ITCH 2009 PlenarySunday, February 22, 2009Don Juzwishin CHE PhD

1987: TODAY’S CHALLENGES -TOMORROW’S SOLUTIONS

1990: IMPROVING COMMUNITY HEALTH THROUGH APPLIED TECHNOLOGY

1994: CHANGING OPPORTUNITIES 1996: APPROPRIATE SYSTEMS /

APPROPRIATE DECISIONS 1998: NEW PARTNERSHIPS: BETTER CARE 2000: FROM POTENTIAL TO PRACTICE 2007 - TODAY’S INFORMATION FOR

TOMORROW’S IMPROVEMENTS

REVOLUTIONIZING HEALTH CARE with INFORMATICS:

FROM RESEARCH to PRACTICE

to offer or accept a challenge; "threw down the gauntlet"; "took up the gauntlet"

form of punishment in which a person is forced to run between two lines of men facing each other and armed with clubs or whips to beat the victim

REVOLUTIONIZING HEALTH CARE with

INFORMATICS: FROM RESEARCH to

PRACTICE

Health 2.0, Medicine 2.0 and Web 2.0: Enabling

technologies for practice, policy and systems

Power and will of the people Web 2.0

Power and will of autonomous health care providers and researchers committed to collaborate and advance best practice and continuous quality improvement Medicine 2.0

Power and will of the state to achieve a high performing health care system and improvements in the health and quality of life of its citizens Health 2.0

Health informatics is a necessary condition for the revolution but it is not sufficient – it needs a cultural revolution to take place as well

The fundamental tenant of this address is that improvements to the health care system must come from reforms to its structures and processes not by imposing e-health on an archaic artifact

Data source: 2005 Canadian Internet Use Survey.Figure source: Statistics Canada, 2008, "Getting a second opinion: Health information and the Internet", Health Reports, Vol. 19 No. 1, catalogue number 82-003-XWE.

Data source: 2005 Canadian Internet Use Survey.Figure source: Statistics Canada, 2008, "Getting a second opinion: Health information and the Internet", Health Reports, Vol. 19 No. 1, catalogue number 82-003-XWE.

While most (94%) think it’s important to have access to one’s own medical history, only six in ten (60%) say its ‘easy’ to access them

a majority (55%) of Canadians indicate their medical history is tracked on paper, not electronically (30%)

Simpson, 2008, Ipsos survey

(93%) Canadians believe that medical errors can be prevented by improving collaboration between medical professionals using technology, and that efficiencies could be created through the additional exchange of information amongst care gives and medical professionals (91%).

Simpson, 2008, Ipsos Survey

A similar proportion (87%) is of the opinion that electronic health records help medical professionals make better decisions when address health issues of patients.

Nine in ten (91%) believe that the information they get from their medical professionals allows them to take an active role in managing their own health and the health of the family members. Simpson, 2008, Ipsos Survey

Similarly, most (89%) say they want to play a more active role in the health care decisions made for them and their family

Simpson, 2008, Ipsos Survey

Three rules of open spaces that have emerged on the Internet ▪ (1) no body owns it,

▪ (2) everybody uses it and

▪ (3) anyone can improve it.

They characterize the Internet with (1) openness, (2) peering, (3) sharing, and (4) acting globally

▪ Tapscott and Williams

Web 2.0

Health 2.0

Medicine 2.0

Informed

Public

Providers

Policy Makers

Decision Makers

Improved

Knowledge

Practices

Personal Health

Policy

Decisions

Improved

Outcomes

Population

health

Reforms

Web 2.0, Health 2.0 and Medicine 2.0 offer the

platform for the cultural revolution to take place

Changing trend of the World Wide Web and web design

Enhance creativity

Communications

Secure information sharing

Collaboration

Functionality

Social networking, video sharing, wikis, blogs, folksonomies

"Health 2.0 is participatory healthcare characterized by the ability to rapidly share, classify and summarize individual health information with the goals of improving health care systems, experiences and outcomes via integration of patients and stakeholders.“

Ian Furst

http://waittimes.blogspot.com/

“Medicine 2.0 applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.”

▪ Eysenbach GMedicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and OpennessJ Med Internet Res 2008;10(3):e22<URL: http://www.jmir.org/2008/3/e22/>

Hughes et al. argue there are four major tensions represented in the literature on Health/Medicine 2.0: lack of clear definitions;

issues around the loss of control over information traditionally the purview of health care providers;

safety and the dangers of inaccurate information; and

issues of ownership and privacy Hughes B, Joshi I, Wareham J

Health 2.0 and Medicine 2.0: Tensions and Controversies in the FieldJ Med Internet Res 2008;10(3):e23<URL: http://www.jmir.org/2008/3/e23/>

It is now humanly impossible for health care professionals to single handedly accumulate and possess the knowledge to deliver the health care with the safety and quality made possible by current scientific knowledge

It is unpardonable to ignore or not undertake a policy action that will benefit the health of the population or improve its quality of life.

It is unpardonable to not undertake the improvement of the functioning of the health care system in respect to its effectiveness and efficiency

“Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them.”

Laurence J. Peter

Synergy between health care reform and Web 2.0

Synergism – the cooperative action of discrete agencies such that the total effect is greater than the sum of the effects taken independently

Provide 24/7 access to high quality evidence on the effectiveness of health care interventions

Provide the opportunity for social networking, support groups, sharing of experiences

24/7 monitoring of health status parameters – smart house

Instantaneous feedback on medication effects Encourage health literacy being a priority in education The citizen, consumer, patient own their personal health

record Reduce adverse events Access to remote locations Support of chronic disease management and health

promotion

Provide 24/7 access to high quality evidence on effectiveness of health care interventions

Provide immediate news of breakthrough findings or cautions

Identify and share international best practices Provide opportunity for immediate and trended

outcomes associated with interventions Offer opportunities for collaboration and

partnership Provide decision support tools New forms of education and continuing

education

A storehouse of linked data Provide a bridge to anonymous data and

information on the citizen, customer, patient community

Facilitate clinical and field trials matching client criteria and research design requirements

Bring them into the collaboratory Need to make explicit peer review processes

Make explicit accountability relationships, roles and responsibilities

Provide transparency on the monitoring and performance of the health care system

Provide access to linked data bases Drive and link health policy informatics from

the sub cellular to the individual and population health levels

• Potential to improve and inform citizen knowledge and understanding

• Provide opportunity to shift the ownership of the personal health record to the citizen

• Provide instantaneous access to the highest quality evidence of clinical and cost effectiveness of health care interventions to citizens, providers and policy makers

• Provide the state with knowledge and insights of what policy actions have what results

Migrate the personal health record to citizens, consumers, patients

Provide 24/7 and universal access to high quality evidence on the effectiveness of health care interventions to citizens, providers and policy makers

Encourage apomediation Require transparent declaration of private

versus public interests in technologies

Leadership Courage - sacrifices Vision Commitment Hard work Effective bridges between research, practice

& policy

The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.

George Bernard Shaw (1856 - 1950), Man and Superman (1903) "Maxims for Revolutionists"