Monthly Archives: March 2008

Medical wikis: a easy way for physicians to be on the Internet

Following David Rothman’s initiative I started to collect wikis focus on health. I have added to the list Wikiecho launched by Dr. S. Sulfi

Wikiecho is a project to create a free, up-to-date and reliable online resource covering the rapidly advancing field of echocardiography . Check out the Help page to see how you can edit any page , or the Project page for more information about Wikiecho and getting involved.

This new initiative makes me think about E-Health and Society: An Empirical Study of Catalonia. One of the findings of this research project points out that the Internet is conceived by healthcare professionals as a space of information, not of communication. Moreover, the large majority of physicians does not use the Internet to spread their work. Only 19% have a personal web site and only 5% a blog. Furthermore, of those who have a web site, only 5% say that they established the site to communicate with their patients.

The research project also shows that most medical doctors consider the web as a provider of contents. 65% consider that the information posted is relevant. The majority considers that looking for information in the Internet would be positive for their patients and for the relationship between doctors and patients. However, 49% of doctors never recommend patients to check their medical condition on the Internet, and another 38% only do it rarely.

So, the principle of consulting the Internet is well considered by doctors, but they rarely put it into practice with their own patients. Research report results reveal that the lack of time during face to face consultation and the lack of training as the main reasons of this behaviour. Furthermore, physicians who have developed their own website talk about the Internet health information with their patients more than those who haven’t developed their own website.

E-Health and Society: An Empirical Study of Catalonia at eHealth News EU

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.

Rating Physicians and Hospitals and Web 2.0: Could it really change health demand?

Checking my RSS I have found a interesting post titled Health Care’s Broke: Physician Rating and Quality Indicators where the author mentions some physicians’ and hospitals’ opinions about Web 2.0 rating tools:

You’re only going to get the extreme patients to evaluate you (and often the unhappy ones)

The unhappy patients will have the opportunity to publicly say how terrible the doctor is, but because of privacy rules, the doctor or hospital cannot comment or defend him or herself

There is too much emphasis on bedside manner and convenience, and not enough information on outcomes — “How Good A Doctor Am I?”

Even if there is information on outcomes (like in the hospitals’ cases) if this determines payment or discourages future patients because of a bad rating of outcomes, the physician will be much less likely to risk treating a very sick patient, who will likely have a bad outcome no matter what

These systems also ignore where a hospital operates or where a doctor works — hospitals with large populations of poor patients are likely to be sicker than hospitals in affluent areas. Academic hospitals which often care for many incredibly complex, sick patients might be compared to relatively straightforward, simple patients at another hospital down the street.

After this, the author suggests some relationship between “Pay for Performance” and Web 2.0 rating tools and he gives some advices for hospitals and physicians.

A few moths ago I posted about Web 2.0 challenges the tools for rating quality of health information on the Internet and I wondered if Web 2.0 could really change the production and consumption of health information and the consequences of this virtual shift on quality and on expert and lay knowledge.

Right now, I also have to wonder about the consequences of Web 2.0 on patients’ preferences when they are looking for a hospital. Could this kind of application really move the demand side of healthcare market? What is the social scalability of Web 2.0 initiatives to be worth?

E-Health and Society: An Empirical Study of Catalonia

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.

The Medicalization of Cyberspace

A few weeks ago, Jordí Sánchez-Navarro sent me a link to a book titled The Medicalization of Cyberspace written by Andy Miah and Emma Rich (see Table of Contents)

The entire infrastructure and culture of medicine is being transformed by digital technology, the Internet and mobile devices. Cyberspace is now regularly used to provide medical advice and medication, with great numbers of sufferers immersing themselves within virtual communities. What are the implications of this medicalisation of cyberspace for how people make sense of health and identity?

The Medicalisation of Cyberspace is the first book to explore the relationship between digital culture and medical sociology. It examines how technology is redefining expectations of and relationships with medical culture, addressing the following questions:

  • How will the rise of digital communities affect traditional notions of medical expertise?
  • What will the medicalisation of cyberspace mean in a new era of posthuman enhancements?
  • How should we regard hype and exaggeration about science in the media and how can this encourage public engagement with bioethics?

This book looks at the complex interactions between health, medicalisation, cyberculture, the body and identity. It addresses topical issues, such as medical governance, reproductive rights, eating disorders, Web 2.0, and perspectives on posthumanism. It is essential reading for healthcare professionals and social, philosophical and cultural theorists of health.

I have started to read the book but I haven’t finished it yet so I can not comment many things. As you can see above I have reproduced the back page of the book and linked the table of contents. It looks very interesting.

I am positively amazed by the digital identity of the authors. Andy Miah and Emma Rich have their own web sites and they have developed a blog with the same title of the book The Medicalization of Cyberspace. It looks like the “new generation” of researchers are taking care of the Internet to spread their work and build their networks.