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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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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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Peering into the (ehealth) fog of war … January 16, 2008

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

At one point in time, a long time ago (around 2000), I wondered if centralized, government maintained electronic health records was the way to go.  In defense of this position, my arguments revolved around the notions of efficiency and control, in that it was easier for systems to be monitored, maintained, and updated if they were all in one place.  But, as anyone with a technical background could point out, there are significant technical issues behind such a strategy.  It would seem that some people agree: "German doctors say no to centrally stored patient records".

What I find interesting is the proposed "counter" solution:

As an alternative, the German private doctors’ body is suggesting the use of encrypted USB-sticks. These could be handed over to patients and would carry all relevant patient data, including digital images such as radiographs or CT-scans

Wow.  I haven’t heard a call for the use of physical based media in quite some time.  Personally, I thought that this line of thinking was disappearing as the feasibility of cloud computing increases and slowly becomes a realistic option.  In all fairness, there are a few other very interesting points raised by the group representing the German physicians.

After reading this article, I get the distinct feeling that as of 2008, we’re staring into the "fog of war" as no-one is certain as to what strategies or solutions will ultimately prove successful.  Might be interesting to start documenting what ideas people think will work or not work.

From my involvement in this industry in North America, I got the distinct impression that a strategy that mixes personal and public records was emerging.  Basically, health care organizations and governments (depending on their level of involvement in the delivery of care) would maintain an electronic record that is stored and available to authorized parties of the "system" (be it regional or otherwise).  Patients would then maintain some sort of "personal health record" that they can control.  The organizational records are often deemed to be the "electronic health record".  Maybe it’s me, but the title, "electronic health record" seems to have a more legitimate or official connotation than "personal health record".

It will be interesting to see what strategy(s) emerges.

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ehealth election madness September 26, 2007

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

Here in Ontario, we’re in the midst of a provincial election. Voting day is October 10, 2007 and I suspect that the level of attacks will increase as voting day approaches.

I’m not writing about political parties, but I am somewhat surprised with some of the debate regarding ehealth. The former government (Ontario Liberal Party led by Dalton McGuinty) has an election promise regarding the development of electronic health records and other health care related issues in their platform piece titled “Power to Patients”.

Create an electronic health record by 2015 and give Ontarians control over the information contained in it

What was interesting, however, was the response by one of the parties titled “Dalton McGuinty’s three ‘e’ approach to e-health”. They criticize McGuinty’s e-health strategy for being evasive, expensive, and election oriented for promising an electronic health record by 2015.

In all honesty, I’m not sure that I can disagree with any of the statements made in the press piece. On the other hand, having been on the “inside” during my brief stint on the Ontario Hospital eHealth Council, I know that things aren’t as easy as they appear. 2015 is far enough away that achieving a working electronic health record should be achievable. People compare Ontario’s progress with Alberta’s, but we have to understand that Alberta is unique (I briefly explained some of that in a previous post).

In any case, what was interesting is that when I searched the other major political parties’ websites, I couldn’t find any mention of a strategy or promise regarding e-health or electronic health records. Yup, the incumbent government hasn’t been perfect, but it would seem that they at least have a plan for e-health in Ontario, which seems more than what the other candidates seem to have. But then again, this could all be hype because of the election.

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Podcasting in healthcare - 2007 update August 30, 2007

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

As some of my readers might remember, I ran a series of posts on examining the potential role of podcasting in healthcare. At the time, I wasn’t too keen on podcasting in healthcare:

Recently, I came across a post titled “Will Podcasting Survive?” on a blog that I follow (Read/WriteWeb). In this article, the author, Alex Iskold, examines podcasting as the evolution of radio. Even though the technologies available to create and distribute podcasts are more widely available than ever, this medium of podcasts seems to have stagnated. He presents some data/graphs to highlight and support the idea that podcasting is stagnating. He gives four main reasons for this trend:

  1. Competition with video and blogs
  2. Limited applicability
  3. Monetization is a challenge
  4. Competition from big media

He concludes with:

It appears that podcasts are not picking up steam, and rather, podcasting is actually slowing down. There is not enough incentive for people to jump exclusively into podcasting because of tight competition from video, blogs, big media and a lack of clear monetization methods. However, it does not mean that podcasts are not here to stay.

