eHealth and the Means-Ends Problem

Prescribing ChangeIt’s been a busy week and one that has focused on means and ends and provided me with many examples of how those two things get confused and become de-linked.

I started the week off in Vancouver with meetings focused on my ongoing research looking at collaboration and outcomes associated with the study and evaluation of the Life Sciences Institute at the University of British Colombia. Our research is trying to ascertain the means from the ends — and even what those ends are or should be. Does increasing interaction between scientists of different disciplines produce more research? better research? different research? and if so, is this a factor of the people?, the setting?, facilitators within the LSI and outside?, something else? or some combination? It’s the kind of problem that makes researchers squirm or jump (thankfully, I’m in the latter).

These kinds of means and ends are important for not only research, but understanding innovation in practice and creating better strategies to facilitate that. Nowhere was that more clear than in the two days of presentations and discussion at Medicine 2.0, perhaps the most important gathering of people — researchers, clinicians, decision makers, patients and advocates — interested in learning more about how collaborative e-tools brings about change. Events like these are dangerous; for those in eHealth and those outside it.

For those outside, the danger comes from having a group of innovators share with the world how ‘Web 2.0’ tools can facilitate self-organization, community engagement, and patient involvement in ways that challenge the status quo quickly and with tremendous force. As I tell my students in my Health Behaviour Change course at the U of T : the only people who truly welcome change are wet babies.

Take the eHealth Ontario debacle, which continues to roll along. It now has come to the attention of the public that Ontario already has an eHealth record system linking close to 100 facilities only it is focused solely on child health (i.e., those under the age of 19), when its spent millions on developing a completely new one, presumably for the other part of the population (?). What is required here is changing the tools to address a larger population, but more importantly, changing a mindset that there needs to be new tools, rather than adapting existing ones. The means (a centralized database for health records in this case) is confused with the end (a healthier province & a more efficient and effective health care system). A quest for getting the ‘right’ means or getting a particular ‘means’ is delaying our ability to move towards the healthy end.

From the inside eHealth, these kinds of events are dangerous for reasons that are not that different than those of outsiders. In this case, there is a tendency to focus on the means without consideration of the environment in which those methods are deployed. At Medicine 2.0 there were talks ranging from a focus on patient support needs and portals, public health support strategies, wiki-based clinical practice guidelines, and a variety of ways to engage various audiences with tools like Facebook and Twitter. In nearly every presentation the focus was on the novel ways in which technology could facilitating change. Yet in the audience and at the breaks these presenters (myself included) found ourselves talking less about the tools, but the organizational cultures and shifts that need to take place to make these tools work. Indeed, the tools can do a lot, but without an organizational mindshift within our health and public health systems, even the most innovative, responsive and affordable tools will not truly make the change that is espoused.

We are clear on our end, now its time to reconsider our means in light of the tools and the culture that exists around them.

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