The healthcare IT landscape

The United States spends over $2.6 trillion annually on healthcare. This amount represents approximately 18% of the gross domestic product (GDP), a percentage that has doubled in the last 30 years and is the highest of any country in the world [11]. Over 75% of these costs are due to the management of chronic diseases, which currently affects 45% of the U.S. population. By 2023, it is expected that costs to manage chronic diseases alone will rise to $4.2 trillion [3]. Many look to information technology to help reduce costs, increase efficiency, broaden access to healthcare, and improve the health of the population.

Meanwhile, recent years have seen a dramatic shift in the nature of computing with the advent of smartphones and tablet computers; the latest surveys estimate that over 50% of Americans have smartphones [10]. This wide-spread availability of a powerful mobile computing platform, with a rich interface and a variety of built-in sensors, has created a boom in mobile health (mHealth) applications like RunKeeper and Fooducate [9]; mHealth application downloads increased from 124 million in 2011 to 247 million in 2012 [8]. These mHealth apps and devices are becoming more prevalent due in part to the rising cost of healthcare and their suitability for managing chronic diseases, particularly in the aging population [5, 6], and in prevention and wellness programs [1].

Smartphones and tablets are rapidly moving into the clinical workplace as well. A recent estimate indicates that as many as 62% of doctors use mobile tablets [4]. Although some hospitals embrace smartphones and tablets by distributing them to their staff [7], a 2012 survey found that 85% of hospitals allow their clinicians to bring their own device to work [2].

Furthermore, universal connectivity (cellular, wireless, and home broadband) has enabled a tremendous variety of services to move to the “cloud.” Services like Dropbox and Google Drive make it easy for individuals to store, manipulate, and share content on cloud servers located in distant data centers. Services like Amazon S3 and Google App Engine make it easy for developers to build scalable computational backends without installing or managing their own infrastructure. These trends are pushing more individuals and enterprises to push an increasing fraction of their computing into Internet-connected servers run by other organizations – raising important questions about security and privacy.

Finally, recent years have seen rapid developments in smart, miniaturized, low-power, adaptive and self-calibrating instrumentation, enabling the emergence of mobile devices for monitoring and managing individual health conditions; examples range from wearable devices that measure physical activity (such as the BodyMedia armband) to Wi-Fi enabled bathroom scales (such as those from Withings or Fitbit) to stick-on ECG patches to monitor heart conditions (such as those from Corventis) to implanted insulin pumps (such as one from Medtronic). Most are wireless, able to upload data to a smartphone or to a cloud server for analysis and access by both the individual and caregivers.

The dynamic healthcare ecosystem and rapid technology evolution lead to new challenges in securing tomorrow’s healthcare information infrastructure. More on that in the next post!


  1. Firat Alagöz, André Calero Valdez, Wiktoria Wilkowska, Martina Ziefle, Stefan Dorner, and Andreas Holzinger. From cloud computing to mobile Internet, from user focus to culture and hedonism: The crucible of mobile health care and wellness applications. In Proceedings of the International Conference on Pervasive Computing and Applications 2010, pages 38–45. IEEE Press, December 2010. DOI 10.1109/ICPCA.2010.5704072.
  2. Aruba Networks, Inc. 2012 healthcare mobility trends survey results, February 2012. Last accessed January 26, 2013, Online at
  3. R. DeVol, A. Bedroussian, A. Charuworn, et al. An unhealthy America: The economic burden of chronic disease. Milken Institute, Santa Monica, CA, 2007. Last accessed January 26, 2013, Online at 38801018&cat=ResRep.
  4. Brian T. Horowitz. Tablet use nearly doubles among doctors since 2011: Report. Online at 2011-Report-177298/, May 2012. Last accessed January 27, 2013.
  5. Robert Istepanian, Swamy Laxminarayan, and Constantinos S. Pattichis. M-health: Emerging mobile health systems, volume 1. Springer, 2006.
  6. B. Kumar, S.P. Singh, and A. Mohan. Emerging mobile communication technologies for health. In International Conference on Computer and Communication Technology (ICCCT), pages 828 –832, September 2010. DOI 10.1109/ICCCT.2010.5640393.
  7. The University of Chicago Department of Medicine. DOM iPad Initiative Increases Resident Productivity. Online at, February 2011. Last accessed January 27, 2013.
  8. research2guidance. Mobile health market report 2011-2016: The impact of smartphone applications on the mobile health industry (vol. 2). Online at, January 2012. Last accessed January 26, 2013.
  9. Alexandra Sifferlin. 5 great health apps you should download now. Online at, August 2012. Last accessed January 26, 2013.
  10. Nielsen Wire. America’s New Mobile Majority: a Look at Smartphone Owners in the U.S. Online at, May 2012. Last accessed January 27, 2013.
  11. WHO World Health Organization. World health statistics 2011, 2012. Last accessed January 26, 2013, Online at
This entry was posted in Trends and tagged , , by David Kotz. Bookmark the permalink.

About David Kotz

David Kotz is the Provost, the Pat and John Rosenwald Professor in the Department of Computer Science, and the Director of Emerging Technologies and Data Analytics in the Center for Technology and Behavioral Health, all at Dartmouth College. He previously served as Associate Dean of the Faculty for the Sciences and as the Executive Director of the Institute for Security Technology Studies. His research interests include security and privacy in smart homes, pervasive computing for healthcare, and wireless networks. He has published over 240 refereed papers, obtained $89m in grant funding, and mentored nearly 100 research students. He is an ACM Fellow, an IEEE Fellow, a 2008 Fulbright Fellow to India, a 2019 Visiting Professor at ETH Zürich, and an elected member of Phi Beta Kappa. He received his AB in Computer Science and Physics from Dartmouth in 1986, and his PhD in Computer Science from Duke University in 1991.

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