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:

• Their self-expanding processing and communicating capacity in terms of volume, complexity, and speed.
• Their recombining ability on the basis of digitization and recurrent communication.
• Their distributing flexibility through interactive, digitized networking.

I would like to thank indeed Ruslan David, eHealthNews.EU Portal Administrator/Editor, for his help to disseminate the results of the research project E-Health and Society: An Empirical Study of Catalonia and also for his wonderful job as Editor of eHealthNews.EU - the First European eHealth News Portal.

Between 2005 and 2007 I worked in a research project titled Project Internet Catalunya - Technological Modernisation, Organisational Change and Service Delivery in the Catalan Public Health System (PIC Salut) directed by Prof. Castells and supported by Catalonia Government. I’m glad to announce that the English summary is already available: E-HEALTH AND SOCIETY: An Empirical Study of Catalonia (see Spanish version PIC Salud - Modernización tecnológica, cambio organizativo y servicio a los usuarios en el sistema de salud de Catalunya).

Summary

This study examines the health related uses of the Internet and information and communication technologies (ICTs) in Catalonia. It is a multilevel study that comprises the observation of the population at large, of health professionals, and of health care organizations, such as Primary Care and Hospitals.

It is based on 7,784 on-line interviews, and on 106 face to face interviews, as well as on extensive field work research and direct observation of health organizations in Barcelona, Vic, Sabadell, Palamós, and Tarragona. It was conducted between April 2005 and July 2007.

Conclusions

The different studies we have conducted show a generally positive feeling among health
care professionals, patients, and the population at large on the uses of Internet and ICTs in the health care processes. Furthermore, most professionals, doctors and nurses alike, are intensive Internet users at home. Patients are eager to consult health matters on the web.

Primary care centers and hospitals are also gradually using e-health management and service delivery systems, although the introduction of SAP-Health is still exceptional and the training of the personnel to use advanced health care systems is limited and critically perceived by the nurses and auxiliary personnel.

While the uses of Internet and Intranets for information are widespread, the uses for communication are very limited, with the exception of communication among physicians and among researchers. Patients are largely excluded from online interaction with health care professionals and their online support groups rarely receive permanent advice. While doctors are positive towards the health uses of the Internet, they distrust the use that patients could make of unguided information and prefer to maintain the traditional, personal interaction with their patients.

Thus, the uses of ICTs in the health system do not seem to yield significant increases in productivity, efficiency and quality because their introduction is rarely accompanied by the organizational, managerial, and cultural changes necessary to set up an interactive network at the heart of the health delivery system. ICTs are tools confined in specific functions, not a platform permeating the entire process of health delivery. Furthermore, the updating of the technological infrastructure of the health system would require considerable investment whose justification is not obvious in the absence of an organizational restructuring of the health care units, particularly of the large public hospitals.

Thus, cultural resistances and organizational routines present a major obstacle to the technological overhauling of the health care system, a project that appears to be indispensable to be able to simultaneously control health costs and improve health care quality.

Empirical data of chapter one and two and the results of another research project titled Citizens, Health and the Internet in Catalonia directed by Prof. Castells and based on a telephone survey (2,000 interviews) are the materials of my dissertation. So comments will be very welcome, specially those related to chapter one, chapter two and conclusions.

Vince Kuraitis has posted A First Comparison of Google Health and MS HealthVault perfectly summed up by the following table from his post:

A few weeks ago, Jordí Sánchez-Navarro sent me a link to a book titled The Medicalization of Cyberspace written by Andy Miah and Emma Rich (see Table of Contents)

The entire infrastructure and culture of medicine is being transformed by digital technology, the Internet and mobile devices. Cyberspace is now regularly used to provide medical advice and medication, with great numbers of sufferers immersing themselves within virtual communities. What are the implications of this medicalisation of cyberspace for how people make sense of health and identity?

The Medicalisation of Cyberspace is the first book to explore the relationship between digital culture and medical sociology. It examines how technology is redefining expectations of and relationships with medical culture, addressing the following questions:

• How will the rise of digital communities affect traditional notions of medical expertise?

