Based on the online survey Citizens and ICT for Health in 14 European countries (14000 Internet users were surveyed) and supported by Social determinants of Health and ICT for Health (eHealth) conceptual framework, therefore based on the results of empirical research, I have tried to summaries the lessons learned in the following eHealth steps.

SUMMARY
Full draft report
Ppt presentation

I.    Background
The Citizen Panel Survey carried out in SIMPHS2 to better assess users and patients’ needs and expectations with regard to ICT for health, directly supports the objectives of the Digital Agenda in the area of eHealth which are to both cope with societal challenges and create opportunities for innovation and economic growth by reducing health inequalities, promoting active and healthy ageing and increasing empowerment. It also contributes to the goals of the European Innovation Partnership on Active and Healthy Aging which addresses the societal challenge of an ageing population focusing on the main areas of life events (Prevention, Care and cure and Independent living) with the following expected results:

• An improvement of the health status and quality of life of Europeans, especially older people;
• An improvement of the sustainability and efficiency of health and social care systems;
• Boosted EU competitiveness through an improved business environment for innovation

In this policy context the analysis of users’ demand undertaken through the SIMPHS2 Citizen panel survey aims to:

• develop typologies of digital healthcare users and measure the impact of ICT and the Internet on health status, health care demand and health management.
• identify factors that can enhance or inhibit the role and use of Personal Health Systems from a citizen’ s perspective with special emphasis on mHealth, RMT, disease management, Telecare, Telemedicine and Wellness.

To reach these objectives, we started by defining a theoretical framework for policy-making, which was used to design and gather relevant information. A multivariate statistical analysis was subsequently carried out to identify the underlying conceptual dimensions emerging from the data collected. Key relationships between concepts (underlying dimensions) were identified to understand ICT for Health as a complex ecosystem. We concluded with some lessons learned.

II.    Conceptual framework: Towards social determinants of ICT for Health

Two frameworks are at the root of our own conceptual framework “Towards social determinants of ICT for Health”. One is the WHO Commission on Social Determinants of Health Framework which summarises how “social, economic and political mechanisms give rise to a set of socioeconomic positions, whereby populations are stratified according to income, education, occupation, gender, race/ethnicity and other factors; these socioeconomic positions in turn shape specific determinants of health status (intermediary determinants) reflective of people’s place within social hierarchies; based on their respective social status, individuals experience differences in exposure and vulnerability to health-compromising conditions”. While this framework does not relate directly to ICT for Health, the structural determinants perfectly overlap the core argument of personal and positional categories of and distribution of resources in van Dijk’s “Causal and Sequential Model of Digital Technology Access by individuals in Contemporary Societies” which is the second framework in which our approach is rooted.

As a result  and as illustrated in the next we defined “Towards social determinants of ICT for Health” as follows:

• Social determinants of health and health inequalities, therefore structural and intermediary determinants produce different levels of ICT access (motivation, material, skills and usage).
• Unequal access to ICT will generate different levels of ICT for Health access as well as different levels of willingness to use ICT for Health.
• ICT for Health access depends on the properties of ICT and the relationship among Motivation; ICT for Health readiness and Internet Health information.
• Motivation includes Triggers, Empowerment and Barriers
• ICT for Health readiness includes Awareness, Material access; Skills and Usage
• ICT for Health Assessment includes how individuals use and evaluate this type of technologies for themselves or for others (social life of information) as well as their perception about usefulness and learning.
• ICT for Health Access gives rise to different level of Participatory Health through the utilisation (individually and socially) of ICT for Health in daily life and behavioural changes due to the ICT for Health impact on: Health management; Health care demand and Health care quality
• These impacts could modify both structural and intermediary determinants and distribution of health and well-being.

III.    Online panel survey technical information

Based on the above framework, we gathered data through a questionnaire which we designed and structured around five main blocks :

• Block A: Health status and health care and social care services use
• Block B: ICT for Health Motivation and Health Information sources
• Block C: ICT Access
• Block D: ICT for Health Readiness and Evaluation
• Block E: Socio demographic profile of participants

To reach our target population, we have used the Internet as a methodological tool. Survey research is becoming a frequently used methodology due to the advancement of computer hardware, software and increasing access to the Internet. Furthermore, online surveys offer a valid alternative to the postal, telephone or face-to-face surveys as long as technical, methodological, ethical and legal considerations are taken into account. Table 1 resumes the technical characteristics of the study.

