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Leveling the playing field: the Global eHealth Innovation Network. Alejandro (Alex) R. Jadad, MD DPhil FRCPC Director, Program in eHealth Innovation Rose Family Chair in Supportive Care Professor, Health Administration and Anesthesiology University Health Network University of Toronto.
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Leveling the playing field: the Global eHealth Innovation Network Alejandro (Alex) R. Jadad, MD DPhil FRCPC Director, Program in eHealth Innovation Rose Family Chair in Supportive Care Professor, Health Administration and Anesthesiology University Health Network University of Toronto
Massive exodus • Record public unemployment • Physician unemployment • $? for health (<$8 B) • 70% under poverty line • Massive immigration • Record employment levels • Shortage of physicians • $100 Billion • 10% under ‘relative’ poverty line
The gaps across the world • The assets of the top 3 billionaires are more than the combined GNP of all least developed countries and their 600 million people • The income gap between the richest fifth of the world’s people and the poorest fifth is 75 to 1 (it was 30 to 1 in 1960) • 10 countries account for 84% of global research and development expenditures
The richest fifth of the world’s population has 74% of telephone lines • The bottom fifth only has 1.5% • More than 50% of people in the world have never used a phone • Chile, the country with the highest telephone penetration in Latin America, has a teledensity of less than 25 • But, the telephone is not used efficiently even in countries where teledensity is above 90% • We need more than technology to achieve change
10 times more Internet users in North America than in the whole of Latin America Canadians have 20 times more access than Colombians …and 600 times more than Haitians
Use of Internet in America Most connected Canada 60% USA 50% Virgin Islands 10% Uruguay 7.5% Aruba 5.8% Brazil 5.7% Aruba/Barbuda 5.5% St. Kitts/Nevis 5.2% Bahamas 5.1% Chile 4.1% Costa Rica 4.0% Least connected Haiti 0.09% Ecuador 0.15% Honduras 0.33% Paraguay 0.36% Nicaragua 0.42% Bolivia 0.43% Guyana 0.43% Guatemala 0.51% Cuba 0.54%
Mind the (widening) gap! Incentives for carriers to serve underserved and unserved
We have lots in common… Populations that care a lot about health Huge expenditure in health and desperate need to increase efficiency Low levels of computerization in the system Lots of politics and big egos No incentives for providers to use knowledge or technology Confusion or denial
Program in eHealth Innovation Mission: To help people access the information and services they need, when and where they need them, regardless of who they are.
What can (should) we do? “E-mail is no substitute for vaccines, and satellites cannot provide clean water”
How can we maximize success? Effective international collaboration Economies of scale Virtual and physical resources Building on leadership ‘Real-enough-time’ evaluation Strong input from all groups of decision-makers
Creating a mini-model of the world The Global eHealth Innovation Network
Toronto: An ideal starting point… • Communities from over 170 countries • Single health care system • > 1000 health professionals unable to work • Largest city with one medical school • Innovators conducting research on technology, social sciences and health • Excellent track record for international work • Large funds for research infrastructure
Harnessing diversity • 1,070 patients surveyed up to this month at University Health Network • They spoke 59 languages and came from 90 different countries • 60% said they have used the Internet (68% as a source of health information) • 77% would like to communicate with providers through e-mail and Web sites • 40% would like to participate in projects to find solutions (in 33 languages and from 50 countries)
Research Idea exchange Education Management Business eHealth Innovation Collaboratory Economies of scale Downtown TO 10,000 Sq. Ft. Space for 50-60 people Support for hundreds Virtual and physical resources Completion: 1 year (Physical infrastructure)
Simulation environments eHealth Collaboratory Living laboratories Research platform
Group collaboration • Tools for research collaboration • Distance education suite • Tele-health support
Overall Network Structure Health knowledge Simulation Laboratories eHealth Collaboratory Living laboratories Social sciences Technology
EGALITÉ! E = Ensuring G = Global A = Access to L = Links, I = Information and T = Technology to promote É = Equity in health
