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Lessons from my father… January 10, 2009

Posted by Hans in : analysis, nature of ehealth , add a comment

My father’s most recent health experience and his visit to the ER has highlighted a few things about health and managing one’s care. Here are some things to take from my dad’s experience:

  1. eHealth Can Improve Coordination of Care: In this case, having a single care record could have prevented this mis-hap. Our family doc saw my dad somewhat regularly and was more aware of my dad’s progress. He made a recommendation, but this information wasn’t passed along to the specialist. Only after visiting the ER and a call from the ER doc did all of the docs get together to coordinate things.
  2. Being a Good Patient is More Than Following "Doctor’s Orders": My dad is great a following directions. Because of his diabetes, our family physician told him to start exercising and change his diet. The next day, he started walking and now he runs 5-10km each day and is very active. He also has changed how he eats and has essentially cut out refined sugars. Normally, most patients don’t follow instructions well (and thus the issue of patient compliance), but my dad did and improved markedly to the point where he doesn’t need medications because he can control his condition through lifestyle changes. But, simply following orders didn’t really help my dad. Which brings me to the next lesson…
  3. Patients Need to Take Ownership: My dad is great a following orders, but he is very passive. He doesn’t ask questions and doesn’t look to take initiative. Part of this may be that he doesn’t feel comfortable in this role. But as our health care system continues to evolve, a significant understanding is that patients will be more active in managing their care. As such, patients MUST take ownership over their care: ask questions, read and learn about your condition, collect and keep copies of your care record, know what your lab results are, etc.
  4. Not Everything Is Preventable: In my dad’s case, this point doesn’t really apply, but all of my health education and training remind me that when we deal with people (and their health), not everything is preventable. Medical science only knows so much and can only go so far. There are so many things going on that predicting how all of the interactions may turn out is nearly impossible: your genetic predisposition, environmental exposure,your personality, the food you eat/diet, the air, drugs/medications, daily cleaning and grooming products, EMFs from electronic devices – these all interact with one another and no-one really knows how. Even if you do everything *right*, you can’t prevent some things.

My dad is fine now, but his experience highlights some things that we all should be doing. Hopefully some of these lessons will help someone get better care and health.

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A new definition of health? December 14, 2008

Posted by Hans in : academics, nature of ehealth, news , add a comment

There was an interesting editorial published this past week in the BMJ titled "How should health be defined?" by Jadad and O’Grady. The basic idea of the article is that while health was defined in 1948 by a panel of experts that changed our notions of health and illness, is it time for a new definition?

Jadad and O’Grady suggest that use of the Internet may be a viable means of engaging people from around the world. The authors created a definition of health blog to test out their idea. We’ve seen that public engagement in the 21st centry may look very different when/if the right conditions are in place. President-elect Barrack Obama seems to be using his change.gov website to solicit ideas and spur discussion on policy issues. Whether or not this type of enagement will work for broader topics like the definition of health is yet to be seen.

I’m cautiously optimistic and hopeful that we can begin to change how patients and the broader public participates with the health care system.

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Another experience at the ER November 18, 2008

Posted by Hans in : Uncategorized , 2comments

Unfortunately, I had another experience with the health care system recently – well, not me, specifically, but my dad. He was taken to the ER and so I spent a few hours waiting with him.

The interesting thing was to see Credit Valley Hospital’s new ER. As always, they had the mobile computer stations, but what was fascinating was how little the nurses used them. The nurses spent most of their time documenting on coloured forms which were either stapled together or kept together via clipboard.

Some of the biomedical devices were fascinating too. There was a device that monitored the blood pressure (BP), heart rate (HR), and a few other clinical measures that I couldn’t make out. My dad had something connected to his index finger with some sort of light/laser that presumably measured blood sugar. What was most annoying was that some sort of alarm on the device kept going off every two minutes or so. I tried to make sense of the display, but to my untrained eye, many of the values weren’t very meaningful. I had a chance to watch a few nurses make adjustments to the device and it was very interesting to watch the nurses navigate through the multiple levels of menus using a dial. My friends and colleagues at the Centre for Global eHealth Innovation might be interested in some of the usability/human computer interaction issues. Nevertheless, the sad thing was that this biomedical device was a stand-alone device not connected to any other (as far as I could).

The staff were all very nice, but having worked in the ehealth area for quite some time, I wonder how we can get the indivudal clinicians involved with ehealth. One of the challenges that seem very apparent to me is that using technology is foreign to the daily work process of the clinical environment. Seems like there is much work to be done to get clinicians to adopt ehealth.

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OHA Health Achieve 2008 – thoughts from day 1 November 4, 2008

Posted by Hans in : conferences & conventions , 1 comment so far

I had the privilege of attending the opening session of this year’s OHA Health Achieve, one of the world’s "premier health care events". As always, the event was packed and the speakers didn’t disappoint. Here is a quick recap with some comments.

Opening Session
After some opening remarks from the OHA Board Chair, the convention was officially started with a plaing of the national anthem. The video montage was a bit over the top and seemed like it was produced in the 1970s/1980s with shots of landscape, wildlife, winter, people in stereo-typical "Canadian" garb. Because of the instrumental embellishments, the audience didn’t participate in singing as they did in the past. Question: what’s wrong with a simple version of the national anthem?

Wendy Messley was the moderator for the morning and she did a very good job. She opened with some very humorous remarks and got the audience in a good mood. It’s too bad that she doesn’t have more opportunity to ad-lib in her role on CBC’s W5 news programming. She seems like she would be a very good interviewer.

