Speeches
Lodewijk Bos, ICMCC
Presentation given at the conference “Medical Care Quality Management: New Horizons”, organized by the Academician E.N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 22 September 2011, Novosibirsk, Russia.
Ladies and Gentlemen,
Good morning.
First of all I would like to thank the organization of this event for their kind invitation to present.
I am President of the ICMCC Foundation, the International Council on Medical and Care Compunetics. I am also Editor-in-Chief of the only cross-disciplinary scientific journal that focuses in its full width on all aspects of Health and technology, targeting all possible reader groups, professional (doctors, nurses), scientific as well as patients. This journal is a joint initiative from Springer Verlag and the IUPESM, the international umbrella organization of biomedical engineers and medical physicists. And I am senior editor of our own ICMCC book series with Springer Verlag.
As a foundation, ICMCC is the only global organization dealing with user (and specifically patient) related aspects of the use of ICT in medicine and care. For this we introduced in 2004 the term compunetics, which stands for the social, societal and ethical aspects of the use of computing and networking. We do it in medicine and care. Since a couple of years the University of Westminster in London has a department of behavioral compunetics.
Our goals contain amongst others the supply of information, especially to the patient, but also making all stakeholders aware of the consequences of the use of ICT. Directly derived from these are our focus on electronic records and digital homecare, essential elements of the various conferences we organized as well as of the books we publish. In 2006 we produced a digital knowledge center on patient record access, in 2007 we wrote a guideline to the WHO on the patient right to record access and in the same year we started an internet news page on health IT, which by now has grown to be one of the leading news sources in the field on the internet with an average of over 2,500 unique visitors per day and almost one million pageviews per month. In 2008 we started our science pages, one of the best linked databases of scientific publications in the field.
Today’s presentation is titled: Innovative information technologies in a health care system.
The first what comes to mind is the question what is Innovative? Innovation is derived from the latin word innovare, which means to renew or change and mostly refers to the creation of better or more effective products, processes, technologies, or ideas, generally signifying a substantial positive change compared to incremental changes. So innovation means the introduction of something new, an idea, a method, or a device but in my view should be based as much as possible on existing technologies. Beautiful examples are the iPad or the smart phone.
The next issue mentioned in the title in “information technologies”; technology that concerns information. But as information is very dependent on how it is distributed, we often refer to it as “information & communication technologies”.
And finally health care system. It assumes an organized structure, and refers to health and the social aspects of health, care.
To build a system the various parts need to be linked together. Therefore we need an infrastructure. That infrastructure depends on hardware (computers, devices, buildings), connection (broadband, GSM) and structure (standards). But in health care the social aspects are part of the infrastructure as well.
Health care costs rise in an incredible way. This is due to the fact that the number of people on this planet increases, that we get older and that we have more knowledge and possibilities to cure and care. Innovations in health care are necessary to, at least partially, find ways to cover and diminish those costs.
In the past decade some major hindrances have disappeared in the developed world and slowly start to diminish in the upcoming economies and less developed countries. The main reasons are the implementation of broadband and GSM networks. Due to these developments it has become much easier for people to communicate, to get informed and for technology to be developed and implemented.
To build a system you need interaction between the parts. In a health care system these parts are organizational, technical and human. It needs hospitals, primary care practices, insurance companies, cities, regions and the national government to participate; patients, health professionals but also those who are not a patient yet as well as those who participate in giving care like family, neighbors. And finally there is the technology aspect.
Let’s start with the technology. Unfortunately the technology world suffers from two related problems, reinvention of the wheel and not invented here. Europe has been a leader in this sense. Every country had its own innovation projects, most often not realizing what was done or ongoing in other countries. Every country is developing its own electronic health record system; every country has its own telemedicine project trials. The same we see happen in the United States and even worldwide. When I was asked to perform as a discussant at the presentation of a draft Worldbank report on telemedicine in developing countries to the World Health Organization in 2006, I told them that I was astonished by the fact that there was no reference to already existing technologies in the developing world. There was no inventory; the wheel was reinvented each and every time. And at a globally incrementing cost. But thankfully things are changing. Last July the WHO published a “Compendium of new and emerging technologies” which gives a first overview of available and under development technologies in medicine and health.
