E-questions for an e-age

More than 10 years ago, as he watched the Web start to explode, Dr. Alex Jadad had a feeling it was going to change the world, — and health care.

He was in a position to know. At the time, Jadad, founder and director of the Centre for Global eHealth Innovation at the University Health Network in Toronto, was completing a PhD. in knowledge synthesis at Oxford University. Essentially, he was distilling large amounts of disparate information to get at what is really important.

“Ninety-nine percent of research is not relevant to patients or clinicians,” Jadad said. “It’s for other reasons, but not to guide clinical decisions.”

His critics did not believe in mechanisms for handling and sharing large amounts of information.

“When I finished my PhD – boom, the web exploded,” Jadad said. “I said, ‘Look, this is the type of thing that will overwhelm us if we don’t have a mechanism to let us make decisions in a very systematic way.’ (The Web) was going to affect everything and everybody.”

Founded in 2000, the eHealth Centre is driven by three questions, beginning with: What if?

“What if we had an environment where we could create a window to the future of the health system?” Jadad asked more than five years ago.

“We needed a place to simulate situations where people make health related decisions,” he said. “We then had to expose them to new ways of doing things. For example, how would people in their homes use new technologies to improve their health?”

The work that now takes place at the Centre is what Jadad describes as the acceleration of the inevitable.

“Clinicians (and other health care staff) are going to be using the Internet to communicate with each other,” Jadad said. “We are bound to have an electronic health record that we could access over the Internet. We are bound to have telemonitors in our homes to help us live healthier lives.”

The public has to be given the opportunity to participate in decisions about their health and to use information and communications technologies (ICT) to provide access to the information and services they need, regardless of where they are, according to Jadad.

“The question is: How can we make it happen faster?” said Jadad. “Look, after 100 years of the telephone we still don’t even use it properly.” He finds it lamentable that few people can call their family doctor and get through right away.

“Why can’t I check my medical record like I check my financial record?” Jadad asked. “What are the legal or political implications?”

Most of the litigation, in terms of physicians, has to do with poor communication, according to Jadad. Physicians who communicate properly with patients don’t get sued.

“It’s usually (angry) patients who sue physicians,” Jadad said. “They are (unhappy about) not having access to their (health) information.”

In late April, the Canadian Medical Association Journal (CMAJ) said that because provinces are extending their time limits for filing malpractice suits — in Saskatchewan, for example, from two years post-treatment to 15 – physicians will need more storage space for patient records.

“Doctors will need storage space, digitalization,and time spent to manage those files, said Marcus Davies of the Saskatchewan Medical Association. “They have to ensure a proper chain of custody on every file,”

To Jadad, that’s part of the point: “How we communicate, how we exchange information has not changed, probably, in 200 years. What are the implications of doing things differently with respect to things like litigation or payment?”

Jadad grapples with that question through the Centre’s second driver: So what?

“We have this Centre to address those questions,” he said. It’s an approach that allows his team to answer questions like: What should happen (by leveraging ICT-enabled health care)? Who was left out? Why were they were left out? How can we support those who have been left out?

The Centre hopes to define initiatives that encompass all stakeholders’ requirements.

“We are not wasting resources by having everybody do something that everybody doesn’t need to do,” said Jadad. “Now you reduce your expenditure dramatically.”

Jadad believes that even if you take the time to demonstrate to stakeholders how ICT-enabled health care works, it still takes time for the established system and mechanisms to catch up.

The third and final question at the core of the Centre’s operations is: What next?

“If you show that something can be done differently, and it can make a difference, improving peoples health and lives, that’s not enough,” Jadad said. “You have to make sure the system is respected and that it doesn’t take 10 to 15 years to adopt innovations.”

He doesn’t have all the answers now. But he does have the tools to find them. And that, he said, is all he set out to do.