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Open Access Publishing - power to the people March 31, 2005

Posted by Hans in : academics, analysis, opinion, research , add a comment

There’s an interesting commentary in this week’s BMJ titled “Open access publishing: Too much oxygen” by Jeffrey Aronson. Aronson’s basic argument is to temper support of open access publishing. He also believes that the current model of publishing is working well pointing to the number of different journals sprouting up. Aronson argues:

We need to ask whether immediate free access to readers, with whatever method of payment is used, would benefit science (not the scientists or the grant giving bodies, who are also zealous about this idea) and hence society. To zealots (”the dream is now achievable”) the benefits of this 100% oxygen may be self evident. But we have little evidence about the balance of benefits and harms. I believe that the potential advantages are few and the disadvantages many.

I’m all for being cautious, but how can providing access to information be a bad thing? I suppose my opinion is based on the notion that we need to empower individuals by devolving power from the experts. I do, however, agree with Aronson that those who are advantaged should burden more of the costs. But, I disagree that the general readers should be the ones paying. In the traditional paper-based model of publication, I can see how the readership would need to pay: there is a physical journal that must be produced. Someone needs to pay.

But, in the “information age”, online journals have a totally different cost structure. I point to the great success of the thriving community of journals at Biomedcentral.com or of the Journal of Medical Internet Research (JMIR). [Note: I am not mentioning JMIR because I have published there. I just happen to like the model that is in place.] At JMIR, anyone can access the articles and the content without restriction all the time. You pay for access to additional features like the availability of PDF files. JMIR also provides waivers of the article processing fee if the authors are from developing countries or have other mitigating circumstances. The cool feature is that you can pay to have your article reviewed in a shorter time (I suppose in a sense it’s queue jumping). But, this faster access to review doesn’t mean you’ll get published.

In my opinion, research supported and funded by public monies should be made freely available. The model provided by JMIR seems reasonable. You only pay for convenience like a PDF file. I just recently heard of the Public Libraries of Science (PLOS) and it intrigues me. I’ll have to do more research on it to see what they’re up to.

Popularity: 11% [?]

Canadian Medical Association Leadership Series: Future Practice 2005 March 31, 2005

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The Canadian Medical Association (CMA) released a new publication in their Leadership Series titled Future Practice 2005.

The report is a series of articles directed toward physicians about the use of technology in their office and also provides some updates as to the current state of telemedicine and electronic health records in Canada. I haven’t had a chance to read the articles over in detail, but some of them seem interesting (from a knowledge translation perspective). Here’s a list of the articles:

The articles seem to be organized in sections:

Getting Started:

Getting Ahead:

Getting the Facts:

Getting Connected:

Popularity: 9% [?]

Now for some *real* eHealth March 30, 2005

Posted by Hans in : news , add a comment

Now, here’s an interesting article from MSNBC.com that is really about e-health. The article describes healthy ways to respond to a computer crash. I never realized that so many people talk to their computer or get violent toward it. I know that in my most frustrated moments, I wish I could smash my computer. Looks like the most important part of improving your health is learning to deal with your frustration: take a break and walk away from your computer for a moment.

Popularity: 8% [?]

New articles on evaluation in eHealth/health informatics March 30, 2005

Posted by Hans in : academics, research , add a comment

I came across two new articles on evaluation in health informatics.

The first is an editorial by Ammenwerth and Shaw proposing that continuous, context-based evaluation could be one of the means of improving the use and implementation of information technology in health care. What I found most interesting about the editorial was how the authors propose embedding evaluation within a decision making framework. Also, an explicit reference to the Innsbruck declaration on health informatics evaluation (more to come on this topic during a future post).

The second article reports on the development of an inventory of evaluation studies of information technology in health care between 1982-2002. What I found interesting in this paper was that the authors only searched the National Library of Medicine’s PubMed - what about other biomedical indices like EMBASE or CINAHL? The description of the analysis and categorization of articles was very well done.

Popularity: 11% [?]

eHealth is not a panacea March 29, 2005

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

There seems to be a prevailing sense that by using information and communications technology more effectively in health care, that many of the problems we face will somehow (magically) disappear. An opinion piece available on Computerworld’s website (”It’s the year for e-health records” by John Halamka) makes it seem like eHealth will be the cure to all that ails the health system. Dr. Halamka is a physician and CIO of a health care organization, so I’m sure has an idea about what he’s talking about.

In his piece, he was making the case that eHealth needs to be adopted faster and by more people in health care (namely physicians) and pointed out some possible strategies to use. His suggestion that the Bush government provide financial incentives to get physicians to adopt technology is pretty standard thinking in the health informatics field: line up financial reward with the target behaviour. Here in Ontario, the government basically threw $300-$500 million at family physicians to reorganize their practices and adopt electronic health record systems. I also agree with Dr. Halamka’s suggestion that health care needs to start implementing more automation like other industries. But, there are some major challenges that need to be overcome.

