Transcript Slide 1

The Network Society & Knowledge
Economy
Portugal in the Global Context
– Lisboa, March 4-5, 2005
Organizational reform and
technological modernization in
the public sector
Internet and Mobile Technology in health
systems:
Organizational & Sociocultural Issues in a
Comparative Context
James E. Katz (Rutgers University)
Sophia K. Acord and Ronald E. Rice
Objectives
Why e-health for Portugal
Compare to US
Potential for e-health technology
development
Look at social science dimension &
suggest opportunities for Portugal
Conclusions
Part A: Why E-health?
E-health important lever for
Health improvement for populace
Modernization spur for infrastructure
Growth engine for economy
Serves human rights
Portuguese people
E-health offers great potential for reducing
mortality
Improving health of children
– Accident prevention & cancer in young people
Young people’s (15-34) mortality rates
among highest in EU
Cardio-vascular disease high in older
people
Portugal: Low density of
healthcare practitioners
>80% of healthcare professionals work in
3 largest cities
– >60% in Lisboa
Shortage of dentists & nurses
– 3 dentists per 100k in 1988
– 3.1 nurses per 100k in 1994
– versus US: About 190 MDs per 100k
Portugal
~ 7% of GDP (1992) to healthcare
2nd lowest in Europe
USA
13% of Gross National Product (GNP)
consumed in 2004
– Compares 5.6% in 1960
– For US auto-makers, cost of worker
healthcare more than raw materials
50 percent of Americans take at least one
prescription drug
– 17% take four or more
Survey of EU 2003
Portugal, Spain significantly lower in
Internet use
After Greece, were the lowest in the EU
(for Spain, 13% and Portugal 14%)
Portuguese respondents
1.6% use the Internet to seek health
information daily
2% said they did so weekly
2% monthly
8% still less often
Portugal, Spain have low rate of
rural Internet health access
Especially among the elderly
Portuguese physician practices
Only 58% of Portuguese physicians use
the Internet
Only 40% do for medical purposes
– Well below the EU average
(European survey, 2003)
Portugal also leader
Smart cards
EU road map
Part B: E-health use in US
US
80% of adult Internet users (half of
population) searches on health and
medical topics
30% of email users have sent or received
health-related email
December 2002
Consumers in US
Connect to online support groups
Visit websites
– Special sites for volunteers & reports on trial
of new therapies
25% looked online for drug information
December 2002
Patient want ready email
contact with physicians
80% said they wanted this, according to
Feb 2005 online survey
– But not if had to pay additional (< 30%)
(Wall St. Jor, Mar 2, 2005)
Survey suggests importance of
personalized & tailored info, but also cost
constraints
Problems with major websites
Readability
(Ebenezer, 2003)
Rarely aimed at patients
(Tench et al., 1998)
E.g., NHS library & mdconsult.com
– Both aim to provide accurate and secure
information to health-seekers
Patients are unaware of highquality data sources
Health seekers tend to use general search
engines, such as Google
– Instead of turning to specialized resources
(Boston Consulting Group, 2001, 2003)
(Sigouin & Jadad, 2002)
Centralized and commercial
websites non-interactive
Lack customer interaction features
Instead provide only unidirectional
information
(Cudmore & Bobrowski, 2003)
Example: Pharmaceuticals
Fewer than 1 in 3 pharmaceutical
company websites offer way to respond
online to consumer requests
Fewer than 1 in 2 health-supply websites
respond to online requests or questions
(Pharmaceutical, 2003)
Public sites also one-way
Government health sites are even less
interactive
(Rice, Peterson & Christine, 2002)
Personal websites
Personal health websites play big role in
construction of medical knowledge online
Represents growth of interest in ‘local’
knowledge
In a search for rheumatoid arthritis, 34% of
relevant sites were posted by an individual, more
than those posted by non-profit organizations, and
over 6 times more than those posted by
educational institutions
(Suarez-Almazor et al., 2001)
Physician websites offer
great potential
In the US, 1 in 3 physicians have web site
Obstetrics/gynaecology and internal
medicine specialists highest rate
(AMA, 2002)
Most physician websites focus on practice
enhancement tactics, rather than concrete
patient service
Sanchez (2002)
Many commercial support services
available
Offer physicians electronic support
Websites
Secure emails
Patients find sites are cumbersome, partly
due to the concerns about liability and
assumption of responsibility
Part C: Potential for e-health
technology development
Been concentrating on www
USA highly web-oriented
Visual
Mobile
Multi-media services (MMS)
Physician webcams for
practitioners
Promising in concept, difficult in
implementation
Example of double-headed
microscopes
Bamford et al. (2003) implemented a
country-wide network of physician 35
webcams in UK histopathology
departments
A year after installation, 71% had not even
used the networking software
All using physicians found it effective for
diagnosis and exchanging opinions
Why failed?
