At a societal level, I suspect that localisation-based services and augmented reality will be an important wave.  It’ll probably be one of those developments where we look back in a couple of years and think ‘how could we ever have lived without it’; a bit like the mobile phone is now. New tools like Google Goggles or the Layar platform look amazing. These are tools that recognise the environment around you and deliver relevant information. For example, point your phone at a work of art or a bottle of wine and out pop the wiki articles or product information. Think about it: it changes the way we search for information quite fundamentally. You don’t need to type in keywords to become smart about your context. This will have a major impact I think.  It’ll probably be the defining technology trend for the next five years at a societal level; with serious implications to business and marketing obviously.

 

Mobile payment is another key trend I think. Look at the way this is taking off for street parking. The mobile phone is becoming so multifunctional; and so personal. In fact, is it still a phone? My kids don’t use it to call anymore.

 

But government regulation is a potential stumbling block in these evolutions.  For example, the EU is asking Google to refresh its Street View images (available on Google Maps and Google Earth) every six months. Is that viable? Privacy is important but I think that we need a pretty fundamental rethink of privacy legislation.  

In health care the main technology trends fall under the umbrella term ‘e-health’, covering things like telematics and the electronic health record.  In Belgium we’re trying to address all this via the e-Health platform. But I think that today we’re in a situation that is similar to the dotcom bubble just before it burst in 2000. The problem at that time with most internet ventures was the back-end; all these dotcoms had beautiful front-ends but the back-end logistics wasn’t organised or automated. We have a similar problem today in health care. Everybody is very excited about the potential of telematics but the back-end isn’t ready. Too many hospitals today are still working with paper records; but simultaneously they’re being asked to exchange electronic records with other hospitals, the government, GPs, etc. Too many hospitals simply aren’t ready for that.  And the gap between the have’s and the have not’s is growing, because the technology is evolving so rapidly. Clearly we need to allow time for the entire sector to catch up.

 

Notwithstanding this concern, there has been a great deal of progress in most hospitals. Ten years ago, IT was considered a straight-forward cost. Today that situation has changed fundamentally: IT has become a mission-critical service. The problem is that the market isn’t really mature yet. The supplier base is still very fragmented and if you look at the cases there are more failures than successes. The government is focused on this issue, however, to help set standards and guard quality. That’s important.  And most hospitals are on track: the intent is definitely there to automate. The pressure is clearly on.

 

We at the Leuven University hospitals are trying to take it step further by sharing a fully integrated medical record system among our partner hospitals. That’s an important development that goes beyond telematics where one is only exchanging data between separate systems. Here we’re actually sharing services, which allow us to move toward real collaboration at the level of care paths. For example, the bariatric surgery (stomach shrink surgery) care path is now exactly the same in Leuven as it is in Diest. That’s important for quality control.Take chemotherapy as another example. The main danger with chemo lies in the prescription of the right doses. Now we have strict computerised monitoring of dose control, at all our locations, using exactly the same systems and procedures. In the past we had much less control over these things. A patient was ‘transferred’ from one hospital to another; that meant handing over control. Today that patient may move from one site to another, but the attending team and the care process remains the same. Medical staff from Leuven can consult with staff from Diest while looking at the same electronic case file. In the past that would involve a cumbersome process of mailing a pile of documents. And the system is being extended to GPs and patients too. For example, referring GPs already have full access to their patients’ hospital records and can track their progress—although the patient does have to approve this access. Similarly, for patients we’re building a user-friendly interface whereby tailored information is offered, that will help the patient prepare for his hospital stay for example, or help with the revalidation.  

I think this trend toward larger groupings of hospitals is inevitable.  And the system integration will happen at that level; I do not think that we will move toward one universal system. We’re going toward deeper integration, but at the level of hospital groupings. This is important to the financing of health care too. Health care costs are increasing, unsustainably so.  Patients are being asked to pay more, health insurance is becoming more expensive; but obviously this is eliciting resistance from consumer organisations. And the pressure will only increase. That’s why we’ll probably head toward a system of ‘negotiated care’, where the insurance companies negotiate prices with hospitals on the basis of certain quality guarantees. For example, one of the health insurance mutuals here has apparently observed that there are significant differences in the performance that different medical teams deliver in areas like hip replacements—but the price is the same wherever you go.  That’s why I think we will move toward negotiated care, and the initiative will come from the insurance companies. And that’s why these hospital groupings will need to integrate their IT systems, because only in this way can they guarantee consistent quality, i.e. that the care trajectories and the procedures are the same across their entire operation. The competition between these hospital groupings is likely to become more intense, especially when we start seeing new international players enter the market—which they have a right to do given the EU’s Services Directive. It is these types of factors that are making IT so strategically important for hospitals. As hospitals we need to be a lot more proactive in managing quality, otherwise it will lead to a situation where third party players start doing exit interviews among patients.  

 

The potential for improved quality control is still tremendous. For example, in the prescription of medicine it is important that you check for possible interactions—dangerous interactions—between different drugs. Technology is now being used to check for interactions automatically. For example, if a physician prescribes a drug—and registers this in the medical record—then the system will generate various levels of alert, depending on the danger of the interaction. Similarly, the system can detect possible allergy risks. But now we’re also seeing systems that link the lab results to prescriptions, so that the physician can adjust the dose on the basis of organ functioning.

I guess this is a service that will grow in popularity.  There will be more pressure from the insurance companies to encourage people to have healthier lifestyles; but I don’t expect all people to start taking that responsibility.  Also, a personal health record will never be regarded as reliable by professional care givers—it’s no different to what a patient tells his or her doctor.  So it can’t replace the ‘official’ records and the e-health platform being built for those official records.

 

I’m hopeful that the e-health platform being developed in this country will strike the right balance between openness and privacy. The key principle here is that the patient needs to confirm the referral pattern, i.e., who is authorised to access his or her medical data. That should convince most people that they don’t need to keep their records under their pillow.