The following long article appears in the December Atlantic Monthly.
Paging Dr. Luddite
Information technology is on the brink of revolutionizing health care— if physicians will only let it.
A premature baby can be as small as the hand that cradles the head of a full-term infant. In a neonatal intensive-care unit, babies are often so covered with sensors that doctors and nurses struggle to find enough skin to place them on. A squadron of machines stands vigil around their tiny beds, monitoring heart rate and half a dozen other vital signs, in intervals that can be measured in thousandths of a second. All of this watchfulness is very expensive; a stay in a neonatal intensive-care ward can last months and cost hundreds of thousands of dollars.
Given that expense, and the constant danger these babies face as their underdeveloped lungs and immune systems struggle to cope with the world, the use we make of all this information is surprisingly primitive. Periodically, a nurse stops by, eyeballs what has happened since the last check, and makes a note in a chart. A doctor reviews the chart, and may scroll back through the readouts. But he or she has no easy way to view them all in one place. The machines do not talk to each other, or to anyone else; each electronic guardian stands its own lonely watch.
Technology analysts refer to the elements of systems like this as “data silos”—each data set stored by itself, never touching the others. Over the past few decades, many industries have started breaking data out of their bunkers and using powerful computers to cross-index them, revealing previously unsuspected patterns. In health care, however, data isolation is still the norm.
IBM hopes to change this. Pioneering technology now enables the company’s systems to store and analyze streaming data in real time, a task that was previously too big for ordinary computers to handle. In a small field trial at Toronto’s Hospital for Sick Children, IBM is using that technology to test a theory already suggested by some studies: that tiny changes in heart rate may indicate infections at least 12 hours before they would otherwise become apparent. At the moment, the machines are simply watching, storing data and their predictions, so that IBM can test whether its prognostication works. But if all goes well, in the summer of 2011 the machines will start relaying heart-rate changes to clinicians, who will then be able to start antibiotics earlier, before an infection rages out of control.
The new system would be a significant advance. Preemies are already vulnerable to lifelong complications ranging from vision problems to permanent brain damage. Infections can play a big role in those problems, and early detection offers a chance to stop bacteria before they can compromise organs or kill their victims. That should mean shorter intensive-care stays, smaller medical bills, and most important, a chance at a longer, healthier life.
But early treatment of infections is just the start. Researchers also hope that bringing together these streams of data will allow them to “mine” records for other potential early warnings—perhaps enabling them to detect the seizures that so often inflict brain damage on neonates. This sort of monitoring could be expanded to the many adults who also need watching, in intensive-care units and trauma centers everywhere.
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The full article is well worth a browse. Enjoy. And yes EHRs and EMRs get discussed further down!