The practice of medicine is slow to change. This is generally a good thing, especially when people’s lives are at stake. The growth of evidence and medical innovation is as rapid as it is complex, so caution and sober analysis should defeat hasty transformation.
There is, however, one area in which medical professionals and institutions are especially, and even embarrassingly, slow: computers. Some doctors, nurses and hospitals either disdain digital technology, are daunted by it or are just indifferent. This poses several challenges.
The first is when, or, whether, to adopt a new tool. In the case of “e-Health,” the evidence is clear: Computers can improve care if used wisely. Failure to adopt a new technology when there is evidence it will help is a professional and ethical mistake.
This points to a second challenge: If we do not become competent in using our new digital tools, we cannot successfully address the novel scientific and ethical challenges that arise.
The history of contemporary bioethics is, in many respects, a history of challenges posed by new technology and our ability to adapt to it. From organ transplantation and dialysis to artificial life support and the latest implements of genetic science, every generation can count on a suite of thorny problems to confront and solve.
One pressing issue is the unintended consequence of competition in the electronic health record industry. A number of competing firms manufacture the systems that collect and store patient information. Their duties to maximize profit, protect intellectual property and secure market share has meant that the various systems often cannot communicate with each other.
After some $20 billion in government stimulus-package money was spent to support “meaningful use” and computer adoption, chances are your health record at Hospital A cannot be read at Hospital B. Such records should be shared with the click of a mouse, but we might as well be putting papyrus scrolls on a stage coach.
Even more interesting is the ability of computers to make diagnoses and prognoses. Traditionally at the core of a physician’s expertise, diagnoses made by computers are often more accurate than those rendered by humans. When has a doctor fallen behind by not using such a tool? If we are going to allow such robo-docs to diagnose disease, what kind of education, policies and oversight are required to guide the humans at the switch?
Also, computers are very good — generally better than humans — in predicting whether critically ill patients will die. How much weight should be given such prognoses, and how should we integrate them into hospital practice?
Consider also public health and biomedical research. In a world increasingly shaped, and alarmed, by pandemic influenza, SARS, Ebola and, now, Zika, it is clear that the health of communities requires widespread data collection, extensive sharing and rapid analysis, while weighing legitimate privacy interests.
Fortunately, researchers are effectively harnessing the power of information technology. Drug and device research, disease surveillance and the latest analyses of blood and tissue specimens all make extensive use of computers. Florida’s research universities, including the University of Miami, the University of Florida and the University of South Florida, are grappling with the challenge of balancing informed consent and privacy while trying to improve the health of populations. Funded by the National Institutes of Health, scientists in Miami and Gainesville have created centers for “translational research” to move discoveries from laboratories to patients.
Their greatest discovery so far might be that balancing consent and privacy requires community involvement and support. Some zealots insist that any use of patient information, even when “anonymized” or de-identified, requires the permission of every patient. Others argue that because we all have already benefited from the analysis of others’ information, we thereby acquired the duty to share ours freely to help others, especially when adequate security measures are in place and diverse communities are at the table.
These issues are as difficult as they are urgent. Addressing them now is one way to secure the benefits of an exciting new technology while anticipating the social and ethical challenges it raises.
Kenneth W. Goodman directs the Institute for Bioethics and Health Policy at the University of Miami Miller School of Medicine. Henry Mack is associate dean of academic affairs at Broward College and adjunct professor of philosophy at Florida International University.