The goal of health information technology is to improve care and cure, to make it accessible to as many people as possible and to avoid redundancies and replication. It should not be necessary to repeat a recent X-ray just because it is not available to another doctor. It should not be necessary for patients to repeat their history every time they see another doctor or visit another institution. It should not be necessary that cure or treatment cannot be delivered because the expertise is not available locally or regionally.
In Europe and the United States we see what the consequences are of what we call the disadvantage of an early start, the so-called “dialectics of lead”. The Netherlands have the highest number of computers in primary care practices, with an initially large number of different types of software unable to communicate with each other. So they created an infrastructure to make this exchange possible. But when they started developing that system they forgot to involve the patient. So when they realized the importance of patient participation or even just the access to his or her record they had to make numerous adjustments. At the same time a major discussion about privacy arose. They now begin to realize that the whole process started on the wrong foot. It should have started from a patient’s point of view. The United States suffer from similar problems. They have developed many EHR systems that, once again, are unable to communicate. They are now trying to create an infrastructure to exchange that information, but are confronted with issues that should have been at the roots of EHR technology like identification processes, standards, privacy.
A country like Australia shows how difficult it is to come to unique patient identifiers, necessary to assure a secure exchange of data.
Another example is the world of medical devices. If we want to convince medical professionals that data originating from other doctors or institutions can and should be re-used we have to make sure that those data can be proven trustworthy. Therefore it should be mandatory that the doctor will be informed about the devices that produced these data, in other words, the output should be accompanied by up-to-date calibration information. That, unfortunately, is mostly not the case. This means that many adjustments have to be made again to the software used. The same mistake is being made in the latest hype in health information technology, mhealth, the use of mobile phones to provide us with patient observation data. In principle mhealth has a strong and cost saving future. It saves manpower and time when patients monitor their own blood pressure, glucose level or fall risks and thankfully these applications become available in all kinds of mobile phone applications and even in clothing. However the data produced which will be sent to and stored by electronic records have to be trustworthy, which means that we have to apply golden standards to these applications. For the last 2 years mhealth has been a booming business, focusing on smart phones, giving birth to many start-ups that are destined to go flat. A recent study shows that from all applications that have been downloaded only 5 percent is still being used after 20 days. Another problem is the availability and cost of modern smart phones. Only a limited number of people in de developed world can afford smart phones, even despite the strong advertising and teasing exercises from the network providers. The majority of the world still uses “normal” cellphones.
From the developing world we already learned how effective SMS messages can be, something that can be done with simple cellphones. It is used for malaria monitoring and many other diseases including HIV and tuberculosis. However, these applications require a network neutral approach. The developing world has started to learn from this. More and more the Western world is returning to “old school” text messaging for diabetes, obesity, immunization, HIV or medication compliance to name just a few.
Telemedicine has come a long way. Once started as a technology to bridge large distances it has now developed into a discipline that limits the use of point-of-care medical presence. The long distance aspect is still used, like the links between Africa and India for medical services and education. But telemedicine is also increasingly applied in the western world both to connect the home with the care provider (e.g. digital homecare) and to make the connection between primary care physicians and specialists, especially in the area of dermatology. Hospitals rely as well internally on the services by using telemedicine carts (robots) to connect between patient and provider.
All these devices and applications produce data that have to be stored in an apprehensive and accessible way, Electronic Health Records. I will not spend much attention to ongoing discussions on naming. In my view an EHR is a container of links to all health information, which means all information from medical records combined with all other things that might be relevant to a holistic view of your health and well-being. This includes the input from devices, lab results, nurses, paramedics and above all, the patient.
But for an EHR to function properly, as a link to many documents stored in many different locations, they will have to be extremely well standardized. HL7, the leading messaging standard, is on its way to be implemented in Russia, but other internationally accepted standards are much needed as well. These are the terminology standard SNOMED CT, the disease categorization ICD-10 and the laboratory observation standard LOINC. When done properly it will mean that any provider will be able to read and understand a patient’s history from a medical viewpoint.
Connections to images have to be created, for which PACS storage would be required. Unfortunately only a very limited number of Russian hospitals have PACS installed .
Medication records will have to be created. This implicates the implementation of electronic prescribing. E-prescription is a largely proven method to avoid medication errors and seriously improve mortality numbers, but also will provide electronically stored data that can help make public health decisions.