Excessive workloads preventing physician
training
IT staff reluctance to render assistance
Above all, user attitudes
Bamford et al. (2003)
Mobile phone
Studies from Spain provide contrast in
usage patterns
Marquez Contreras et al. (2004) conducted a
controlled group study with hypertension patients;
members of the intervention group were sent
reminder text messages to their mobiles 2 days a
week. Hypertension was significantly lower (52%)
in the control group compared to the intervention
group (65%)
Mobiles in LDCs:
An extensible model?
AIDS fight in Kenya
Free text messaging services available
– Users send text questions and receive free
answers
Sends out daily tips
– how to prevent infection
– deal with disease’s consequences
Mali & AIDS
Local mobile company sends free text
health slogans twice a month to each of
the company’s 350,000 subscribers
Mali & malaria
Prints AIDS and malaria prevention
slogans on at least one million of the prepaid phone cards
– Used mostly by low-income customers
Sample message:
– "Protect your family against malaria - use an
insecticide-treated mosquito net“
(Plus News, 2004)
Examples show
Mobile health applications: health
information can be inserted directly into
the daily lives of targeted populations
Contrasts with more traditional systems
that are physically and psychologically
remote from the active health-seeking
population
Advanced mobile videophone
and multi-media messaging
Mobile medical application which uses
commercial 3G wireless cellular data service
– When the patient is in a remote location, transmits trauma
patient’s video, images, and electrocardiogram signals to
trauma specialist
Chu and Ganz (2004)
Weiner et al. (2003) used videoconferencing in
nursing homes for unscheduled, night-time
consultations
– Mobile multimedia applications were especially effective in
dealing with mental health patients
Part D: Challenges &
opportunities for e-health
Look at social science dimension &
suggest opportunities for Portugal
Most technical facilities in a few
locations
E-health offers remote access to
expensive resources
Other values
Social support highly valued
Users want individualized, specific
outcome information from expert sources
Cultural and social aspects in
deployment
Inherent bureaucratic logic of one-way
information flow
Organizations must reap rewards of sunk
costs and prior efforts
(Castells, 2004)
Difficult environment
Privacy
Equal accessibility
Commercial free speech & access to
markets
Effectively informing, protecting, and
enabling patients and healthcare workers
Legal & medical accountability & quality
And cost
Expensive!
But investment in top-down systems much
higher than bottom-up
Quality control an enduring problem
Digital divide & mobiles
Digital divide caused by mobiles?
– In fact, the very portability of mobile phones
and PDAs, enhanced by further device-todevice wireless technologies, actually make
them versatile
– Provide health care to remote areas, elderly,
and disabled
Lavez et al. (2004)
Huge amount accomplished
Large sunk costs provide vast info
Formally (top-down)
– Resulting in the creation of many useful
centralized services (some commercial, some
governmental)
Informally (self-organizing upwards)
– Resulting in numerous resources of varying
interactivity and quality
Part E: Conclusion
E-health an enormous opportunity for
Portugal
Mobile applications may fit particularly well
Developing country model?
Quandary
How to make systems that allow
democratic co-creation, individualization &
support, address quality
– High degree of interactivity and tailoring
wanted by users, but hard to achieve
efficiently
EU roadmap for e-health
– Quality, privacy & liability concerns may seal
off local initiatives
Exciting, hopeful future
Work the problem from two directions
– Top down
– Enable (or at least not disable) local creation
And two levels
– Quality, tailored information
– Socially supportive & meaningful context
The possiblity
With social, organizational & technical
research, savvy applications can be
created that achieve vital objectives
Obrigado
Thank you