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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).

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A new definition of health? December 14, 2008

Posted by Hans in : academics, nature of ehealth, news , add a comment

There was an interesting editorial published this past week in the BMJ titled "How should health be defined?" by Jadad and O’Grady. The basic idea of the article is that while health was defined in 1948 by a panel of experts that changed our notions of health and illness, is it time for a new definition?

Jadad and O’Grady suggest that use of the Internet may be a viable means of engaging people from around the world. The authors created a definition of health blog to test out their idea. We’ve seen that public engagement in the 21st centry may look very different when/if the right conditions are in place. President-elect Barrack Obama seems to be using his change.gov website to solicit ideas and spur discussion on policy issues. Whether or not this type of enagement will work for broader topics like the definition of health is yet to be seen.

I’m cautiously optimistic and hopeful that we can begin to change how patients and the broader public participates with the health care system.

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Worlds colliding…industry vs. academia May 13, 2008

Posted by Hans in : academics, nature of ehealth, opinion , 1 comment so far

It’s interesting to see how differently ehealth is viewed by academics and industry.  To one, ehealth is the potential of using new mediums to explore ideas and possibilities, while to the other, ehealth is more of a means to an end.

For the past few years, I’ve been in the academic world exploring the limits of our existing evaluation theory as applied to ehealth innovations.  As a researcher (or perhaps more aptly, ‘would be’ researcher), I focused on the concepts of ehealth and how one could evaluate these constructs.  The pursuit was academic and intellectual, even though I tried my best to remain grounded in solving, what I perceived to be, real problems.  Perhaps that’s why much of my writing and thinking on this topic has been focused on the patient and how users of the technology (health care providers included) can be empowered by ehealth.

More recently, I’ve been exposed to the industry perspective of ehealth.  In this world, ehealth is all about programs and projects, about deployment schedules, funding options, and providing the framework to move a health care system along.  Here, there really isn’t any time for or value of the rigorous methodological approaches (and debates) surrounding randomized control trials, systematic reviews, or even articulating an epistemological viewpoint on how knowledge is constructed or derived.  Ehealth, in this context, is a business matter that requires analysis, forecast, and action.

For me, I feel somewhat stuck between two worlds, not having left the academic/research world, and yet being asked to help address some industry problems.  Discussions in the realm of industry hardly mention patients except in strategy/vision documents.  Ehealth is big business, dominated by government bodies and vendors.

I’m not saying that one is better than the other.  I merely point out something that wasn’t *real* to me until recently.  I always knew that industry is different and operated differently than the research world, but perhaps I was a bit naive about how much difference there really is.

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A voice against irrational exuberance in ehealth January 23, 2008

Posted by Hans in : academics, analysis, opinion, research , 1 comment so far

For those interested in a somewhat contrarian viewpoint about ehealth, I suggest you check out Scot Silverstein.  I just recently came across his site documenting some "common examples of health care IT difficulties".  You can also listen to his interview available via the Government Health IT site – an excellent site.

In his interview, Dr. Silverstein raises some very important points:

My interest in Dr. Silverstein’s work is in our common view on technology:  that there’s great potential to make positive changes, but that success isn’t a certainty – what is commonly referred to as "technological determinism".  I’ve written as far back as 2004 about technological determinism and ehealth, namely to be skeptical about the absolute certainty that the IT professionals have about ehealth (e.g., my post about IBM building computer models to solve health care’s woes).  I think it’s important to have a balanced view on being hopeful of the possibilities, but also being realistic about the challenges (some final thoughts from a 2005 ehealth conference).

I hope to do some more reading on his website to see what other nuggets I can glean from his work.

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Is this the future of peer review? January 22, 2008

Posted by Hans in : academics , add a comment

Came across an interesitng report of how an "author used blog comments to peer review a book".  Before dismissing this report, please consider that the book "examines the study of video games, and the blog in question is Grand Text Auto, an academic blog founded in 2003 that deals with ‘digital narrative, poetry, games and art.’".

Given some of the moves toward open access publishing for all government supported research projects, looks like the academic publishing world may be undergoing some change.

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Online Evaluation Resource Library January 12, 2008

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

Here’s an interesting resource for those interested in evaluation, titled the "Online Evaluation Resource Library" (OERL).  The goal of the OERL is to:

the continuous improvement of evaluations used to monitor and judge projects’ effectiveness. OERL provides a rich collection of evaluation best practices, guidelines for their applications to projects, and a forum for stimulating ongoing dialogue in the evaluation community. OERL is designed to support applications of sound evaluation methodologies to projects, not to replace a full course of study for those going into the evaluation field.

I did a quick search for resources regarding ehealth and related topics but didn’t find anything.  Maybe it’s an opportunity.  Nevertheless, for those interested in getting started on evaluations of health related IT projects, OERL might be a good resource for ideas.

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JMIR a top health services and informatics journal June 23, 2007

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For those interested in publishing their work, you should consider the Journal of Medical Internet Research (JMIR). JMIR is now the #2 medical informatics journal based on the ISI/SCI impact factor ratings, with a rating of 2.9. The “impact factor rating” is a statistical measure of how frequently articles from a specific journal are referenced by other articles. The thinking is that “better” articles will be referenced more frequently. You can read more about this announcement here.

