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ICT standardization and eHealth – a TalkStandards.com forum event February 25, 2010

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

I was recently made aware of an interesting website called Talkstandards. Talkstandards has a stated goal to be “an active online community where developers, researchers, policymakers and other interested parties can share ideas and collaborate on the global standards system”.

What is most interesting is that will be hosting a live, online forum event titled “ICT Standardization and eHealth” starting at 1100 EST (1600 GMT) today. The forum isn’t open right now, but the topics look interesting:

It’s good to see some community building to tackle the issue of standards and interoperability. While the US has an initiative to address standards in health care, I’ve wondered how having a plethora of options, while practically a challenge to manage, might be a strength in the long-term if we view this fragmentation in terms of bio-diversity. At this moment, I’m a big proponent of coming to consensus on interoperable standards that are used by everyone. The internet is demonstrating (in real-time) that standards allow for the most number of people to participate – and we all benefit from the collective experience.

I’m looking forward to the Talkstandards event. Not sure if I’ll have anything to contribute, but I will be observing and following the comments.

Popularity: 5% [?]

Has ehealth become toxic? February 24, 2010

Posted by Hans in : Uncategorized , 2comments

A recent article titled “The chopping block: Which way Infoway?” makes me wonder if the term ehealth has become toxic in Canada.

First, a little bit of context. The National Post has been publishing a series of articles/comments on potential things to cut in order to bring (federal) government spending under control. Canada Health Infoway (Infoway) was clearly a potential target for the newspaper.

Given the eHealth Ontario spending scandal resulted in resignations, firings, and nearly $1B in funds being spent, I can understand public suspicion over anything ehealth related, particularly if it is related to government spending. In a similar vein, when speaking to some folks, I mentioned how I was interested in ehealth research and asked “are you sure?”, obviously trying to distance themselves from the scandal.

I can understand how people might be wary of the term ehealth given some of the setbacks in terms of not really delivering on the hype and promises, but does this signal a lack of support for the work that needs to be done? Perhaps this is just one step in the evolution of the field where there will be no distinction in how information and services are delivered. A colleague of mine recently reminded me of a comment I made a while back: the term ehealth will cease to exist in a few years time. Much like the term “e-business” has disappeared from the vernacular, I am confident that ehealth will no longer be used. Use of electronic tools will become part of how things are done without the need to bring attention to it.

So, even if the term is a bit “toxic” within the Canadian context at the moment, perhaps it is just one step in the journey.

Popularity: 6% [?]

Health Affairs issue on “E-Health in the Developing World” February 23, 2010

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

The current issue of Health Affairs (February 2010, Vol. 29, No. 2) is focused on ehealth with a tag-line of “E-Health in the Developing World”.

I just stumbled onto this issue so I haven’t had a chance to read it yet. There are a number of articles grouped into some interesting categories including:

I’m looking forward to reading some of the accounts from this issue. Based on my understanding of Christensen’s theories on disruptive innovation, developing nations can be the place where new ideas can be established. Relatively simple innovations have an opportunity to meet the needs of users who have much less demanding needs and as such, the opportunity for rapid innovation can take place. In developed areas like Canada, the US, or Europe, innovations are challenged to meet the high demands of users who are accustomed to a level of sophistication and polish. The result is that innovations often don’t have a chance to develop and find a place within the market.

I will be keeping track of developments from the developing word as that is where the cheaper, simpler innovations are likely to emerge. In North America, governments have already committed billions to creating large systems which can share information across the country and meet the exacting demands of multiple users (e.g., physicians, nurses, allied health, researchers) and for different needs. On top of these two demands, innovations must also satisfy stringent regulatory burdens which adds additional complexity (and cost).

Popularity: 6% [?]

Chronic conditions account for growth in health care spending February 22, 2010

Posted by Hans in : Uncategorized , add a comment

A recent article published in Health Affairs titled “Chronic conditions account for rise in Medicare spending from 1987 to 2006” points to the changing nature of health care in developed countries. What is particularly scary is the disjoint between what (North American) systems are designed to deliver versus what the needs are. While some may see this as a threat, I see this as evidence for an opportunity to transform the health care system.

