ICTconsequences[Access, Use and Consequences of ICT in Network Society]
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As I mentioned before, I have been invited to participate in the International Seminar “Aplicación de las nuevas tecnologías a la prevención y asistencia en adicciones (”New technologies applications to prevention and assistance of addictions” (26th and 27th, June). Here goes my presentation:
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As a result of Health and Web 2.0 in the Information Age Conference: from empirical data to Web 2.0 trends, three videos and two power point presentations are available. Furthermore, the conference’s speaker and I had a interesting conversation with Salvador Tordera, a journalist from Open University of Catalonia. A few days ago, Salvador has written a report titled Medical consultation 2.0:
Chatting about sexuality in Second Life, receiving a text message from your doctor to remind you to take your medication, checking on your position in a hospital waiting list online… All of these actions are already possible thanks to the application of information and communication technologies (ICTs) in the health sector. The internet is a very powerful tool that gives users greater autonomy and control over their health –which surveys around the world have shown to be the greatest concern in people’s lives. As with all processes involved in the rapid changes in the information age, ICTs open up very interesting possibilities –but not without certain risks.
Using the internet for medical questions has increased both among service users and professionals in the sector. In Catalonia, 40% of internet users carry out searches or procedures relating to health. Despite the increase in the amount of information available, it has not led to greater interaction between those involved in the system, increased flexibility or decentralisation. The vast majority of the content related to health on the internet is limited to informative sites giving advice or guidance from institutions and professionals, or user associations and individuals.
According to experts in the field, the internet is used just like any other media with the added problem that its channels have not yet completely developed; in other words, they do not make full use of the unique nature and benefits of the net. These are some of the conclusions outlined in the UOC’s Project Internet Catalonia (PIC) study coordinated by professor Manuel Castells, which dedicated one of its lines of investigation to the use of ICTs in the health sector.
With the arrival of web 2.0, the user has ceased to be just another consumer and has become a producer of content. With this new development now a reality, Professors Rita Espanha, from Portugal’s Sociological Research Centre - Communication Observatory, and Michael Hardey, from the Hull York Medical School, UK, were invited to a seminar by the TicSalut Foundation and the UOC to talk about the results of their latest research.
Information control
Studies show that 25 percent of the information relating to health on the internet is incorrect. Faced with this fact, an inevitable question emerges: what can be done to control the information on a subject that is so crucial to people’s lives? “Virtually nothing. As with the rest of the information on the internet, certification is an initiative devised by providers, but users are free to choose which source they use and decide whether to believe it or not; it is up to them,” argues Professor Espanha.
According to this sociologist’s research in Portugal, “users always trust information more when it is published by public institutions and when it has close cultural links to them”. However, she also considers that we need to bear in mind that the internet is global: “if someone with gastroenteritis in Brazil (where the illness can be fatal) consults a website in Portugal (where the illness is less serious due to the existence of an established health infrastructure), incorrect advice can be extremely dangerous for the patient”. Although it can be difficult at times, due to the vastness of the internet, users need to take an active and responsible role and adapt the information to their own situation.
The expansion of web 2.0
In the majority of countries, such as Portugal or Catalonia, health technology is still using the first version of the internet, although the new participative web tools (wikis, blogs, social networks, etc.) are opening up the way and bringing with them new benefits. Professor Michael Hardey has been studying the evolution of the internet in relation to health in the English-speaking world for some years. Hardey assures us that “web 2.0 has become an inseparable part of people’s daily activities. This is particularly apparent with the under-30s and nowadays the health sector, as well as other professional sectors, cannot ignore it.” Social networks are being established as a platform for measuring the quality of the services and, in particular, for sharing experiences and concerns relating to illnesses (www.patientslikeme.com). These tools were discovered and pioneered by HIV sufferer associations, who were the first to organise themselves over the internet.
In California, USA, which has a market led healthcare system, there are some initiatives where patients rate hospitals and doctors online (www.rateMd.com). Likewise, mash-up websites have also been developed that allow patients to anonymously enter details relating to their illness and then monitor it on a map and locate patients with similar symptoms (www.whoissick.org). According to Hardey, mash-up applications allow very useful variables to be combined from a health point of view; for example, a user who has asthma could be warned by mobile phone that they are about to enter a street with a high level of pollution.
