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.

Little by little Web 2.0 movement is being approached by theory and empirical data. As an example of empirical data approachs, OECD has launched Participative Web and User-Created Content. Web 2.0, wikis and social networking

The concept of the “participative web” is based on an Internet increasingly influenced by intelligent web services that empower users to contribute to developing, rating, collaborating and distributing Internet content and customising Internet applications. As the Internet is more embedded in people’s lives users draw on new Internet applications to express themselves through “user-created content” (UCC).

This study describes the rapid growth of UCC, its increasing role in worldwide communication and draws out implications for policy. Questions addressed include: What is user-created content? What are its key drivers, its scope and different forms? What are new value chains and business models? What are the extent and form of social, cultural and economic opportunities and impacts? What are associated challenges? Is there a government role and what form could it take?

These kind of initiatives help us to a better understanding of Web 2.0 phenomenon and to analyse in what way and in what measure the ICT’s, especially the Internet, are appropriated by the current social structure, the Network Society.

On 17-18 June 2008 in Seoul holds OECD Ministerial Meeting: The Future of the Internet Economy

The Internet is a key infrastructure for global economic growth and social development. Three major trends – Convergence, Creativity and Confidence – are influencing the policy environment for the Internet Economy. Each of these trends reflects significant shifts in the use and functionality of the Internet. Collectively, they represent a major transition in the evolution of the Internet and the economic system that has developed around it. Therefore, it has become increasingly necessary that policies supporting the Internet Economy be carefully crafted and co-ordinated across policy domains, borders and multiple stakeholder communities.

Ministers and stakeholders meeting on 17-18 June 2008 in Seoul will consider social, economic and technological trends shaping the development of the Internet Economy. They will forge broad principles that can provide an enabling policy environment for the Internet Economy.

As background for the Ministerial meeting analytical reports are being released:

A Policy Brief on the Future of the Internet Economy: Major changes are affecting the scope and scale of the Internet. As a result, the Internet is increasingly high on the policy agenda in many OECD and non-OECD countries. This Policy Brief reviews likely future developments in the Internet economy and how policy-makers can help the Internet to adapt to evolving requirements caused by convergence, continue to drive innovation, and be trustworthy.

Convergence and Next Generation Networks: OECD has just issued a new report on convergence and next generation networks and their potential impact on policies and regulations. The report addresses issues of competition in the new fibre environment, convergence of video, voice and data services, the rapid growth of new technologies, such as HDTV and mobile television, and the related demand for spectrum, as well as new possible “divides” between urban and rural areas created by the uneven development of high-speed fibre networks.

Consumer empowerment in communication services: Improving the ability of consumers to choose between competing suppliers is important for well functioning markets. The report examines how to increase market flexibility for consumers in communication services, and improve access to information.

Development of Policies for Protection of Critical Information Infrastructures: Some information systems are critical because their disruption or destruction would have a serious impact on the economic well-being of citizens or the effective functioning of government or the economy. Based on two studies conducted in 2006 and 2007, this OECD report analyses security policies to protect critical information infrastructures in Australia, Canada, Japan, Korea, The Netherlands, the United Kingdom, and the United States.

Malicious Software (Malware): A Security Threat to the Internet Economy: Malware has evolved from occasional “exploits” to a multi-million dollar criminal industry. This report informs policy makers about the evolution and impact of malware, as well as the counter-measures being taken. It concludes with suggestions for greater co-operation across the various international communities addressing malware.

Broadband and the Economy: Broadband and networked ICTs are diffusing rapidly, but there are significant differences in use among countries, sectors and firms, and their impacts are only beginning to be felt. Broadband and networked ICTs are important in meeting health, demographic and environmental challenges, and policy plays an important role in expanding their use and enhancing their impact.

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!

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.