Iskold’s conclusions seem to support my thoughts about podcasting in health care, albeit his conclusions are a bit more general in nature. Specifically, podcasts are “something you need to specifically listen to. They typically consist of a discussion you need to be able to focus on to follow”, making podcasts much like listening to a lecture. For some, it will be great, but for others (the vast majority, in my opinion), podcasts will not have much value, other than to be another resource that can be accessed.

Well, a year has passed, and I ran an update using Apple’s iTunes media software (v7.3.2.6) and was surprised at some of the results.

Table 1: Podcasts by topic using Apple’s iTunes on Aug. 30, 2007 (1200 EST) from Canada

Topic/ Keyword 2006 2007 Notes
health 105 150 Mostly health and fitness offerings and a few educational offerings. E-health Insider has a podcast.
medicine 105 150 Seems like a hodge-podge of podcasts focusing on specific conditions. From the descriptions, I get a sense that these are styled like “talk-shows” or something like the CNN offering “Your Health with Dr. Sanjay Gupta” (he has a podcast available from the CNN’s health page)
healthcare 84 141 A wide variety of topics covering improvement, education, self-help, and business. An interesting podcast by CDW talks about technology/IT management issues in healthcare.
doctor 105 150 Not really health focused, as the search returns anything using “doctor” in its name.
e-health/ehealth 1 6 Some very focused and interesting offerings including conference proceedings, e-health insider podcasts, an Australian industry publication podcast, and an individual podcast focusing on issues for Latin Americans.
telemedicine 1 3 Recordings from symposia.
telehealth 0 1 Weekly podcast from Canadian Society of Telehealth
informatics 5 139 Wow - what a surprise! I haven’t had a chance to go through everything, but there seems to be quite a range of podcasts here ranging from comedy, education, careers, and topical listings
cancer 105 147 A good variety of podcasts, mostly related to education and self-help with a few personal accounts of living with cancer. I was a bit surprised by the small increase in numbers, as I expected this section to grow much more than the other topics.
patient 105 150 Again, a wide variety of topics focusing on self-help, education, and general health.
cardiovascular 20 39 Some very focused topics.

I was very much surprised by the significant jump in informatics and the few new ehealth podcasts. I didn’t expect those numbers at all. My expectation was to see more health topics (i.e., health, ancer or cardiovascular), when in fact there wasn’t quite as many - granted 40–50% increases are significant.

Given Iskold’s comments about the slowing trend of podcasting and increasing video content, I wonder if video will supplant podcasting in healthcare. Granted, there may be considerably more podcast offerings on the Internet that are not hooked-up with Apple’s iTunes software.

In my own personal experience, I stopped listening to podcasts on a regular basis. I can’t say exactly why I stopped. All I know is that I didn’t find listening to podcasts to neither particularly enjoyable (even for purely entertainment podcasts) nor efficient. I was always irritated at the slow pace of the discussion, or irritated at the difficulty in jumping to the topic of interest. In the end, I decided to stop altogether.

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Now coming to a theatre near you: Capital Health is recruiting… August 26, 2007

Posted by Hans in : opinion , add a comment

I don’t know about you, but I generally don’t like to watch advertisements, especially the 10–20 minutes of paid advertisements just before the start of show at the movie theatre. Normally I pay little attention to the ads, but I almost fell out of my seat when I saw a recruiting ad for Capital Health, “one of the largest integrated health regions in Canada” (it’s located in Edmonton, Alberta). I don’t know about you, but I don’t expect to see recruiting ads for “health care careers” when watching the late showing of actions movies like “The Bourne Ultimatum”.

I was curious about the ad, and so I did a quick check of the Careers & Training section of the Capital Health site. For those interested, there are some interesting postings ranging from clinical, corporate, and even academic/research.

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A prescription for Google Health? August 21, 2007

Posted by Hans in : analysis, opinion , 11comments

About a year ago, Google indicated that “health care information matters”, with little to report since then. Google seemed to have formed a health board comprised of physicians and some patients to guide its efforts. Recently, I’ve read a few pieces speculating about Google’s efforts toward building a health care product/service (here and here).

In 2005, I had an idea for how Google could potentially disrupt health care. I even shared it with my supervisor, who thought it was an interesting idea and mentioned he would mention it during a meeting he had set-up with some senior execs at Google. Unfortunately, the meeting never took place, and I sort of forgot about it because of my studies.

