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State of the Union address 2006 and ehealth January 31, 2006

Posted by Hans in : news , add a comment

As I was folding laundry, I was watching the 2006 State of the Union address by President George Bush on TV earlier this evening. I wasn’t really paying much attention because of the rhetoric about freedom, peace, fighting terrorism, and building a strong economy. But, when Pres. Bush started talking about healthcare, I was surprised at what he said.

Bush said:

“We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors“.

Whoah! Now that’s what I call making a statement. In a previous post, I noted how Canadian politicians don’t seem to be aware of ehealth and some of the issues and challenges of using more technology in health care. I may not agree with some of the strategies of the American system, but I have to admit that the government is taking a leadership role to make electronic health records a reality.

Popularity: 9% [?]

ehealth and a challenge of sharing information January 22, 2006

Posted by Hans in : analysis , 1 comment so far

Recently, I accompanied my mom to the local hospital. A few days ago, my mom fell during an ice storm and broke her wrist. Luckily, she was able to see the orthopaedic surgeon at the fracture clinic to rule out any complications.

This particular hospital has a very interesting set-up. There are computer carts located outside of every examination room (sorry, no photos as I forgot to bring a camera). The carts themselves were pretty lo-tech (a PC mounted on a cart, with the case locked in a protective housing). But, the number of units actually surprised me. Obviously, this hospital has invested quite a bit on computers. As an aside, I noticed that the interface seemed very basic - text based with only a handful of primary colours. I wonder if any usability testing has been done.

In any case, what I want to write about is that there are dangers to having so much computerization. When my mom checked in with the receptionist, a paper file was created (now that I think about it, it’s sort of odd). The surgeon and ortho tech used the paper file to record some information. What was interesting, however, was that the file had all of my mom’s demographic information. During a short wait to get the cast, I took a quick glance at the chart and noticed that there were information errors. Luckily, the information was not that important and can be easily corrected. When I notified one of the health professionals, they said to notify them during the next visit.

Okay, so from an ehealth/research perspective, I think we all need to recognize that there can be problems/dangers with having information automatically stored and reproduced. Perhaps patients should be required to confirm information on their chart each and every time they visit a health care institution. Imagine some of the problems that could occur if information collected and recorded at one institution is propagated throughout a regional or national electronic health record system.

I think that we need to remember that ehealth is not a panacea. I’ve always held the notion that the technology is only a magnifier of human capabilities - helping us do things faster (be they good or bad). In the case of health care, we need to remain vigilant in not assuming that the information found in the computer systems will always be correct.

Popularity: 8% [?]

ehealth, specialists, and strategy January 17, 2006

Posted by Hans in : analysis, opinion , 2comments

Sometimes I wonder if the strategy for developing and deploying ehealth/health inforamtics is effective. In Ontario, and probably in many parts of Canada, the government has developed a series of massive infrastructure projects to create a functional electronic health record. What this means is that there are multi-million dollar projects to design, develop, test, and deploy a collection of systems that will eventually (hopefully?) provide the necessary functional elements for a provincial electronic health record. There is a big emphasis on primary care and in getting the physicians to “buy-in” to the strategy (see ePhysician project). Don’t get me wrong - I think the intentions are good, but I wonder if an alternative strategy should be considered?

Last week, I had an appointment with a specialist for a follow-up visit. The experience was interesting on many levels. First, I didn’t notice any electronic automation or record keeping. The receptionist used a computer, but from what I could tell, the computer’s only function was to validate health card numbers (for reimbursement purposes of course) and (possibly) for contact information management (i.e., address book). Scheduling was done by the receptionist using a paper schedule and pencil. The specialist maintained paper-based records.

So, what does this visit have to do with ehealth strategy? Well, I was wondering if maybe the emphasis on deployment should be at the specialist level rather than the primary care physician level. When patients visit a specialist, the scope of diagnoses and treatments is narrowed from what a generalist/family practice may encounter. Also, from what I’ve been able to learn, specialists tend to focus on specific types of information, usually collected in a very particular way. Electronic scheduling and access to lab results would probably address a significant portion of the ehealth needs for a specialist.

