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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Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Reference info:

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

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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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1. ehealth is NOT ehealth:  Industry and government operate using a completely different definition of ehealth than what was used in the academic circles I was in.  For me, ehealth was a concept; it was (and is) something that requires investigation.  Perhaps that’s why the systematic definition that I conducted a few years back is so important.  We were able to catalogue the different definitions being used.  To government, ehealth is a term used to describe large-scale information technology/infrastructure projects that happen to occur within the health care sector.  It’s not wrong as these provider agencies have different responsibilities than the researchers.
2. Research is the thing that academics do:  When undertaking projects, decisions need to be made.  Because of the time constraints, people seem to search for a few short time to compile all of the information they can to base a decision on.  In a sense, people conduct a review except that it’s not systematic.  I am surprised by the attitude that academics live in some fantasy land doing research while everyone else is doing *real* work.  Sure academics operate under different constraints, but they have contributions to make too.
3. Academics/Researchers need to get more involved:  Some of my research colleagues may disagree with me on this point, but I believe that academics and researchers need to get more involved with the world.  There is so much that needs to be done that people need help.  I’ve seen examples where some engineering professors partner with an industry group and both sides benefit.  For the professor, he (or she) can find opportunities to conduct more research and/or find projects for students.  Students get opportunities to learn, while the industry partner(s) benefit from the expertise of the professor and also get a chance to assess potential future employees.
4. Patient?  What patient?:  Maybe I’m a bit cynical, but I’m worried about the patient.  No-one talks about or considers the patient.  It’s always about achieving a project deliverable and coming in on budget and getting the clinicians (i.e., physicians) on board.  I understand that finances are important and that clinicians play an immensely important role, but who speaks for the patient?  Patients and regular people need to get more involved in the entire ehealth agenda (be it from a research perspective or from an industry advocacy perspective) or else they/we will be left out again, just like during the early stages of when the health systems were being developed.  This is a perfect opportunity to make real change.

I’m thinking that this experience will be an interesting one for me as I navigate between these two worlds.

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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:

• regular, timely posts of news and opinions
• broad variety of topics covering health informatics, ehealth, and health care in general
• offers insight and ‘counter opinions’ to public releases and media reports

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

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In the meantime, I would like to suggeset another blog that came to my attention that may be of interest to you.  It is titled "e-Health Tech:  e-Health Technology, Research, Initiatives and Education" and can be found at "http://e-healthtech.org/"

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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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1. I hope to do some posting about my experiences with my dentist and how technologies are being used in that area of health care.
2. Some thoughts about the dichotomy between industry and academia in terms of the outlook of ehealth
3. Some thoughts on recent developments in the mobile/handheld world. By this, I mean specifically Apple’s iPhone and some of the potential implications for health care

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