eHealth trends – personal predictions on significant factors

by Hans on 2005/05/05

I’ve been in bed recovering from a nasty bug and just going over some ideas about my research, the e-Health 2005 Conference, and just brainstorming in general. I’m going to go out on a limb and record my predictions for trends/factors that will drive eHealth in the near future. I’ve already posted about “patient safety” as the current narrative of eHealth. Personally, I think this idea will slowly fade away as the factors push forward. So, without further hesitation, I present to you my predictions for factors/trends that will shape and influence eHealth.

1. Evidence Based Health Informatics/eHealth
I think we can already see the signs of eHealth heading in this direction. As systems become more difficult to develop, finance, and evaluate, the pressure for evidence will grow. In other realms of the medical world, “evidence-based medicine” is starting to be the mantra. I know that Murray Enkin calls it the “tyranny” of evidence, but speaking with people like Vivek Goel, I know that evidence-based thinking is proliferating to other domains. There is now things like “evidence-based” policy making. Here’s an interesting read if you’re interested: Dobrow, Goel, & Upshur. (2004). Evidence-based health policy: Context and utilisation. Social Science and Medicine, 58 (1), 207-17.

So far, eHealth and health informatics seem to be driven on the idea/belief that computers will bring benefits (whatever they may be). As more and more systems become deployed, I think the discussion will start to shift to “how much better” and “which one is better” – prove that this is better.

2. Evaluation
As we move more towards an evidence based mind-set, I think the discourse will shift to evaluation. Right now, we’re still struggling with how to do this, picking and choosing methods as we think appropriate. Depending on your training and disciplinary focus, there is a tendency to use the methods that are familiar and deemed “acceptable”. I won’t say too much more on this one, but I think there’s considerable work that needs to be done to evaluate and to develop evaluation theory to study eHealth.

3. Inter/multi/trans – disciplinarity
This one will be big. We already see this happening as there is a forced interaction between the technology people (i.e., developers) and users (i.e., clinicians). But, as we start to adopt technologies en masse, I think there will be some fundamental shifts in the dynamics and relationships between everyone in the system. Thus the social sciences will follow. In this way, I see the slow dissolving of disciplinary boundaries as we move towards thematic teams. We’ll be talking about team approaches and the valuable contributions of all those involved. Maybe that’s why I’m very intrigued by next year’s eHealth conference, titled “e is for everyone”. No one group can do it alone, and the sooner we realize this, we’ll be far better off.

4. Human Factors/Usability
I think human factors is really starting to shift many people’s thinking already. But, I think the true effects will not be felt for a few years yet. Human factors hasn’t really hit ‘main-stream’ in this area just yet. I’m not sure there is much else to explain on this one.

5. Post-Normal Science/Post-Modernism
I’m probably the least confident in this prediction. I think that eHealth and health informatics will start to shift away from the cut and dry reductionist model of science (i.e., cause & effect). Traditional science or “normal” science as we know it today will still have it’s place, but I think there will be a shift to embrace other forms of thinking. Qualitative research paradigms, critical approaches, and just non-deductive means (among others) will start to play a greater role. I don’t think there will be as much disagreement along disciplinary ways of “seeing the world”. Personally, I think this will be a natural growth from the multi/trans-disciplinary approach to eHealth. New ideas will emerge and will not be so rigid as they are now.

6. Open Source
Okay, now here’s what I think is a no-brainer. Open source software. Even though the current business mind-set (as mentioned by both Dr. Louise Liang at Kaiser and Richard Granger from NHS) almost dismisses open source as a viable option for mission critical applications, I think there will be a significant role that open source will play. I can’t articulate the arguments as well as other, so I won’t. Eric Raymond does a brilliant job in his book The Cathedral & the Bazaar.

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Feel free to comment and agree or disagree. As I said at the beginning, these are just my personal predictions of how eHealth will be influenced and changed. Today is Thursday May 5, 2005. Let’s check back in five years and see how things turn out.

Hans.

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