We
need to radically change the way healthcare professional education is
delivered.
Even
twenty years back tertiary care hospitals were able to diagnose and treat
complicated cases reasonably well, under one roof.
However,
now the thrust is on wellness rather than illness. The majority of the patients
suffers from NCDs (non-communicable diseases) and need long-term treatment and
monitoring from home rather than in a hospital setting.
Information and Communications
Technologies (ICT) is already enabling doctors, nurses, and patients to help
each other. In the process, it is also facilitating primary care doctors to
disrupt specialists, and for nurse practitioners to disrupt doctors.
The second role for ICT in
transforming the cost and quality of health care is through the enhancement of
medical records from pen and paper based to electronic forms or EMRs – ones that
are portable, easily accessible, and interoperable. These can substantially
reduce the costly paperwork that burdens today’s caregivers. Further, these
will make it easier to avoid costly mistakes, and will enhance the involvement
of patients in their own care.
In its most basic form, an
electronic medical record (EMR) is simply the electronically stored version of
what has always been recorded with pen and paper. However, the ability to
customize and focus the personal health records or PHRs on consumer involvement
may allow it to overcome many of the hurdles that have slowed the adoption of
EMRs.
Unlike the US and Europe, in India, the EHRs have not yet been implemented
extensively. That offers a regulatory advantage as the Health Ministry has come
out with guidelines for adopting Standards. The National Health Policy 2017 has
advocated a facilitating environment:
23. Digital Health Technology Eco – System: Recognising the integral role
of technology(eHealth, mHealth, Cloud, Internet of things, wearables, etc) in
the healthcare delivery, a National
Digital Health Authority (NDHA) will be set up to regulate, develop and
deploy digital health across the continuum of care. The policy advocates
extensive deployment of digital tools for improving the efficiency and outcome
of the healthcare system. The policy aims at an integrated health information
system which serves the needs of all stake-holders and improves efficiency,
transparency, and citizen experience. Delivery of better health outcomes in
terms of access, quality, affordability, lowering of disease burden and
efficient monitoring of health entitlements to citizens, is the goal.
The future world in which today’s
health professional students will practice will be substantially different from
the world for which the medical schools are preparing them. One difference is
that many diseases that are in the realms of intuitive and empirical medicine
today will have migrated toward the domain of precision medicine in 20 years. Therefore,
many diseases will eventually be diagnosed and treated by clinical decision
support systems, nurses and physician assistants. Organizing and supervising the
work of allied health professionals will be a major dimension of
most of the physicians’ jobs.
Another difference can be
perceived between personal versus process expertise. There will always be a
need for deeply experienced, intuitively expert physicians to find complicated
solutions. Many diseases will go on defying precision medicine, and new
diseases will emerge. Today’s methods of preparing medical students to work as
individuals is appropriate for those who will work in tertiary care hospital
setups — though we will likely need fewer such physicians 30 years from now.
But most of the physicians in the future will work in settings where much of
the ability to deliver care will be better embedded in processes (clinical workflows)
and in (smart) equipment, rather than exclusively resident in individuals’ capacities.
Any medical college is yet to establish a health professional course in which
students can learn how to design self-improving processes that prevent mistakes
from occurring.
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