Health in an age of information
"Cause we are living in a material world
And I am a material girl
You know that we are living in a material world
And I am a material girl"
You know these lyrics. Madonna's single "Material Girl" and its accompanying video were huge hits in 1985, and went on to define much of her career. But was she right? Is she really a material girl? And are we living in a material world? More than 30 years after she sang this song, we find that the world we live in is becoming less and less about material things, and more and more about information.
From the perspective of the national and global economy, information technology is a vast and growing sector that is displacing manufacturing in value and influence. A similar trend is apparent in the economy of our daily lives: financial transactions are routinely conducted electronically, and reliance on the physical tokens of notes and coins starts to seem quaint.
The rising influence of information even shows in our understanding of reality itself. We’ve known for some time that the apparently solid objects of our experience are composed of atoms that consist mostly of space. And as physicists probe ever more deeply, even subatomic particles seem less and less substantial. Some theorists go so far as to propose that this gossamer-thin materiality rests on a bedrock of – you guessed it – information. As the science writer James Gleick puts it:
"The bit is a fundamental particle of a different sort: not just tiny but abstract – a binary digit, a flip-flop, a yes-or-no. It is insubstantial, yet as scientists finally come to understand information, they wonder whether it may be primary: more fundamental than matter itself. They suggest that the bit is the irreducible kernel and that information forms the very core of existence."
Healthcare is no exception to these trends. As treatment methods become more sophisticated, we find that the quality of healthcare is increasingly dependent upon the quality of the information available to practitioners and patients.
It may seem like a truism to say that better health information leads to better healthcare, but in some respects the healthcare profession has been remarkably slow in embracing information technologies. Facsimile machines, for instance, are still in regular use to convey messages between medical practitioners, despite having been phased out in most other sectors. And handwritten notes are still commonplace in both large and small clinical practices.
There are good reasons for this conservatism, starting with the Hippocratic injunction to first, do no harm. Obvious as it is that reliance on facsimile messages and handwritten notes is somewhat old-fashioned, it is not so obvious that they are actively harmful. Newer systems for storing and communicating information may be more efficient and promise greater safety, but that promise ultimately needs to be tested in the crucible of daily practice. In such circumstances, a "devil you know" approach has clear attractions.
Network effects are another inhibiting factor. A single telephone is of no use whatsoever – it becomes useful when there is another telephone that it can call. And it becomes more useful still when there are hundreds or thousands of other telephones. Similar issues arise for other communications and storage technologies: they only become useful when both sender and receiver have similar equipment and apply compatible protocols.
The complexity of healthcare information is yet another factor. The financial sector has readily adopted modern information technologies in part because the key data in that sector is numeric information, which is easily represented and thoroughly standardised. In contrast, the underlying information in healthcare is exceedingly complex: it is often difficult to represent and only loosely standardised.
Despite all this, it has been estimated that adopting modern information technologies to Australia’s healthcare sector will save hundreds of lives and millions of dollars each year. Let’s repeat that: hundreds of lives and millions of dollars could be saved each year by adopting modern information technologies to healthcare.
This represents the challenge, the mission, and the promise of the Australian Digital Health Agency’s work. Improving healthcare information may sound abstract, but this is work with very real, practical outcomes in the material world we live in.
Dr Andrew Westcombe is a technical editor at the Australian Digital Health Agency, with a PhD in Philosophy.
 Songwriters: Rans, Robert; Brown, Peter. Material Girl lyrics © Sony/ATV Music Publishing LLC.
 Gleick, James, The Information: A History, A Theory, a Flood. Pantheon Books, NY, 2011, pp. 9-10.
 See http://www.strategyand.pwc.com/au/home/press/press-releases/displays/48757598