Editorial
Health information and communication technology in healthcare communication: The good, the bad, and the transformative

https://doi.org/10.1016/j.pec.2013.10.007Get rights and content

Introduction

Information and communication technology (ICT) have transformed our lives in banking, education, leisure, and human relationships. Health Information and communication technology (HICT) is no different; it is here to stay and there is no turning back. The presence of computers in the examination room has already transformed the traditional patient–doctor relationship from dyadic to triadic. It is now an interaction between the patient, the doctor and the computer [1]. Searching the World Wide Web for healthcare information is second only to searching for sites related to sex, while multiple forms of social media, now increasingly mobile, are challenging the limits of healthcare providers’ professionalism [2]. Information and knowledge are instantaneously accessible to patients, learners and care providers, adding an external brain or digital prosthesis to our cognitive capacity. In short, our use of computers and digital media has the potential to significantly shift the dynamics of health professions education, practice, and communication.

The promise of HICT is to empower both patients and providers and, in so doing, improve health care delivery and outcomes. The reality of HICT is something else again. Care providers and patients have experienced multiple barriers to HICT ranging from the computer screen exerting a disabling influence on relationship formation to HICT-related mortality and morbidity [3]. How will healthcare providers respond to these challenges and what will the nature of conversations be in the brave new digital world? While very prominent in lay discourse about healthcare there is surprisingly little dialog about meeting these challenges in health professions education and practice [4]. As a result, healthcare providers are actually at risk of being relegated to a back seat in the digital healthcare revolution.

As editors for this special issue, we have selected a sizeable group of papers that address some of the most important challenges in HICT impact on communication. Out of the many submissions, twenty-six (24 papers, a letter and a report) were chosen for their quality and scope to describe the cutting edge of research and practice in this arena. Multiple countries in four continents are represented here: North America (USA, Canada), Europe (UK, Norway, the Netherlands, Switzerland), Asia (China mainland, Hong Kong, Israel), and Australia. While multiple questions have been addressed by the authors others still remain, and new ones are sure to arise. In this editorial we provide an overview of the territory that is covered as well as some challenges for the future.

Section snippets

General trends

Multiple opportunities and barriers to using HICT to support healthcare communication are addressed by authors in this special issue [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]. Based on their research, we now know that a generation of providers and patients now exists, with no apparent age demarcation, which use and rely upon HICT. For example, Agur Cohen [5] describes a physician digital

The impact of electronic health records (EHRs) on communication

The opportunities and challenges of exam room computing are addressed from multiple perspectives. Attempts to improve providers’ skills in the computerized setting as well as instruments to support them are described. Frankel and Saleem [13, p.367], “use cockpit communication as an example of highly a coordinated complex activity during flight and compare it with providers’ communication when computers are used in the exam room”. They conclude, “…that there is a great deal of room for improving

Patient empowerment and social media

Websites that target patients’ decision making and information-seeking often include testimonials of patients’ experiences. An interesting endeavor by Kelly et al. [22, p.433] used an objective impact assessment questionnaire to gauge and bridge the presentation of purely subjective patient experiences of health information websites. Through theme identification, item generation, expert and patient refinement – their item pool was created and validated. Having been validated through community

IT as healthcare infrastructure

Healthcare interventions, as well as tools and models that seek to improve patient outcomes abound. Linn et al. [8, p.387], for example, describe a multimedia intervention to improve medication adherence in Inflammatory Bowel Syndrome patients. The intervention seeks to synergize interpersonal and technologically-mediated strategies. Based on an MRC (UK Medical Research Council) framework, the intervention was developed based on theory, existing evidence and extensive modeling. It consists of

Disparities and digital disparities

Concern about how HICT could be used to level the playing field for disadvantaged communities, provide greater access and address issues of low health literacy are fairly obvious. The complexities of digital equity, however, are much more than just socioeconomic. Xiao et al. [23], for example, address the mismatch between the number healthcare institutions and relative rarity of pharmacies in China and propose “bridging” solutions. These solutions are already available in China, but have not

The e-doc and HICT in Health professions education

Much has been reported in literature about the need for health professionals to develop, an e-persona, i.e. a professional virtual presence that skilfully takes advantage of the new options offered by HICT. A salient example is already mentioned earlier (van Gurp et al. [18]) concerning telecare in end of life care, another by Bravender et al. [28] addresses training of physicians to better communicate with teenagers through a web-based intervention. Agur Cohen [5] as already mentioned,

Conclusions

Healthcare is experiencing a flood of HICT based modalities that are already transforming the way providers and patients think about, access, and act upon digitally supplied healthcare information. In many cases the transformation has already had a profound impact on clinical encounters, rendering the traditional face to face patient encounter only one of many options, and often not the preferred one. The office visit of yesterday is rapidly being transformed into medical care “to go,” that is,

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