Technical information

Population: Citizens aged from 16 to 74 years old who have used the Internet in the last three months.
Scope of countries: Austria, Belgium, Germany, Denmark, Estonia, Finland, France, Italy,    Netherlands,  Sweden, Slovenia, Slovakia, Spain, United Kingdom
Type of survey: Online
Sample size:    1,000 interviews per country - 14,000 interviews in total.
Quotas: Country - Gender (Female/Male) - Age Group (16-24/ 25-54/ 55-74)
Sampling error +0.85% for overall data and +3.16% for country-specific data. In all cases, a maximum indeterminate probability (p=q=50), for a confidence level of 95.5% is applicable for each one of the reference populations
Weighting: Proportional allocation for each country. Weighting by country to be able to interpret the overall data.
Sampling: Individuals have been sampled in a completely random manner.
Fieldwork period:  20 July 2011 to 20 August 2011

It should be noted that the data analysed in this report relates to an Internet user population which also forms part of online panels. Accordingly, it can be deduced that the respondents’ profile in terms ICT uses is slightly more advanced than that of the general population of the surveyed countries. However the underlying dimensions identified and their relationship remain valid.

IV.    ICT access

With respect to Internet based activities, the sampled population mainly uses it to search for information (68% every day), sending e-mails with attachments (41%), online banking (20%), social networks (39%) and instant messaging (23%). Internet activities are linked with the male gender, the youngest age groups, a university education, self-employment and entrepreneurs, students, population density and a good state of health.

The factor analysis helped identify the main underlying dimensions of Internet activities. Four factors have emerged:

• Basic uses
• Individual uses
• Social - Web 2.0 uses
• Tech uses

These factors represent a social gradient of Internet activities from the easiest use of the Internet (basic uses) to the most sophisticates activities (tech uses).

V.    ICT for Health Motivation

Individuals were asked about the triggers to utilise ICT for Health. More than a third of the sampled European population indicates a significant use of ICTs in health to better understand a health problem or disease (39%), to find additional sources of information (36%) and to develop knowledge and personal satisfaction (35%). A little further behind, but still with a relevant frequency, there is the perception that ICTs in health are very useful to help a family member or a friend who is ill (31%), to prevent illnesses or to adopt a more healthy lifestyle (28%), to find a solution to or a treatment for a health problem (28%), to obtain different points of view about an issue (22%), and to access an online health service (21%). Finally, and as a counterpoint, only 11% of European citizens give much importance to the use of ICTs in health for participating in online discussions.

With respect to the socio-demographic characteristics of the population, the perception of the importance of ICT in health as triggers is much more positive for women, young people, the middle aged, those with a tertiary education, the employed, students, and people in a bad state of health or with long standing illnesses.

From these items two factors have emerged:

• social and services oriented and
• individual oriented uses.

Empowerment, broadly understood as the development of personal involvement and responsibility is one of the goals of prevention, promotion and protection in health. This definition assumes that responsibility is a more active form of control while competence refers to aptitudes or qualities that make it possible to be more autonomous and take a role in decision-making. Factor analysis identified these two dimensions of empowerment Moreover, three different perspectives of personal empowerment seem to coexist with respect to Health:

• ability to comply with expert advice (professional perspective)
• Self-reliance through individual choice (consumer perspective)
• Social inclusion through the development of collective support (community perspective)

Overall, this greater digital empowerment for the European citizens when it comes to their health and the healthcare professionals is linked with higher education levels, the worst states of health and the existence of long-standing illnesses

Finally, individuals were asked about the barriers to utilise ICT for Health. Lack of privacy (52%), security (51%), reliability (47%) and trust (46%) were the four main barriers for ICT uses for health indicated by the sampled European population to be very important. Other justifications were the lack of liability (38%), health literacy (36%), knowledge (33%), access to ICTs for health (29%), motivation and interest (28%), and the lack of digital skills (24 %).