After two years of hard working, I’m glad to announce the research Project Internet Catalonia about Health directed by Prof. Castells and titled “Technological Modernisation, Organisational Change and Service Delivery in the Catalan Public Health System” has been published (PIC Salut)

This study analysed the interaction between organizational change, cultural values and technological change in the Catalan health system. The study is subdivided in five distinct parts. The first one is a content analysis of the webs related to health in Catalonia. The second is a study of the uses of Internet in health related issues among the population at large, the patients’ associations, and the health professionals, on the basis of an Internet survey adapted to each one of these groups. The third is a field work study of the experimental programs conducted by the Catalan government in several local areas and hospitals to integrate electronically the patients’ clinical history. The fourth is a study of the organizational implications of the introduction of information systems in the management of hospitals and primary care centres in the Catalan Institute of Health, the major public health provider in Catalonia, on the basis of an Internet survey and in-depth interviewing. The fifth is a case study of the organizational and social effects of the introduction of information and communication technologies in one of the leading hospitals of Catalonia, the Clinic Hospital of Barcelona. The study was conducted between May 2005 and July 2007.

During the next month, January 2008, a synthesis report in English will be published.

As a part of this research project under Prof. Castells’ direction I have been directly involved in the second study (a study of the use of the Internet in health related issues among the Internet users, the patients’ associations, and the health professionals, had been done using Internet surveys adapted to each one of these groups). I have been working on some of the results talking about “Health and the Internet: still Web 1.0″. See below some of the key findings:

• Professionals are connected to Internet and make an intensive use of the Net, mainly for questions related to the search and consultation of information.

• The use of the Internet as a communication medium with other professionals of the sector is extended among all the professionals, but the levels of use of the Internet or the electronic mail to communicate or interact with their patients is scarce.

• The increase of the information flows available in the Internet has not been accompanied by an increase in its interaction.

• However, we have to emphasize a tendency that indicates that those professionals who develop their professional practice in competitive markets make more intensive use of the Internet and the electronic mail to interact with their patients or users.

• Most professionals positively value the relevance of the contents available in the Internet and they do not consider that the patient search for information is negative either for the professional - patient relationship or for the patients’ management of their health.

• However just a small percentage of professionals recommend their patients to consultation health information on the Internet or even talk about the Internet with them. This is probably due to the lack of time during their face to face visits.

• Nevertheless, the behaviour of the pharmacists shows us a new case where the factors related to the market oriented context are the key. These professionals do not have time constrictions and are more accessible that the rest of the professionals, given the physical distribution of the pharmacies.

The Internet survey carried out by Internet users shows us:

• Internet users are characterized by: the high proportion of women, a high education level, easy access to the Internet from their own home, and a high frequency of use. They integrate the use of different sources of information in their activities related to the health. However, physicians are the key source.

• Women have a more active role than men with all the sources, including the Internet

• The frequency of use of the Internet for questions related to health is far from the levels that would allow us to talk about ciberchondriacs.

• The people’s interest on patients support groups as an information source remind us of the importance of lay knowledge, since the utility and the confidence of this source is very high.

• The main consequence of the Internet use for questions related to health is the increase of information available. Just a low percentage of people makes decisions relative to the diagnosis or treatments of their health problem. This data supports the hypothesis of the people’s consciousness when they manage the inherent tension to the use of the Internet, emphasizing the need of the physicians as an expert.

Now is time to focus on my thesis and try to publish some of the findings on academic journals. Any suggestion will be welcomed

Health and Social Care Information: A review of provision in the North East is a research report written by Suzanne Lockyer and Elizabeth Blenkinsopp. The authors state “There are currently many drivers for change in the provision of health and social care information to the public” and mention that “the aims of this review were to collect examples of good practice from North East and to propose a model for co-ordinated and sustainable provision (of information)”

To achieve their aims they have carried out an extensive literature review, which I would recommend. This review is grouped into four brad themes:

• Politics and Funding
• Public perception of health and social care information
• Providers
• Delivery (technology and methods)

After this revision, which was undertaken to provide background information for the study, three different methodologies have been used and described in detail:

• Questionnaires (Patient Advice and Liaison Service, social care and public libraries).
• Focus group (with key providers from the three sectors) which
• Telephone interviews (with key national and regional stakeholders from the three sectors).

