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ehealth’s elusive return on investment September 2, 2008

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

Government Health IT published an interesting article titled, "The quest for value". The author, Nancy Ferris, reports on some of the challenges, difficulties, and frustrations with trying to demonstrate a return on investment (ROI) or tangible cost savings when using information technologies within health care settings.

My own research and experience in this area has me believe that the main assertion of the article is more or less true - that the link to tangible, measurable results (i.e., ROI) is difficult. I would add that the main reason for this difficulty is because there is no direct causal link between use of IT in health care and outcomes, or at the very least, the link is so weak, that other factors drown out the benefits. A report released by the EU (www.financing-ehealth.eu) titled "Conceptual framework, healthcare and eHealth investment context and challenges" presents some similar findings that the benefits are only realized in the future (see the latter parts of the report).

Personally, I think this concept of trying to identify a cost-savings or return on investment in health care is a bit absurd. Even in industry, trying to calculate return on investment regarding the use of IT is a challenge. I can’t remember the exact quotation, but a CEO of Fedex (or UPS) once indicated that even though they can’t completely identify the ROI of using IT, they said that they can’t NOT use IT and said that it’s just the cost of doing business.

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Upcoming Medicine2.0 Conference: Web 2.0 in Health and Medicine August 26, 2008

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

Just a quick reminder to those who aren’t aware, but there is a very interesting conference being hosted in Toronto, Canada titled "Medicine 2.0 Conference: Web 2.0 in Health and Medicine".

Medicine 2.0® is an international conference on Web 2.0 applications in health and medicine, organized and co-sponsored by the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and a number of other sponsoring organizations.

The conference is being organized by Dr. Gunther Eysenbach, a friend and colleague of mine, and it looks to be a great event. Unfortunately, I can’t attend, but I plan to do some writing on the topic in the next few days.

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Smart homes and health - some thoughts from Alex Jadad August 6, 2008

Posted by Hans in : news , add a comment

A recent article in the Toronto Star (August 2, 2008) reported on some future thoughts, opportunities, and challenges to the housing market from an ehealth perspective as presented by Alex Jadad. It’s an interesting read and provides a glimpse into the mind of Alex and how he thinks.

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Interesting conference - Making the eHealth connection August 5, 2008

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

I came across an interesting conference site titled "Making the eHealth Connection". The goal of the conference is to "to raise the profile of eHealth, form new partnerships and identify promising new areas of work for the Global South". Unfortunately, this month-long conference is invitation only.

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Informaticopia July 3, 2008

Posted by Hans in : news , add a comment

For those of you who aren’t already aware, Informaticopia is a great blog run by Rod Ward and colleagues.  The blog presents "eclectic news and views on health informatics and elearning" and is based in the UK, but reports on worldwide issues.  I’ve been following Informaticopia for a few years now and have learned greatly from it.

Just recently, Rod and co were recognized for their great work with a nomination for a Computer Weekly blog award.

Why do I like Informaticopia?  Several different reasons:

If you haven’t done so already, please check out the blog.

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Google Health: the beginning or the end of ehealth as we know it? February 21, 2008

Posted by Hans in : news , add a comment

Google announced the launch of a pilot project in collaboration with the Cleveland Clinic to provide select patients access to their medical record using the Google health platform.

According to the Associated Press, Google will:

begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools.

I think we’ve all known that something like this was coming. I’m just surprised that Google decided to jump directly in with such large undertaking. I would have predicted (and even suggested) starting with something a little less ambitious.  Does Google’s entry (and Microsoft’s Health Vault) change the ehealth landscape?  Is this the "tipping point" where we get to see tangible progress in ehealth that benefits patients?

Regardless, I think Google’s involvement will provide more publicity to the entire field, and also provide some additional competition to the industry. I’m curious to see how the established parties will respond.

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A glimpse at Google health? January 24, 2008

Posted by Hans in : news , add a comment

Seems like Google is doing things in the background regarding their health product.  Another blog reported a Google Health login page.  Some of the features listed on the login page sound like things I predicted with my "prescription for Google Health".  Definitely something to be on the lookout for, especially given Microsoft’s foray into ehealth with their HealthVault offering.

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One step at a time: Pharmacists and physicians exchange patient data electronically January 22, 2008

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

Canada Health Infoway announced a first in Canada:  Pharmacists and physicians exchanging medical data stored in patients’ electronic medical records.

Pharmacists can now “access lab test results, allergies and other vital data from consenting patients’ electronic medical records”, allowing them to “collaborate with physicians and the rest of the provider team and resolve drug-related issues more effectively and efficiently for their patients”.  The physicians seem also seem to be ecstatic about this new development as they are now able to “make better use of the expertise provided by pharmacists, make more efficient use of my time and hopefully, provides a more convenient and effective patient experience”.  This announcement is another sign of increased collaboration between the various health professionals in the system.

On a personal note, I can attest to how difficult this project must have been.  On a few occasions, I’ve been involved with developing “data dictionaries” from within an institution and across multiple institutions.  All I can say is that the task is tedious.  I spent six months reconciling definitions of indicators across a multi-site hospital because each department measured things differently.