Given that chronic conditions are an increasingly important aspect of health care needs, I can’t help but point out that more needs to be done to support informal caregivers. By “informal caregiver”, I mean the family members and friends who support patients and provide necessary services that the health care system cannot. Like I mentioned, these are exciting times, but there is a tremendous amount of work to be done.

Popularity: 6% [?]

Will consumers pay for health content? February 18, 2010

Posted by Hans in : news , add a comment

A Nielsen report titled “Changing Models: A global perspective on paying for content online” found that consumers are likely to pay for some types of content. The graph from Nielsen’s report summarizes the findings:

201002180012.jpg

What about health information/content? I would guess that respondents would indicate “would consider paying” very positively. Conducting a “willingness to pay” study would be very interesting to find out if health information/content would rate higher. I would probably group respondents into the following categories:

I suspect that people are willing to pay for health information. We already know that genetic testing and the information provided therein is an increasing part of the medical testing market. Whether this type of demand translates into specific or broad willingness to pay is still unknown. Perhaps the results will be similar to the results on willingness to pay for content online as reported by Nielsen.

Note: The content (i.e., graph) is property of the Nielsen Company.

Popularity: 7% [?]

Quick thought – is health care getting too big? February 17, 2010

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A post on Roger Martin’s blog at Harvard Business Review titled “The Inauthentic Communities of the Modern Executive” has me wondering if health care has gotten “too big”. In the post, Martin describes senior management has become separated from its customers due to the sheer size and growth of the corporation. No longer having that personal connection, senior management is distanced from the individuals and communities it serves. Martin writes:

Executives could have a relatively intimate relationship with their customers, who were mainly located in their company’s home region or at least country. Employee bases were smaller and concentrated close to home, which tended to make executives a prominent force in their home cities. And their shareholders stayed on the register for a much longer period than they do today.

This structure had a number of beneficial effects for executives. It was easier to get to know customers, figure out how to serve them, and continuously improve a product or service. It was easier to get to know employees because there were fewer of them and they lived nearby. And since the home city was more important to the company and the executive typically had a network of friends outside the company in that city, the executive was less likely to have a schism between his corporate role and personal role relative to the city. That is to say, doing things to benefit the city made sense both corporately and personally. On top of that, shareholders were more likely to encourage or at least tolerate long-term planning rather than very short term results because they planned to be around for the long-term.

While not perfect, this structure enabled the executive to live a reasonably authentic life; the way he wanted to live personally was largely aligned with her corporate responsibilities. He wanted to make the customers — whom he was likely to know personally — happy. He wanted to support his employees’ well-being — employees who he and his family probably knew. He wanted to be a respected figure in the city, a city that was important to his company and his family. And he wanted to make his shareholders happy because he knew that they had placed a long-term bet behind his company. If he worked on all those aspects of his community, he could be successful and happy. And by serving customers and employees well, the corporation was likely to keep on prospering.

We’ve started to see this trend in health care over the past while. Arguments for “economies of scale” and efficiencies have resulted in large, multi-site hospital corporations emerging as the norm. These larger organizations then start the cycle of competing for people, resources, and mind-share resulting in a predictable “arms race” to become the most prestigious health care institution either through research or best care.

We have also seen the move toward regionalized models of care which are an attempt to move away from the centralized “command and control” model to something that can better respond to local needs. In Ontario, the Localized Health Integration Networks (LHINs) are supposed to serve in this capacity to “determine the health service priorities of our regions” but I wonder if we are simply adding another layer of administration to the system and making the system bigger without knowing it.

Martin concludes his post, describing the effect of professional managers:

In the intervening years, as corporations have ballooned in size, the community has become far more impersonal and distant. Customers and employees have become more dispersed and distant and the home city has become less central — even expendable, as Boeing’s abandonment of Seattle demonstrated. And perhaps most important, a company’s owners have become a group of distant professionals who trade their holdings at the click of a button. Many large shareholdings, in fact, aren’t even managed by people.