My idea was that Google develop a personal health record using basic Web2.0 technologies already in its portfolio. Google has several services that could potentially be re-organized into a functional health information product:

This idea of Google developing a consumer oriented electronic health record was based on the theory of disruptive innovations described by Clayton Christensen.

Currently, efforts are underway to develop electronic health records (EHRs) by governments, regional authorities, hospitals, health information companies, and pretty much everyone else in health care. EHRs have been somewhat of a “holy grail” in the health informatics community since the 1970s, promising an assortment of benefits. Currently, there is no standard EHR product available, and so vendors have been pitching integrated solutions for the last little while. In recent years, hospitals (at least in Canada) have been examining the possibility of assembling EHRs based on “best of breed” technologies - basically taking one component from company A and another component from company B etc. With more governments getting involved in setting an agenda for ehealth/eletronic health records, the vendors seem to be more open towards adopting standards for sharing information between systems and with other organizations (a push for a more regionalized model). Needless to say, these efforts are quite costly in terms of purchasing hardware, building-up an infrastructure, training, and licensing costs. Physicians and other smaller medical groups have been largely left alone to purchase products from vendors - which isn’t necessarily a bad thing.

So where does Google fit in? Well, Google could release a “free to use” personal electronic health record – here are some reported “screen shots” of the would-be Google product (looks like my suggestion might be pretty close). How would it work?

For patients
This product would be a central place that a patient could record and store health information. Information could be found on the web and then recorded for future reference (search). Patients could record some thoughts and questions about the information they found (blog or docs). Alternatively, patients could keep a “health diary” recording responses to medications, daily activities, food eaten, difficulties with activities, etc (blog). Some specialists have mentioned that patients don’t remember enough detail about past events to be helpful when first noticing symptoms, leading to delays in diagnosis/treatment and additional tests. Basically, all of the functions of a personal health record freely available to patients. The “home page” (or “about page”) could list pertinant information (age, existing conditions, allergies, etc). Basically, the patient version is an easy way for patients to view their own information, add additional information, and link to family members (social networking), and share with health professionals.

For providers
While patients can create large quantities of data (usually in text format), this isn’t so great for busy health professionals. Health professionals could be provided a “dashboard” that summarizes the information contained in electronic health record – things like charting medications taken with responses. Obviously some development of appropriate applications would need to take place. Ideally, lab data could be either imported or linked to provide a full picture of the patient. The best thing would be for Google to pitch this type of service to small physician offices who don’t have the expertise to set-up and maintain their own systems. All a physician would need is an internet connection and a few computer terminals. Scheduling could be handled either by the patient using the calendar service and monitored by some administrative staff. No more lost charts!

But wait…
Some will mention that this Google health product will not be “good enough” to meet everyone’s needs. You’re right. But it doesn’t need to be. Google can simply release this product and develop it by adding new features and functions along the way and go “up-market” (following the classic disruptive innovation curve). Of course, Google would need to insure security and privacy and be cognizant of any reglations and laws.

Others might point out that the existing vendors will not sit still. True, but most vendors are interested in making money, and thus they focus on selling to hospitals, HMOs, or other health care groups. Patients aren’t a lucrative market (yet). Vendors might release a product aimed at patients, but that’s more to ensure that hospitals will keep buying their products. Google has an inherent cost advantage here because its services are free to the users because it’s paid for (presumably) by advertisements. Google stays happy because it maintains its user base, and thus increasing its potential ad revenue. At first, the product might not have all the features, but new ones can be added quickly by opening up APIs so that developers can add new features, putting pressure on existing vendors to provide services at Google’s price points and pace (yikes – how do you compete against free?).

Another potential snag is that hospitals and lab companies will not want to share their data with Google. Yeah, that’s true. But, as more standards emerge and governments push for sharing of information, getting other players involved (like Google, Microsoft, or another firm) should be easier. It’s not a question of whether existing players want to, but more a question of when will they be forced to start sharing information.

As Christensen predicts, we’ll soon enter a stage of “commoditization and modularization” where standards allow for components to be swapped interchangeably (we may be closer than we think). If that’s the case, then vendors will need to switch their efforts at providing integrated products to focusing on specialized components like decision support modules, data visualization, or other applications that can “plug” into a larger framework.

