The Technology Today column is being reignited amidst a frenzy of new technological developments, setting the stage for an unprecedented transformation in health care. Technology is, in fact, the "growling engine of change"1 that underlies the rapid revolution we are experiencing. To lay the proper foundation, this column focuses on the fuel that drives technology and digitization and describes where we are today and how digitization is propelling us into the future.
Background
If you step back and look at the whole picture of the world, and not just health care, you will see we are living in a period of astonishing progress. To really grasp the incredible magnitude of change, think about mobile phones, and ask yourself, "Why do we even call them phones anymore?" They are so much more.
Mobile phones contain not just telephones but also cameras, clocks, stop-watches, calendars, flashlights, photo albums, voice and video recorders, a post office, banks, calculators, a multitude of games, CDs, books, maps, movie theaters, dictionaries, translators, and millions of stores where you can buy just about anything, anytime. Something that fits in your purse or the pocket of your scrubs or laboratory coat has more computing power than the Apollo spacecraft that put a man on the moon.
The mobile phone, however, was not what transformed the entertainment and retail industries. The rapid transformation of these and other industries came about through the digitization of data. Digitization refers to the conversion of an analog signal to a digital signal.2 Analog data are measured as continuous variables, whereas digital data are measured as simple, discrete variables. Books, movies, photographs, and much more have been converted into digital formats, making them easier to process, transmit, store, and display data.2 Beginning to sound familiar?
Digitization of Health Care
The digitization of human beings is allowing us to transform the health care industry. Topol, in his must-read book The Creative Destruction of Medicine,3 describes 4 digital arenas in medicine: (1) genomics, (2) wireless sensors and devices, (3) imaging, and (4) health information systems. Each of these digital medical technologies is propelling health care forward at an unprecedented pace, focusing on human biology, physiology, and anatomy to illuminate what Topol refers to as the "high definition man."3
Genomics
Many nurses can identify with the genomics area of pharmacogenomics, and a good example is clopidogrel (Plavix). On March 12, 2010, the Food and Drug Administration issued a boxed warning alerting consumers and health care providers that the drug might fail to sufficiently anticoagulate the blood of patients lacking the gene CYP2C19.4
For years, nurses have had front row seats to the effects of medications on patients. We have seen an array of benefits as well as intolerances or adverse effects among patients. Pharmacogenomics is beginning to explain the variation we have witnessed in practice. More importantly, using pharmacogenomics to treat patients will allow for more individualized and therefore more targeted and beneficial medication therapy. One day we will likely base medication therapy on our genome, much as we do today for blood administration on our blood type.5
In addition to genomic-based therapies, genome-based diagnostics are growing.6 Genomic-diagnostic tests can be diagnostic in confirming specific conditions or prognostic in predicting the possibility of a specific condition developing in an individual.6 Although these tests have potential for directing individualized care, eliminating overtreatment and undertreatment, more work needs to be done to validate the impact on health outcomes. The example of prostate-specific antigen as a screening test for prostate cancer has left clinicians and payers cautious about genomic testing.7 In a randomized study of 76 693 men at 10 US study centers, the mortality rate did not differ significantly between patients screened by prostate-specific antigen and those screened by rectal examination after 7 to 10 years.7
Wireless Sensors and Devices
Smartphone apps are receiving a lot of attention. Two such apps representing significant advances in wireless devices are AliveCor's electrocardiogram and Masimo's pulse oximeter. The AliveCor app enables users to monitor a person's heart rhythm, download it, save it, and even e-mail it. The device includes a smartphone case with 2 sensors. By placing the fingers of the left hand on the left sensor of the smartphone case and the fingers of the right hand on the right sensor, with the bottom of the phone in the right hand, the electrical circuit is completed and a lead I electrocardiogram is generated (http://www.alivecor.com).
Similarly, a pulse oximeter smartphone app by Masimo is combined with a pulse oximetry cable that plugs into the charger port of the smartphone. The device on the other end of the cable clips on a finger and measures oxygen saturation, pulse rate, and perfusion index. The smartphone displays allow people to view data trends and export data into a spreadsheet for long-term storage (http://www.masimo.com).
