e-Health 2005 Conference – thoughts from day 1

Here are my observations from day 1 of the e-Health 2005 conference. I would have posted more often during the day, but wireless Internet connections were not provided as part of the conference. I can’t believe that at an eHealth conference, Internet access is not provided for free – access was available for about $15 for the day I think. In any case, here is a compilation of my thoughts from throughout the day. I can’t possibly relate everything that I heard, but I’ll try and highlight things that piqued my attention, and/or things that I had some thoughts on. I’ve provided links to the abstracts for the student presentations.

Opening Session
I arrived a few minutes late, so I missed the opening remarks, and the first speaker. I stepped in just as Alex Jadad gave a short 5 minute presentation and then introduced Dr. Carolyn Bennett. Dr. Bennett gave an interesting presentation on putting both *health* and *patients* back into health care. She gave examples from her work as the Minister of State (Public Health) and how SARS really opened the eyes of the politicos in Ottawa.

Dr. Bennett said something that intrigued me. She said that we need to focus on the “things that technology can do”. I found this particular statement interesting because by thinking about technology as being able to do things means that we are viewing technology as equal to humans. This type of thinking, at its fundamental level, does not conceptualize technology as a tool that human beings use to complete some task. In my opinion, I would focus on “what we can do with technology”, maintaining the idea that humans are in control. I’ll freely admit that my thinking this is highly influenced by Neil Postman’s book, Technopoly: the Surrender of Culture to Technology.

Dr. Bennett also talked about building an integrated system that is connected to other parts of society. She used the example of the Walkerton incident and how the signs were there: pharmacies were running out of pepto-bismal and other drugs, animals were getting sick, and a spike in specific diagnoses. She thinks that if we only looked at all of these different types of information, we can identify much earlier potential health crises. On one level, I agree with her that we should be doing more with the information that we have at hand. On the other hand, I’m somewhat worried about the development of a “big brother” all in the name of protecting our health. I mean, let’s look at the United States and how the citizens have seemingly given up many of their civil liberties and rights in the name of “national security” and protection. What are the things that we need to be concerned about here?

Plenary session 1: Physician adoption of clinical information systems: Successful experiences implementing CPOE
This session was moderated by Dr. Michael Guerriere. Both Dr. Louis Capponi from New York City Health and Hospitals Corporation and Dr. Peter Rossos from the University Health Network presented on their experiences of working with clinical systems. It was interesting to hear what their respective “lessons learned” were. I can’t say that what they presented was earth-shattering or surprising. Maybe it’s me, but both the presentations sounded like I’ve heard it dozens of times.

One thing I did remember was that Dr. Capponi suggested that we need to cater to the “early adopters” and those most likely to benefit from using computerized physician order entry (CPOE) and similar technologies. I can’t believe how many times I’m hearing Rodgers’s Diffusion of Innovation being used in the health informatics domain. I totally disagree with using Diffusion of Innovation to justify selecting “early adopters”. I’m going to have to sit down and finish writing my manuscript about Diffusion of Innovation and why it should not be used to guide adoption of clinical systems in health care. I like the work that is going on at Vanderbilt University, in particular, the work of Dr. Nancy Lorenzi and her behavioural approach. Using the “early adopter” mindset leads to selection bias and potentially incorrect generalizations as some serious issues (in my opinion).

Here’s a passing thought that I had as this session came to a close. Why are all of the speakers men? Why are they all physicians? What’s up with this use of jargon? It reminded me of the work of Ivan Illich and the development of professionalism and how language leads to control and power. Guess all of this reading of Illich and Focault is influencing me.

Interactive Polling/Quiz #1 – Gunther Eysenbach
There was a short little interactive quiz that Gunther Eysenbach lead. This first session was about getting information as to who was in the room. There were some very interesting questions (and answers). We used some polling technology – basically a keypad with some sort of wireless connection. Results were tabulated real time and presented almost instantaneously. It was a neat little twist.

Student Session #1
The first student session had two presentations. Michael Bliemel from McMaster University (business) presented some of his research. His presentation was titled “Antecedents to information satisfaction in consumer health retrieval“. I missed a portion of it, but the parts that I heard were interesting. My biggest concern is that I’m not sure that he’s really assessing satisfaction with the methodology that he’s using. A few students made similar comments afterwards.