It was just as this process was taking place that the idea that shareholder value was a corporation’s principal objective function took hold, largely, I think, through the agency of business schools, whose dramatic rise coincided with the decline of the traditional business community. With the new creed came an army of professional proselytizers who have come to be the principal agents in the executive’s new community: Wall Street stock analysts who cooed with approval when shareholder value was put first and delivered spankings when it wasn’t; Wall Street investment bankers touting “value accretive merger and acquisition ideas”; strategy consultants providing approaches to slash costs and “enhance shareholder value”; and the financial press looking for a story.

I wonder if the influx of management professionals focusing on quality of services, efficiency, and value have in some way replicated what Martin talks about. Is this a good thing? I am not advocating that we abandon efficiency, effectiveness, quality, and patient safety. What I am wondering is if we are making our health care organizations too large and complicated such that the managers are so far removed that “patient care” is just a catch-phrase used flippantly, much like how many companies talk about “customer satisfaction”?

I will admit that I do not have any solutions or suggestions to this potential issue. There are benefits to be realized as an organization like a hospital increases in size – increased specialization and diversity of services is one glaring example. But, every time I walk outside of the mammoth buildings of the large hospital corporations, I can’t help but notice that the administrative corridors and buildings seem to be getting larger and larger with more opulent furnishings.

The question I wonder is – is there a better way? Is health care getting too big? If “yes”, what do we do about it?

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Google as ISP – potential ideas for health care innovation? February 10, 2010

Posted by Hans in : news , add a comment

Google just announced that it will be developing an experimental fibre network. According to the announcement, these are the plans:

planning to build and test ultra high-speed broadband networks in a small number of trial locations across the United States. We’ll deliver Internet speeds more than 100 times faster than what most Americans have access to today with 1 gigabit per second, fiber-to-the-home connections. We plan to offer service at a competitive price to at least 50,000 and potentially up to 500,000 people

With this experimental network, Google has the following three learning objectives (for now):

  1. Next generation applications based on ultra-high speed connectivity
  2. New deployment techniques of connectivity
  3. Openness and choice

This seems like a perfect opportunity to test out ehealth innovations in terms of efficacy, feasibility, and usability. It’s interesting that the first example they use (first sentence) mentions a health clinic. Whether there will be many health applications is yet to be seen. However, I am very excited about these types of experiments.
However, as Scot Silverstein is apt to point out, we need to be skeptical of claims and learn from the past success AND failures of IT projects in health care. He has a great website, titled “Contemporary issues in medical informatics: Common examples of healthcare information technology difficulties“, housing resources and commentary on many of these issues. I’ve profiled some of his work in a previous post titled “A voice against irrational exuberance in ehealth“.

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eHealth in the peer-reviewed literature… February 3, 2010

Posted by Hans in : news, research , 1 comment so far

Much to my surprise, two leading health care journals have articles on ehealth.

The first is JAMA (vol 303, no 5, pp 391-470; February 3, 2010), which rarely publishes on the topic of ehealth.

The second is a special theme issue on global ehealth (Feb 2010, vol 29, no 2). The Health Affairs blog has a good description of the articles.

Looks like there’s an increasing interest by those in the research communities on the issues of ehealth. I haven’t had a chance to read all of the articles just yet, but it some of the titles look interesting.

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Website: Hospital.com February 1, 2010

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

I came across this wonderful website titled “Hospital“. Seems to be a great resource for news and information from a hospital perspective.

From the website, it describes itself as

… one of the top free resources of general health on the Internet. Our content is delivered by our top-notch writing staff, and is focused on being timely and relevant. hospital.com is also the central site of our network of medical websites that also includes physician.com, Pathology.org, Medicalschool.org and Disease.com.

I recommend you check it out.

Popularity: 10% [?]