Equally exciting are the wireless sensors. For example, nanoparticles are being examined for their utility in the diagnosis and treatment of cardiovascular disease.8 Segueing off the successes of nanotechnology in oncology, nanoparticle delivery systems can deliver drugs directly to targeted cells, and nanoscale contrast agents can identify disease in earlier stages than current diagnostics, allowing for earlier treatment and prevention.8
Contact lenses are being investigated for their possible role in measuring ocular glucose in patients with diabetes, thereby avoiding numerous finger pricks.9 Disposable biosensors in contact lenses are being tested as a point-of-care technology providing continuous glucose monitoring. Adding this technology to automated insulin delivery systems via wireless transmission of data will one day allow for a complete closed-loop system, providing continuous insulin therapy as needed.3
Imaging
Next time you are on an airplane, pick up the airline's shopping catalog from the seat-pocket in front of you; you may see an advertisement for a 3-D printer. The cost may be around $1000, and think of what you could do with it. Far more exciting is the 3-D printing of human organs that is currently under way. A type of bioprinting, organ printing is one of the newest and most promising tissue engineering technologies, with the potential for creating a supply of organs that is currently exceeded by demand.10 Using biopaper and bioink in a bioprinter, researchers are producing simple tissue composites and trying to overcome the primary challenge of creating life-sustaining vasculature for printed organs.
Health Information Technology
The most famous health information technology is the electronic health record (EHR). In 2005, authors of a seminal RAND report asked whether EHRs could transform health care and answered affirmatively.11 They predicted that EHRs could save the United States more than $81 billion annually. Seven years later, a new RAND report acknowledged mixed reviews on EHRs and growth in health care spending of $800 billion since the initial report.12
The biggest issue with EHRs is the EHRs themselves.13 As a general rule, they currently are difficult to use and have minimal usefulness to end users. Although EHRs solve issues of illegible handwriting and duplicate testing and can expedite the ordering of diagnostic tests and supplies, they create a whole new set of issues. Today the digitization of human data via EHRs is largely manually done by clinicians.
Digitization of Nursing
What do technology and the digitization of humans mean for nursing? We must begin to answer this question, as paradigm shifts in the digital world of other industries have resulted in closures of music stores, video rental stores, and chain bookstores.3 The answer for nursing lies in innovation.
Brian Norris, a former chief nursing informatics officer, serves as a good example. At the age of 32, he and others launched MappyHealth, a social media biosurveillance system that won the Health and Human Services challenge in September 2012 (http://www.socialhealthinsights.com). Traditional efforts toward reporting infectious diseases have proven unreliable. MappyHealth is a software application that continuously mines Twitter data for health care words and terms. It is interesting to watch how chatter in 140-character tweets on social media is proving worthwhile in alerting health care professionals to disease outbreaks.
Perhaps a good place to begin the digitization of nursing is to think about what patient data are important to nursing practice and how we can begin to digitize that data or tap into data that are already being digitized, such as social media. What will nursing look like if we print organs such as hearts instead of repairing what is there? If medications are ordered and dispensed using genomic data, what will our role be?
Think less about engaging patients through technology and more about empowering them. We talk about health literacy today and the multiple challenges that involves. Begin thinking about eHealth literacy and the different challenges that will bring.
We must also ask, "What are the risks if we do nothing?" Would we lose our future in the digital world? How well does nursing fit into the 4 digital arenas outlined by Topol?3 Are our digital arenas different?
Conclusion
Digitization and technology have tremendous potential but are not without challenges. As with any innovation-be it fire, planes, or automobiles-there are downsides. Although we use fire to cook and stay warm, it can burn people and resources. Although planes and automobiles have enabled mass transportation of people and products, they can be used for ill purposes, and serious injuries can result from car and plane accidents. As we move forward in the discoveries birthed from the digitization of health care and nursing practice, we must be vigilant in dealing effectively with both the benefits and challenges that will come. It is an exciting time to be a nurse!
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