I’m glad to announce that Health and Web 2.0 in the Information Age videos are available at YouTube.

Health in the Information Age by Rita Espanha

Health and Web 2.0 by Michael Hardey

Health and Web 2.0: initiatives from Catalonia Government by Joan Guanyabens

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

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

Finally, I would like to thank International Graduate Institute (Open University of Catalonia) and TicSalut Foundation for sponsoring the conference.

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 Cardoso

Results 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!

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.

As he did with Google’s PHR, talking even about trust issues, Vince Kuraitis analyzes Microsoft’s HealthVault and four misconception about it:

Misconception #1: HealthVault is a personal health record (PHR).

Misconception #2: People don’t trust Microsoft, so they won’t sign up for and use HV.

Misconception #3: Patients don’t understand PHRs, don’t want them, and don’t know what they’d do with them. This is a rate limiting step to market growth for HV and its partners.

Misconception #4: By launching HealthVault first, Microsoft beats Google to the punch.

Catalan, and also the Spanish, health care system is not as market-oriented as that of the USA. Health is still a collective good or social good and most of the health care providers are bureaucratic and rigid organizations run by regional government, which could be considered as a negative externality. As far as bureaucratic and rigid organizations have more difficulties to implement health information systems, Personal Health Information Platform, launched by the government directly to citizens, it could be a good tool to put pressure on these organizations to develop or implement changes related to their information systems.

Furthermore, this Personal Health Information Platform could be an institutional Internet health content management system controlled by healthcare professionals and citizens by means of Web 2.0 tools where lay and expert knowledge could be mixed.