Now, getting back to the Ontario situation. Instead of concurrently working on multiple projects, what if all of the efforts were focused on one or two things - lab results and a secure infrastructure for example. Alberta has focused on only a few systems at a time and has experienced success using this approach. I concede that Ontario is not Alberta, just like Canada is not the UK (in terms of size of population and arguably “complexity” of the problem). But, thinking that we can do it all at once may be unwise. I think the reason why people distrust government initiated projects is because the projects tend to be massive, finish late, and cost more than expected. Shouldn’t we try and learn from past mistakes and learn from successful projects to see how we can do things better?

I’m going to follow-up with posts on the potential role of open source in health care and possibly a profile of a research project that I think is a glimpse of the future (assuming I get permission of course).

Popularity: 10% [?]

e is for … evaluation? January 12, 2006

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

This year’s e-health conference is titled “e is for everyone” but I want to focus on another “e”: evaluation. I have heard a few people suggest that the next “big thing” in ehealth is evaluation. I’m not sure if I agree or disagree with this prediction.

Up until recently, much of the effort in health informatics/ehealth has centered around developing the electronic health record (EHR) or in conducting “proof of concept” type tests. Now that some of the technologies are starting to be deployed and used, I think the next logical step in evaluation would be to start evaluating in terms of efficiency and/or effectiveness. But, does this necessarily mean that evaluation will be the driver of ehealth?

I had a chance to speak with an experienced, senior government worker regarding ehealth. She indicated that there seems to be a general consensus and recognition that the use of technology is the future. Rather than focusing on the future technologies, she said that what is needed is evidence that things work - the simpler the better. Perhaps amidst all the past hype surrounding ehealth, a tendency to propose large, complex solutions took hold of the field. When we look at the work of Alberta, I think we can see that a “master” plan existed, the development path followed a staged approach; building one functionality at a time and then moving on.

I suppose that in the end, I’m not entirely convinced that evaluation per se, will be the next big thing in ehealth. Actually, my position is somewhat ironic given my research in evaluation and ehealth. I think that evaluation will become more important. But, I suspect that evaluation will become part of the development process.

Popularity: 11% [?]

I wonder about the things we value January 11, 2006

Posted by Hans in : opinion , 2comments

Yesterday, Steve Jobs gave his highly anticipated keynote address at Macworld 2006. I watched a delayed version of the event for a number of different reasons: 1) I have some stock in Apple and am trying to determine when/if I should sell; 2) Steve Jobs is touted as being one of the best public speakers in the world, and so I am interested in learning about his technique and style; and 3) I have some interest in learning about Apple products (apart from the investor motivation). Regardless, what struck me as very curious was the degree to which the audience (and I suppose general public) was absolutely enthralled and energized by the event. No doubt that Steve Jobs is a talented public speaker and that Apple is on a roll, but can these two reasons account for the devotion and attention paid to a computer/entertainment company? A few other examples include the devotion to movies (e.g., Star Wars, Harry Potter), technologies (e.g., Linux, Open Source), and other entertainment (e.g., sports, music). I hope you get the point.

Over the past year or so, I have started to wonder why health care (and as an extension, ehealth) fails to garner as much attention as these other areas. Here in Canada, we publicly say that we value health care and that health care is important to us as a society. And yet, we seeminly do not approach health care with as much zeal, passion, or excitement as with the entertainment/leisure/technology examples. I concede that we do spend a significant portion of our financial resources on health care (just under 10% of GDP in Canada). This fact alone suggests that we do value, in monetary terms, health care.

But, where’s the excitement? Much of the talk surrounding money and health care centers around controlling costs. If society put as much energy into developing new drugs, new technologies, or even new ideas into health care as we do to entertaining ourselves, would anything be different? Perhaps. Maybe there would a greater proliferation of options avialable to health care provides and patients regarding the use of ehealth. Maybe costs would decrease because of greater competition, reliability, and use. I really don’t know. All I do know is that there is not as much zeal surrounding health practitioners using new technologies as an announcement about a new iPod or Apple computer.