The second student was Wenfeng (Cathy) Yang, and she presented some of her research, titled “Design of a knowledge acquisition tool using a constructivist approach for creating tailorable patient education materials“. Honestly, I’m not sure what the topic of her presentation was. From what I understood, it seemed like she was examining some computer system that can generate customizable information sheets to patients. I got lost as to how the “constructivist” approach fit into her research because the inputs didn’t flow back to the patient. Information was vetted through the perspective of the health care professional. So, in my mind, I didn’t know how this work was any different than knowledge translation.

Great Debate: Are we ready to realize the vision and do we have what it takes?
This session was moderated by Wendy Mesley. Panelists were divided into “pro/for” and “con/against”. Jonathan Burns and Trevor Hodge represented the “pro/for”, while Matthew Morgan and Dwight Nelson represented the counter.

This debate was fairly entertaining, with both sides trading barbs at one another. Basically, the “pro” side argued that eHealth is a journey that is underway and that we all need to hop on the train that’s leaving. The “con” side argued that we aren’t anywhere near where we want and need to be. Matthew Morgan said a few things that I found hilarious! For example, “CIO is code for career is over” or “consultant means unemployed”. What made if even more funny was how he said it tongue-in-cheek about Michael Guerriere (his former boss).

Even though no-one really articulated one, the message came across loud and clear: the vision for ehealth is the electronic health record. Somehow, eHealth seems to have been co-opted by health professionals and business types and so, the vision is now electronic health records. When was this vision articulated and how come I never got a chance to participate? I found it interesting that one of the speakers (Dwight Nelson I think) mentioned how the Canadian public seems relatively unengaged and disinterested in electronic health records. Well, why would they be interested? Only the health care providers, institutions, and established powers are interested in this thing. Throughout this debate, I was thinking – who cares? Why is the health care provider at the centre of the entire discussion and debate?

Another interesting thing that someone said (Trever Hodge, I think) mentioned that vendors need to have a say in articulating this vision. Why? Why do the vendors have a say in what Canadians want in their health care system?

Question: if patients are so important to everyone, how come there were no patient advocates or patient representatives presenting anything or participating in any of the main sessions? Are we, as James Twitchell writes in Branded Nation, merely paying lip-service to patients and patient care? Has the almighty dollar, and I mean the establishment of the foundation and research dollars, taken over? You can hear and see it all throughout the day – people in business suits talking about return on investment, strategic investment, funding, leveraging for return, etc… and the list goes on. Since when has business lingo and business thinking taken over health care? Okay, I’m not naive to think that there is no place for business, but if we’re taking about setting and achieving a vision, why is business setting the agenda?

I was happy to hear a reference to my publication (What is eHealth (3): A systematic review of published definitions). Unfortunately, the speaker mangled the reference and credited it to some other journal. Oh well, he’s not an academic and doesn’t really care. I was a bit surprised to hear the comment and attitude that “we don’t need academics making up new definitions of ehealth. Besides, who cares?”. Well, I would figure that a great number of people do – that’s why we have at least 51!

Two last thoughts about this debate. I was a bit uncomfortable with the idea that competition in health care is a good thing. Generally, I’m supportive of competition because in market conditions, competition seems to encourage innovation and better service for customers. But, I wonder if this type of thinking can be applied to health care, particularly in the Canadian context. Are we going to implement competition for some ideological reason? My final thought is more a criticism of the thinking that seems prevalent in this session – that everything electronic is automatically better than pen and paper. I’m not sure that this is true.

Breakout Session #2 – Towards a performance measurement framework
This session was hosted by Mark Nenadovic, a manager at Canada Health Infoway. While the last five minutes of the presentation was interesting, the rest of it was a “look what we’ve done at Canada Health Infoway”. I mean, why do we need to rehash who and why Canada Health Infoway is?

When the presentation finally got to the measurement part, I was interested. Some things that I didn’t know:

• Canada Health Infoway sees itself as a “strategic investor”
• The measurement framework is designed around three “simple” questions: 1) Does the system work? 2) Is it being used? and 3) So what?

