As the world has been dazzled by recent images from the Webb telescope I am reminded of the response back in 1990 when the Hubble telescope sent its first images back to earth. Different technology is used by both – each with its own uses. However, the latest opens a chapter of far wider understanding of the universe than what we had just weeks ago. This is due to advances in the use of technology.
Much has been made of the increased uses of technology during the pandemic. QR codes, for example, have seen a resurgence allowing for more than hands-free menus. Doctors notes and patient instructions are now provided with follow up questionnaires, as well as the ability to access scheduling without typing complex URLs or waiting on hold. Telemedicine, which is the exchange of medical information from one site to another through electronic communications, began much earlier through use of the telegraph and telephone, so this is not new. What was commonly the domain of a few dermatologists is now used by many specialties, including primary care doctors, physical therapists, and psychotherapists among others. This has necessitated developing further technologies, such as blockchain, to protect patients by complying with HIPAA, and improved technologies meeting the needs of varied populations globally.
When I first entered the exciting world of healthcare technology it was to understand and establish dosing protocols for plant medicines – primarily cannabis sativa, the substance often known by its pejorative name, marijuana. There needs to be more research. However, with over 10,000 medical studies to date, there is enough validation that this plant has medicinal properties. That is commonly agreed. What is not understood is how to use it – how much to take, what varieties, what form, how often. Do all people with the same diagnoses use the same products and amount? What relationship is there between age and weight? Does it matter how it is consumed, or if it is on an empty stomach? These are questions that cannot easily be answered with current healthcare technologies as the pharmaceutical industry is designed to work for single molecules, and in most cases, synthetics. The medicines I was seeking to understand contained up to 500 compounds which changed to other compounds through shifts in temperature and time. Two flowers from the same plant may contain different compounds depending upon where it grew on the plant. With so many complexities and potential data points, the task of understanding would be nearly impossible without the use of technology.
It is important that when developing healthcare technologies that we do not shortcut the information gathering process. If we do not ask a question, we cannot study the answer. In studying cannabis medicine, it was clear that various specialties could benefit from data. Farmers would know what to grow, manufacturers would know what to produce, retailers to sell, and most importantly, healthcare providers to prescribe. Technology would open the way for empirical data collection. This data could then be used by researchers to find more answers.
The Electronic Health Record (EHR) systems being used by most hospitals and doctors offices are designed with one primary purpose – to get the patient through the billing process. A common refrain among doctors, besides not having enough time with patients, is the EHR they are using is not designed to benefit the doctor/patient relationship. On the positive side, the use of EHRs has facilitated the sharing of information across healthcare providers reducing, for example, patients requesting copies of reports sent, and the inclusion of patients in accessing their healthcare information in real time rather than waiting for test results, etc..
Through the use of application programming interfaces (APIs) the information gathered by EHRs can be significantly expanded to inform specialists without having to modify the existing systems. In the case of cannabis medicine, the approach I took was to create a set of modules based upon potential end-users’ needs. A neurologist, for example, has different informational needs than a geneticist. Conversely, a geneticist may wish to know what the neurologist needs to direct research and development of particular compounds. By allowing various fields of specialty to collect data in areas that are relevant for them, and at the same time giving access to the larger data set the APIs make possible, has the potential to remove redundancies, further medical R&D, break down prejudices, and allow for quicker responses in times of healthcare emergencies.
The questions I wished to answer required the cooperation of patients, physicans, testing laboratories, geneticists, manufacturers, retailers, and farmers. The questions asked of each were quite different, yet the answers are part of one large data set being used to solve the cannabis dosing conundrum. Without technology to manage this large data set I would still be sifting through papers instead of designing clinical trials based upon empirical data. Technology is an important step to better, more equitable healthcare.