Weighing up winter, and real healthcare computing

One of the most frustrating things with the tech tools which we now have in our pockets and on our desks, is how under-used they are. There are so many major issues which they can solve, but for various reasons do not yet come close to addressing.

As a medical practitioner, one of the most valuable pieces of real-time information is what infections (and other ailments) are common at any time. Those trying to run our healthcare systems are almost completely dependent on such information for day-to-day capacity planning. These days, a high proportion of us have ‘smart’ phones, tablets, computers which are connected to the Internet. Yet we analyse very little information about health, illness and disease in real time.

When I ran a clinic, and had to plan staffing, capacity, etc., phone and email reports of fresh cases were the only way that I could know what was going on, whether we were going to be sat around twiddling out thumbs, or working flat out. Although our clinical computing systems collected all the requisite data, there was no system in place to monitor what was happening out there in real time. Furthermore, our only information came from primary healthcare practices, not from potential patients themselves.

Here is what I wrote in my frustration, after a long and intensely cold winter here in the UK:

Last winter will leave many lasting memories, of exceptional snow and Arctic temperatures, disruption to deliveries, and most of all the flu that struck almost everyone down. But media and government were really only able to quote figures for the relatively small number of deaths. Tragic though these were, the national impact of the flu epidemic seemed much greater. Less than one on ten of my friends and family escaped the flu during December and January. Even if only half the population suffered, that would have been around 30 million cases of flu over some 50 days – one of the greatest epidemics in recent years.

Yet, despite the billions that have been spent on healthcare computing, no-one really has a clue how many of us suffered an influenzal illness. Severe infectious diseases like yellow fever and typhoid are bound to take you to medical attention, are readily diagnosed accurately, and being notifiable diseases will bring the full might of the public health system to bear. Relatively few of us who suffered flu troubled our GPs, and those who did seem to have gone almost unnoticed. For whilst GP computer systems convert longhand diagnoses into special Read Codes that can feed the epidemiologist, this does not appear to happen in any meaningful real-time national system.

So whilst we can all quote depth of snow and the low temperatures that marked December 2010, no-one knows how many of us fell ill. If we had a National Illness Service, concerned only with the hospital care of those with major ailments, this might be understandable. But it is ostensibly, and should be, a National Health Service. Any condition that resulted in perhaps as many as 100 million days of illness across the country should not go unnoticed and unmeasured.

We now have the wherewithal to do much better. With many millions of computers, smart phones and other Internet-connected devices in the country, it could not be hard to monitor a substantial sample of the population daily to assess the state of the nation’s health. A few seconds of simple questions completed in the middle of the day should serve to discover how well participants are, and whether they are being troubled by those common conditions that are known to cause extensive suffering and significant economic impact: coughs and colds, low back pain, gastric upsets, anxiety, depression, and so on.

I am sure that I am not the first to suggest such a scheme, an illustration of how we could be better using our new communications and connected nation, far beyond submitting electronic tax returns and retaxing our cars online. Government should now be looking above today’s simple services – mostly aimed at cutting the cost of collecting revenue and navigating our bureaucracy – towards novel tools that could change our understanding of society. It is encouraging that the current National Census has an electronic option, allowing us to make returns online, but its fundamental design has changed surprisingly little since that of 1841.

Such ideas may be anathema to those who bear the brand of privacy above most other human rights. Compared to the information already harvested from us silently as we browse websites, tucked away in cookies or betrayed in an IP address, properly developed and protected tools could be robustly private. Perhaps they would need a sea change in public trust in government, but at the same time they could start restoring faith that our rulers were genuinely interested in their subjects, and the many miseries of last winter.

Unaltered from the original, which was first published in MacUser volume 27 issue 6, 2011.

Since then, there have been what can most kindly be described as pilot studies. But we seem to be no closer to this holy grail of health computing, or are we?