From e-Health to i-Health...this is no accident

posted 19 May 2011, 10:33 by Michael Boniface
In 2001, the British Medical Journal decided to ban the word “accident” in relation to injuries or events that produce them. 10 years later e-Health initiatives across Europe still fail to deliver on their promises of greater efficiency for healthcare professionals and improved health outcomes for patients. Information integration, data fusion and decision support is a huge challenge but information integration that is distributed across regional and national domains of control and where there can be “no accidents” seems unlikely.

History shows that disruptive technology can only have a successful impact through a balanced approach that addresses both technical and socio-economic drivers (e.g. the failure of Grid computing to become ubiquitous). This is true even if huge budgets are used to achieve relatively modest levels of innovation (e.g. the UK’s NHS IT Infrastructure project).

But how can the Future Internet provide the resilience, reliability and dependability for stakeholders whose appetite for risk is close to zero and whose application requirements are as complex as human life itself?

These topics were debated at FIA Budapest during the session on Dynamically Adaptive FI Applications: Beyond Adaptive Services. The session explored application scenarios from health, logistics and media with each posing driving requirements for adaptability in service infrastructures. Katarzyna Wac, University of Geneva, argued that an integrated health care approach supported by Future Internet technologies “anytime-anywhere-anyhow” was a key to achieve the ambitious goal of efficient and effective management of diseases and enabling the self-management of patients ‘on-the-move’. These ideas were mirrored by Nuria De Lama, ATOS Origin, who talked about e-Health in the FI-PPP, following on from ideas presented by ATOS at FIA Valencia last year.

The technical aspects of health scenarios are not without significant challenges but maybe new thinking and cultural attitudes are necessary for ICT to have an impact in healthcare delivery.  A seed was planted by Dr Heikki Huomo, Director of the Center for Internet Excellence, who argued the need to exploit the network effect and move from e-Health to i-Health. Heikki described how online communities and social media could support the wellbeing of individuals, contribute to wider societal health objectives and deliver massive efficiencies. Online support groups and real-time identification of pandemics were both examples of how communities and their data could deliver benefits to the healthcare system. Conversations between mothers on social networks about problems with flu vaccinations could be used to quickly identify trends in large populations, certainly more quickly than healthcare providers collecting and analysing data from each doctor.

We are already seeing i-Health emerging with services such as Moodscope reaching a membership of 25000. As is often the case in these discussions, we are back to the puzzling issue of participation and privacy. Many people would rather share personal and sensitive information in trusted online groups hosted by a third-party service providers than allow their data to be distributed within systems run by governments. Of course i-Health is unlikely to replace e-Health but the two approaches should be considered complimentary. The challenge for dynamic adaptability will therefore be on the co-existence and cooperation between different collaboration architectures designed for community sharing (i-Health) and for structured healthcare business processes (e-Health).

So, the societal process of shifting the blame will be problematic for engineers developing dynamic and adaptive services in the Future Internet. We expect system behaviours to be increasingly difficult to characterise, monitor and control considering the high levels of interconnectivity between services. In a culture where there can be “no accident” the events that produce misbehaviour will have significant consequences, and maybe the simplicity of i-Health will allow ICT to deliver greater impact in the health domain in spite of the linguistic endeavours of some.