e-Health 2005 Conference – some final thoughts

Okay, so I’ve had a night to think about my experience at the e-Health 2005 Conference (day 1, day 2). Here are the thoughts that I take away with me.

1. Patient safety – the new narrative of eHealth
It seems pretty obvious that the mantra of “patient safety” (and to a lesser degree – quality of care) is the new story by which eHealth will be championed. In previous years, “efficiency and cost savings” seemed to be the story that was told to try and convince people to invest in and to use eHealth innovations. Just think about the dot.com era and how everything was about making health care more efficient by harnessing the power of the Internet.

Just because this new narrative has taken centre stage doesn’t mean that this talk of efficiency (i.e., money issues) hasn’t died out. You can still hear people talking in business-speak. What surprised me was that “evidence-based” was only mentioned a few times throughout the conference. I have a sneaking suspicion that”evidence-based health informatics/ehealth” may still yet emerge as a dominant narrative in this area.

2. For many, eHealth means “electronic health record”
The underlying topic for almost every presentation at this year’s conference was the “electronic health record” (EHR). Why is it that people cannot get over the fact that eHealth is more than just having a digital version of a medical record? Maybe I’m in the “wrong” in thinking that eHealth is more than EHRs and hospital information systems. Please prove me wrong. In my opinion, we need to break free of this thinking that eHealth is technology or EHRs if we want to realize a breakthrough in really improving the health system.

I point to two publications that suggest that eHealth is not just the electronic health record:

• Oh et al. (2005). What is eHealth (3): A systematic review of published definitions. Journal of Medical Internet Research, 7 (1), e1.; and,
• Pagliari et al. (2005). What is eHealth (4): A scoping exercise to map the field. Journal of Medical Internet Research, 7 (1), e9.

3. Technological determinism goes unchallenged
This idea that things will auto-magically improve just because we start using technology in health care just astounds me. We have a great number of extremely smart people in this field and yet there is this attitude of technological determinism: the technology WILL….

Sure, I think there is great potential that technology can assist in making things better, but the technology (in my opinion) is only a tool that we use to extend human capabilities and to do things faster. For example, having health information in electronic format means that it can be accessed and communicated much faster to a greater number of people than in the past, irrespective of the information’s quality or use. Bad information is still bad information.

I’m not suggesting that we turn back the clock and become all Luddite, but I think we should critically assess what it is we are doing and advocating. As McLuhan and his followers point out, technologies are rarely neutral in its consequences. We often are affected in ways we don’t really understand as we embrace new technologies. Don’t ignore the risks and unintended consequences.

Okay, to provide a counterpoint to myself, I will end with a short quotation by Albert Einstein that I think we all believe somewhere in the back recesses of our brains. It’s something similar to what Friedman articulates in his “fundamental theorem of medical informatics” in a shorter (and more eloquent) format:

Computers are incredibly fast, accurate, and stupid. Human beings are incredibly slow, inaccurate, and brilliant. Together they are powerful beyond imagination.

I really hope that the combination is as he says. Question: how will we use this power? For the improvement of all of us, or to lead us toward a path of destruction?

4. Evaluation is still tough
I didn’t hear too much about evaluation during this year’s conference. I’m still getting the sense that the field hasn’t really been able to move into a stage of evaluation because we’re so focused on implementation and development at this time. The few times I heard discussions on evaluation were about many of the challenges that are faced when trying to do impact assessments. Guess I really need to speed up my research to get this information “out there” 🙂

I have to give some kudos to the Medical Device Informatics Group for giving an excellent presentation on human factors in design and evaluation of eHealth innovations. I think this is a great start. But, we really need to start engaging in meaningful discourse on the topic of evaluation. I’m still a bit hesitant to reducing all of the evaluation metrics to cost – there’s just something that isn’t completely right about that.

5. Where’s the patient?
We love to talk about health care being “patient centered” and that eHealth is all about giving power back to the patient. I’m just not sure that people actually believe that – well, maybe they do believe it. I just don’t see actions following what they say. For example, the entire conference was essentially presented from a health care professional/manager’s perspective. With the exception of Kevin Leonard’s presentation, there was very little in terms of giving patients a voice.

If we take this discussion a bit further and look at it in terms of power, why is it that except for Dr. Louise Liang, ALL of the main presentations were made by men who are almost all physicians? Okay, Wendy Mesley was on stage, but she was the moderator. Oops my mistake – Dr. Carolyn Bennett was there too (but she’s a physician). I was once challenged by a colleague of mine (Nancy Viva Davis Halifax, PhD) to consider medical informatics from a feminist perspective, that it is still a male and physician dominated field. At the time, I wondered why gender played a role. But, after reading a bit of Foucault, I’m wondering…why is the eHealth agenda set and run (only) by men in suits? How can we meaningfully engage people who aren’t part of the mainstream health care culture?

6. We need to kill Canada’s sacred cow (i.e., health care)
I’m stealing this idea from Mike Duffy. He nailed it on the head. We need to get rid of this aura around health care and really engage in discourse about the future of health care and how to improve it. Otherwise, we’re going to be in a heap of trouble in the not to distant future.

7. We’re in this together
Something that came across very clear is that we can’t do this on our own. We are all in this together. Either we work together as Canadians (and with other countries), or we’re not going to realize this vision. I think it goes beyond just working between different jurisdictions, but we need to really break down barriers. Perhaps this is the hope that we place in eHealth – that we really collaborate. I’ve often wondered how to produce multi-disciplinary professionals. Maybe eHealth is it.

From Kaiser and the NHS, we learn that no one group can do it alone. We can’t send out edicts and expect people to respond. We need to collaborate and cooperate in order to make things better and to realize the potential benefits we all dream about.

What I’d like to see at next year’s conference:
Here are some suggestions that I’d like to see in future iterations of this conference. Take them for what they are – just suggestions:

• Access to the Internet: Have free wireless Internet access for attendees – doesn’t anyone else think it was absolutely insane that at a leading conference on using new technologies in health care that we didn’t utilize some of the very basic tools we want to use every day? I’m sure we could cut back on the amount of paper consumed if we had access to the web, particularly copies of the presentations.
• Food: Not that I was complaining too much, but is it too much to ask for some healthy and/or vegetarian alternatives to the food? I noticed several people not eating because of special dietary needs (i.e., allergies and the like). We should be promoting and practicing healthy behaviour at all of the opportunities we have. Oh yeah, would it be too much to ask for some chairs and tables for lunch?
• More interactivity: I think there was a great start at this year’s conference with the polling/quiz sessions. As per my first comment about having wireless access to the Internet, we could really increase the interactive component by utilizing some of the web tools. Blogging with people commenting real-time. We could have live discussions facilitated on discussion boards. I’m not even being very creative here.
• Have an academic track: I know that the organizers made a very tepid attempt at “supporting” a student initiative this year. I know, I know – organizational momentum is difficult to change, but I applaud the program committee for pushing the boundary and taking a chance. Maybe instead of having just “student” events, expand it to include a full “academic track” integrated with the other tracks. I think there’s a great deal to learn from researches as well as the actual people who implement and run the health system. Who knows, by putting everyone in close proximity to one another, there could be some exciting new projects that could sprout.

Next Year
Next year’s conference is set for April 30 – May 3, 2006 (same dates as this year), but will be hosted in Victoria, British Columbia. The conference title was announced during yesterday’s closing session: “e is for everyone“. The title sounds like there can be some possibilities. I guess it’s up to the program committee to lay out some interesting tracks.

** Note: I am posting a copy of this entry at another blog at the Centre for Global eHealth Innovation.