Firstly, women are much more sensitive to barriers to the ICT use for health than men, particularly in terms of a lack of confidence. Similarly, the perception of barriers to ICT use for health is also much more evident in older people, those with lower levels of education and the inactive. Lastly, it is also worth highlighting that the presence of long standing illnesses is also very sensitive to lack of confidence.

The underlying dimensions of these items are:

• Lack of confidence and
• Lack of readiness.

VI.    ICT for Health usage

When it comes to specifically using the Internet for health and wellness, the research has provided interesting information, with notable relative differences. The main use of the Internet for health is for individual information searches, rather than sharing information, communicating or interacting about health and more particularly information searches about physical illnesses or conditions.

Over half of the sampled European citizens have never used the Internet to buy medicine or vitamins online (56% of the total); participated in online support groups for people with the same health issue (60%), used social networking sites for health and wellness issues (58%); used e-mail or websites to communicate with a doctor or their office (58%); analysed the privacy policy for personal information in medical websites (52%); explained a medical issue online in order to make contact with an e-health medical service (61%) or with other users (58%); disclosed medical information on social networking sites (67%); or disclosed medical information on websites to share pictures, videos, or movies (67%).

The specific use of ICTs in the health sector is still quite limited among the sampled European citizens. Around three-quarters of the sampled population have never experienced any of the specified ICTs for health uses: 79% of individuals have never made an online consultation through videoconference with healthcare professionals. 75% have not received medical or clinical tests online either. 77% have not accessed or uploaded medical results via a specialist provider, such as Google Health or Microsoft Vault. 76% have not accessed or uploaded medical results via an Internet application provided by a health organisation. 76.6% have not used health or wellness applications on mobile telephones either. And 73.6% of the sampled population has not used ICT applications to transmit vital signs and other clinical information anytime or anywhere.
With respect to the remaining socio-demographic factors, the analysis shows homogeneity in terms of the overall use of ICT for health, which is more frequent in the young population, those with a tertiary education, students and the employed, those in densely populated urban areas, people in a bad state of health and those with long standing illnesses.

The factor analysis of ICT for health activities reveals two underlying dimensions:

• ICT for Health oriented towards Information and Communication and
• ICT for Health oriented towards services and devices.

Finally, these items allow us to analyse individuals’ level of awareness, skills and willingness. First of all, individuals were directly asked about their level of awareness. Second, the number of activities carried out by individuals was considered as a proxy for skilled individuals. Third,
individuals who stated they never carry out these activities or were not aware of them were asked about their willingness to carry out these activities. The factor analysis of willingness reveals three underlying dimensions

• Willingness to use Internet Health information
• Willingness to use Web 2.0
• Willingness to use services and devices

These factors are consistent with the underlying dimensions of ICT readiness mentioned before.

VII.    ICT for Health Impact

The study has also provided evidence about the consequences of ICT for Health utilisation. It has to be said that the perceptions are positive overall. 58% of the sampled European population state they agree that ICT use for health allows savings in terms of  cost of travel and time. 56% state that they would be willing to share personal health information with their doctor despite the privacy issue. 55% state that ICTs for health can improve the possibilities for caring for themselves and monitoring their state of health. 55% agree with the fact that ICT use for health leads to greater patient satisfaction. 54% agree that e-health can improve the quality of the medical services received. 50% of the European citizens consider that ICT use for health can change their behaviour towards a healthy lifestyle.

Slightly under half of the sample of European citizens, 43%, agrees that ICT use for health can improve their state of health. 42% consider that they would feel more comfortable and safe if they used a remote monitoring system for their health condition. 42% consider that ICT use for health increases ICT use in other fields of daily life. 32% agree that the use of health services through the Internet substitutes face-to-face consultations with doctors. 32% agree that online health services and face-to-face services are of equal quality. And lastly, 23% of European citizens would be willing to pay for access to Internet health services to improve their state of health or that of their relatives.

Positive attitudes about the impact of ICT for health are more prominent  among the youngest population, those with a tertiary education, and those that live in densely populated areas. The only notable difference between individuals with bad state of health and those with good state of health is the perception by the former that ICT uses for health can improve the quality of health services received (57%). Meanwhile, citizens with long standing illnesses clearly state their favourable perceptions of ICT use for health, as opposed to citizens that do not have long standing illnesses. In particular, they state that ICT use can improve patient satisfaction (56%), improve caring and health condition monitoring skills (57%), save travelling costs and time (60%), and that they are willing to share personal information through the Internet with doctors and health organisations despite privacy issues (60%).

