Category Archives: Network Society

Social determinants of Health and ICT for Health (eHealth) conceptual framework

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:

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

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.

a-conceptual-framework-for-action-on-the-social-determinants-of-health-discussion-paper-for-the-commission-on-social-determinants-of-health

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).

deeping-digital-divide

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

social-determinants-of-health-and-ict-for-health-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

Evaluation of Integrated Care: From methods to governance and applications – Economics of eHealth

Based on The Economics of eHealth (I) and some inputs from my colleague Cristiano Codagnone I have developed my presentation to “Recent Developments and Future Challenges of Integrated Care in Europe and Northern America” – 11th International Conference on Integrated Care organised by The International Network of Integrated Care, The Julius Center of the University Medical Center Utrecht and the University of Southern Denmark (March 30 – April 1, 2011 in Odense, Denmark). I would like to thank Dr. Albert Alonso for his invitation to participate in the conference.

eHealth Literacy as a catalyst to overall digital literacy among the elderly

Susannah Fox has invited Jessica Mark to post on www.e-patient.net:

This is a guest post by Jessica Mark, healthfinder.gov and Outreach Program Manager, Health Communication and eHealth Team in the Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services

The result of this invitation is entitled Making Strides Toward Improving Health Literacy Online where Jessica Mark highlighted part of the work done by the Office of Disease Prevention and Health Promotion. I really enjoy her post so I commented this:

Wonderful post! I wonder if eHealth literacy could be also a tool to integrate the elderly into Information Society / Network Society. It could be a tool to engage them within the tremendous potential of the Internet for other aspects of their lives. Health contents could be just an excuse to capture their attention (e-awareness) and help them to be online (e-readiness)

and Jessica Mark replied:

Francisco, thank you! I love the idea of eHealth literacy as a catalyst to overall digital literacy too. I’d love to hear/talk more about how that might work.

First of all, I would like to quote the main message of Prof. Jan van Dijk‘s book “The Deepening Divide: Inequality in the Information Society

“The digital divide is deepening where it has stopped widening. In places where most of peopel are motivated to gain access and physical access is spreading, differences   in skill and usage come forward. The more information and communication technology is immersed in society and pervades everyday life, the more it becomes attached to all exiting social divisions. It tends to strengthen them, as it offers powerful tools for everyone engaged. This occurs in the context of the evolving information society and network society. This type of society makes both digital and social divisions even more critical” (…) The digital divide is conceived of as a social and political problem, not a technological one. Physical access is portrayed as only one kind of (material) access among at least four: motivational, material, skills, and usage” (p.2-3)

As a part of his framework for understanding the digital divide, Prof. van Dijk has developed “A Causal and Sequential model of Digital Technology Access by individuals in Contemporary Societies” (p.24). I have included HEALTH as a field of participation in Society.

van_dijk_framework

“The core argument of the book sets particular relationships between four states of affairs, in a process creating more or less information and communication inequality in using digital technologies (p.14):

  1. A number of personal and positional categorical inequalities in society
  2. The distribution of resources relevant to this type of inequality
  3. A number of kinds of access to ICTs
  4. A number of fields of participation in society

1 and 2 held to be the causes, and 3 is the phenomenon to be explained, together with 4, the potential consequences of the whole process (…). The core argument can be summarized in the following statements, which comprise the core of a potential theory of the digital divide (p.15):

  1. Categorical inequalities in society produce an unequal distribution of resources.
  2. An unequal distribution of resources causes unequal access to digital technologies.
  3. Unequal access to digital technologies also depends on the characteristics of these technologies.
  4. Unequal access to digital technologies brings about unequal participation in society.
  5. Unequal participation in society reinforces categorical inequalities and unequal distribution of resources.

The general term access to digital technologies has been divided into four specific, successive kinds of access to digital technology, computes, and the Internet connections (p.21):

  1. Motivational access (motivation to use these technologies)
  2. Material or physical access (possession of computers and Internet connection or permission to use them and their contents)
  3. Skills access (possession of digital skills: operational, informational, and strategic)
  4. Usage access (number and diversity of application, usage time)

I have posted before about the importance of eInclusion and eHealth and Inverse Care Law 2.0 talking about the successive kinds of access to digital technology but I have not posted about what are the reasons for not having access to the Internet at home to explain why eHealth literacy could be a catalyst to overall digital literacy among the elderly.