Moreover, in the USA, Google Health has been created by the computer giant to create medical profiles that can be consulted online, with the details that users themselves have entered protected by a password. At the moment, it is only available to those in the US, although its coverage will be worldwide in the future. However, as Professor Espanha states, “the main problem with this application is that the patient can decide to hide important information from their medical records”, and this means that we cannot be sure that we are looking at a genuine, professional medical history online. Google’s great competitor, the multinational Microsoft, has a similar application called HealthVault.
John Hopkins Hospital in Maryland, USA, has also developed web 2.0 tools for health that allow its patients with reading difficulties to download news, reminders and advice in podcast format. Institutions in a number of countries have also created virtual worlds, such as Second Life, to make health issues more accessible to the young (in Spain, the Spanish Society of Family Medicine has an initiative in this area).
Health 2.0 in Catalonia
The Catalan government has various initiatives relating to health and web 2.0 applications. Examples include the creation of an online and personalised communication channel from the Health Department and a single clinical history that is accessible and editable from any point on the territorial network.
Changes in the patient-doctor relationship
According to Hardey, one of the sensitive points of this new paradigm (e-health) is the erosion of the, traditionally paternalist (“doctor knows best”), relationship between patient and doctor. This restructuring towards an online model can reduce the support for the traditional channels (face-to-face/paper) and experts warn of the risk of reinforcing pre-established patterns which impede access to health services for certain groups.
The so-called digital divide is also present, as not all users have access to the internet and cannot benefit from these advances, either because of socio-economic factors or a fear of the new technologies. On the other hand, some evidence shows that medical consultations made over the internet help to bring older people closer to the new technology and as a consequence improve their ability to keep up-to-date and reduce their feeling of isolation. In short, e-health encourages users to take a more active, autonomous and efficient role in the management of their own health and, in turn, offers health service providers a better, faster and more personalised way of communicating with their users.
I would like to thank Salvador for his report that summarize our talk.
Today I have attended to Catalonia Health Promoting Hospitals Network kick off meeting. This Network, coordinated by Cristina Iniesta, has organised a conference about Health Literacy with Rima Rudd as key speaker. Rima Rudd conference was marvellous. Here comes my notes from the conference:
She started talking about income and education as the fundamental axis of health, beyond health care services, and health literacy as a pathway to health outcomes.
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She stated that Health Literacy is a function of individuals’ skills and social demands. Core skills of health literacy are:
Literacy skills influences one’s ability to access information and to navigate in highly literate environments of modern societies. After this definition she talked about how literacy skills of individuals constrained participation in economy and in society. Furthermore, she explained how these constrains influenced health care demand taking into account that health literacy is an interaction between individual factors and health sector factors |
Individual factors:
Health sector factors:
After this introduction she reviewed her main research findings. At this point I would like to suggest that you may visit her great website Health Literacy Studies. I also may suggest to check her presentation slide presentation Literacy and Health and her literature revision.
I have uploaded her presentation to SlideShare to spread her wonderful work
Finally, I would like to thank Cristina Iniesta and the rest of the Catalonia Hospital Promoting Health Network for the organization of the event. I’m sure they will become a reference in Health Literacy soon.
On Friday, June 13th, 2008, Catalonia Health Promoting Hospitals Network will be presented at CosmoCaixa. The Network has organised a very interesting meeting titled Health Literacy with Rima Rudd (Senior Lecturer on Society, Human Development, and Health at Harvard School of Public Health) as a key speaker.
Rima Rudd is a health educator whose work centers on the design and evaluation of public health programs for social change. She has worked primarily in school and community settings. Her interests focus on pedagogy, health and literacy links, and participatory and collaborative strategies for learning and for change [+info]
The aim of the meeting is: to provide a forum for ideas and discussion about new communication trend between hospitals and citizens within healthcare system in developed countries.
A month ago I was invited by Cristina Iniesta to participate in one of the network meetings to present Internet, Health and Society. Implications for health promotion in Catalonia. I would like to congratulate Cristina Iniesta and her partners for the organization of the meeting.
I have been invited by Government of La Rioja, through the Regional Ministry of Health, to participate in the International Seminar “Aplicación de las nuevas tecnologías a la prevención y asistencia en adicciones (”New technologies applications to prevention and assistance of addictions” (26th and 27th, June) located at CIBIR, the Biomedical Research Centre of La Rioja. The seminar is organized by Drojnet an European project that evaluates the usefulness of new media in informing teenagers about drugs and their effects on their health. Deadline for registration is June 13, 2008.