It may be clear why a unique identification number is mandatory to achieve such a record. And data should be stored for eternity. Not only for the patient’s sake (do you remember all your diseases during childhood?) but also for research’ sake. Public and population health as well as research will immensely benefit from the data stored in these records.
Allow me a small personal example why a lifelong record is important. 5.5 years ago I went to be operated on a hemorrhoid which turned out to be a very aggressive kind of non-Hodgkin Lymphoma. After finishing my treatment, an enhanced variation of CHOP, the PET scan still showed cellular activity in the colon. Although physical examination came out clean, radiotherapy was strongly advised, in a larger area, as they could not pinpoint the location. However, after the ordeal of the chemo (still the reason why I can’t walk properly 5 years later, to call just one aspect), I refused for the time being. At the next control, 3 months later, the PET scan still showed the same cellular activity. I then asked if this could be due to a restless colon. This was answered with the question if I did have such a condition, to which I answered that indeed I did, ever since I was a very young child. Had there been a record, this information would have been available, either as a medical indication or as an observation by my parents, and a very difficult discussion could have been avoided.
This brings me to another point, the patient input. Medical information is only half as valuable if the patient experience is not recorded at the same time. Why is that so important? The medication records seem obvious; having them included in the record will immediately help to avoid errors especially in the case of co-morbidities. The observations of daily living might be less obvious. Imagine a patient’s blood pressure being monitored via a portable device. The data will be sent to the caregiver. When this person notices that the blood pressure is above normal levels for a couple of days the first reaction might be to prescribe some medication. However, if he or she could read in the patient’s file that his boss wants to sack him or her husband is filing for divorce, the reaction will certainly not be a prescription of medication.
Russia is not known for its advances in Health and health technologies, being quite low in the international ranking. However, the earlier mentioned “dialectics of lead” has a counterpart, the advantage of the late start. A country like Russia can start implementing health information technology with the latest technologies that already have been proven effective in other countries; provided that local, regional and federal government will not suffer from the “not invented here” syndrome. Hospitals will also have to refer from the typical Western attitude of technical greed.
Once you start equipping health professionals with computers, you can start with tablets, which will be easy to use, practical at the bedside and not interfere in the patient-clinician relationship, especially since recent improvements in speech recognition make giving input even easier.
Every hospital wants to have the latest technology in every discipline. Already in 2005 I have spoken about a new hospital structure, where education and rare and extremely complicated cure is delivered by academic institutes; surgery is delivered by regional centers highly specialized in the procedures concerned based on the fact that the more experience a surgeon has, the better the overall outcome is; and finally recovery, natal care and emergency care can be dealt with locally. When I first launched this concept it was ridiculed, now it is slowly entering the minds of decision makers. This way you can offer the best cure methods to patients, which can be run according to market principles (e.g. a Philips and a Siemens cardiology clinic in the same region), whereas recovery can be delivered close to the patients relatives in an environment that resembles hotels, with good food and a nice, tranquil ambience. Recent trials in various countries have shown the effectiveness and the immense benefits to the patient as well as the hospital organizations.
With the increasing access to the internet, patients are inundated with information which they are unable to classify. More than 90% of the information is either not reliable or not written in an understandable language. We will have to create information sites that can be actively linked to the outcomes in an EHR, tailored to the reader’s literacy and doctors will be required to prescribe internet information to the patient, thus creating a participatory relationship which gives the patient a more autonomous position in his health path and make him an active partner in decision making.
The advent of nano and DNA technology will push innovations even stronger. But to be able to apply these upcoming innovations we have to lay the basis by way of the technologies I mentioned in this talk.
Thank you for your attention.
Lodewijk Bos
Slides
27 September 2011 | No Comments »
Categories: Speeches
Muy buenas tardes. Me llamo Lodewijk Bos.
En primer lugar querría agradecer la organización por la oportunidad de presentar a esta conferencia. Hablo y entiendo castellano, pero no tengo experiencia suficiente para dar este presentación en su idioma, entonces disculpen-me por continuar en inglés.
I am President of the ICMCC Foundation, the International Council on Medical and Care Compunetics. I am also Editor-in-Chief of the only scientific journal that focuses in its full width on all aspects of Health and technology, targeting all possible reader groups, professional (doctors, nurses), scientific as well as patients. This journal is a joint initiative from Springer Verlag and the IUPESM, the international umbrella organization of biomedical engineers and medical physicists. And I am senior editor of our own ICMCC book series with Springer Verlag.
As a foundation, ICMCC is the only global organization dealing with user (and specifically patient) related aspects of the use of ICT in medicine and care. For this we introduced in 2004 the term compunetics, which stands for the social, societal and ethical aspects of the use of computing and networking. We do it in medicine and care. Since a couple of years the University of Westminster in London has a department of behavioral compunetics.
Our goals contain amongst others the supply of information, especially to the patient, but also making all stakeholders aware of the consequences of the use of ICT. Directly derived from these are our focus on electronic records and digital homecare, essential elements of the various conferences we organized as well as of the books we publish. In 2006 we produced a digital knowledge center on patient record access, in 2007 we wrote a guideline to the WHO on the patient right to record access and in the same year we started an internet news page on health IT, which by now has grown to be one of the leading news sources in the field on the internet with an average of almost 3.000 unique visitors per day and on June 2 we reached 5 million pageviews for 2011. In 2008 we started our science pages, one of the best linked databases of scientific publications in the field.
The title of my presentation today is “Digital Care, What, Why, How?”
What is digital care? Digital care is care delivered through the use of digital technologies but first and foremost, digital care is care.
Why digital care? Because it can reach those who otherwise would have difficulties receiving care, either due to distance, or to their condition. Digital care enables people to receive care at locations other than the classical ones, like primary care practices, hospitals, or even nursing homes. It allows many elderly to continue to live in a more independent way. It allows patients to take a more active role in their health and disease management. Digital care allows health professionals to manage their time more efficiently, be it by alleviating administrative duties like appointment bookings or record keeping, or by replacing time and workforce consuming tasks like regular blood and glucose checking through validated portable devices. Digital care in the longer term will allow payers, government, insurance companies, and hospital organizations to reshuffle their budgets because it can help to avoid needless repetition of all kinds of tasks, from re-ordering medical examinations to patient check-ins.
How is digital care performed? Digital care combines all digital technologies that were previously known under different names; Telemedicine, Electronic Health Records, e-Prescription, Assistive technologies. We at ICMCC have introduced in 2005 the term Digital Homecare for the digital care performed at the patient’s home[1].
I would like to be somewhat more specific on the various aspects of digital care and I would like to start with the effect on the patient.
In these days we talk about empowered patients. This is the relatively new word used to complete the “e” in e-patient. Originally it was an abbreviation for expert patient. However the expert patient was informed, but not empowered, he did not have an active role in his care path. This terminology shift is a good example of the shift that is taking place in the present patient-physician relationship.
As you can see on the slide, knowledge is the core element. And therefore we need to define three essential terms; data, information and knowledge. Data are the outcome of exams, like blood, x-rays, PET scans, blood pressure. Once you start using those data they become information. I am a chemo patient, but to become that I had to be a cancer patient first; I was diagnosed with Non Hodgkin Lymphoma. Only after the data, like the exact typology of the cancer were known it was possible to transform it into the correct information, in other words, the collection of all we know about this cancer. And when you add experience to that information you get knowledge. You have to have the basic information to make yourself knowledgeable.
Patient centric has become the keyword for modern health. However, the patient is verbally put in that spot, but not in reality. It was decided that he should be in the center, but the moment he actively took on that position, it caused and often still causes big shock waves. It was certainly not the intention to have him act according to it. But it should be. A friend of mine, an English GP named Amir Hannan, calls it a partnership of trust, a partnership on equal terms, where equal is the key word[2]. These equal terms can only be achieved when both sides, patients and caregivers share their essentially different experiences and thus achieve a common, equal knowledge. Doctors have had years of training and practicing which give them ample medical experience; patients have the unique experience of their illness, the perception thereof and the way they function with it. And that is where the importance of information comes in. Only when both have the same information they can come to equal terms.
What is digital about all this, you will ask. So far not much, but digital is the way to achieve these goals. The availability of data will become increasingly easy with the help of electronic health records, the internet will open up a whole new world of information. Already Dr. Google is famous. It is considered one of the nightmares of many medical professionals, patients walking into their practice with stacks of print-outs from the internet. But it also should be the nightmare of many patients, as it requires quite some skills to find the appropriate information[3]. Just Googling diabetes will not bring you much, apart from a couple of million results.
