I have read Nijland, N., van Gemert-Pijnen, J. E. W. C., Boer, H., Steehouder, M. F., & Seydel, E. R. (2009). Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation. International Journal of Medical Informatics, In Press, Corrected Proof.

Abstract

Objective
To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).

Methods
We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.

Results

In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups – the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors – were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.

Conclusion
In order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.

Summary points

What was already known on the topic?

• The increased public interest in medical information regarding health issues are driving forces for the growth of health services on the Internet. However, the growth of e-consultation in primary care has been minor.
• Access to healthcare and information technology is often most difficult for those populations who need it most. E-consultation can be beneficial for certain patient groups, such as frequent GP visitors and chronic users of medication. Yet, it is unclear whether access to e-consultation is most difficult for these populations.

What did this study add to our knowledge?

• Non-use of e-consultation was primarily due to lack of availability among GPs and to information deficits among patients, such as unawareness of the existence of the service and the possibilities of e-consultation. Proper education and instructions are necessary to increase the use of e-consultation.
• Patient groups who were most motivated to use e-consultation e.g., elderly patients, less-educated patients, chronic medication users and frequent GP-visitors, perceived the greatest barriers towards econsultation.
• Web-based triage systems may be promising, because this study indicates that patients are motivated to use such systems for primary evaluation of medical complaints and for self-care advice.

Again, the results of the empirical research revealed the gap between the potencial of ICTs uses in healthcare and the facts that shape these uses. The inverse care law is still working in the transition of healthcare systems to Network Society.

I would like to disseminate a paper entitled Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy written by Joan Torrent, director of ICTs Interdisciplinary Research Group (i2TIC), brand new research group I belong to.

This paper contextualises the disruptive change of the transition to a knowledge-based economy and discusses the social sciences postulations with regards to this phenomenon. Once the general context is explained, the article focuses on the microeconomic foundations, understanding knowledge as an input and as a commodity. Finally, after discussing the microeconomics of knowledge, the paper tackles network externalities and their  impact on economic functions and market structure.

Abstract

The progressive consolidation of a knowledge-based economy has caused network effects to become a focal point of analysis into the changes in behaviour evinced by economic agents. This article analyses the changes in production and demand for knowledge commodities arising from network externalities. The analysis reveals two distinct patterns of behaviour in knowledge-based economic activity. Observable knowledge commodities are governed by the effect of direct and indirect network externalities. Also, their demand curve and business strategy depend on new-user entry (marginal value) and the relative size of the network. However, tacit knowledge commodities are governed by learning network externalities and their demand curve and business strategies are dependent on the value generated by the addition of the goods themselves to the network (intrinsic value).

This paper could help towards a better understanding of  health care systems within the network society.

I’m so excited about World Internet Project 2009 Macao (July 8 - 10) where I’m presenting a paper done with Dra. Rita Espanha entitled Health and the Internet: Autonomy of the User.

Abstract:

Information access and distribution are growing and the ways in which this information and knowledge democratisation occurs are many, scattered and diverse. Individual health, and its daily management, never involved as much information as nowadays.

The aims of this paper are: to identify and characterise the role of daily information and communication practices for health individual management in Portugal and to identify and characterise some trends on a global scale of the Internet use for health purpose.

Considering all Internet activities within WIP database 2007, cluster analysis was carried out to define an e-readiness index to the Network Society. Citizens who have more probability to be in worse health status due to their age are those who have also more probability to be less e-readiness or even dropped out of the Internet.

Parallel to the “informed patient” concept, we must consider also in our approaches the “generation divide” and the “e-readiness divide” concepts associated with health.

The World Internet Project (WIP) is a major, international, collaborative project looking at the social, political and economic impact of the Internet and other new technologies. Conceived as the study of the Internet that should have been conducted of television in its early days, the WIP believes that the Internet’s influence will ultimately be far greater than television. Whereas television has mostly been about entertainment, the Internet has the potential to transform how the world plays, works and learns… +info

I’m working on the presentation but after the meeting it will be uploaded. Finally I would like to thank Imma Tubella, Carlos Tabernero and specially Joan Torrent, colleagues from Internet Interdisciplinary Institute (IN3) at Open University of Catalonia, for their support to travel to Macao.

This paper could help us to frame into scientific medial journals the differences between  Utilised ICT physicians and Integrated ICT physicians and also fix into the drivers of the transition from utilization to integration.

Masters, K. (2008). For what purpose and reasons do doctors use the Internet: A systematic review. International Journal of Medical Informatics, 77(1), 4–16.

