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Lessons from my father… January 10, 2009

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

My father’s most recent health experience and his visit to the ER has highlighted a few things about health and managing one’s care. Here are some things to take from my dad’s experience:

  1. eHealth Can Improve Coordination of Care: In this case, having a single care record could have prevented this mis-hap. Our family doc saw my dad somewhat regularly and was more aware of my dad’s progress. He made a recommendation, but this information wasn’t passed along to the specialist. Only after visiting the ER and a call from the ER doc did all of the docs get together to coordinate things.
  2. Being a Good Patient is More Than Following "Doctor’s Orders": My dad is great a following directions. Because of his diabetes, our family physician told him to start exercising and change his diet. The next day, he started walking and now he runs 5-10km each day and is very active. He also has changed how he eats and has essentially cut out refined sugars. Normally, most patients don’t follow instructions well (and thus the issue of patient compliance), but my dad did and improved markedly to the point where he doesn’t need medications because he can control his condition through lifestyle changes. But, simply following orders didn’t really help my dad. Which brings me to the next lesson…
  3. Patients Need to Take Ownership: My dad is great a following orders, but he is very passive. He doesn’t ask questions and doesn’t look to take initiative. Part of this may be that he doesn’t feel comfortable in this role. But as our health care system continues to evolve, a significant understanding is that patients will be more active in managing their care. As such, patients MUST take ownership over their care: ask questions, read and learn about your condition, collect and keep copies of your care record, know what your lab results are, etc.
  4. Not Everything Is Preventable: In my dad’s case, this point doesn’t really apply, but all of my health education and training remind me that when we deal with people (and their health), not everything is preventable. Medical science only knows so much and can only go so far. There are so many things going on that predicting how all of the interactions may turn out is nearly impossible: your genetic predisposition, environmental exposure,your personality, the food you eat/diet, the air, drugs/medications, daily cleaning and grooming products, EMFs from electronic devices – these all interact with one another and no-one really knows how. Even if you do everything *right*, you can’t prevent some things.

My dad is fine now, but his experience highlights some things that we all should be doing. Hopefully some of these lessons will help someone get better care and health.

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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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Health care leaders lag on IT policy February 24, 2004

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

I came across an interesting news article talking about Newt Gingrich and his frustration with the health care system’s unwillingness to adopt IT. He gave a presentation at this year’s HIMSS conference. Basically, he tells a story of how the youngest in our society are at ease with technology, pushing for more technology, and yet our health care system is somewhat of an anachronism in today’s information-driven society. He uses an example of how a certain state is mandating printed/written prescriptions over electronic ones.

Question: Just because the rest of society is moving in one direction, does it mean that health care should? Should health care move at the same pace, or to the same degree? What about those who choose and prefer paper-based solutions? Do we leave them “behind”? One last thought…how come we always talk about those six-year old kids using technology, and not about what technology can do for the elderly, homeless, or disenfranchised?

I’m not suggesting that we shouldn’t use technology. It’s just that we haven’t demonstrated that we know how to use technology effectively within the context of health care. We’re all still banking on the *potential* benefits of using more ICTs. I guess after reading Neil Postman’s Technopoly some of my doubts took form. Also, as a “scientist”, I adhere to the principle that new interventions do not make a difference (i.e., null-hypothesis) until proven otherwise. This particular lesson was learned during my on-going discussions with my thesis committee.

Centre for Health Transformation

Came across this site based on the article listed above. You can find information at http://www.healthtransformation.net. Apparently, the goal of this centre is to provide options that will help accelerate the transformation of the health care system “to an individual-centered 21st century system of health and healthcare characterized by better outcomes and more choices at lower cost”. There may be an interesting opportunity for the Centre for Global eHealth Innovation to collaborate with this group. I’m going to contact them to see if there’s any interest. Will keep you updated.

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Technological determinism and eHealth January 27, 2004

Posted by Hans in : nature of ehealth , 2comments

During a team meeting at the Centre for Global eHealth Innovation yesterday, a point was raised about an assumption that we may all unconsciously have regarding the use of ICTs to improve health and health care (i.e., technological determinism). I stumbled across an interesting quotation by a newly appointed VP to an “eHealth” company called Medseek.

“Information technology within the Canadian healthcare system remains the key in improving the quality and delivery of patient care. In light of ongoing budgetary constraints and human resources shortages, Canadian hospitals must continuously find innovative ways to reduce costs and increase funding.”

Of course, the VP suggested his products and company is the solution, but that’s not the point. My question is perhaps a little more basic: how do we really know that ehealth and technology will cause positive change? I do not doubt that there will be change, but will it necessarily be an improvement or positive. Neil Postman wrote about technology inherently facilitating (or perhaps even forcing) human beings to change, but cautioned that we do not really understand the nature of this change. Can it be that we change, but don’t realize the implications and/or the consequences which may be either positive or negative?

You can read the full quotation and announcement in the press release.

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