While everyone likes to compare health care with other service industries, I think people try and oversimplify health care too much. Health care is not like financial services, the hotel or airline industry. The demands and pressures found in health care are different. Sure, some aspects are comparable and even similar, but I am amazed that it’s always health care looking at other industries rather than the other way around. True, much of health care could potentially be improved by better use of technology, but we are far from there. Standardisation is not something that comes easily in this field.

The second , and perhaps more important, criticism I have is that there is no mention of human factors or usability issues. Sure, we can all provide rebates, subsidies, or incentives for health care professionals to buy and then use technology, but we haven’t determined what these technologies should look like, how they should function, or understand how they should be designed. We are making a huge assumption that building the system and then plopping it into the health care domain will ensure cost-savings, quality improvements, and a host of other benefits. How do we know for sure that these benefits will be realized?

I strongly hold my view that use of technology and eHealth is not the answer - but it can be part of the solution. Technology is merely a tool that we use (a medium, or a channel) to transmit the human intention and action. We need to address the social, political, and structural issues of health care to really make a difference.

Popularity: 8% [?]

eHealth research funding from Health Canada March 28, 2005

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

Here’s an interesting call for research proposals from Health Canada titled “Innovations in the Health System: eHealth“. Deadline for submissions is May 4, 2005. One million has been set aside to fund up to six projects.

The objective of the research grants is as follows:

The Health Policy Research Program (HPRP) is seeking to enhance the evidence base available to support the adoption and implementation of eHealth technologies that will result in better health outcomes and create efficiencies within the Canadian health system.

The specific objectives are to determine critical factors which affect:

  • adoption, implementation, and sustainability of eHealth;
  • outcomes of eHealth implementation; and
  • governance challenges associated with eHealth applications.

Results from this research will assist federal, provincial and territorial decision-makers as well as other stakeholders in their ongoing policy work to promote a shared vision for the adoption, implementation, and sustainability of eHealth in the health sector.

Here’s the listing of the research themes that funds will cover:

1. Barriers to the adoption, implementation, and sustainability of ICTs in the health system

Adoption and implementation of ICTs is slower in health than in many other sectors. The substantial up-front costs of implementing ICTs as well as the challenges of automating the health system and even the desktops of health professionals are all contributing factors. It has generally been recognized that the path from early adoption to full scale implementation requires a firm commitment by governments and health professionals to a change management strategy. While many theories exist on successful adoption, there are currently no clear guidelines to lay the framework for the successful design, development and implementation of ICTS in healthcare.

Research is needed on:

  • the processes and strategies, including the roles of governments and health professionals, that have led to the successful adoption and implementation of eHealth;
  • how barriers to adoption, implementation, and sustainability of ICTs in the health system have been addressed;
  • whether the barriers have been quantified and evaluated and, if so, how;
  • the key factors and strategies for success and their applicability across the health system.

2. Outcomes of eHealth implementation

It is anticipated that wide-spread implementation of eHealth applications will result in numerous benefits such as improved health status, health system performance, and evidence for decision-making, as well as the recruitment, retention, and training of health professionals. It is also recognized that different eHealth investments yield different returns and implementation may result in unexpected impacts.

Research is needed on:

  • the outcomes (anticipated and unanticipated) of implementation of eHealth applications;
  • whether the outcomes support the federal government’s vision of integrating sustainable development into operations and how;
  • whether the outcomes have been quantified and evaluated and, if so, how;
  • changes in health status and health business processes when adoption of ICTs is successful.

3. Governance issues

Governance broadly refers to the interaction of processes, institutions and traditions that determines how decisions are made (for example, policies, guidelines, regulations, legislation). The growing use of ICTs in the health sector is translating into multiple challenges for health regulators. These challenges include the provision of services across jurisdictions, the development of electronic clinical guidelines, and the need for multi-jurisdictional authorization for access to information. The governance of eHealth will involve a highly coordinated commitment from a large number of stakeholders and decision-makers with different needs and priorities. As technology evolves, leadership will be required on several different fronts to address new questions, new issues and the changing roles of stakeholders.

Research is needed on:

  • the ongoing and anticipated governance issues;
  • options for addressing governance issues;
  • how the roles of those who collect, produce, and disseminate the information are affected.

I think this call for proposals is a great sign of potential future research opportunities in ehealth.

Popularity: 9% [?]

Strategies for Searching EMBASE March 28, 2005

Posted by Hans in : academics, research , add a comment

A recently published article by Haynes et al (2005) studied how to optimally search EMBASE (see below for citation information). For those interested in searching for articles on EMBASE, you need to consider the factors of a search:

EMBASE is “a comprehensive and international bibliographic database renowned for its extensive coverage of the drug and biomedical literature”, similar to the National Library of Medicine’s Medline. I’m told that EMBASE seems to cover the European literature better than Medline.

The authors suggest different search strategies depending on your need:

Citation Information:
Haynes, R.B., Kastner, M., Wilczynski, N.L., and the Hedges Team. (2005). Developing optimal search strategies for detecting clinically sound and relevant causation studies in EMBASE. BMC Medical Informatics and Decision Making, 5: 8. Available at: http://www.biomedcentral.com/1472-6947/5/8.