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I’m going to participate in the track “Health , Communication and New technologies” talking about “Health and the Internet. The transition of health system to Network Society: an empirical analysis of Catalonia” based on E-Health and Society: an empirical study of Catalonia directed by Prof. Castells.
I’m excited about this Seminar for many reasons: I will meet interesting people who are working in eHealth in Spain and Europe; Drojnet project looks like a good initiative to explore eHealth and Digital Natives topics and I will have the opportunity to talk with their authors; and it will be a good opportunity to know Regional Ministry of Health of La Rioja initiatives in eHealth. Finally, I would like to thank to the organization of the seminar for the invitation.
I’m glad to announce that Health and Web 2.0 in the Information Age videos are available at YouTube.
Enjoy them! Thanks again to those who made this conference possible. Of course, Feedbacks are welcome!
First of all I would like to thank Gustavo Cardoso, Miquel Angel Mayer and indeed Rita Espanha and Michael Hardey for the marvellous working days we had in Barcelona. It was a honour to have the opportunity to share during three days thoughts, reflections, past researches and ideas about health and the Internet. I’m sure those are just the beginning of future collaborations. Thank you very much for such a wonderful days.
The conferences matched the audience’s expectations. Michael and Rita have allowed me to upload their presentations to the Internet as long as many people have showed their interest in the conference but they were not able to attend to Barcelona. I ‘m pleasure to announce that both conferences were video recorded and will be available in two week at UOC YouTube Channel.
Rita Espanha and Gustavo Cardoso have been reserching the transition to Network Society in Portugal. Most of the researches are available at OberCom. OberCom (Observatory for the Media) is directed by Gustavo Cardoso. He and Rita Espanha supervise the centre’s scientific research development; manage the centre research networking and institutional relations. OberCom is a non-profit research centre whose main goal is the production of data and diffusion of information about the Media, thus contributing to better knowledge of the field of communications in Portugal.
As I posted before, they have developed a research project titled Health in the Information Age. Their main conclusions were showed in Rita’s presentation
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In 1999 Michael Hardey wrote Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise. He was one of the first researchers who started to analyse Health and the Internet and the transformation of the relation between health professions and their clients/users/patients. In 2001, “E-Health”: the Internet and the transformation of patients into consumers and producers of health knowledge was published. Is it sound like Web 2.0?. His forthcoming paper will be Hardey, M. (2008) Public health and Web 2.0, Journal of the Royal Institute of Health Promotion 128(4):171-179
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Finally, I would like to thank International Graduate Institute (Open University of Catalonia) and TicSalut Foundation for sponsoring the conference.
Yesterday, I was invited by Cristina Iniesta, Hospital del Mar Manager Director and Health Promoting Hospital Network Coordinator, to present the results from Internet, Health and Society in Catalonia in one of the network meetings at Hospital Sant Joan de Deu.
The aims of the presentation were: (1) to analyse in what way and to what extent the Internet is adopted and embedded by Catalan health system; (2) to discuss the implications for health promotion, taking into account Health Promoting Hospital objectives and, (3) to find ways of future collaborations.
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The atmosphere of the session was excellent. I’m sure we will find many ways of future collaboration. Finally, I’m grateful to Kathryn O´Connor, my wonderful English teacher at UOC, for introducing me Cristina Iniesta and, last but not least, I would like to thank Cristina Iniesta for her kind invitation and her open thinking.
On 23th and 24th of April I was at Lisbon invited by Gustavo Cardoso and Rita Espanha to the presentation of the research project Health in the Information Age supported by Fundação Calouste Gulbenkian
Brief description:
The first objective of the study is to analyse in what way and in what measure the ICT’s, especially the Internet, are appropriated in the health field (internet and information systems) in the following domains: ICT’s and the Health Professionals; Users and ICT’s; The Health Information Systems; ICT’s and Media contents about Health.Research funding:
Serviço de Saúde e Desenvolvimento Humano da Fundação Calouste Gulbenkian.Project Coordinators:
Rita Espanha and Gustavo CardosoResults are already available in Portuguese.
This research project had been developed at the same time as E-health and Society: An empirical study of Catalonia. During that time, methodological issues were shared so comparative studies will be done in further collaborations.