Eurostat’s survey on ICT usage in households and by individuals (2010) stated that the main reasons not to access the Internet at home in almost all countries are related with MOTIVATIONAL ACCESS (does not need to; does not want to) and SKILLS ACCESS

eurostat_access_internet
Using Spain as an example I have crossed these reasons by Age:

spain_non_access

Individuals between 55-74 emphasised the importance of SKILLS ACCESS and MOTIVATIONAL ACCESS. Following the framework and the figures above mentioned, eHealth literacy could be a catalyst to overall digital literacy among the elderly because:

  1. Health could be a motivation for the elderly to use the Internet (e-awareness)
  2. This motivation could be used as a trigger to learn how to use this technology (e-readiness)
  3. Health professional and/or health care workers as well as relatives and/or friends could facilitate this learning process (ehealth literacy)
  4. Use of the Internet for health could open new fields of participation in society for the elderly.
  5. These new fields of participation in society could diminish categorical inequalities and unequal distribution of resources.

Thanks Susannah Fox and Jessica Mark for your inspiring post and comments

Digital Health Care Demand or eHealth Care Demand in Europe – Eurostat

Lately, I have been working with aggregate data from Eurostat ICT usage household survey focused on the usage of the Internet and Health by European citizens. It is worth mentioning that this is a working in progress. Below you can find all variables available per year.

Table 1. Variables available per year at Eurostat ICT usage household survey

Caption Years
The type of goods and services I ordered over the Internet in the last 12 months for on-work use are: Medicine 2009
The type of goods and services I ordered over the Internet in the last 12 months for non-work use are: Non-prescribed medicine 2009
The type of goods and services I ordered over the Internet in the last 12 months for non-work use are: Prescribed medicine 2009
I would like to do on-line: health-related services (eg interactive advice on availability of services in different hospitals, appointments for hospitals) I_GOVHLP *** 2006
I’ve already done on-line: health-related services (eg interactive advice on availability of services in different hospitals, appointments for hospitals) I_GOVHLY *** 2006
I have used Internet, in the last 3 months, for seeking medical advice online with a practitioner I_IHAD 2003 2004 2005
I used Internet, daily, for seeking medical advice online with a practitioner 2003 2004
I used Internet, monthly, for seeking medical advice online with a practitioner 2003 2004
I rarely used Internet for seeking medical advice online with a practitioner 2003 2004
I used Internet, weekly, for seeking medical advice online with a practitioner 2003 2004
I have used Internet, in the last 3 months, for making an appointment online with a practitioner I_IHAP 2003 2004 2005
I used Internet, daily, for making an appointment online with a practitioner 2003 2004
I used Internet, monthly, for making an appointment online with a practitioner 2003 2004
I rarely used Internet for making an appointment online with a practitioner 2003 2004
I used Internet, weekly, for making an appointment online with a practitioner 2003 2004
I have used Internet, in the last 3 months, for seeking health information on injury, disease, nutrition, improving health, etc.) I_IHIF 2003 2004 2005 2006 2007 2008 2009
I used Internet, daily, for seeking health information on injury, disease or nutrition 2003 2004
I used Internet, monthly, for seeking health information on injury, disease or nutrition 2003 2004
I rarely used Internet for seeking health information on injury, disease or nutrition 2003 2004
I used Internet, weekly, for seeking health information on injury, disease or nutrition 2003 2004
I have used Internet, in the last 3 months, for requesting a prescription online from a practitioner I_IHPR
2003 2004 2005
I used Internet, daily, for requesting a prescription online from a practitioner 2003 2004
I used Internet, monthly, for requesting a prescription online from a practitioner 2003 2004
I rarely used Internet for requesting a prescription online from a practitioner 2003 2004
I used Internet, weekly, for requesting a prescription online from a practitioner 2003 2004

Due to the data available, I have chosen 2005 to carry out a cluster analysis to develop a typology of Digital Health Care Demand or eHealth Care Demand in Europe. This is just a first step, the aim is to analyse the drivers and barriers of eHealth in Europe from the demand side. The next table shows the percentage of total individuals by country, (I_GOVHLP and I_GOVHLY  2006)

