The term ‘The Age of’ is used to describe a sweeping change where the difference brought about by a catalyst is noticeable and for a period of time the change applied becomes the definition of an evolution.

At a recent event senior members of the healthcare delivery team in Ireland described the era we are about to enter as the ‘Healthcare Information Age.’ This brings good and bad connotations; firstly it’s a slightly ajar door to push against when the leadership of healthcare are using the area you are responsible for as a descriptor for the reform and change of healthcare and its current delivery culture. However it is also symptomatic of the current technology availability in the Irish healthcare system, that in 2015 we are only just beginning to describe the impact of technology on healthcare as a striking change. I have written before about the pockets of innovation and excellence all over Ireland and about how our focus in reality needs to be about joining these up, and that is how I see us getting to the Healthcare Information Age, or at least one of the steps on the way.

In thinking this through a comment from my A level medical history teacher sprung to mind;

“Before planning for the future study history first to ensure that lessons are learnt and mistakes that others have made before can be avoided, look in the rear-view mirror before turning right into the change lane!”

With this in mind a friend and his colleague developed a description of what they think are the eight ages of healthcare in Ireland:

The First AgeLocal and Essential – publicly funded care provided for the poor and indigent (1880’s – 1910’s). Technology in this period of time is just after Edison’s light bulb so care would have the ability to be provided more safely at night however with the advent of Coca Cola in 1886 the path to obesity and tooth decay would have been started.

The Second AgeThe Age of Public Health – TB and water/sewage sanitation improvement is the key focus (1912 – 1930’s). Arguably the first analogue computer was ‘live’ at MIT under the name the ‘differential analyser’. A long way from the computer impacting upon health but maybe the first time that more complex analytics of health situations became possible.

The Third AgeThe Old versus the New – Strong professional and Roman Catholic Church opposition prevents the introduction of “socialised medicine” in the guise of a Irish National Health Service (1930’s – 1947). A key invention in the path to the study of health was invented during this age, the electron microscope, a new frontier in clinical research is opened through this invention.

The Fourth AgeThe Foundation of the Modern Irish Healthcare System – The Department of Health is founded in 1947. It is during this period that the skeleton of the current, public and private system we recognise today was established (1947 – 1970). The forerunner of the internet was booted up for the first time in 1969, the Arpnet allowed US government computers to communicate at high speed over a network.

The Fifth AgeThe Centralisation of Administration and Policy – Responsibility for healthcare administration and policy moves from local authorities to eight regional boards. The policy focus is to develop acute hospital care. This age is also characterised by perceived fragmentation and inefficiencies in Irish healthcare.  (1970 – 2000). 1992 brought about the first ever Smart pill, perhaps a forerunner to the internet of things being truly applied to healthcare delivery.

The Sixth AgeThe Age of Reform – This era is characterised by the most radical organisational restructure of the healthcare system since 1970 with a focus on placing the patient at the centre of the system and care delivery. As the Celtic Tiger grew so did private health insurance subscriptions and the private hospital sector also (2001 – 2007.) This age brings about an explosion of new and exciting elements to the health care environment ranging from the first artificial liver to the fever screening system for buildings to you tube, a tool now used to discover so much more about any illness that any patient may feel they have before they even get a medical opinion.

The Seventh AgeThe Age of Austerity – The global financial crisis dramatically impacts funding and resourcing in the Irish healthcare system. Progress on a number of major national initiatives, including the development of a new national children’s hospital, stall. Higher unemployment places greater pressures on the public side of Irish medicine (2007 – 2014). The explosion of the connected person and social media as a disruption to healthcare define this age both areas continue to evolve the concept of the quantified self as a patient experiencing healthcare.

The Eighth AgeThe Age of the Digital Economy – Economic recovery is taking hold and the time for planning the next major reforms of Irish healthcare has arrived. Information and digital technology now need to play a greater role in delivering improved outcomes for patients (2014 – Today) In 2015 we will see the explosion of the wearable device that, if the hype is to be believed, will see patients recording information for themselves as part of their daily lives that can be used for the provision of care and driving clinical outcomes.  

In studying the past we build a lens to look on the future, the reason my medical history teacher said we should study the past was always to learn lessons for the future to try to influence how we innovate and live. So these eight ages give us the history, but if the history teachers are to be believed then we need to consider this to tell us about the future. The excitement that technology, not just computer technology and data will bring to healthcare in the coming ten years far outweighs the changes over the last eight ages.

I shamelessly stole the term ‘post-modern age’ (where it is related to Health IT) from a wonderful clinician here in Ireland who has provided personal drive to ensure technology can bring about an outcome to care provision.

What does it mean though? In this case, I think it is a descriptor for recent times in healthcare technology in Ireland. This is best typified by looking at the past and using the concepts in healthcare to build the themes for a technology supporting infrastructure. A mix of the modern, where it can be made to work and the past because of necessity due to funding and resourcing. This works well in so many cases, take the Epilepsy EPR a solution grown from within a hospital setting that evolved over a period of time. Or another example is the Picture Archiving Communication Service (PACS) deployed in Ireland under the project known as NIMIS.  This solution is a phenomenal implementation with a huge user base, live in  51 sites, with over 10 million exams, 20,000+ users and records for about half the population of Ireland.

What is ‘post-modern’ about these implementations? I believe it is in how the best has been made of them, in the case of the Epilepsy EPR it has grown from clinical engagement considering what the outcomes were that were needed and then working with technologists to achieve them. In the case of NIMIS it is the decision to procure a world class PACS solution and enable that as a corner stone for connected health in a country enabling it to evolve as the Radiology Information System is improved and the Individual Health Identifier becomes available.

A new realty though is where the concept of traditional technology changes the health outcomes and care dynamic, where access to large complex data sets that relate to the DNA and genomic nature of every human being will become part of healthcare provision. A start up with a 30 year vision called Human Longevity has an ambition to do just that, applying the principles defined by J. Craig Venter in Life at the Speed of Light to the provision of healthcare and indeed even the regular everyday Electronic Health Record (EHR). The sequencing of a whole human genome will move to under a $1,000 cost by the end of 2015, applying Moores law to this process bares no reality. Human Longevity have the first 10,000 sequenced genomes within an EHR in the USA and have plans to get this to 5 million in 5 years! The availability of this information within the EHR simply describes the next age for healthcare for me.

The next age will evolve from the information age and become something I am not always a fan of using as a descriptor, the Technology age of healthcare will be upon us. The ability to step away from pure information and into an ability to really use technology in the disruption of healthcare will define the next change. Technology will be able to be part of the provider capacity. Technology will be the facilitator that moves health provision away from the old limitations brought on by de-innovation based on old structures, old ideas and old systems.

Technology allows health to more from reactive to predictive through new technology, whether that is a portable genome sequencer like the nano-pore sequencer or the ability to put sensors with visual outputs under the skin like the team at Project Underskin, a product that could be here now but will be acceptable in 5 years!

So, to finish without going too Sci-Fi, I will leave that for another day, ‘The future is already here… it’s just not evenly distributed’  William Gibson

All we need to do is the distribution from innovation to reality to create the next transformative age!




With special thanks to my friend and colleague Derek A. Lande for his help in the development of the different ages of healthcare in Ireland and to the Wired Health team for the inspirational presentations on the future of technology in health.