I would like to thank indeed Gustavo and Rita for their invitation to the meeting and their hospitality. It’s a pleasure to have the opportunity to collaborate with you. Congratulations for you work!
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Lately I’ve been reading some papers from Prof. Dr. Reinhold Haux. I’m really impressed with his career. In 1996 he published with other colleagues A systematic view on medical informatics:
Medical informatics is defined as the scientific discipline concerned with the systematic processing of data, information and knowledge in medicine and health care. The domain of medical informatics (including health informatics), its aim, methods and tools, and its relevance to other disciplines in medicine and health sciences are outlined. It is recognized that one of the major tasks of medical informatics is modelling processes. In this context, biological, communication, decision, engineering, educational, organizational and computational processes are distinguished and described.
One year later he wrote Aims and tasks of medical informatics:
Ten major long-term aims and tasks, so to speak ‘grand challenges’, for research in the field of medical informatics, including health informatics, are proposed and described. These are the further development of methods and tools of information processing for: (1) diagnostics (’the visible body’); (2) therapy (’medical intervention with as little strain on the patient as possible’); (3) therapy simulation; (4) early recognition and prevention; (5) compensating physical handicaps; (6) health consulting (’the informed patient’); (7) health reporting; (8) health care information systems; (9) medical documentation and (10) comprehensive documentation of medical knowledge and knowledge-based decision support. Work is, in part, already in progress. To all these aims and tasks medical informatics can and maybe should make substantial contributions. Prior to outlining the above aims and tasks, an account is given of the meaning of medical informatics, of the objective it pursues in general and of its achievements so far. The present paper intends to contribute to a broad public discussion of the aims and tasks for research in the field of medical informatics.
In 2002, he lead the writing of Health care in the information society. A prognosis for the year 2013
Our society is increasingly influenced by modern information and communication technology (ICT). Health care has profited greatly by this development. How could health care provision look in the near future, in 10 years, or more precisely, in the year 2013? What measures must be undertaken by political and self-governing health institutions, and by medical informatics research, to ensure an efficient, medically advanced and yet affordable future health care system? Three factors will greatly influence the further development of information processing in health care within the near future: the development of the population, medical advances, and advances in informatics. These factors have motivated us to set up 30 theses for health care provision in the year 2013. The theses cover areas of health care, such as its people, its information systems, and its ICT tools. Three major goals requiring achievement have been identified: patient-centered recording and use of medical data for cooperative care, process-integrated decision support through current medical knowledge, comprehensive use of patient data for research and health care reporting. In consequence, political institutions should provide a framework for networked, patient-centered health care. They are called on to regulate the storage and exchange of health care data and of appropriate information system architectures. Finally, the health care institutions themselves must emphasize professional information management more strongly. Relevant research topics in medical informatics are: comprehensive electronic patient records, modern health information system architectures, architectures for medical knowledge centers, specific data processing methods (`medical data mining’), and multi-functional, mobile ICT tools.
This article promoted a interesting debate among other experts. In 2006 he wrote Individualization, globalization and health – about sustainable information technologies and the aim of medical informatics:
This paper discusses aspects of information technologies for health care, in particular on transinstitutional health information systems (HIS) and on health-enabling technologies, with some consequences for the aim of medical informatics. It is argued that with the extended range of health information systems and the perspective of having adequate transinstitutional HIS architectures, a substantial contribution can be made to better patient-centered care, with possibilities ranging from regional, national to even global care. It is also argued that in applying health-enabling technologies, using ubiquitous, pervasive computing environments and ambient intelligence approaches, we can expect that in addition care will become more specific and tailored for the individual, and that we can achieve better personalized care. In developing health care systems towards transinstitutional HIS and health-enabling technologies, the aim of medical informatics, to contribute to the progress of the sciences and to high-quality, efficient, and affordable health care that does justice to the individual and to society, may be extended to also contributing to self-determined and self-sufficient (autonomous) life. Reference is made and examples are given from the Yearbook of Medical Informatics of the International Medical Informatics Association (IMIA) and from the work of Professor Jochen Moehr.
This year he also published Health information systems – past, present, future
Summary In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz’ lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.
All these articles show the development of ICT during last decade in health care systems. It has to be remarked that there is a soft shift from determinism to a sociocultural understanding in the way technology is approached. This development also shows how health is taking advantage of the distinctive features of the ICT stated by Prof. Castells:
