Understanding and Managing the Complexity of Healthcare

8 Technologies for Care

In Technopoly, Neil Postman observes, “A new technology does not add or subtract something. It changes everything…. New technologies alter the structure of our interests: the things we think about. They alter the character of our symbols: the things we think with. And they alter the nature of community: the arena in which thoughts develop” (Ball & Bierstock, 2007). Historically, technology has enabled a greater simplification of routine aspects of our lives but also has added complexity to socioeconomic dynamics at both lower and higher levels of our ecosystem. Technology has entered every space of our lives from how we communicate, interact among ourselves, entertain, and work to how we access the outer space of Earth. A recent article in the Economist (January 12, 2013) on “The Great Innovation Debate” reminds us of the great inventions of the late nineteenth and early twentieth centuries including modern sanitation, telephone, antibiotics, and means of transportation, which may have positively affected our lives to a greater extent than most recent inventions including smartphones, supercomputers, gene therapy, and stem-cells transplants. In fact, recent inventions are not fully accessible and have higher variations of added value. As the same article recaps, it may be just too soon “to judge how a big deal these inventions will turn out to be.” Healthcare has embraced technology in all its forms. People have become knowledgeable about their health and wellness. Many processes in the delivery of care, operations, and administration have become paperless. Technology diagnostic and therapeutic equipment for “looking inside the body,” including CT scans and X-ray, are in high demand. But the adoption of technologies in healthcare may also have come into conflict with equity and cost-effectiveness and, more importantly, may have contributed to the soaring healthcare costs and externalities such as reduced security of health information. Technology alone cannot heal, but when appropriately incorporated into care, technology can help healthcare professionals and 8 Technologies for Care 140 Chapter 8 consumers make better decisions, become more efficient, engage in innovation , and understand both individual and public health more effectively (Federal Communications Commission, 2010). Technology in healthcare is both a curse and a blessing. One on end, it induces complexity in the system by enabling strong connectedness, an increasing number of entities, relations, and dynamics, and emergent characteristics and functionalities; humans interacting with technology also add a new level of complexity. On another end, technology provides the means of reducing complexity in the system, through improved and effective processes including information flow, diagnosis, and knowledge access, through more efficient logistics including access to supplies, and through an increasing accessibility of medical science innovations. Technology is therefore a means for managing the complexity in the healthcare system while also potentially causing greater complexity in the system. In chapter 2, we argue that the goal should be to increase the complexity of healthcare where it can best be managed in order to reduce complexity for patients, their families, physicians, nurses, and other clinicians as it has successfully been achieved in other industries. Technology can be the enabler in shifting the complexity from the end users to the “back office” of the system. To understand better the technological impact on the complexity of the healthcare system, in this chapter we will review existing emergent technologies derived from two basic dimensions, information technology and e-healthcare. The emphasis is on potential benefits and challenges in adopting these technologies, but also on the ability to manage complexity in a systemic manner. This review of technologies adopted by the healthcare system is by no means comprehensive. There are numerous other technologies that have entered the space of medicine and healthcare from genetic microarrays for identifying differentially expressed DNA sequences and nuclear magnetic resonance for protein structure determination to pill-sized devices that could capture imaging of esophageal lining and CT scan for screening breast cancers. We instead will keep the discussion focused around our underlying themes, information-based and e-healthcare technologies. Health information technology (health IT, or HIT) refers to informationdriven health practices and the technologies that enable these practices including electronic healthcare records and telehealth. HIT is a multidisciplinary body of knowledge and technology related to the design, development , implementation, and use of information-intensive technologies in healthcare settings (Chiasson & Davison, 2004). Technologies for Care 141 E-healthcare is an emerging medical service paradigm, which employs information processing and communications technologies to enhance traditional medical and healthcare...