Table 2. eHealth variables available 2005 at Eurostat ICT usage household survey

COUNTRY I_IHIF I_GOVHLP I_GOVHLY I_IHAD I_IHAP I_IHPR
AT 0,160251 0,227954 0,029526 0,004705 0,007748 0,002626
BE 0,1914 0,183276 0,017496
BG 0,122097 0,009661
CA 0,58
CY 0,080042 0,195897 0,00136 0,002788 0,000551 0,001706
CZ 0,034713 0,096489 0 0,003308 0,003896
DE 0,325024 0,021079
DK 0,238382 0,41458 0,030644 0,02493 0,016902 0,007123
EA 0,162218 0,251884 0,017979 0,005567 0,003255
EA16
EE 0,163774 0,19904 0,030725 0,108567 0,083567 0,049192
EL 0,021608 0,131537 0,001472 0,003506 0,001282 0,000433
ES 0,12751 0,035553 0,024121 0,004409 0,000907
EU15 0,181379 0,245943 0,021312 0,019812 0,005783 0,004567
EU25 0,160867 0,227894 0,019862 0,017239 0,005385 0,004105
EU27 0,160867 0,216619 0,018973 0,017239 0,005385 0,004105
FI 0,38971 0,273988 0,012912 0,027487 0,033743
FR
HR
HU 0,096088 0,119384 0,053411 0,007618 0,004358 0,001954
IE 0,104775 0,043551 0,008591 0,006391 0,001092 0,000679
IS 0,394597 0,388167 0,119582 0,027373 0,013017 0,007694
IT 0,087271 0,17439 0,008182 0,015709 0,003513 0,001996
LT 0,085267 0,179464 0,020233 0,012467 0,002665 0
LU 0,410491 0,367017 0,015976 0,016174 0,006943 0,007728
LV 0,073536 0,156269 0,009821 0,004649 0,001445 0,00052
MK
MT 0,161734 0,122316 0,010373 0,004483 0,003271 0,001495
NL 0,407242 0,387001 0,008289 0,017196 0,007235 0,014481
NO 0,257325 0,36145 0,021409 0,0113 0,008636 0,002586
PL 0,071422 0,174514 0,00652 0,004253 0,001301 0,000916
PT 0,100267 0,174263 0,003997
RO 0,062036
RS
SE 0,232107 0,295204 0,061132 0,042376 0 0,009893
SI 0,153678 0,268123 0,011941 0
SK 0,091329 0,214051 0,013288 0,000493 0,001545 0,000192
TR 0,031177 0,002588 0,000698 0,000024
UK 0,254573 0,200448 0,02922 0,044428

With these values I have constructed new categorical variables considering  descriptive statistics (percentiles per each variable) as follow: less than 25% is LOW, between 25% and 75% is MEDIUM and more than 75% is HIGH.

In order to develop a typology of countries’ utilization of the Internet related with Health, a Non-Hierarchical Cluster Analysis of K-means was undertaken, to five of the five variables identified above I_IHIF, I_GOVHLP, I_GOVHLY, I_IHAD, I_IHAP (Table 2). These factors were selected due to their significance within the cluster analysis.

Table 3. Results of K-means—quick cluster analysis. Method of analysis: non-hierarchical cluster, final cluster centroids.

Clusters

1. Digital Health Care Demand Leaders (n=8)

2. Digital Health Care Demand Primary Strivers (n=3)

3. Digital Health Care Demand Secondary Strivers (n=12)

ANOVA

Sig.

I_IHIF

2,5

3

1,67

12,733

0

I_GOVHLY

3

1,67

1,58

18,345

0

I_GOVHLP

2,5

3

1,58

14,053

0

I_IHAD

2,5

2,33

1,67

6,793

0,006

I_IHAP

2,5

2,67

1,92

4,173

0,031

Cluster one consists of countries where citizens place a greater emphasis on the Internet for health purposes, specially those variables related with health care services. This group is thus referred to as representing ‘Digital Health Care Demand Leaders’. Cluster two is characterised by a minimum difference, with less emphasis on variables related with health care services (transactions) and more emphasis on information, so are consequently labelled ‘Digital Health Care Demand Primary Strivers. Finally, Cluster 3 is labelled ‘Digital Health Care Demand Secondary Strivers

And now… the floor is yours…. pick up a country a put it on a cluster… soon I will post the characterization of the cluster analysis, including traditional, non-digital, variables from the health systems. Furthermore… what about 2010?

