Challenges from the digital revolution

Abstract

We note with interest the recent editorial (January 2006 JRSM1) and letter (January 2006 JRSM2). They reflect facets of the massive growth in communications technology in healthcare. The doctor-patient relationship has been affected by the information available on the Internet and the presence of self-help groups and web sites moderated by expert patients.3 Geographical—but not linguistic—barriers are becoming irrelevant. Another form of telephone consultation1 of value is the nurse-lead telephone help lines run for patients with chronic conditions by centres of excellence—for instance, the Arthritis Centre, Northwick Park Hospital and the Scleroderma Centre at the Royal Free Hospital, London. Outsourcing2 is not restricted to moving tasks to lower cost centres: the opposite may occur. For example, on-line journal submission systems have moved tedious data entry away from journals' editorial staff to the submitting authors. Similarly, digital cameras, and easy-to-use software, have allowed physicians to subsume the task of medical photography—albeit at lower quality than qualified medical photographers, who are also scrupulous in obtaining consent and meeting the needs of data protection. Regretfully, medical photography departments are being closed. The availability of mobile phones with integral digital cameras allows physicians to capture ephemeral signs at the bedside or in the clinic. For instance, a camera phone was used by one of us to acquire an image of a transient rash that allowed the diagnosis of adult onset Still's disease to be reached. But the use of mobile phones in hospitals remains contentious as they may affect medical equipment.4 Nevertheless, the widespread ownership and reliance on mobile phones makes blanket bans of their use in hospitals unenforceable. We expect the use of telecommunications in healthcare to expand. It is clear, however, that innovation should be carefully risk assessed and monitored lest the law of unexpected (and unwanted) consequences be invoked.