John Patrick gave an enthusiastic talk on his 21st visit to DACS to update us on the many happenings related to Healthcare and the Internet. Ready or not, the electronic healthcare revolution is upon us.John is the president of Attitude, LLC, the author of Net Attitude, and was Vice President of Marketing for Personal Systems and Vice President of Internet Technology for many of his 34 years while working for IBM. His long list of activities included computerizing libraries, advising the World Wide Web Consortium, and more recently, activities in multiple aspects of the healthcare industry, from the personal to the corporate level. He has worked with Danbury Hospital on its board for 10 years.More recent topics by John can be found at patrickweb.com and at twitter @johnrpatrick. Of particular interest related to today’s talk was his presentation, “Electronic Medical Records: Do They Reduce Healthcare Costs.”John emphasized in tonight’s talk that while the Internet is still like an adolescent, it is growing up fast. Healthcare is merging with the Internet big-time through “disintermediation.” The effect is that the usual middlemen in healthcare are gradually being cut from the action while patients and doctors are increasingly using the Internet to access and share health information and data. This allows for greater efficiencies and reduced cost. “There is a personal healthcare revolution ahead.” The Internet allows ways to empower people to improve their own healthcare.However, still in its infancy is the “power of the click” in healthcare e-prescribing and other healthcare services. Healthcare on the Internet still has numerous problems to overcome including: privacy, security, massive amounts of data to analyze, compatibility of data across e-labs, e-dispensing, e-imaging and healthcare provider forms, to name just a few.By contrast in retail, “Amazon gets clicks right,” with 10-15% of the $200 Billion of U.S. online retailing. (All retail sales in the U.S. are about $4 Trillion per year with about 5% of that number consisting of online retail sales.) In retail, however, the print media industries of books, magazines and newspapers are still struggling to stay profitable and to adapt to the Internet.The good news for healthcare includes advances in personal health applications and devices which work with smart phones and tablets to instantly connect individuals with their doctors when a condition is detected needing intervention. iPads connected wirelessly to personal sensors on the skin or in the body are already reporting data to doctors and flagging important conditions. For example, a tiny chip in a pill can now transmit to a skin patch that can transmit to an iPhone–sending information to the doctor that the patient took the pill. A smart bathroom scale can transmit health data too.Smart ambulances already can retrieve your personal data on their way to the hospital thus speeding up the required services. CardioNet can transmit your heart rhythm 250 times per second to a smart phone monitoring your condition. By doing this, hospitals can reduce hospital returns of discharged patients—a bad situation that drives up costs while upsetting patients and their families. AliveCor from the back of an iPhone can transmit vital statistics. Patients can even do their own cardiograms. Asthmapolis, a wireless unit that fits on an inhaler, uses GPS to report patient use, allowing quick intervention should a problem arise. LUMOback is a band aid-like device that can continuously monitor posture in real time–sensing and sending vibration reminders to the individual to stand or sit better to reduce back pain. LUMOback helps to keep people healthy thereby helping to reduce the huge Healthcare costs for back pain mitigation.Using an e-bedside application, a surgeon can show images of muscle and bone to explain the procedure that will be used in surgery. By doing this, patients feel better knowing what’s going to happen to them, happy that the doctor has connected with them on a personal level, and receive more information about the rehabilitation needed later. To do things like this with personal virtual modeling and personal genomics for a patient requires that really big amounts of data must move around on Internet optical backbones. Smaller or sparsely spaced communities require thinking “out of the box” to allow for the new healthcare initiatives to reach them via dependable broadband optical fibers.By 2020, John estimated that the power of IBM’s Watson (Watson of computer chess tournament fame) linked with healthcare information from research and patients will be available to doctors on their iPhones. The use of powerful analytics such as this will potentially greatly improve personal and community healthcare initiatives. Assessing the overall health of communities and regions will be possible and allow for interventions against epidemics or regional chronic conditions.Obstacles to this Internet revolution in healthcare still remain and are serious. They include security in the cloud, personal privacy, trust between patients, doctors and health providers—all of which will require much more forward thinking. John said “Think big, act bold,” and “Start simple, iterate fast.” The creative thinking requires an out-of-the-box approach, given that entrenched behaviors are hard to change. The government could be more helpful in getting health standards set. (Danbury Hospital is a leader in ways to improve compatibility of the hundreds of medical records that don’t share well.) Many things in healthcare could be simpler. Pay-for-view medical articles are a bottle neck and they have to change. John is annoyed that data about your blood still doesn’t belong to you; the doctor “owns” it.Factors that would help to overcome these obstacles include improving Internet speed and reach to all communities. Game-changing technologies include tablets with web apps and the use of the HTML5 protocol, which improves compatibility across operating systems, computers, tablets, and smart phones, transmitting data to and receiving it from medical devices. Digital modeling of a human being allows for simulations of new drugs and treatments without harming the patient, to make customized personal care. A microarray is a multiplex lab on a chip that can allow for the assay of personal DNA and other tissue material.Things are improving. Healthcare is aligning more with patients and care is becoming more accountable. Electronic health records are better and are more widely available. Specialized social networking with sites such as “patients like me” already helps people to share with other patients facing similar conditions, thus taking better charge of their personal health. ZocDoc allows patients to find doctors if one is needed immediately. Movement towards payment for health wellness rather than payment for illness is also a hopeful trend.Fees for the quality of care, not just for service, are starting. Hospitals and doctors will be paid based on scores that include patient satisfaction. Doctors and hospitals will reach out to do better.Despite the growing pains as healthcare and patients connect via the Internet, John Patrick is optimistic and sees lots of creative energy already being spent trying to tackle the complex problems. For further study, visit the links in this review to become more informed about our changing world of healthcare.