Austria AT
Belgium BE
Bulgaria BG
Cyprus CY
Czech Republic CZ
Germany DE
Denmark DK
Estonia EE
Greece EL
Spain ES
Finland FI
France FR
Croatia HR
Hungary HU
Ireland IE
Iceland IS
Italy IT
Lithuania LT
Luxembourg LU
Latvia LV
Macedonia MK
Malta MT
Netherlands NL
Norway NO
Poland PL
Portugal PT
Romania RO
Sweden SE
Slovenia SI
Slovakia SK
Turkey TR
United Kingdom UK
EU (15 countries) EU15
EU (25 countries) EU25
EU (27 countries) EU27

THANKS indeed Ismael Peña for his inspiring work

The integration of Information and Communication Technology into medical practice

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into medical practice” has been accepted and is already in press at the  International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

PREPRINT

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

ABSTRACT

OBJECTIVES:

To identify doctors’ utilization of ICT; to develop and characterise a typology of doctors’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice.

METHODS:

An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken.

RESULTS:

Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as ‘integrated doctors’. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled ‘non-integrated doctors’. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an ‘integrated doctor’.

CONCLUSIONS:

The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands.

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

eHealth Week 2010 – Barcelona

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:

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

Paralel Sessions

Plenary Sessions

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.

Health and the Network Society: Spanish/Catalan book launched

I’m delighted to present my book: Health and the Network Society published by Ariel now available at the book stores. I perfectly know that it would not become a best-seller but I hope it could contribute just a little to foster new debates and further research on ICT and Health.Health systems are embedded within technological, economic, social and cultural changes of our current social structure: the network society. This book is based on empirical research about the transition of the Catalan health system towards the network society. The results show how the interaction between the technological, economic, organizational, social and cultural dimensions are facilitating the emergence of new profiles of citizens, patients and healthcare professionals. The determinants that shape these new profiles allow us to identify the inhibitors and drivers of Industrial healthcare systems towards the Network healthcare systems.

Innovation in health: a social science perspective – Andrew Webster

“Innovative health technologies: health systems in transition Workshop”

Supported by: Internet Interdisciplinary Institute (IN3)

Organized by: Francisco Lupiáñez-Villanueva (Internet Interdisciplinary Institute –UOC) and Michael Hardey (Hull/York Medical School – Science and Technology Studies Unit, Department of Sociology, University of York)

Data: 26th November

Place: UOC IN3 building. Av. Canal Olímpic, s/n. Edifici B3, 08860 Castelldefels (Barcelona)

Andrew Webster’s presentation - Innovation in health: a social science perspective

This presentation offers a brief account of the ways in which innovation, and more specifically medical innovation, can be understood from within a social science perspective, illustrating the ways in which innovation has to be seen as an articulation of both old and new assemblages, the broad range of socio-technical relations that make it possible and indeed workable. In light of this discussion, the paper goes on to raise a number of issues that need to be addressed in future policy and practice contexts, relating to the take-up, choice, evaluation and globalisation of innovation.

Andrew Webster

Professor Andrew Webster is Director of the Science and Technology Studies Unit (SATSU), and Head of Department of Sociology at the University of York. He was Director of the £5m ESRC/MRC Innovative Health Technologies Programme, is member of various national Boards and Committees (including the UK Stem Cell Bank Steering Committee and UK National Stem Cell Network Steering Committee) and was Specialist Advisor to the House of Commons Health Select Committee. He is national co-ordinator the ESRC’s £3.5m Stem Cells Initiative (2005-9), and was a member of the Royal Society’s Expert Working Group on Health Informatics. He is currently undertaking externally funded research on stem cells as well as the implementation of pharmacogenetics into clinical practice, and is coordinating a new European (EC) grant on Regenerative Medicine (REMEDiE). He is Co-Editor of the Health Technology and Society Series: Palgrave Macmillan (launched at the Royal Society, October 25 2006). His most recent book is Health, Technology and Society: A Sociological Critique (Palgrave Macmillan) 2007. He was elected a Fellow of the Academy of the Social Sciences in 2006.

Notes from “The Hacker Ethic: The New Culture after the Current Global Economic Crisis”

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.

Towards Health Mass-Self Communication

On 26th October I have the opportunity to act as a moderator in a symposium called Communication in health 2.0, organized by the Institute for Continuing Education (IDEC) and the University of Pompeu Fabra’s Science Communication Observatory (OCC). First of all, I would like to thank Vladimir de Semir, Gemma Revuelta and Clara Armengou for their invitation and their organization of the symposuum. I really think that University has a role as a hub to disseminate and research about this topic in collaboration with the rest of the actors (industry, healthcare providers, professionals, Government,…).

Act as a moderator gave me the opportunity to work on the Health Communication field as a framework of part of the research I have been doing and develop the first step towards the conceptualization of Health Mass-Self Communication.