Some things just make you wanna scream. For the last year or
so, the thing that most often makes me want to let out a real rebel yell is
when I hear people say things like: “why can’t we have an eHealth system that
works like Facebook?” Honestly, I’ve heard some VERY clever people ask this;
people whose intelligence I know to be extremely high and whose opinions and
views I genuinely respect. But seriously – any time I’ve heard this it just
makes me want to scream… until today.
Today I had an epiphany. Today I found myself thinking: “we need eHealth to be like Facebook.”
I thought this as I was posting a response on LinkedIn. My friend
Paul Gallant had referenced an article on a forum I follow. This article quoted
Will Falk, Donald Drummond and Dominic Covvey opining that there was nothing cutting
edge about Canada’s eHealth strategy (or more precisely, Canada HealthInfoway’s eHealth strategy). These experts thought the strategy was obsolete;
that it was too top-heavy, too “big iron” and that it was already being lapped
by mHealth and tablet technologies. I don’t at all agree with that assertion,
and in fact said in my post that “it is infrastructure in the middle of the network that does the job of resolving person and
provider identity, that stores shared health information in a coded way, and
that is able to provide care plan alerts and triggers -- and this mundane middle bit is what creates the
"network effect" needed for person-centred health to become a
reality.”
And that’s when I had my epiphany. I concluded my post by
saying: “We had PCs and mobile phones before Facebook. It was the middle bit that created such an astounding
network effect.”
Why would I say something like that? I’m on the record as
having made some pretty unequivocal statements about how different eHealth is
from Facebook and what a mistake I think it is to compare the two. Have I got
some apologies to extend? Perhaps some public retractions to make?
Well… let’s not jump to Googling recipes for crow just yet…
there are still some important reasons to expect eHealth to be very different
from Facebook. But there are some similarities, too, and these are worth
exploring.
I’ve been doing work the last couple of years in the area of
mHealth – the use of mobile technologies, including mobile phones, to do
eHealth. The work I’ve been involved in has been in sub-Saharan Africa. The
reason mHealth is a big deal there, and elsewhere in the developing world, is
quite simple: in these regions the mobile phone is the pervasive computing
device.
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| ICT Adoption in African Countries -- ITU 2009 |
The problem, though, is that on its own mHealth doesn’t really do anything. I’m a bit uncomfortable with
how unkind that sounds – but the truth is, healthcare is an
information-intensive domain and mobile phones or tablets or PDAs are generally
lightweights when it comes to data management or computational muscle. Their
real advantage is their ability to provide a network connection.
So… that’s why we need a set of powerful applications and
services that can do useful work on the other end of that network connection. We
need cloud-based computing and data management muscle so that our lightly
powered edge devices can leverage it. We need eHealth infrastructure that is like
Facebook; we need a central service that will deliver the important “network
effect” that will support continuity of person-centred care over time and
across multiple delivery sites. We need a timeline
that provides a longitudinal record of our health related interactions and we
need standards-based interfaces so that trusted actors and applications can
access and work with that information to support care delivery on our behalf.
I heard Infoway’s CTO, Dennis Giokas, articulating a
strategy much like this one at the Infoway Partnership meetings in Halifax last
November. This isn’t an obsolete strategy – it is the only strategy that will
lead to the kind of healthcare ecosystem we all want. Indeed, I believe it is
the only strategy that will let us leverage the technological advances in
tablets and smartphones that are the subject of so much hype lately (and which
Falk, Drummond and Covvey are so keen on). The challenge is, it is a strategy
that relies on us finishing the work we’ve started. Yeah – that boring work that
no one seems to see the value in. We need to finish the work of building our cloud-resident,
service oriented, standards-based eHealth middle
bit. Without it, there is no mHealth… or none that does anything important anyway.
I’ve come to believe that we need a new catch-phrase, a new marketectural description that really
captures the essence of the value in this middle bit. We need a concise moniker
that will evoke the important ways that individual care will be supported by this
infrastructure. I have one that I like. I think that a person-centric, mHealth plus eHealth
infrastructure should be called… wait for it: meHealth.
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