eHealth and rural communities: Can eHealth keep hospitals from closing?

by Hans on 2005/05/12

We keep talking about how eHealth will bring about benefits to the health care system by making it more efficient and effective, but I wonder if there isn’t a significant western, urban “group think”, or even myopic view at play here. In my (limited) dealings with health care issues concerning northern and rural parts of Canada, I have realized that the issues challenging rural areas are very different than those faced by large urban centres.

An article in today’s CBC reports of the impending closure of a small community hospital because it is losing six of its seven physicians. In an attempt to lure and keep physicians, the community offers physicians salaries of $300,000 (and more) to come and work in a small northern, rural community of about 10,000.

With the E-Health 2005 conference (arguably Canada’s pre-eminent forum for eHealth and health informatics) being completed last week, I wonder what types of solutions the delegates and presenters could suggest to this small community. I doubt that discussions and urges to adopt an electronic health record would be of much use to this community.

Question: how can eHealth benefit northern, rural, and remote communities? I met someone from the University of Guelph’s Rural Health Studies Program (Ms. Linda Mayhew) who was interested in this question. We had a very short discussion, but some of the challenges she mentioned seem more “real” than what the large urban centres seem to face. How can technology be used in real ways to help maintain health care organizations faced with crippling shortages of professional care providers (i.e., physicians and nurses)?

On the other hand, I wonder if we are approaching the problem the wrong way. No doubt, northern communities face real and challenging problems of recruiting and keeping health care professionals in their communities. I would also argue that other issues like addressing access issues because of distance, securing adequate funding, and acquiring expertise need to become a priority for decision makers at the governmental level. But, what if we are ultimately fighting a no-win situation? I mean, if we look at Christensen’s thesis that disruptive technologies are all around us, could we look to another solution (not necessarily an information and communications technology-based solution) that could help address some of the problems? What about looking at system-level reform? What about accredit nurses to do more in the health system? If we are looking at innovative and novel solutions to address real problems, why are we limiting the discussion to just looking at computer technologies rather than really examining alternative structures and models?

I suppose we are all stuck in this group think that all powerful technologies will somehow solve all of our problems. Neil Postman’s predictions of societies held in awe of technology may be closer to the truth than we think. The technology is only a tool that we use to address challenges that we, humans, face. I think that if we approach the question in this way, we would look at eHealth as something that can augment our abilities rather than as some panacea for a broken system.

So, what role is the role that eHealth can play in addressing Geraldton hospital’s plight? I think we all need to think long and hard to come-up with solutions to answer this question. If we can answer this question, I think many other rural communities could be much better off for it.

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