Electronic kiosks where patients register with a swipe of a ‘smart card’. Hospital ID bracelets with scannable bar codes. Computerized bedside monitors which allow test results and treatment data to be recorded on the spot. Prescriptions electronically packaged and delivered by ‘drug robots’. Individual patient drugs distributed by MedCOWS (Computer on Wheels). Informed patients who use laptops to enter personal health information and obtain their laboratory test results at the same time as their physicians.
   These are but a few examples of the present and future world of healthcare information technology (IT). We and our colleagues barely recall a time when computers were mysterious devices, relegated to climate-controlled back rooms and understood only by a handful of ‘techies’. Twenty years from now, none of us may remember a healthcare world devoid of PCs, handhelds and other electronic assistants. This new wave of disruptive technology is challenging traditional assumptions made by existing healthcare providers and manufacturers.
   In the late 1990s, industries such as telecommunications and merchandising invested heavily in IT. At the time, critics argued that no new products would be generated from this investment, and that merely redistributing a delivery model could not improve quality or services and may add extra financial burdens. Within a decade, the critics mellowed out. Consumers clearly recognized the fruits of this investment and quickly became savvy about the internet highway, which led them to a multitude of new purchasing options including online shopping, traveller reservation systems and e-brokerages.
   Google and Microsoft, IT companies that profited from the information revolution soon recognized that many internet searches are related to health. These corporations are now actively competing to build a presence in the healthcare sector. The Electronic Health Record (EHR) is a major example of the eHealth revolution. An EHR is an individualized personal health record that is accessible online from many separate but integrated, completely wireless IT systems. Critics argue that EHRs will allow sensitive personal health information to be made public, resulting in loss of confidentiality. They fear that data monitoring systems will ‘crash’, resulting in vast losses of crucial information. On the other hand, EHR proponents point to existing secure databases and their many and varied advantages. Just one example: following a car accident, police can access victim’s demographic and personal data within few minutes whereas health personnel have no such access. In future, paramedics and emergency room personnel could quickly access EHRs and use the eHealth data they contain to determine crash victims’ pre-existing health conditions, medication allergies, and other potentially life-saving information.
   Another new and fast growing trend known as personalized healthcare (pHealth) has also arisen during the past few years. pHealth has made it feasible for a person to locate information on the internet to develop personalized prevention, treatment and wellness programmes. Restructuring vast quantities of information for individualized use is a complex process, but IT companies have shown that they are up to the challenge. Google, for instance, has invested in the genetic profiling company 23andMe, whose slogan is ‘genetics just got personal’. Starting this month, for US$ 1000 and a bit of spit, 23andMe customers can learn what is known about how their complex biological code shapes, who they are, and how they can predict vulnerabilities to diseases. Microsoft has acquired Medstory, whose motto is ‘information that matters’, and whose goal is to provide consumers with easily accessible data about virtually any health-related topic. These are but two examples of emerging business trends in new eHealth and pHealth options.
   The concept of patient empowerment emerged in the 1970s in the USA and Europe in the context of the civil rights movement. Patients and their organizations demanded a right to self-determination over decisions affecting their health. In addition to political pressure for giving consumers and patients more rights, there were also factors in the healthcare sector itself, driving the move to eHealth and pHealth. Of course, the financing of healthcare is a prime example. In 2005, US national spending on healthcare totalled nearly US$ 1.9 trillion, 14.9% of the nation’s GDP (4.9% in 1960). A recent congressional budget office estimate projected this spending to increase to 25% of GDP in 2025, and 49% in 2082. As US consumers are being forced to shoulder an ever-growing share of their healthcare costs, it has been suggested that by exposing the healthcare industry to increased consumer pressure, market forces will hopefully expand options for improved care at less cost. A federal government study estimates that the adoption of interoperable electronic medical records systems could produce efficiency and safety savings of US$ 142–371 billion. Proponents of EHRs also contend that IT will lead to major benefits such as streamlining activities, redesigning work flow, standardizing policies across hospitals, reduce the time spent in documentation by healthcare personnel, and at the same time provide more data for monitoring and analysis of individual physician and hospital practices.
   Despite these trends, the USA trails a number of other countries in the use of eHealth and pHealth. It is estimated that only 15%–20% of US physicians’ offices and 20%–25% of hospitals have adopted EHRs. Persistent barriers include high costs, lack of certification and standardization, concerns about privacy, and a disconnect between who pays for IT systems and who profits from them. In contrast, total IT spending by the UK’s National Health Service is set to hit £2.9 billion over the coming year. Other European and Scandinavian countries are also ahead of the USA in implementing IT strategies.
   Has IT become relevant to healthcare in India? Highly relevant, it turns out. Top IT leaders at Bear Stearns’ 20th Annual Healthcare Conference in New York unanimously projected India, with its massive and largely computer-literate younger generation, as the next Asian healthcare hub. The anticipated growth rate of the Indian healthcare market has been pegged at 22% annually, reaching US$3 billion (Rs 12 000 crore) by 2010. A higher demand for quality services, increased healthcare spending, closer linkage of health with quality of life, availability of advanced diagnostic and treatment options, and greater access to healthcare insurance are some of the factors expected to drive eHealth and pHealth growth. In turn, Indian IT and related industries are expected to benefit. In addition to the huge investments announced recently by the federal government and private hospitals, corporations such as Reliance Industries Limited (RIL) plan enormous healthcare investments to the tune of Rs 25 000 crore over 7–8 years.
   Proponents also note that IT in India could coordinate activities at primary healthcare clinics and enhance prevention and treatment programmes which strive to reduce disproportionate rates of child mortality, tuberculosis, leprosy, and a host of other illnesses. Whatever the future may hold, healthcare will not be the same in the US and in India, with the emergence of enhanced consumer choices and empowerment facilitated by the internet revolution.