Finally the factor analysis reveals two underlying dimensions:

• Impact on quality of healthcare and healthy behaviours
• Impact on healthcare access.

VIII.    Social determinants of ICT for Health: key dimensions

All items gathered were grouped into underlying dimensions through multivariate statistics following our conceptual framework. This exercise allows us to transform items into concepts and therefore understand the complexity of the ICT for Health ecosystem.

Underlying dimensions of Social determinants of ICT for Health

All above mentioned unveiled the complexity of ICT for Health. To tackle this complexity,   correlation analyses of all dimensions have been performed. The main results of these analyses are summarised in the following figure:

• Social determinants of Health (structural and intermediary), especially education and age, produces different levels of ICT readiness. Advance uses of the Internet such as Tech and Web 2.0 uses are more likely to be carried out by the young, the healthy and the well-educated population while basic uses are mostly performed by the elderly, therefore individuals with worse health status (chronic patients and individuals having reported higher numbers of health problems).
• Unequal ICT readiness generates different levels of motivation. Individuals making more advance uses are triggered by the potential of ICT to facilitate social interaction and services related to health while individuals whose uses are basic or individual are triggered mainly by Internet health information for personal proposes. Furthermore, individuals with the lowest level of readiness (basic uses) and having reported more health problems lack confidence in the use of ICT for Health. Nevertheless, this lack of confidence is counterbalanced by a higher level of empowerment (competence oriented).
• Both ICT for Health usages (Services and Devices and Information and Communication) are specially driven by social and services triggers while individual triggers are only slightly correlated with Information and Communication usages, therefore less advanced uses.
• Both dimensions of Empowerment push ICT for Health usage. Individuals who are more competence-oriented are more inclined to Information and Communication usage while individuals who are more control-oriented are more likely to use Services and Devices. Thus individuals who feel more responsible for their health status are more likely to use Services and Devices while individuals who want to be more autonomous (competence refers to aptitudes or qualities that make it possible to be more autonomous) are more likely to utilise Information and Communication. If we consider individuals’ education, age and health status it looks like Services and Devices are related with well-being and wellness practice, therefore with health prevention and promotion while Information and Communication are more related with illness, therefore with cure and independent living
• All individuals using ICT for Health faced the same barriers; therefore lack of confidence and lack of readiness are not correlated significantly with ICT for Health usages. Nevertheless, lack of confidence is negatively correlated with the ICT for Health impact on the access dimension. Individuals need a certain level of confidence in ICT for Health to go beyond information and communication and engage with services such as RMT, Personal Health Records or videoconference consultation.
• The utilisation of Services and devices is strongly correlated with the perception that ICT would have an impact on both healthcare access and quality and healthy behaviours while the utilisation of Information and Communication is slightly correlated with Quality and healthy behaviours only.
• The number of health problems reported by individuals is only slightly correlated with Information and Communication Usage and it is unrelated to Services and devices utilisation. Therefore, individuals who could take more advantage of Services and devices, due to their health status, are more likely to be oriented towards information and communication usage only.

IX.    Lessons learned

The study reported here reveals the potential of ICT for Health to promote active and healthy individuals and increase empowerment. Even though our findings relate to Internet users, it is worth pointing out that new health inequalities are emerging due to the impact of the “traditional determinants of heath” on ICT readiness.

Therefore, eInclusion policies related to ICT for Health are needed to ensure that individuals with low socio-economic status and more health problems are able to benefit from these types of technologies. These ICT for Health divides specially impact on the elderly. However, there is an opportunity for them to engage with the Information Society through ICT for Health due to the importance of health issues in their daily life.

The relationship between the different typologies of ICT readiness and ICT for Health Motivation and Impact reveal that:

• Young individuals are already using this type of technologies mostly in relation with wellness and healthy live style. These uses enable an entire world of possibilities related with health promotion and prevention, especially considering that young individuals are heavy Web 2.0 users.
• Middle age individuals are also active users of ICT for Health acting as gatekeepers of this type of technologies within the household. Therefore these individuals could act as enablers for others i.e. both for the elderly and the young within households
• The elderly are basically using ICT for Health for information and communication purposes. There is a gap between this type of use and services and devices uses which could be more effective in relation with cure and chronic conditions.