*Note: Only a provisional version of the file is available online HERE. The final version should be available soon.

Popularity: 10% [?]

Learn how to search EMBASE better March 28, 2005

Posted by Hans in : academics, research , add a comment

Brian Haynes, Monika Kastner, Nancy Wilczynski, and the Hedges Team at McMaster University published this interesting and useful article on how to better search EMBASE. FYI - “EMBASE is a comprehensive and international bibliographic database renowned for its extensive coverage of the drug and biomedical literature” (EMBASE.com). EMBASE is similar to the National Library of Medicine’s Medline (publicly available at PubMed). EMBASE doesn’t have a tightly controlled medical vocabulary (i.e,. MeSH terms) to categorize articles like Medline. Also, I’m told that EMBASE seems to cover the European literature better than Medline.

Some quick highlights from the article:

The authors conducted a pretty rigorous study with examples illustrating the types of articles you would find and the sensitivity, specificity, precision, and accuracy statistics for different search strategies. Apparently, there are similar recommendations for searching Medline.

The article is available on BMC Medical Informatics and Decision Making. Here’s the citation information:

Haynes, R.B., Kastner, M., Wilczynski, N.L., & The Hedgest Team. (2005). Developing optimal search strategies for detecting clinically sound and relevant causation studies in EMBASE. BMC Medical Informatics and Decision Making, 5: 8.

A provisional version of the article is available, but the full article should be available soon at: http://www.biomedcentral.com/1472-6947/5/8/.

Popularity: 10% [?]

Conceptualizing self and others when using eHealth March 27, 2005

Posted by Hans in : analysis , add a comment

I wonder if using eHealth has any affect on how health care providers perceptions on their role(s) and/or the patient-provider relationship. What about for patients? Health/health care has essentially been a face-to-face interaction for essentially hundreds (if not thousands) of years. Now, we’re introducing technologies directly into the heart of what is a very intimate and personal interaction.

Anecdotally, I have heard physicians raise concerns about using a computer (i.e., desktop, laptop, tablet PC, handheld) during the patient encounter because of a perceived “barrier” between themselves and the patient. I’ve also heard one physician mention that it takes more effort to get a “picture” of the patient when reviewing a patient’s chart in an electronic format versus using the paper version.

If (and this is a big if) there is some impact on cognitive processes, then we should investigate these issues. Andre Kushniruk and associates have found cognitive changes occur when recording information on paper versus a structured electronic “chart”. So, we know that when we use technology, there are changes that occur in how we store, organize, and even perceive information. Does this phenomenon extend to things like relationships and even people? Maybe there’s opportunity to do research on some of these issues.

Popularity: 7% [?]

eHealth: A North American phenomenon? March 25, 2005

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

Question: How widespread is eHealth around the world?

Answer: I think that there’s considerable interest from many parts of the world. I mean, when I see the many health informatics/ehealth research centres (e.g., UK, Australia, Canada, United States, Germany) there seems to be considerable interest.

But, since I was born and raised in a Canadian environment, I really don’t have a true understanding of what the rest of the world is like. In Toronto, there seems to be a palpable interest in things eHealth (okay, I admit that I may think this because I’m in an academic research setting dedicated to eHealth - Centre for Global eHealth Innovation). One of the things that I’ve grown accustomed to is access to cheap, reliable, quality telecommunications. Let me explain.

In Canada, we have always had unlimited phone plans for local calls. I’m told that Canada has one of the most sophisticated telecommunications infrastructures in the world. Right now, the average local phone bill is around $28-$32 per month where I live. Adoption of mobilephones have been relatively slow in Canada compared with other countries. I think this is because we weren’t used to paying per unit time (second, minute, call - whatever). Although initially billed by the minute, the phone companies have started to roll out flat-rate unlimited call packages for mobile phones. You can already see mobile phone adoption increasing. Lately, there has been some differentiation in wired/land phone packages instead of paying a flat-rate for unlimited (and often unused) calling.

Now, when I think about other countries, this idea of having “unlimited” use is a foreign concept. I was just looking at an Australian phone company, and they charge by both the call and the duration! Ouch! I’m told that in Europe, billing by unit time is the norm as well.

Okay, so how does this relate back to eHealth? Well, many of the ideas that are being bandied about are based on the assumption that the costs of reliable telecommunications services, namely Internet and digital phone services, is very low. But, getting phone or Internet service may not be very cheap in places other than Canada. My initial thought was “#$%*&!!”. How can anyone afford eHealth outside of Canada when the costs are so high? Maybe we North Americans need to rethink these ideas of full-blown real-time video conferencing between patients-providers over the Internet. Could alternative modalities like store-and-forward or text based services be an appropriate compromise?

I haven’t even tackled the issue of developing countries with poor telecommunications infrastructures. Maybe we need to rethink things…

Popularity: 8% [?]