Will programmers in health IT have to take the Hippocratic Oath?

The rise of healthcare IT raises many questions, including the ethical decision making of software makers

Will programmers in health IT have to take the hippocratic oath?
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In the health IT development hype cycle, a number of novel technologies have been announced and marketed. One example is the Qualcomm Tricorder Xprize, which is a competition designed to encourage developers to build a device that will diagnosis and self-treat a number of chronic conditions without the need for a physician. This prize is from the same organization (Xprise) that tried to encourage suborbital flight from commercial spacecraft companies.

Technology is so pervasive in healthcare that books have been written about “The Internet of Health Things” (Kvedar J.C., The Internet of Healthy Things) that describe the wonderful new sensors patients can wear and measure their health every day. Even within older data collection paradigms, the healthcare area is talking about patient-reported outcomes and how we need to incorporate this data with the electronic health record to help improve patient care.

Caution advised

We need to be cautious, however, about the future promise of health IT. Consider, for example, the recent struggles of Theranos, a health-technology and medical-laboratory-services company. It might be shut down by the FDA, and the "Securities and Exchange Commission and the U.S. attorney in San Francisco are investigating whether the company misled investors and regulators about the state of its technology and operations," according to the Wall Street Journal.

The current regulatory environment around health professionals was designed to limit the number of non-licensed professionals providing health advice. That means your smartphone and other devices will not be licensed healthcare providers.

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The regulations are so complex that the government is setting up a website to help navigate all of the rules. If you look at the website set up recently by the FTC about the number of different overlapping rules, the laws that govern healthcare technology are large.

Further, when working in the health technology innovation space, everyone needs to realize that mistakes can have deadly consequences. A cautious approach is warranted. Example: A report earlier this week showed how a risk calculator to determine if patients need to be on medication for cardiovascular disease may have led to incorrect prescriptions of statins. The error in algorithm existed since 2009. The algorithm was not regulated by a government agency, since doctors were suppose to know if the algorithm gave the wrong results.

Technology can't replace health professionals

On another note, healthcare providers are trained about the limitations of their skills and when they need to consult an outside expert. This level of self-awareness for health diagnosis programs or measurement is not routinely done in technology.

What is surprising is many of the devices we talk about are trying to replace health professionals. Why go to a doctor when a tricorder will diagnosis and treat you? Why go to the office when you have all of your data streaming to the healthcare team? Why wait in an office to be seen by a clinician for 15 minutes? Those questions can have dangerous consequences because patients could begin to rely solely on the technology and not an expert to provide opinions and advice.

Health professionals go to undergraduate and graduate school to help improve the lives of others. Upon graduation, they take oaths—from the Hippocratic Oath for physicians to the American Nurses Association Code for Nurses, as well as multiple other oaths or pledges for all of the allied health science professionals. Going back to the definition of profession: a paid occupation, especially one that involves prolonged training and formal qualification. Will we require the programmers of the health IT devices to take oaths? Or of if computers are self-aware, will the computers take oaths?

All of our health IT was developed by very smart people. However, we hold physicians, nurses and other health professions to a higher standard than other job categories. Further, we do not hold our technology to the same high standards as we do individuals, especially in the court of law.

As we rush to technology to help improve our lives, a different paradigm needs to emerge. We do not need to replace health professionals, but we need to engage them in novel methods to leverage the strengths of both computers and humans.

For a healthy 20-year-old patient with no chronic health conditions, does it make sense to have a physician review the number of steps or miles the patient completes on a daily basis? Or does using a daily activity-monitoring device make sense to track an elderly individual who is at risk for falls where a decrease in daily movement represents a change in health or a possible injury? Who is the appropriate health professional to review all of this data? What role do the algorithms have in helping to identify challenges? Who is held liable if the algorithms are coded incorrectly or if the health professional does not understand the results and makes a poor decision? Those are the types of questions healthcare organizations and professionals need to answer.

Just like self-driving cars have led to lots of questions about state regulations, so have healthcare devices. The sophistication of the algorithms will allow better healthcare, but we have to figure out what does and does not work.

Healthcare professionals love tools that help patients improve health and outcomes; however, the goal is to augment not replace the professionals. Even in Star Trek, the tricorder was used by a doctor. The Qualcomm X prize is trying to make a tricorder more functional than science fiction.

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