eHealth 2005 Conference – thoughts from day 2

by Hans on 2005/05/02

Today proved to be an interesting day at the e-Health 2005 Conference as it was both better and worse than day 1.

Plenary Session 2: Walking the talk – learning from the doers
This session was moderated by Dr. Alex Jadad and featured three speakers representing some of the work going on in the United States, United Kingdom, and Canada.

Dr. Louise Liang shared about her experiences as the Sr. VP of Quality and Clinical Systems Support, at Kaiser Permanente in the United States. Basically, Kaiser is a huge, huge, huge organization comparable to most countries in terms of the number of people it serves, number of health professionals on staff, and the size of its budget. I knew that Kaiser was big, but the numbers that Dr. Liang talked about just blew my mind: $28 Billion annual budget! Dr. Liang shared what Kaiser’s vision about the use of technology was, where they had come from, and what is likely to come in the near future. Basically, Kaiser’s take is that there is no such thing as technology projects – all projects are fundamentally business projects that have technology components. I really enjoyed Dr. Liang’s presentation as she was a very good speaker.

Next up was Richard Granger, Director General of the National Health Service (NHS) Information Technology from the United Kingdom. First off, this guy is hilarious. He gave an excellent update as to what is happening in the UK and did it with such aplomb and wit. I’m not sure if it’s this British humour thing, but he really made the presentation enjoyable, apart from the specific content he presented. I found some of this points particularly telling.

  • Basically, he indicated that the function of technology is to provide information about clinical activities to the managers of the system, and to allow for the tracking of patients as they move through the system.
  • There is a battle around transparency of information about the system, and that members become very defensive as the “go live” approaches.
  • Digitization of information enables medicine to be better. The alternative is the current paper-based system, which is not an alternative. Things must get better.
  • This one surprised me: implementation of new systems takes as long as the half-life of the system. Therefore, we need to implement faster.
  • Avoid over dependence upon a single supplier/vendor.

The UK presentation led to the final one by Richard Alvarez of Canada Health Infoway. His presentation was good, but I had heard almost all of it previously. The one thing I noticed was that Canada Health Infoway’s $1.2 billion seems absolutely pithy compared with the UK and US counterparts. Richard Granger noted that he has $6 billion pounds available over a 10 year period. At the beginning of the session, Alex noted that the combined budgets of the three individuals speaking totaled over $20 billion. So, after doing the math, the Kaiser budget for IT must be enormous. Maybe we should be lobbying for more, here in Canada.

After the three presentations, there was a general panel discussion responding to questions. The answers were pretty forthright and honest. My biggest beef is that I absolutely hate it when people come up to the microphone and spend 5 minutes talking with no real question emerging. I mean answer your question and then sit down – the rest of us don’t want to hear you speak. I thought that this habit of trying to show-off only occurred in academic settings but it seems to be everywhere.

Student Session #1
The morning session had two presentations, both on the topic of electronic health records. The first was by AT Es-Sayyed, titled “A systematic review of international electronic health records activities“. I found this presentation interesting to learn about some of the activities occurring around the world. The second presentation was by Shuo (Sean) Wang, titled “The reality of electronic health records implementation – health policy analysis“. I’m not sure what I got out of this presentation, except that there is quite a bit of posturing from the many different stakeholder groups around roles and the EHR. Sean concluded that the major policy shift seems to be that the government is taking an active role as steward or even custodian of the record, removing it from the health care provider. There was a very active discussion afterward with a great number of opinions and positions presented.

For this session, I functioned as the moderator/facilitator. It was an interesting experience. I can’t say that I enjoyed the experience because I couldn’t really pay attention to either the presentation or the discussion because I had to be aware of the time, and recognize the questions and audience members.

Afternoon Plenary Session: Personal Health Record for Citizens There were two speakers this afternoon. The first was Ken Mandl from Harvard Medical School, and Kevin Leonard from the University of Toronto.

Ken Mandl’s presentation was interesting, but rather dry. He presented on a concept that seems to be gaining some interest in the United States: the personal health record (PHR). This PHR is supposed to be something that patients own and control and can be considered a subset of EHRs that are being developed. The rationale seems to be to provide the patient with a single contiguous repository of the patient’s information that can be shared among the disparate parts of the health services industry. At first it seemed like a waste of energy because of the duplication of work, but then I thought about the US situation. Hospitals and health care groups are probably even less likely to collaborate than here in Canada. Therefore, the only common element is the patient. If the patient controls and maintains his or her own record, then there is at least the possibility of having a complete picture available for someone. It was an interesting idea.

Next was a presentation by Kevin Leonard. He spoke as a patient and shared his experience of trying to engage the system. I have to admit that I’ve heard Kevin speak on several occasions, and I have to say that this presentation was the absolute best that I have ever heard him speak – in either the class-room, in person, or during a presentation. The talk was informative, entertaining at times, personal, and clearly affected the audience. Way to go Kevin. I was wondering why in the past I found Kevin’s talks (to be honest) very boring and I mentioned this to Joe Cafazzo. He had an interesting take. Kevin views technology as a necessary evil to achieve what he’s really interested in: patient advocacy. After hearing this presentation, I think I would have to agree. You can read about his work in his book, titled “A Prescription for Patience“.

Concurrent Session
I didn’t attend a concurrent session today. I didn’t find any of the sessions particularly interesting and I was beat, so I decided to just hang-out at the vendor display area and rest.

Student Session #2 The final student session ended with two very interesting presentations. Teresa Chiu and another student (I am so sorry that I forgot your name) spoke about “the language of information exchange for Chinese-English caregivers“. This work is very interesting, exploring the concept of language preference. Unfortunately, it’s still at a very early stage (only three participants for the usability study), but I think it may prove to be something worth continuing in the future. For Canadians, I think this type of research will become much more important as we head towards a more cosmopolitan society, and I don’t mean Toronto only.

The second presentation was by Holly Witteman, and she presented a position paper titled “The elusive search for one-size-fits-all e-Health solutions“. Holly argued (and pretty convincingly too) that one-size fits all/most solutions are ultimately more detrimental to user uptake. Her alternative solution is to provide customization, citing examples from banking, Internet sites, and a few others that elude me at the moment. I think that on a conceptual level I agree with her main position, but some part of me is still hesitant and resistant to it somehow. My concern is this idea of slippery slope about setting boundaries. How do you know when to stop/start identifying groups? At what point does customization become personalization? Also, how do you balance customization with overall usability issues? I think there’s more debate that needs to go on, but it’s an interesting idea.

Other Thoughts I think that with the student sessions complete, I would say that it was a success. The goal of starting something and building for the future seems to have been accomplished. I was absolutely surprised to see a huge contingent of students from Dalhousie University – with promises to bring more students next year too. Maybe my thoughts may change in the future, but I think the seeds to expand the student tracks have been planted.

I’d write more, but I’m beat and it’s time to go to bed. I’ll write more tomorrow after the final day and maybe do a wrap up with things that I’d like to see next year.

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