Although the reading of the whole project is strongly recommend, just the conclusions are reproduced below:

There is evidence of a wide range of provision, with no shortage of information available. There are enthusiastic and professional providers in all sectors. However, collaboration is needed to maximise the individual skills apparent in the three sectors.

Libraries emerge as having great potential. They are viewed by both the public and other providers as a neutral space and as a recognised ‘place’ for information. However, there is also potential to extend their role and this may be more challenging.

Overall, four barriers were identified by the research:

• Information Professionals lack awareness of available resources – both within and between organisations.
• There is duplication of effort and information overload by Information Professionals.
• There is a need to raise public awareness of where to go for information. This also relates to the placing of information; many respondents to the questionnaire noted the value of placing information in ‘non-health/social service’ locations.
• There is a current lack of staff training across all three sectors (Health, Social Services and Public Libraries) in information skills, people skills and dealing with queries outside own profession.

Let me further add that I’m in totally agreement with the recommendations made by the research team. However I would like to remark the importance of three more points.

Firstly, hospital and community pharmacists should be taken into account in the public health care system. It is important to bear in mind that they are more available to the citizens than any other health professional; they have sufficient knowledge to help citizens to manage their health; they generally have enough communication skills and they have incentives to mantein a good relationship with their clients.

Secondly, the Internet is not just a content platform. It is necessary to take advantage of the Internet as an interactive space where social arrangements are possible. That means on the one hand collaboration and coordination among the different actors and initiatives -on line, off line, multi channel-, and on the other hand the expectations of centralization and the experience of decentralization should be managed.

And last but not least. The government has a key role as a node in the network which provides the regulatory and legal framework and develops information health policies to the whole society.

eHealth News EU has published Advanced eHealth Country Reports on eHealth ERA Project Website talking about the Database of European eHealth priorities and strategies

The database of European eHealth priorities and strategies is a service to European States and their citizens. The purpose of the database is to enhance knowledge about eHealth activities and to facilitate co-operation between states and regions in the field of eHealth.

This initiative remember me the WHO eHealth Programme

The programme on eHealth aims to support countries in further developing their health systems by improving access, quality and efficiency, through the use of information and communication technologies. Today, eHealth can support the different functions of the health system, providing a unique opportunity for strengthening the information, intelligence and knowledge processes.

Also the European Commision has supported The European e-Business W@cht. This initiative has many resources about Health and social services sector.

The mission of the Sectoral e-Business Watch is to support the work of the European Commission’s DG Enterprise and Industry in the field of ICT and e-business policies. In this policy area, DG ENTR itself has a twofold mission: “to enhance the competitiveness of the ICT sector, and to facilitate the efficient uptake of ICT for European enterprises in general.

At ICTconsequences Bibliography I have collected many articles about ehealth framework. You could find some of them from the International Journal of Electronic Healthcare.

Google Health Advertising Blog has posted Doctors and the Web 2.0 talking about White Paper “Physicians and Web 2.0″ done by Manhattan Research:

Manhattan Research is a healthcare market research and services firm, laying the foundation for strategic planning for global pharmaceutical, biotech, device and diagnostic, and life sciences companies.

Manhattan Research guides clients in understanding market forces, trends, and impacts of physician and consumer use of information technology, including next generation digital media such as social networking, blogs, podcasts, and Web 2.0.

I refuse to speculate on the commercial propose of both sources. I just notice that the results contrast with what we have found in Catalonia (Spain). Our surveys to physicians, nurses, pharmacist, Internet users and also a 1300 web content analysis show Health and the Internet is still Web 1.0.

I suppose that Catalonia Health System, as well as many systems in Europe, are less market oriented than American Health System. That fact could influence on a slower adoption of the Web 2.0 by physicians because on whether they do not appropriate all the benefits of those technologies or they do not have many incentives to innovate using those technologies.