Objectives: To determine doctors’ reasons for using the Internet, and the factors that influence their usage.
Data sources: A systematic review of 38 studies, from 1994 to 2004, describing surveys of doctors’ Internet usage.
Results: All of the studies were in the developed world, primarily in North America. Approximately 60–70% of doctors have access to the Internet, but in several studies access is more than 90%. Access is steadily increasing. Most Internet activity focuses on email and searching in journals and databases, but there is a very wide range of activities. Professional email with colleagues and patients is low, but increasing. The major factors discouraging usage are time, workload and cost, while too much information, liability issues and lack of skills
also feature as discouraging factors. Factors encouraging use are unclear, but overall patient satisfaction and belief in improved service delivery, time saving and demand from patients are factors. There is a trend that males use the Internet more than females, young more than old, and specialists more than generalists, but these differences are not across the board, and show variations between studies.
Conclusion: In spite of the limitations, it is clear that doctors are highly connected to the Internet, and their professional usage is increasing. Factors encouraging and discouraging usage are more complex than simple connectivity. Usage differences between demographic groups do exist, but are equalising. More and consistent research is required in this area.

I have finished to check the proof of my article entitled Opportunities and challenges of Web 2.0 within the health care systems: an empirical exploration for Informatics for Health and Social Care (An International Journal of Informatics in Health Care).

Here goes the abstract:

The Internet has become one of the main drivers of e-health. Whilst its impact and potential is being analysed, the Web 2.0 phenomenon has reached the health field and has emerged as a buzzword that people use to describe a wide range of online activities and applications. The aims of this article are: to explore the opportunities and challenges of the Web 2.0 within the health care system and to identify the gap between the potential of these online activities and applications and the empirical data. The analysis is based on: online surveys to physicians, nurses, pharmacist and patient support groups; static web shot analysis of 1240 web pages and exploration of the most popular Web 2.0 initiatives. The empirical results contrast with the Web 2.0 trends identified. Whereas the main characteristic of the Web 2.0 is the opportunity for social interaction, the health care system at large could currently be characterised by: a lack of interactive communication technologies available on the Internet; a lack of professional production of health care information on the Internet, and a lack of interaction between these professionals and patients on the Internet. These results reveal a scenario away from 2.0 trends.

The article has been done with Miquel Angel Mayer and Joan Torrent, colleagues from Interdisciplinary Research Group on ICTs (i2TIC), and will be published on September 2009.

This July (16th and 17th) Science Commons has organized a workshop in Barcelona. The goal is to conclude the workshop with a set of shared principles that can effectively guide the development of a collaborative infrastructure for knowledge sharing — one that increases the value of each independent contribution to the global knowledge commons. To reach this goal the organizators have design an excellent programme. Furthermore, I’m sure that participants will enrich the discussion.

On the other hand, the last Eurohealth publication, a joint initiative between the European Observatory on Health Systems and Policies and the London School of Economics and Political Sciences - Health, includes an article entitled Access to research data in Europe written by Philipa Mladovky, Elias Mossialos and Martin Mckee:

Summary: The European Commission’s Seventh Framework Programme (FP7) is much more ambitious than its predecessor and health research has been boosted, taking €6 billion of the overall budget of €50.5 billion. Yet, in contrast to other leading research funders, FP7 is largely silent on the issue of access to research data. Sharing health research data is in many ways more complex than other types of research data because of the ethical and regulatory issues. However, these and other technical, legal, cultural and institutional barriers to increasing access to research data should not discourage policy development in this area, since there are many potential benefits.

Keywords: Data, Data Sharing, Research Funding, European Commission

This article could be another input to encourage and stimulate the workshop discussion and to promote Health Commons.

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 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.

My first approach to theoretical blueprint of Web 2.0 was Informationalism and the network society: a theoretical blueprint of Web 2.0. Via Fabio Giglietto Facebook I have noticed about an articled written by David Beer and Roger Burrows titled Sociology and, of and in Web 2.0: Some Initial Considerations.

Abstract
This paper introduces the idea of Web 2.0 to a sociological audience as a key example of a process of cultural digitization that is moving faster than our ability to analyse it. It offers a definition, a schematic overview and a typology of the notion as part of a commitment to a renewal of description in sociology. It provides examples of wikis, folksonomies, mashups and social networking sites and, where possible and by way of illustration, examines instances where sociology and sociologists are featured. The paper then identifies three possible agendas for the development of a viable sociology of Web 2.0: the changing relations between the production and consumption of internet content; the mainstreaming of private information posted to the public domain; and, the emergence of a new rhetoric of ‘democratisation’. The paper concludes by discussing some of the ways in which we can engage with these new web applications and go about developing sociological understandings of the new online cultures as they become increasingly significant in the mundane routines of everyday life.

I consider the article help us to a better understand of Web 2.0 buzzword.

As well as the video there is an article titled The only Castells Summary of the project Internet Catalonia on the uses of the Internet