Jeff Goldsmith (www.healthfutures.net/) is the final speaker, with a lecture titled ‘Informatics’ influence on the future of health care’. He compared US health spending against the whole of the Canadian economy, and that it is similar to the GDP of Germany.

Emerging technologies:
1. - genomics - will be a lot bigger deal than most people think. Many of the highest powered applications in healthcare are around gathering genetic data; will make a big difference in how we care for patients.
Clinical implications of genomics will include new business models for pharmaceutical companies. Metabolic information, especially around understanding the genetic contribution to adverse drug reactions, will be one of first uses of genetic information in patient records. There are also huge issues around access to the information gathered. Long term potential is for individualised therapies, antibodies, vaccines for specific illnesses in indivduals’ bodies.

2. - intelligent clinical care systems - will be a mature technology when it is cheaper and easier to use. The nature of the record (a historical record of what was done in the past) will change - interaction of existing and new elements, such as cellular information, metabolic pathology, interventions, anatomic detail, genetic information. We need a tool to locate where patient is right now and a navigational tool set for the whole care team (GPS navigation model).

Jeff describes evolution of EMR from passive documentation, (individual unit of care) through clinical navigation system (episode of illness), through to knowledge resource (clinician’s practice). He compared the remembering of previous visits to sites such as Amazon, and suggested that new EHR tools will include such systems.

Usability issues are an important aspect of reasons why healthcare IT tools are not as widely used and embraced by clinicians as they could and should be. Suggests there will be a digital divide in access to healthcare IT tools.

3. - remote patient monitoring - convergence of remote sensing with intelligent clinical software to maintain people in home, as well as monitoring of hospital patients. On the sensor horizon are things like the eNose (to smell infections), RFID-like sensors for clinical parameters, and integration of suites of sensors. Modalities will include smart clothes, smart homes, etc. Issues arise of who will access all the telemetric data, and how it will be used. Also - because we can do it, should we; and how can IT maximise scarce professional time in patient care activity, and so make a difference?

Among implications for nursing, Jeff suggests there is/should be no IT installation without work redesign - clinical transformation does not come out of a box. IT objectives should be about providing more nursing time for direct patient care.

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