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The Imposter Phenomenon June 23, 2007

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I attended a fascinating presentation earlier this week. The presentation was about the “imposter phenomenon” by Diane Zorn (PhD candidate at York University).

The Imposter Phenomenon is when high achievers (e.g., graduate students, professors, lawyers, physicians, etc) are “plagued by the fear that they are not as capable or intelligent as others think they are, that they cannot keep repeating their sucesses, and that they will reventually be found out as frauds”, despite outstanding accomplishments and frequent praise.

What I found most interesting was that this phenomenon isn’t so much an individual’s fault (according to Diane Zorn), but the result of environmental and cultural forces. In graduate school, the university culture fosters unhealthy lifestyles and often unwittingly promotes this imposter phenomenon. Diane Zorn presented data that showed how working to get a PhD is detrimental to your health: loss of hobbies, isolationism, decreased and dysfunctional communication skills, high incidence of depression, high stress, and so on.

One interesting finding was about Harvard. Apparently, Diane gets very positive feedback whenever she runs a seminar/workshop on this topic at universities and companies across North American and Europe. Audience members seem to share about their own insecurities and generally support Diane’s thinking about the imposter phenomenon. The one time she presented at Harvard, she got a completely different response – basically they disagreed with her. When she asked the Harvard audience about their response, they basically said “We’re at Harvard. Why would we feel that way”. As Diane said, Harvard looks like a perfect opportunity for a case study.

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To PhD or not Phd? August 12, 2006

Posted by Hans in : academics , add a comment

I’ve been asked on several occasions about studying ehealth/health informatics at the graduate level (i.e., masters or doctoral/PhD degrees). Some seem to be interested in advancing their own knowledge so that they can use their new found knowledge and skills to further their career in the workplace. For those interested in pursuing a doctoral degree (PhD), here’s a great resource that may help determine if the PhD/doctoral degree is right for you (http://www.cs.purdue.edu/homes/dec/essay.phd.html)

The information is provided by Purdue University and seems to be written with computer science students in mind, but the concepts seem applicable to other disciplines. Since I’m currently going through the PhD progress, I would have to say that this degree is not for everyone. You may have the skills and talent to complete the PhD, but all of the other aspects of the degree may not be a good “fit” for you. One thing that I’ve learned is that completing a PhD is like a marathon (not that I’ve ever run or completed one). The journey is quite lonely, as you only have yourself to get everything done. Basically, you have to love your topic so much that you are willing to forego other opportunities (a night out, vacations, relaxation, etc) so that you can work on your research. Usually, this means reading the latest journal articles, preparing a manuscript for publication, reviewing your data, or just thinking about your topic.

I’ve been thinking about a post about possible career options for those interested in ehealth/health informatics, so I’ll try and get something written up for the near future.

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Reference manager, electronic databases, and other thoughts from a systematic review April 28, 2005

Posted by Hans in : academics , 1 comment so far

Here are some thoughts as I work on my systematic review.

Electronic Databases

I’ve been searching Medline and EMBASE and I have as good a search strategy that I’ll get. Since I’m mostly looking for theory-type papers, I think I’m going to get a considerable amount of “noise” – okay, I can deal with that. What I find frustrating is the process of getting the citations out of the databases and into a reference manager (I’m currently using Thomson ResearchSoft’s Reference Manager 10). In my current search, I have close to 5000 hits to sift through (my colleague has a list of over 9000!). What I find frustrating is that I can only save/export 200 citations at a time. What is up with that? For your information, I’m using the Ovid versions of the databases. So, I have to download 200 citations at a time and then load them into Reference Manager. What a tedious process. Oh yeah, and when downloading, there must be at least a hundred different formats – what’s up with that?

On another note, I wonder if GoogleScholar will ever provide the functionality of being able to download the search results into a file or reference manager? Hmm…now wouldn’t that be interesting?

Reference Formatting

Since I’m in a pseudo-rant mode, what is up with the hundreds/thousands of different reference formatting styles? Okay, I can understand that there are some significant differences between body notes (e.g., APA formatting), footnotes, and end-notes (e.g., Biomedical journals), but is there really a need to have more than that? Considering that the differences amount to cosmetic differences? I’m a bit bitter because I spent a weekend fighting with Reference Manager to get my references into a journal’s format when submitting a manuscript – it wasn’t fun. In all fairness, I understand that the biomedical journals are trying to come to some consensus with the Vancouver/Universal Biomedical Journal style. I suppose change has to occur somewhere.

Personally, I like the APA reference format because when I read a body note, I’m more aware of the source than when seeing superscript numbers. The body notes seem to provide more information – I also like the reference list because it’s in an alphabetical format. But, body notes are a real pain when there are several references, or a list of items referenced extensively. The read-ability of the text becomes almost impossible because it’s interrupted with body notes. In this circumstance, I’d have to say that end-notes are probably superior because it’s less obtrusive. But, by using numbers, you lose something. I know that for me, I’m less likely to look-up the reference when end-notes are used because it’s more work to stop reading and find the reference – maybe that’s a bad habit of mine.

Well, back to work on my systematic review. I’ve got to load up some more citations into Reference Manager.

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