I’m interested to see just what Google has up it’s sleeves. The idea that I’ve just described would also follow in Google’s current practice of releasing “beta” products, getting feedback and gaining market share, and then monetizing the product with new releases (see their history with their office products). In one scenario, Google could provide a suite of EHR products for physician offices for free, or with some basic support for an annual cost, slowly moving up the value chain. It’s unlikely that large hospital corporations will ditch the investments they’ve made in the near future. Besides, large corporations have much more demanding needs that Google probably can’t match initially. But, things may change. If enough patients start using Google’s services for Health, maybe there could be a radical shift in power from the health professionals to patients.

I don’t know about you, but I’m very curious to see what Google releases.

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Nintendo Wii: A glimpse into the future of health promotion? July 11, 2007

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

I’ve been very impressed with the Nintendo Wii. The game system is simple to use and very fun. Even though I have a Sony Playstation 2, I hardly ever play it any more. When I do try to play it, I find the games to be far too complicated to play (especially trying to learn the complex controls for sports games). Personally, I think Nintendo has a great business plan that is taking advantage of the theory of disruptive innovations as described by Clayton Christensen.

Basically, Nintendo is expanding the market of game players and not competing for the same “hard-core” gamers that Sony and Microsoft target. Instead, Nintendo focuses on fun, easy to learn games that seem more family and group oriented. Okay, the graphics aren’t great, but after playing a Nintendo Wii, all I remember was how fun it was.

Nintendo just announced a new fitness product called the “Wii Fit”: it consists of “a flat, board-like object that rests on the floor and is touch-sensitive” (article via Arstechnica). The purpose is to use the game system to get into shape by engaging in fitness activities like yoga, aerobics, and other activities that get your heart pumping. With obesity a public health risk, maybe this product can get kids more physically active.

In the past, I wrote about how video games may be a disruptive force in health care. Maybe health promotion initiatives need to get more creative in trying to get the message out. I think the industry is doing its part, especially with groups like the Serious Games Initiative. I wonder if Nintendo’s new product(s) is just the beginning of a new type of gaming experience. After playing the Wii, I can understand how being active can make the gaming experience more enjoyable and interactive. Nintendo just seems to be more blatant about the health aspects.

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Telehealth Ontario: Is it doing more harm than good? January 17, 2007

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

A while back, I wrote about my experience using the Telehealth Ontario service. In my particular case, my experience was satisfactory.

As I understand things, Telehealth Ontario is meant to be a service that “can help you decide whether to care for yourself, make an appointment with your doctor, go to a clinic, contact a community service or go to a hospital emergency room”. Basically, the service is meant to advise people on whether they should wait to see their physician or go to the local emergency department (ED/ER). I think the rationale is to decrease the number of inappropriate visits to the ED/ER and (hopefully) decrease costs.

So far so good, right? Since I posted my experience, I’ve received several comments on the service both in support of and against the service (see the comments section at the bottom of the post). I’ve been mostly non-judgmental about the service so far, but a recent comment has made me wonder. “Dazed” shares his recent experience:

Disastrous.

We have a 6 week old daughter. Last night she was crying in a higher pitch than normal, and had not urinated in about 6 hours. My wife asked me to call telehealth for the first time. The “nurse” who answered started with questions about my daughter who essentially stopped crying about a minute into the call. She asked a question, I would give an answer and she would ask again. It became pretty apparent to myself my daughter was ok as she really didn’t have any symptoms. However the nurse kept asking similar questions. She then asked how often my daughter was feeding and I replied every hour or two. The nurse then about 5 times said every few minutes is too much. She wouldn’t listen to me. Eventually I grew frustrated and basically let her answer her own questions. Eventually she came to the conclusion my daughter was dehydrated. (Even after I had explained she had fed normally and had a dr. checkup 3 days previous and my daughter had been putting on weight very well). The nurse came back and said that I needed to get her to a hospital. I was a bit exhausted of her and frankly my daughter seemed ok just a bit cranky. To get off the call I finally said I would take her to an emergency centre.

This is where it gets bad. The phone rang about 3 minutes later, my wife answered and the nurse asked if we were taking my daughter to the hospital. We had spoken after I got off the phone, and we felt she was ok but would watch her. My wife said no to the nurse. The nurse immediately started asking about the welfare of the child, and why we were not going if I had said I was going to emergency. This went on for about 5 minutes when my wife, again to get off the call said we would visit a hospital.