• What will the medicalisation of cyberspace mean in a new era of posthuman enhancements?

• How should we regard hype and exaggeration about science in the media and how can this encourage public engagement with bioethics?

This book looks at the complex interactions between health, medicalisation, cyberculture, the body and identity. It addresses topical issues, such as medical governance, reproductive rights, eating disorders, Web 2.0, and perspectives on posthumanism. It is essential reading for healthcare professionals and social, philosophical and cultural theorists of health.

I have started to read the book but I haven’t finished it yet so I can not comment many things. As you can see above I have reproduced the back page of the book and linked the table of contents. It looks very interesting.

I am positively amazed by the digital identity of the authors. Andy Miah and Emma Rich have their own web sites and they have developed a blog with the same title of the book The Medicalization of Cyberspace. It looks like the “new generation” of researchers are taking care of the Internet to spread their work and build their networks.

I’m working on the introduction of my thesis tentatively titled “Health and the Internet in the Network Society” and I have started to read Ways of Knowing: a New History of Science, Technology and Medicine by John V. Pickstone.

About the book:

In Ways of Knowing, John V. Pickstone provides a new and accessible framework for understanding science, technology, and medicine (STM) in the West from the Renaissance to the present. Pickstone’s approach has four key features. First, he synthesizes the long-term histories and philosophies of disciplines that are normally studied separately. Second, he dissects STM into specific ways of knowing—natural history, analysis, and experimentalism—with separate but interlinked elements. Third, he explores these ways of knowing as forms of work related to our various technologies for making, mending, and destroying. And finally, he relates scientific and technical knowledges to popular understandings and to politics.

Covering an incredibly wide range of subjects, from minerals and machines to patients and pharmaceuticals, and from experimental physics to genetic engineering, Pickstone’s Ways of Knowing challenges the reader to reexamine traditional conceptualizations of the history, philosophy, and social studies of science, technology, and medicine.

About the author:

John V. Pickstone is director of the Centre for the History of Science, Technology and Medicine and the Wellcome Unit for the History of Medicine at the University of Manchester. He has edited or coedited a number of books, most recently Medicine in the Twentieth Century (with Roger Cooter), and has written widely on the history of biomedical sciences, medicine, and science in Britain, and on medical innovations and policy.

My notes will be reproduced at the wiki.

The Spanish Health Minister has published a press release talking about its collaboration with Microsoft to launch Robot Robin, a Windows Live Messenger Assistant that helps young people through the Messenger to resolve doubts about health issues related with sex, pregnancy and alcoholic drinks. It is said that people can add Robin to the personal contact list and interact with him taking into account legal, privacy and security issues.

This initiative points out some trends detected in relation with health and the Internet as Innovative Health Technology:

• The importance of the private sector and the interest of the big companies like Microsoft and Google to get into this huge market.
• The importance of analyze the supply and the demand side, in this case digital natives as a heavy Internet users (demand) and the Internet as a tool to reach this audience, taking into account the possible digital divide.
• The importance of the understanding about how people use existing technologies everyday to develop new uses.

I have been reading Health, Technology & Society. A Sociological Critique written by Andrew Webster, who has also written other articles and books about this issue. I would like to share my notes about the first chapter titled Understanding Innovative Health Technologies, partially  based on other author’s paper Innovative Health Technologies and the Social: Redefining Health, Medicine and the Body.

The book explores fundamental changes in the way we understand and manage our health and our bodies, and how this understanding has been shaped by, and given expression through, developments in medical and related technologies (p.1)  from a sociological perspective. This perspective argues that these technologies and the techniques, models and assumptions on which they are based, are given meaning through the way they are tied into other technologies ans social practices… The meaning of health technologies will also vary in different settings (from clinic, to the home, to the Internet), and vary in the way shape diverses notions of ‘health’ found within and between cultures. In this sense, technologies (not only the health but all fields) are best understood as an expression of, and thereby always expressed through, social relationship (p.1) .