I wonder if we really value health care. If we do, should we not be focusing more of our energy and attention in making it work? I wonder…

Popularity: 17% [?]

space and place in an e-health world January 9, 2006

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

I’ve often stated that we need to explore and understand some of the consequences of adopting and using more ehealth. By consequences, I don’t necessarily mean negative effects. In his book, Amusing Ourselves to Death: Public Discourse in the Age of Show Business, Neil Postman articulates some of the (unintended) consequences of using the television. For example, he explores how use of multimedia de-emphasizes print and how television encourages the development of shorter attention spans.

Now, as for ehealth, I wonder if there are similar ramifications. The concepts of space and come to mind. In the past, I have been a strong advocate for using ehealth technologies to allow people to communicate, collaborate, and connect irrespective of place - the technology allows us to do this. However, I wonder if my position was naive. “Place” and “space” do play important and powerful roles in our lives - just think about the concept of “home”. We all have powerful associations to the place that we call “home”. Do we have a similar attachment to the places that we set aside for work and even for care?

Some of the rationale for moving care back into the home has been borne from the notion that people want to receive care in the home - costing less helps too, right? Well, what does that mean for our public institutions? Imagine if everyone was connected via the Internet and that almost all of the health care interactions took place “virtually”. What would happen to the places that we call “hospitals”? Would these public gathering places cease to exist?

A colleague informs me that patients have strong connections to the places in which they receive care. One example is dialysis treatment. When given the opportunity to receive dialysis treatment at home at night, some patients get concerned because they would miss out on the social bonding that occurs at the hospital. These patients have spent countless hours in one place receiving treatment, and additionally (but perhaps more importantly) relationships with other patients. Will virtual spaces be able to re-create the physical places that we currently occupy?

Richard Florida, author of Rise of the Creative Class, argues that place is very important. He even goes so far as to suggest that place is perhaps the most important factor in determining a city’s (and even a nation’s) future economic survival. I just wonder if by (arguably) saving money and making the system more responsive that we are in fact losing something valuable without realizing the consequence.

If you’re interested in exploring some of these issues, feel free to visit the Health Care, Technology, and Place program. One of the explicit areas of research is place. I will continue to write about place and space as I think about this topic more.

Popularity: 9% [?]

elections & ehealth January 7, 2006

Posted by Hans in : analysis, news, opinion , 2comments

Here in Canada, a national election is scheduled for Monday January 23, 2006. This particular election has been interesting because the major political parties seem to be running an issues-based campaign, passing on much of the negative advertisements and personal attacks of past elections. I’m not sure if this new-found civility will keep-up, but I have been interested nevertheless.

What has interested me the most, however, has been the platforms and policies regarding health care. I have been surprised that there is no mention of ehealth (or related concepts) in any of the party platforms. I have reviewed the Liberals, Conservatives, New Democratic Party (NDP), and the Green Party (sorry, my French isn’t good enough to have checked the Bloc Quebecois’s site). Mentioned in the position papers are national cancer programs, wait-time strategies, promises towards public health funding, and a great number of other ideas. But, no mention of ehealth. Why?

My first thought is that ehealth isn’t really a “sexy” or politically appropriate health care issue. I mean, when speaking to voters, a “computer” doesn’t compare well with nurses, hospital beds, or public health. Why isn’t there one party mentioning what they would do with new technologies? Those of us in this area (both industry and research) seem to hold some notion that what we do will have a (positive) impact on the health care system. Some even believe that ehealth is the means of maintaining the health care system in the future. Are we deluding ourselves to think that anyone else cares?

I think that the political parties need to develop a strategy and position regarding ehealth. If not a full “policy”, at least be thinking about ehealth. When we consider that there are considerable pressures on limited resources, we all need to make informed decisions regarding the allocation and use of these resources. As I read some of the proposals for a national wait-list strategy, I wonder how these programs will be delivered when the current info-structure in Canada has yet to be fully developed and integrated.

I am not suggesting that money is the answer. What is needed is thought and attention to ehealth, viewing it as another foundational piece of the health care system. Getting ehealth and ehealth issues on the “radar” of the politicos is just the first step.

Note: My apologies for not writing for quite some time. Recovery has taken much longer than I had anticipated. Hopefully 2006 will be better than 2005. I plan to write more frequently this year (daily if I can).

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