Individuals between 16-54 with chronic conditions, going under long-term treatment and with more than one health problems are more likely to use ICT for Health than individuals without these type of health problems. Individuals between 55-74 who are healthy are more likely to use ICT for Health, especially for Information and Communication, than individuals with worse health status. Therefore, in the short term, this group of individuals will be pushing for health systems to provide them with new solutions (services and devices) when they need to tackle a health problem. This pressure will increase during the next decade when middle age individuals become elderly. Therefore health systems are facing the challenge of having to promote further ICT innovation to answer these new demands. While this is an opportunity to improve both sustainability and efficiency of healthcare system, it is associated with a number of challenges linked to eHealth deployment.

Further, during this transition, health systems can not leave out the elderly who are not active and healthy: this group of individuals can not be omitted as they are the current intensive users of healthcare systems. There is an opportunity to include them in the Information Society by improving ICT readiness and ICT for Health willingness and awareness.

Lately I have been designing, launching and gathering an online panel survey to a representative sample of Internet users in 14 European countries (approximately 14,000 responses). To ground the questionnaire I have developed a conceptual framework inspired and based on the two main sources. On the one hand, the Marmot Review team:

• Solar O & Irwin A (2007). A conceptual framework for action on the social determinants of health. Discussion paper for the Commission on Social Determinants of Health. Geneva, World Health Organization.
• Commission on Social Determinants of Health. (2008).  Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
• Marmot M et al. (2010). Interim first report on social determinants of health and the health divide in the WHO European Region. Copenhagen, WHO Regional Office for Europe.
• Marmot M et al. (2011). Interim second report on social determinants of health and the health divide in the WHO European Region. Copenhagen, WHO Regional Office for Europe.

On the other hand, a Framework for Digital Divide Research developed by Jan van Dijk in several publications:

• Jan van Dijk and Ken Hacker (2003). The ‘Digital Divide’ as a Complex and Dynamic Phenomenon. The Information Society. Vol. 19, Nr. 4, 315-326.
• Jan van Dijk (2005).The Deepening Divide, Inequality in the Information Society. Thousand Oaks, London, New Delhi: Sage, 240 p.

In a recent presentation about Health and Web 2.0 I tried to match both frameworks and I have posted about Inverse care law 2.0  several times using different scientific and statistical sources.  It is worth pointing out (and obviously reasonable) that I have not found any references or mentions to ICT for Health in the literature about social determinants of Health gathered through Marmot Review team website.

However, both frameworks (see red boxes in both figures) mention individual and social characteristics as social determinants of health and of the Internet usage. Furthermore, van Dijk includes HEALTH and ABILITY as a personal category (and I have added Health as a sphere of participation in Society and emphasis the Divides).

Based on and inspired by this two frameworks I have developed Social determinants of Health and ICT for Health (eHealth) conceptual framework.

All concepts and boxes  of this framework are based on scientific references and the relationships established by arrows have been empirical or theoretical driven. I’m currently working on it, however I have shared this framework to gather inputs to improve it. I would love to know your comments and ideas.

UPDATE: Citizens and ICT for Health in 14 EU countries: results from an online panel survey

On behalf of my co-authors, Wainer Lusoli, Margherita Bacigalupo, Ioannis Maghiros, Norberto Andrade, and Cristiano Codagnone from Information Society Unit - European Commission, DG JRC Institute for Prospective Technological Studies (IPTS), Seville, Spain, I’m presenting “Health-related Information as Personal Data in Europe: Results from a Representative Survey in EU27″ at Medicine 2.0′11 (Stanford University, USA).

Abstract published at Medicine 2.0 website here:

ABSTRACT

Emerging technological and societal developments have brought new challenges for the protection of personal data and individuals’ rights. The widespread adoption of social networking, participation, apomediation, openness and collaboration stretches even further the concepts of confidentiality, privacy, ethics and legality; it also emphasizes the importance of electronic identity and data protection in the health field.