The author states that medical technologies are two-sided: they provide new, more detailed, sources of information about our illness but at the same time new forms of uncertainty and risk. These relate not only to our understanding of the illness but also the expectations that inform and guide the social relationship through which we define and manage it. If technologies are congealed social relationship, those that disrupt existing relationship can be specially problematic.

Therefore,  new health technologies not only disrupt relationship we have with other people, they can also redefine our relationship towards our own body and our sense of being well or ill, our sense of control over our body and its parts (p.2).  A sociological perspective is also interested in the processes through which new health technologies are introduced in the first place, and what factors have shaped their introduction. Health and its definition depend not merely on a person’s sense of well being, but on powerful professional, commercial and institutional interests that captures health in order to define, control and exploit or deliver ‘it’ (p.3) .

New technologies, new health?

Webster identifies three innovative health technology based on those areas that are receiving disproportionately large levels of public and private funding upstream or those appearing in documents of health policy world that spends all its time scanning for the ‘horizon’ for ‘disruptive’ technologies…(p.6):

• Genetics-related developments
• Informatics-based systems and eHealth
• Tissue-related biomedicine

Even these three broad areas are strongly related with the development of the Information and Communication Technologies I wil just focus on Informatics-based systems and eHealth. The author refers to E-Health as a mix of digital technologies whose function is to diagnose, monitor, store and relay information about health, the patient, and the huge volumen of management data-flows that characterize national health systems today. They reflect a time of audit, standardization, technocracy and ambitions towards more efficient systems for managing health resources (p.11) . Based on the studies of other author, Webster describes some consequences of these technologies, talking about ’citizen-terminals’, ‘virtual human’, ’smart homes’, ‘health Internet seeker’ and ‘e-scaped medicine’.

Developing the sociological critique

The author remarks there had been a much longer tradition in social theory that located health squarely within the wider structural and cultural dynamics of society (p.15)  and wonders How, we might ask are these structural patterns of health mediated by the new technologies sketched mentioned above: will, for example, the introduction of e-health exacerbate or ameliorate access to health care and advice? (p.16)

What then can we say provides the core issues that would inform a sociological critique of the relations between health, technology and society? Such a critique, he suggests, would explore and challenges the implications of medical technoscience with respect to:

• the socio-economic factors shaping innovation and how these affect the structuring of health care delivery;
• the patterns of inequality in morbidity and mortality;
• the public and the private institutions that are investing huge amounts of political and economic capital in existing and novel areas such as genetics, informatics and tissue engineering fields;
• the regulation and control of new medical technologies;
• embodied knowledge about experience of health and disease. (p.17)

These are the main issues, they need to be understood as part of a wider range of structural and institutional changes characterizing contemporary societies that are not restricted to the field of medicine and health (p.18)

• The growing individualisation of our lives;
• The changing relationships between lay and expert knowledge;
• The increasingly globalised contest over (health) rights and resources;
• The tension between the political regulation and economic promotion of innovation by the state. (p.18)

We can see developments in technoscience in terms of three broad but related changes that have opened up clinical medicine to new influences and actors:

• Socialisation of medical innovation refers to the ways in which lay people are enrolled as active participants in the development of new technologies from the very early stage of develpment.

• Socialisation of clinical diagnosis refers to the fracturing of the medical monopoly over the meaning of health and disease, specially through the arrival of what has been called a ‘new medical pluralism’.

• Socialisation of clinical implementation refers to the ways in which lay people are required, but also perhaps actively embrace a turn towards taking greater responsability for making new health technologies ‘work’.

These three processes have then redefined the spatial, experimental and epistemic boundaries of convetional medicine and clinic. The critique must be the attentive context of use of technologies to reflect any notion of technological determinism across different contexts. It must explore the ways in which users (patients, carers, clinicians, etc.) make sense of technologies and how re-order the meaning of health. It must examine the expectations and hopes that surround them, and the subtle and not so subtle forms of inequity and insecurity they create.