depicting the possibilities. I could be skeptical about some of his ideas, but my skepticism would be time-based. A lot of the objections I could come up with now will be eliminated by better technology before too long. I'll have to think harder and come up with some enduring points about which to be skeptical.
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