Leveling the playing field: the Global eHealth Innovation

NetworkAlejandro (Alex) R. Jadad, MD DPhil

FRCPCDirector, Program in eHealth Innovation

Rose Family Chair in Supportive CareProfessor, Health Administration and

AnesthesiologyUniversity Health Network

University of Toronto

The gap according to me…

• 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

Globalization, equity and uncertainty

What is the role of eHealth?

• 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

Mind the (widening) gap!

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

Most connectedCanada 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 connectedHaiti 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%

Use of Internet in America

There is also a language gap!

Mind the (widening) gap!

Incentives for carriers to serve underserved and

unserved

Should we be looking at all this differently?

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

Can we overcome barriers together?

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.

“E-mail is no substitute for vaccines, and satellites cannot

provide clean water”

What can (should) we do?

Bypassing bureaucracy

How can we maximize success?

Effective international collaboration

Economies of scale Virtual and physical

resourcesBuilding on leadership

‘Real-enough-time’ evaluation

Strong input from all groups of decision-makers

Creating a mini-model of the worldThe Global eHealth Innovation

Network

•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

Toronto: An ideal starting point…

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)

eHealth Innovation Collaboratory

Research

Education

Idea exchange

BusinessManagement

Economies of scaleDowntown TO10,000 Sq. Ft.

Space for 50-60 people

Support for hundredsVirtual and physical

resourcesCompletion: 1 year

(Physical infrastructure)

Research platformSimulation environments

eHealth Collaboratory

Living laboratories

A health usability laboratory

A multi-tasking flexible environment

Group collaboration• Tools for research

collaboration• Distance education

suite• Tele-health support

Living laboratories

Social sciences

Health knowledge

Techno

logy

Overall Network Structure

Simulation Laboratories

eHealthCollaboratory

Living laboratories

EGALITÉ!E = EnsuringG = GlobalA = Access to L = Links, I = Information andT = Technology to promoteÉ = Equity in health

Instant access to information

With no wires!

Anywhere!

Enhancing the relationship!

Telehealth

Virtual coaches

Improving literacy

Making it fun, when possible!

Beyond keyboards and mice!

FaceMail-11-Apr-01-114034-EDT.lfxm

I hope it is possible!