My daughter calmed down, had a wet diaper and a stool movement and fell asleep.

2 hours later at 12:30 in the morning we get a call from CHILD SERVICES stating they had been contacted from Telehealth nurses and were fearful for my daughters safety. That we needed to report to an emergency room immediately and have a hospital official contact Child services that we had indeed arrived. We argued slightly but really just wanted this nightmare to go away. We asked for the nurses names and headed to the emergency room. Upon arrival we explained ourselves to the triage nurse who upon examing our daughter said this is a waste of time, that our daughter was fine, she said we seem like nice people and she called the Child services number. At first nobody answered. We had to wait 30 minutes (In the emergency room of a large Toronto hospital with a 6 week old infant-germs apparently had not entered the telehealth’s nurses thoughts) for a child care rep to call back. The triage nurse said “what is telehealth doing, this child does not need to be here.” The child services basically said the nurse at telehealth said the baby was in danger. The triage nurse said we were free to go, that if we wanted to we could see a doctor but it wasn’t necessary. By this time feeling we were awful parents, we stayed for 2 hours waiting to see a doctor just to be sure. By this time we scared to take off my daughter diaper, just to “prove” she had now urinated, nothing seemed wrong. The doctor finally arrived, we explained our evening. He laughed and said telehealth and child services do this alot. He inspectect my daughter for 30 seconds, my daughter urinated on the examination table. The doctor appologized for us having to come in and said my daughter was fine.

So it ends. No today child services calls and say that they have to come with a nurse to inspect our home and give our daughter an examination. They said they can only come during working hours. Now I need to miss work. They have to have someone inspect my home. I am sure this is recorded by either health canada or the provincial government. I believe our family doctor needs to be contacted.

Obviously I have contacted an attorney, and have been advised to have someone in the house with us when the inspection takes place.

Could anyone help me in the sense that has anyone else gone through something like this. It is humiliating. If anything we are new parents, likely overly cautious, phoned telehealth for information and an opinion. Because of a 5 minute telephone call, poorly asked questions and not listening to answers, it has turned into a weeklong and now possibly litigious affair.

I will NEVER consider calling again. And by the way most nurses and doctors in emergency centres I have spoken with today, Telehealth is a massive burden on emergency rooms, doing the exact opposite of what it was attended for.

Do I have legal recourse?

All I can say is “wow”. I don’t know what exactly happened, but this recount sounds quite crazy. What exactly is Telehealth Ontario’s boundaries, responsibilities, and/or expectations? From the few accounts I’ve read, Telehealth Ontario seems to provide limited value as a service – it works for some, but may be a burden to others (like the ER docs or the family in the quotation above).

In all fairness to those who work at Telehealth Ontario, they probably don’t have the freedom to use their own judgment and determine which cases don’t need to be followed-up or not. I suspect that staff are required to follow some sort of script and aren’t allowed to deviate from the script for fear of litigation and other liabilities.

Regarding Dazed’s case, I don’t know if this incident is an exceptional case where the “system” seemingly has broken down somehow, or whether this example is Telehealth Ontario “in action”. I’m not blaming the Telehealth Ontario staff - they have guidelines to follow and are doing their job. The issue is that when we build a system with inflexible rules, there are no opportunities for common sense and good judgment to be applied.

As for specific advice for Dazed, I’m not really sure what to say. The hassles that you will most likely go through are really unfortunate. Your idea to have an attorney present is probably prudent just in case something really goes awry. If things don’t get resolved to your satisfaction, I’d probably recommend making some noise by trying to reach someone at the Telehealth Ontario offices, then contact either your local politician (both Provincial and Federal), and perhaps even contacting a reporter to see if they can help in some fashion – if not for yourself, then to prevent this type of incident from happening again. Other than that, I really don’t know what else to suggest.

To close this post, I’m not passing judgment on the telehealth service. I believe that the concept of a “free, confidential telephone service you can call to get health advice or general health information from a Registered Nurse” is an excellent one. My experience as an evaluator has taught me that much of the challenges lie in the implementation of the idea. Another item that is somewhat concerning would be the complains and comments from health care providers. Something needs to be done to address these concerns to make the service better. My question still remains: is Telehealth Ontario doing more harm than good? If we don’t know the answer, then maybe we need to find out.

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