Now that pharmacists and physicians have access to the same information about a patient, what’s next?  I’ve been participating in a home care knowledge translation course and a trend I’ve been noticing is exploring increased roles for pharmacists - notably in the area of education and medication checks.  The research that we’ve reviewed suggests that pharmacists haven’t made much of an impact (yet).

Regardless, I think this announcement by Canada Health Infoway is a great first step.  I would have liked to have known how the pharmacists are using this information.  What’s next?

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The “Google generation” and some implications for ehealth January 18, 2008

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

The findings of a recent report on how the "Google generation" uses technology and searched for information has some potential implications for ehealth (view the full report [35 slides] or read a summary article via ars technica).  In this case, the Google generation was defined as those kids born since 1993.

Kids seem to be familiar and comfortable using technology (i.e., what people would call ‘technologically savvy’).  However, this competence in using technology doesn’t translate into their ability to find information.  Assumptions about youngsters improving their search skills by experimentation and use alone would seem to be false.  What else was interesting was that kids prefer interactive activities (duh!), but they weren’t so picky about visual over text.  Visual was preferred to text, but it wasn’t a huge difference.

For those of us interested in ehealth, I think there are some important things we need to consider.  For example, my supervisor, Alex Jadad, often likes to challenge people by saying that we need to build a system that our kids will use because they are technologically savvy.  They may be more comfortable with information and communication technologies, but we can’t assume they’ll be "experts".  Some things to consider:

What seems clear is that we need to be careful about the assumptions we make about people using technology.  Young people may have a head start in terms of comfort and familiarity, but they aren’t "automagically" experts of finding information.  In fact, according to this study, their comfort and familiarity may lead to a shallow understanding of technology.  Something to think about.

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What can ehealth learn from Steve Jobs, Apple Inc., and Macworld? January 18, 2008

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

As in the past, I watched the 2008 Macworld keynote address by Steve Jobs.  This time, I was a bit surprised by some of the responses of the media and crowd.  Apple’s stock getting hammered didn’t help.  In any case, I think there are some good lessons for ehealth, and health care in general, that can be learned from Steve Jobs, Apple Inc., and Macworld.  Here are five lessons that we can learn:

1.  Focus on the user experience
This one should be a "no-brainer", as Steve Jobs always emphasizes building products that provide an excellent user experience.  You can see this in the design of Apple products.  For whatever reason, health care, and by extension ehealth, hasn’t really focused on the patient experience.  It is, however, getting better.  But, we’re still far away from anything remotely resembling a "patient-centered" system.  The system needs to change its orientation from being health care practitioner centered (i.e., physician) to putting patients first - and I don’t just mean lip-service, but real change.

An analogy of this would be the largely stereotyped caricatures of Microsoft and Apple.  Microsoft is seen as catering to the needs of business, whereas Apple promotes itself as a "consumer" oriented company.  This would translate into ehealth catering either to the existing institutional and professional powers versus patients and consumers.  FOCUS ON THE PATIENT EXPERIENCE!

2.  Demand excellence
Steve Jobs is portrayed as some tyrannical CEO who can be difficult.  However, he is known as a person who does not compromise and demands excellence from all staff and employees.  We can all learn to not compromise and give-in, but push for something better by demanding excellence.  Patients probably know this intuitively, but haven’t really had an organized voice to channel their expectations.  I know that individuals in the health care system all push to be the best they can be, but sometimes the rules, the bureaucracy, and the system just grind people down.  All of us need to demand ehealth to be excellent and not just convenient.

3.  "Think different"
This was a campaign slogan for Apple a few years ago.  I think it’s apt for ehealth of today.  Instead of succumbing to the often cited difficulties and generally accepted ways of doing things, we in the ehealth field have an amazing opportunity to push the boundaries and imagine all of the possibilities of what can be done to make things better.  Normally I hate the phrase of "thinking outside the box", but I think it fits here.  Apple Inc. is known to do things differently.  With so much more at stake, shouldn’t we also "think different"?

4.  Celebrate achievements & build excitement
I think Macworld is a great example of an event that gathers people together to celebrate the past achievements of the past year and also build excitement for the upcoming year.  eHealth needs to do more of this.  I know that there are annual conferences in the US, in Canada, and in other parts of the world, but they sure don’t get much press coverage.  If the Canadian conferences are any example, these are generally attended by industry folks with very little publicity.  A while back, I pondered the idea of having an ehealth or a health Olympics.  Maybe it’s time that we band together to create something bigger that can garner more attention and more excitement.  I don’t know about you, but whenever I talk about ehealth and the possibilities, I get excited.  We have a good chance to be important contributors in helping to make health care better for everyone.  We need to capture this excitement and inspire others.  Macworld does a great job of this for the "Apple faithful", but also generates quite a bit of buzz from non-Apple customers.

5.  Build partnerships
Apple is starting to learn how to build partnerships that are meaningful (e.g., Intel and Google).  Sure, they’re not great at it, but they’re trying.  The ehealth field can learn from this.  Instead of trying to do things on their own, we need to get together and build partnerships.  The problems and challenges are far too big for any one company or group to do it alone.  Governments and private sector groups working together is a good start.  Instead of competing with one another, we should encourage co-opetition so that more can be achieved.  But, don’t forget the patient!  The patient needs to be included in this partnership too.

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