Governments across the Atlantic have adopted legal instruments to defend personal data and individuals’ rights, such as the Health Information Portability and Accountability Act (1996) in USA, the Recommendation No. R(97)5 on the Protection of Medical Data issued by the Council of Europe (1997) in addition to specific legislation adopted by each EU Member State as part of the Data protection Directive 48/95 transposition process. These reflect policy makers’ concerns about the need to safeguard medical and health-related information. On the other hand, bottom up developments such as the widespread usage of “PatientLikeMe” and the availability of industry based platforms for user-owned electronic medical records (i.e. Google Health or Microsoft Health Vault) are often pointed at, arguing that users do not really care about data protection as long as sharing such data produces more value than it destroys. There is, however, a clear evidence gap as to the attitudes of Europeans with respect to this issue.

The purpose of this paper is to identify and characterize individuals’ perception, behaviors and attitudes towards health-related information and health institutions regarding electronic identity and data protection. The research is based on Eurobarometer 359 “The State of Electronic Identity and Data Protection in Europe”, a representative sample of people in EU27 conducted in December 2010. The survey was conducted in each 27 EU Member States via a national random-stratified samples of ~ 1,000 interviews; overall, 26,574 Europeans aged 15 and over were interviewed face-to-face in their homes. The questionnaire asked questions about data disclosure in different context, including health. Specifically, it included questions related to health and personal information, disclosure in Social Networking Sites and on eCommerce sites, trust in health institutions, approval required for disclosure and sensitivity of DNA data. Specifically, we will provide an encompassing portrait of people’s perceptions, behaviors and attitudes across EU27, we will examine the influence of socio-demographic traits and Internet use on such attitudes and behaviors. We will explore significant differences across major regional block. Finally, we will present results from factor analysis that aimed to identify commonalities between variables, and from cluster analysis, use to create typologies of individuals concerning health-related behaviors. Empirical analysis allows to broaden and deepen understanding of the consequences of data protection in Medicine 2.0. Our data also call for further, joint research on this issue, which links demand and supply of medical and health-related data. Indeed, not all people need or want the same level of detail: researchers and physicians clearly need to access more while end users or insurance companies can live with less information. This is one of the crucial points regarding the revision of the Data Protection Directive in Europe (Directive 95/46).

Recently, EUROSTAT has published the results from ICT usage household survey 2010. I have been analysing these data developing a Digital Health Care Demand in Europe and I would like also to share my analysis of  “individuals who  used the Internet for seeking health information on injury, disease or nutrition” (European Union 27 Member States), inspired by The Power of Mobile written by Susannah Fox. In my case, I would like to emphasis the raise of the inverse care law 2.0 to justify that there is no eHealth without eInclusion, in other words quoting Europe’s Digital Competitiveness Report 2010:

“In addition, while health-on-the-web may empower in various ways those who have access to the internet, the flip side of this is that those without internet access may become relatively more disadvantaged in health matters. For them, the experience may be more one of disempowerment through inability to take advantage of new opportunities. Factors linked to existing health divides, including lower health literacy and less proactive health attitudes, continue to contribute significantly to unequal health experiences and outcomes among less advantaged socio-economic groups. There is already some evidence that these groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides.”

Firstly, since 2004 the percentage of individuals who used the Internet for seeking health information on injury, disease or nutrition (total individuals and individuals who have used the Internet in the last three months) has increased, even though from 2009 we can see a slower increase, specially in those who used the Internet. These trends facilitate the identification of a first gap between users and non-users.

To better capture this gap, I have divided the analysis in two part. On the one hand, considering the total individuals we can see the differences between groups of age and level of education.

Furthermore, we can also identify this gap if we focus on age and education together:

On the other hand, considering  individuals who have used the Internet in the last three months, you can see that there is still a difference between groups of age, level of education and both together:

It has to be remarked that most of these trends show that the divides are not going to disappear with time, in some cases these divides will get wider.  Therefore some groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides. THUS, THERE IS NO eHEALTH WITHOUT eINCLUSION. Social care, Health care, Health Professionals and Social workers may work together and play a role not just in eHealth or on eInclusion but both to avoid ‘double jeopardy’ and  the inverse care law 2.0.