I’m going to try and get a copy of the slides to post here for those who weren’t able to attend.

Student Session #2
Unfortunately, I missed the presentation by TC Davies, titled “Effective use of ecological interface design in the design of e-Health systems“. So, I can’t comment on it.

The second presentation was by Monique Solomon, titled “e-Health communication: Contexts, conditions, and communication in e-health“. This presentation was interesting. Monique presented on her work analysing communication between members of a multiple sclerosis online group. She found that communication took the form of “illness narratives”, and that in particular, this community had communication of three main types: medical information, living with the condition, and positive support. I don’t think I got the exact wording correctly, but I got the general gist of it.

Student Symposium
We had a very engaging session from 6-9pm. I started off the evening session with a short 10 minute presentation on my vision for eHealth. Basically, it was a “dialogue” with the other students and audience members about what I was thinking. I wanted to challenge them to think and really challenge the status quo. I’ll post my presentation and a short write-up in a day or two. I think I’ll need to provide some notes to provide some commentary for my slides. Basically, I argue that if we really think outside the box, I can see eHealth becoming a “digital nervous system” for the world. eHealth can connect all of us together. When this happens, can eHealth lead to the emergence and formation of a global health system? Honestly, how unimaginative and boring is a vision that can only think as far as an electronic health record? Where’s the inspiration? The leadership? I hope that my presentation was well received because I wasn’t able to have a discussion on it afterwards.

The next speaker was Richard Booth, and he spoke about developing a nursing informatics curriculum. His presentation was interesting on one level: what skills do future health professionals need to have? But, on another level, I question why an “eHealth” world is any different from others.

Richard’s presentation lead to an hour long discussion about education and eHealth. I’m not sure why the discussion was centered around education, but I suspect that it’s because Anita Stern (the coordinator for the student side) is interested in this topic. There were some interesting ideas tossed around, but I didn’t hear anything new. Laura O’Grady provided some really great insight by basically saying that the ideas that people were bouncing around have been addressed by much of the research completed at OISE (Ontario Institute for Studies in Education – University of Toronto). She wondered why the medical world refuses to look at the work that they have done there. Good question. Why are we incessantly re-inventing the wheel? Why can’t we look at the contributions of the other disciplines?

The evening ended with a “brainstorming” presentation of ideas by Tony Tam. He shared some thoughts on what eHealth can potentially offer in the future – sorry, but I can’t remember the three main ideas he provided.

One really good positive from this student symposium was the statement of support by many of the faculty members and program committee members that showed-up. They mentioned that they would go to bat for the students in the upcoming year, but couldn’t promise anything because they may be powerless to do anything. Speaking of student issues, it was pretty obvious that this conference was a vendor-driven event. Students seemed to be an after-thought. Maybe in future years, this will change.

Other thoughts
Today was an interesting day. I heard the phrase “evidence-based health informatics” a few times. I wonder if this is such a good thing, or is this becoming the new lingo to co-opt the agenda by those currently in power. Is it possible to change the mindset of the people here? Why are we so focused on the electronic health record?

I was curious as to why Canada Health Infoway thinks that $10 billion is sufficient to develop a pan-Canadian electronic health record. The speaker mentioned that $10 billion is only for capital costs. If operational costs are included, then another $10-15 billion is needed. Whoa. But, to use the analogy that was bandied about today, what good is a railway if there’s no-one available to operate the trains? We can’t be thinking about capital costs separate from operational costs. It just seems wrong.

It was good to see some friendly faces:

• Lan Djang – 5 time Jeopardy Champion. He’s in the quarter finals of the current Ultimate Tournament of champions. I’m told he’s next on TV on Friday May 13, 2005.
• Nancy Gabor – from my days at the Ontario Hospital Association
• Carol McFarlane – also from my days at the Ontario Hospital Association
• Rosalie Richea-Harrison – friend from Waterloo. She was the first person I saw today as I walked into the conference. It was cool to catch-up with her.
• Sanjay Cherian – formerly at Hay Group, but now he’s at Accenture

There were a few other faces that I saw in the crowd, but I can’t match a name to them right now. It’s been a long day, and today looks like another long day.