Speaker 1: Retired Gen. Rick Hillier
Gen. Hillier was not quite what I expected. Actually, he was a great speaker and reminded me very much of Colin Powell. Perhaps not as sophisticated and polished as Powell, but Gen. Hillier definitely exuded charisma in a distinctly Canadian (if not Newfoundland/folksy) way. Hillier spoke about the Canadian Armed Forces and the role of leadeship. He walked us through the different roles and provided examples and stories to back-up his point. What I found most compelling was how articulate and passionate he was. He is definitely a very good speaker.

Hillier’s main message was that leadership is all about people, and that organizations need to invest in its people in order to be successful. He started by explaining how leaders must communicate directly, honestly, and with sincerity. Coupled with communication is the need to equip people appropriately to achieve success. One very interesting point Hillier raised was the need to achieve the "Vimy Effect". Vimy Ridge is a defining moment in Canada’s, and Canada’s armed forces, history. The goal is to identify such pivotal events to bring people together and to inspire them, and thus the "Vimy Effect". Hillier also talked about the role of strategic corporals who are both the official and unofficial leaders wtihin an organization that step-up to ensure success of the organization. This topic led to the idea of selecting and creating special teams from existing members. He finished with the idea of maintaining and establishing a constant supply of people, first by investing in the people that you have (i.e., creating leaders), and second by being aggressive in recruiting people for the future.

Speaker 2: Rt. Hon. Jean Chretien
Mr. Chretien was a bit of a jolt, but in a good way. His principle message about leadership is as follows:

Trust the people you have to do the work. Let them do their job. If they fail, fire them.

He shared this information and drew a laugh, but he re-iterated the last point multiple times. What was most interesting was the stories he shared from his 40 years of political experience. Some of the stories included his relations with the Clintons, George W. Bush, and other world leaders.

Closing Thoughts:
As always, the opening session was very enjoyable with the speakers being of high quality. The session was quite patriotic in nature and espoused how great Canada is, and in particular, how great the health care system is. While I don’t necessarily disagree that Canada is great, I wonder if thinking the health care system is awesome is such a great thing. Perhaps I’m a bit cynical, but healthy questioning is always a good thing. Maybe OHA Health Achieve is more of a celebration rather than an event to be critical and examine. But, that’s a discussion for another time.

Here are some links to write-ups of my past experiences at OHA Health Achieve:

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Unlearning by Alejandro Jadad October 23, 2008

Posted by Hans in : news , add a comment

For those interested in an insightful read about life and what-not, Alejandro (Alex) Jadad, my PhD supervisor, just published a non-medical book, entitled "Unlearning". The book explores the impact of combining online publishing, social networking and the notion of "Freeconomics".

The book can be downloaded for free or purchased at:

http://www.lulu.com/content/4132419

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ehealth’s elusive return on investment September 2, 2008

Posted by Hans in : analysis, news , add a comment

Government Health IT published an interesting article titled, "The quest for value". The author, Nancy Ferris, reports on some of the challenges, difficulties, and frustrations with trying to demonstrate a return on investment (ROI) or tangible cost savings when using information technologies within health care settings.

My own research and experience in this area has me believe that the main assertion of the article is more or less true – that the link to tangible, measurable results (i.e., ROI) is difficult. I would add that the main reason for this difficulty is because there is no direct causal link between use of IT in health care and outcomes, or at the very least, the link is so weak, that other factors drown out the benefits. A report released by the EU (www.financing-ehealth.eu) titled "Conceptual framework, healthcare and eHealth investment context and challenges" presents some similar findings that the benefits are only realized in the future (see the latter parts of the report).

Personally, I think this concept of trying to identify a cost-savings or return on investment in health care is a bit absurd. Even in industry, trying to calculate return on investment regarding the use of IT is a challenge. I can’t remember the exact quotation, but a CEO of Fedex (or UPS) once indicated that even though they can’t completely identify the ROI of using IT, they said that they can’t NOT use IT and said that it’s just the cost of doing business.

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WHO definition of health August 29, 2008

Posted by Hans in : Uncategorized , add a comment

For your information: a link to the WHO definition of health.

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Reference info:

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

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Upcoming Medicine2.0 Conference: Web 2.0 in Health and Medicine August 26, 2008

Posted by Hans in : conferences & conventions, news , add a comment

Just a quick reminder to those who aren’t aware, but there is a very interesting conference being hosted in Toronto, Canada titled "Medicine 2.0 Conference: Web 2.0 in Health and Medicine".

Medicine 2.0® is an international conference on Web 2.0 applications in health and medicine, organized and co-sponsored by the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations.

The conference is being organized by Dr. Gunther Eysenbach, a friend and colleague of mine, and it looks to be a great event. Unfortunately, I can’t attend, but I plan to do some writing on the topic in the next few days.

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Smart homes and health – some thoughts from Alex Jadad August 6, 2008

Posted by Hans in : news , add a comment

A recent article in the Toronto Star (August 2, 2008) reported on some future thoughts, opportunities, and challenges to the housing market from an ehealth perspective as presented by Alex Jadad. It’s an interesting read and provides a glimpse into the mind of Alex and how he thinks.

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Interesting conference – Making the eHealth connection August 5, 2008

Posted by Hans in : conferences & conventions, news , add a comment

I came across an interesting conference site titled "Making the eHealth Connection". The goal of the conference is to "to raise the profile of eHealth, form new partnerships and identify promising new areas of work for the Global South". Unfortunately, this month-long conference is invitation only.

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