At the end of the 19th century, the United States saw a revolution in the transportation industry. The transcontinental railroad was completed, steam ships and locomotives began to move goods and services, and the automobile industry was still in its infancy. Within the medical establishment, healthcare providers were excited about how to leverage this new “automobile” technology to improve healthcare and reduce medical costs.
Between 1906 and 1912, the Journal of the American Medical Society ( JAMA ) published a number of articles that captured the discussion among physicians about how best to use this new technology in the transportation age. Articles entitled the “physicians automobile” 1–3 contained discussions about the return on investment when using an automobile, patient safety, automobile technology, and anecdotes about the successes (and challenges) of incorporating this new form of transportation into medical practice. The focus was on how best to leverage this new technology by the physicians and healthcare providers within the existing ways in which medical care was delivered.
In 1908, however, everything changed. Henry Ford introduced the Model T and brought transportation to the masses. The power of transportation technology was now in the hands of not just physicians, but patients and individuals. By 1912, JAMA stopped writing articles about “the physicians’ automobile” and society soon stopped describing the automobile in terms of what it lacked (i.e., the horseless carriage). The transportation revolution was available to everyone, and the need to identify the user (i.e., a physician) was no longer necessary.
Now, 100 years later, at the turn of this century, we are seeing another revolution—in information technology. With the meaningful use incentive program and the wide-spread adoption of electronic health records (EHRs) by hospitals and physicians, we are seeing discussions about EHRs that focus on how physicians and healthcare providers can use the EHRs to reduce costs and to improve patient safety, patient health, the healthcare system. Meaningful use focused on the adoption of health information technology by doctors and hospitals. The patient was sometimes an afterthought or a qualifier to the existing technology. We still refer to technologies with prefixes such as “ consumer health” or “eHealth.”
But that is beginning to change. The Affordable Care Act established funds to engage patients in Patient Centered Outcomes Research. The precision medicine initiative seeks to engage individuals to join a cohort of one million individuals who want to donate their data to better understand the relationship between genetic, environmental, and other factors in their health and healthcare. We are seeing a shift in which individuals are the focus. It is not consumer health, or eHealth. It is just health for all of us.
In this special issue of JAMIA , members of the AMIA community are on the forefront of research that supports the individual as one of the most powerful transformational force in health information technology. Patients and individuals using health information technology could prove to be the single biggest force for innovation in health and health-care delivery.
How can we, the informatics community, accelerate this (inevitable) transformation? We must continue to advocate strongly for the patients we serve. We must trust individuals with their own information, and empower them to be first-order participants in their care. Patients are entitled to a complete, electronic copy of their medical record, but few take advantage of that right under HIPAA. The use of Open Notes to engage patients, the experience of the Blue Button activities at the Veterans’ Administration, and the development of new apps and resources for the release of medical data to patients have already created significant innovation in the health IT world.
The informatics community can accelerate this progress by partnering with our patients to assure that our research, application, and advocacy aligns with the needs of the individuals we serve.
Figure 1:
Dr. R. G. Walker, Denver, in his very satisfactory car (102), just leaving his office. Reproduced with permission from JAMA . 1908; L(10):811–834.
REFERENCES
- 1. Walker RG The physician’s automobile: its advantages and disadvantages. A discussion of cares, tires, motors, roads, chauffeurs, and repairs . JAMA. 1908. ; L ( 10 ): 811 – 834 . [Google Scholar]
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