Abstract
Over 30 million people in the United Kingdom now use the Internet every day, and around 12 million people use mobile phones to access the Internet. 1 Can the NHS start to make effective use of this rapid development in information technology to improve communication between professionals and patients, and patients' experience of their healthcare? The Department of Health proposes to put patients in charge of making decisions about their health and care. One of the next stages in this process was a consultation set out in Liberating the NHS: An information revolution. 2 The publication of this consultation document coincided with the release of a Nuffield report that discusses the potential benefits and harms of online medicine. 3 Both documents address the uses of online technologies for communication between providers and patients in healthcare.
The wider context for the information revolution is the current push for the health service to place power and control into the hands of patients and to allow patients to be active participants in their own care. 4 Through effective use of online medicine, the future that the government envisages for the NHS is one where face-to-face contact and paper-based transactions are supplemented by modern technology, in the same way that we use our banks online for many transactions, as well as in person. As well as modernizing healthcare delivery, the government sees a role for information technology in self-care, and in encouraging patients to take greater responsibility for their own health and wellbeing. The Nuffield Council on Bioethics report suggests that policy and practice must take advantage of these technological developments; and discusses in depth the potential uses, and the social and ethical consequences of the introduction of such technology. These changes include the move towards the ‘personalization, consumerization and responsibilitization’ of healthcare (encouraging people to take responsibility for their own health).
Both reports discuss more complex ways of providing online medicine, such as giving patients access to and control of their electronic medical records, and in the case of the Nuffield report, technologies such as genetic profiling. There is also discussion in both reports about the use of the commonest online technologies that are used routinely in day-to-day life, and that exist already without needing expensive implementation programmes. Many of the recommendations in these reports can therefore be addressed now. This is important given that previous attempts to provide more complex online services, such as HealthSpace, the central NHS online portal for patients, have so far been unsuccessful. 5
Based on what these reports tell us about the future for online technology in healthcare, a change is required at the patient–clinician interface. Clinicians will inevitably encounter patients who use the internet to seek health information; and many patients will be using online technologies in their day-to-day lives. Clinicians should therefore be actively engaging with the idea of using online technology in practice, especially when they are likely to be using these technologies in other areas of their lives. Such engagement is starting to be seen in general practice, with some practices now offering services such as online booking and cancellation of appointments, access to electronic medical records, and ordering of repeat prescription either via the practice website or using a central practice email address. 6 Computerized history-taking systems are another example of patient-focused applications; potential benefits include the opportunity to provide information in advance of the consultation on the patient's ideas and expectations, allowing the clinician to tailor the consultation to better meet the patient's needs; improved data-recording in sensitive areas such as sexual health; and allowing the clinician to send an electronic update to the patient after the consultation to reinforce the advice given during the consultation. 7 The scope for introducing online healthcare is therefore wide and its implementation need not always be about the latest developments, such as smartphone applications or social networking. Nor does this have to mean the adoption of technologies which are not currently supported by formal guidance and advice.
Another example of how online healthcare can incorporate the more established types of technology is with email, which is common in the day-to-day lives of most healthcare professionals and patients, both at home and at work. Applying such technologies in the way envisaged by the government to facilitate the extension of choice and convenience for patients requires clinicians and managers to seriously consider the wider use of email; and the Department of Health's consultation document invites input from professionals and patients alike to help facilitate this. However, clinicians alone cannot carry the burden of engaging with technology in healthcare. Continuing with the example of email, for example, there are presently no up-to-date guidelines available on how to use email with patients. The most recent peer-reviewed guidelines were from the American Medical Association, and date back to 1998, 8 an era when the use of email and technology for accessing email services was much less common, and substantially more expensive, than now. Until there is formal guidance, clinicians may be reluctant to use such online technologies for clinical care but may consider its administrative uses; for example, using email or text messages to confirm appointment requests.
Some examples of how clinicians and managers can begin to incorporate online technologies into their day-to-day practice are given in Table 1. Online technologies and the ‘information revolution’ are changing the delivery of health services in the NHS and health systems in many other countries. Clinicians and managers need to act to take advantage of these developments now or risk being left behind, as their patients become increasingly familiar with the use of online and mobile communication technologies. If the NHS does not meet this challenge, the alternative future is one where patients are well ahead of clinicians in their utilization of technology, leading to the risk that the NHS is seen as a technologically backwards health system that has failed to take advantage of this information revolution.
Incorporation of online technologies into routine clinical practice
DECLARATIONS
Competing interests
None declared
Funding
HA is a PhD student in receipt of a MRC studentship at Imperial College London
Ethical approval
Not applicable
Guarantor
HA
Contributorship
Both authors contributed equally
Acknowledgements
None