eHealth: A North American phenomenon?

Question: How widespread is eHealth around the world?

Answer: I think that there’s considerable interest from many parts of the world. I mean, when I see the many health informatics/ehealth research centres (e.g., UK, Australia, Canada, United States, Germany) there seems to be considerable interest.

But, since I was born and raised in a Canadian environment, I really don’t have a true understanding of what the rest of the world is like. In Toronto, there seems to be a palpable interest in things eHealth (okay, I admit that I may think this because I’m in an academic research setting dedicated to eHealth – Centre for Global eHealth Innovation). One of the things that I’ve grown accustomed to is access to cheap, reliable, quality telecommunications. Let me explain.

In Canada, we have always had unlimited phone plans for local calls. I’m told that Canada has one of the most sophisticated telecommunications infrastructures in the world. Right now, the average local phone bill is around $28-$32 per month where I live. Adoption of mobilephones have been relatively slow in Canada compared with other countries. I think this is because we weren’t used to paying per unit time (second, minute, call – whatever). Although initially billed by the minute, the phone companies have started to roll out flat-rate unlimited call packages for mobile phones. You can already see mobile phone adoption increasing. Lately, there has been some differentiation in wired/land phone packages instead of paying a flat-rate for unlimited (and often unused) calling.

Now, when I think about other countries, this idea of having “unlimited” use is a foreign concept. I was just looking at an Australian phone company, and they charge by both the call and the duration! Ouch! I’m told that in Europe, billing by unit time is the norm as well.

Okay, so how does this relate back to eHealth? Well, many of the ideas that are being bandied about are based on the assumption that the costs of reliable telecommunications services, namely Internet and digital phone services, is very low. But, getting phone or Internet service may not be very cheap in places other than Canada. My initial thought was “#$%*&!!”. How can anyone afford eHealth outside of Canada when the costs are so high? Maybe we North Americans need to rethink these ideas of full-blown real-time video conferencing between patients-providers over the Internet. Could alternative modalities like store-and-forward or text based services be an appropriate compromise?

I haven’t even tackled the issue of developing countries with poor telecommunications infrastructures. Maybe we need to rethink things…