Note: I have developed the same analysis for all Member States and the gaps are even wider in some countries.

On March 15th to 18th the Ministerial High Level Conference on eHealth and the World Health IT Conference and Exhibition were being held in the same week in a joint initiative called “e-Health Week 2010”. First of all, I would like to congratulate the organizers, specially TICSALUT Foundation and ehealthweek2010, for the very well organized conference and their social media coverage.

The conference was divided into five themes:

• eHealth for Sustainable Healthcare Delivery
• eHealth Addressing Global Challenges through Local Actions
• eHealth works: Here is the Evidence
• eHealth Market: Past and Prospects
• eHealth User Platform

Furthermore,  Paralel sessions and Plenary Sessions were coveraged by @ehealthweek2010 using Twitter #hastag as follow:

Paralel Sessions

• eHealth Governance
• How can IT Help Fight Pandemics
• Is Sustainability of Healthcare Possible without eHealth?
• When Telemedicine does Deliver!
• Embedding eHealth into New Professional Curricula
• Ageing - A Global Challenge
• Empowering the Patient through Information Delivery
• Beyond Technical Interoperability
• eHealth for the Economy
• ICT for a Global Infraestructure for Health Research
• eHealth and Healthcare Org The Chiken and the Egg
• Standards for a Global Scene
• eHealth Procurement
• eHealth for Mental Health

Plenary Sessions

• The ehealth Agenda in the UE
• The right information, at correct place and at the right time
• 2.0 Health care in practice
• EU-US cooperation in eHealth: facing common challenges
• EHealth for urgent public health challenges
• How contributes eHealth in health and well being
• The impact of eHealth in organizations and health personnel
• The dangerous decade. Challenges for system builders national health information
• European market of e-health: dream or reality?

I also had the opportunity to tweet some of the sessions. On one hand, it was a wonderful opportunity for networking and for watching in action how policy-makers, practicioners (specially Hospital managers and IT managers) and the ICT Health industry work together. On the other hand, there was a lack of analytical/empirical presentations so it was remarked by most of the participants that more research is needed. Furthermore, there are many eHealth, mHealth, Health 2.0,…. Health has been always related to technology so probably it is time to delete all the letters and just talk about HEALTH. Nowadays, HEALTH could not be understood without Information and Communication Technologies and these technologies could not be understood without economic, organization, social and cultural changes.

Today I have the great opportunity to attend at a research seminar entitled “The Hacker Ethic: The New Culture after the Current Global Economic Crisis” led by Prof. Pekka Himanen, who is currently a Visiting Professor at Internet Interdisciplinary Institute.

After a very inspiring presentation, Prof. Himanen has encouraged us to keep the discussion online following an open hacker ethic. So here goes my thoughts about his presentation and his challenges:

1. I wonder how and to what extend the results of the analysis carried out in collaboration Rita Espanha and Gustavo Cardoso about the Internet users within the World Internet Project could help to identify those users who can easily face the three challenges mentioned by Prof. Himanen, another 3C formula: (Clean = enviromental crisis) + (Care = welfare state 2.0) + (Culture = multicultural life) and also could clearly identify those who will be excluded or disconected.
2. I wonder how and to what extend the Catalan BioRegion could be considered as part of what Prof. Himanen has called “Innovation center dynamics” due to Prof. Himanen 3C formula:  “culture of creativity” + “community of enrichment” + “creative people”.

I’m excited about the online discussion and Friday meeting.

Yesterday I had the pleasure to attend the defence of Ismael Peña‘ thesis Measuring digital development for policy-making: models, stages, characteristics and causes, “which deals about the digital economy and whether governments should help in its development for it might have a positive impact on the real economy and on the society at large”.

Dissertation supervisor: Tim Kelly

Composition of the committee:

President: Tim Unwin (University of London)
Secretary: Joan Torrent Sellens (UOC)
Members: Robin Mansell (London School of Economics)
Bruno Lanvin (INSEAD)
Laura Sartori (Università di Bologna)

Substitutes:
Gustavo Cardoso (Instituto Superior de Ciências do Trabalho e da Empresa)
Rosa Borge Bravo (UOC)

CONGRATULATIONS Dr. Peña-López. I’m proud to work with you in the same research group I2TIC.

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.