But so far, numbers show that the caregiver is still the main source of information. However, to avoid the problem of unreliable information on the internet, caregivers should start implementing a system of information on prescription. Already in 2006 we invited one of the key persons behind this concept as keynote to our annual conference. And slowly it is being picked up. As was said after the recent Salud 2.0 conference in Valencia: “prescribir internet; información y sitios fiables donde conseguirla“[4].
I already mentioned electronic health records. This is my definition of electronic health records:
A container of links to all medical information about the citizen stored at hospitals, GP practices, pharmacies, independent lab and exam facilities, etc., together with the input from eg nurses, paramedics and devices. The citizen must be able
- to add his input (comments, over-the-counter-drug use, lifestyle, etc.);
- to make corrections;
- to decide who is going to see which part of his data;
- to decide if/how his de-identified data will be used.
Health records contain all health information, which means all information from the medical records combined with all other things that might be relevant to a holistic view of your health and well-being. And part of that is delivered by the patient or citizen himself. That is where the patient’s experience comes in. For only the patient can describe what he or she is feeling, what the day-to-day problems are. And these observations should be combined with the proper medical information to make sense. When I realized that I had turned from cancer into chemo patient, I discovered that there is hardly any documentation on the longer term effects. So I decided to write down some of my experiences, especially since it did not seem to be something that greatly inspired my oncologist’s reporting (Life of a Chemo Patient).
According to the European 2010 country brief [5], the Spanish National Health Service sees the following issues as the minimal requirements for an EHR:
- The hospital discharge report
- The specialty consultation report
- The report of emergency care
- The report of primary care consultation
- The report of laboratory test results
- The report of results of imaging tests
- The report of nursing care
- The medical history summary
In my view two essential aspects are missing from this list, medication records and the patient’s input, the so-called observations of daily living.
Why is that so important? The medication records seem obvious; having them included in the record will immediately help to avoid errors especially in the case of co-morbidities. The observations of daily living might be less obvious. Imagine a patient’s blood pressure being monitored via a portable device. The data will be sent to the caregiver. When this person notices that the blood pressure is above normal levels for a couple of days the first reaction might be to prescribe some medication. However, if he or she could read in the patient’s file that his boss wants to sack him or her husband is filing for divorce, the reaction will certainly not be a prescription of medication.
Allow me to use an example from my own medical history. 5.5 years ago I went to be operated on a hemorrhoid which turned out to be a very aggressive kind of non-Hodgkin Lymphoma. After finishing my treatment the PET scan still showed cellular activity in the colon. Although physical examination came out clean, radiotherapy was strongly advised, a larger area, as they could not pinpoint the location. Telling him that there would be no more than size 29, I refused, for the time being. At the next control, 3 months later, the PET scan still showed the same cellular activity. I then asked if this could be due to a restless colon. This was answered with the question if I did have such a condition, to which I answered that indeed I did, ever since I was a very young child. Had there been a record, this information would have been available, either as a medical indication or as an observation by my parents, and a very difficult discussion could have been avoided.
And therefore my next statement: an Electronic Health Record could and should be the patient’s voice.
I therefore much applaud the initiative from the Andalusia government to start with a birth and newborn registry and I hope that it will become the start of a lifelong record[6]. According to my information patient data in Spain are not centrally stored, but at the location of production . I strongly advocate removing any limitations in storage time. All data will soon be stored digitally, so there will be no paper records, X-ray prints or dental prints anymore. Dr Halamka, IT manager of one of the leading hospitals in the USA, calculated the complete costs of data storage at 5.5 US dollars per patient for a period of 15 years.[7] The advantages are numerous. You will be able to monitor individual developments and possibly indicate risks before they become reality, especially when combined with genetic profiling which will be available within the next decade. It will also help medicine to develop into a more personalized version. It will allow us to make data pools, important for public health research and management. And it might help to solve problems for which we have rarely solutions at the moment, due to lack of data like so-called rare or orphan diseases, realizing that 1 in every 25 persons suffers from such a disease.
Another aspect of digital care is telemedicine. In essence telemedicine and telecare are medicine and care delivered from a distance. Telemedicine has been a focus of projects funded by large organizations and governments already for the last 25 years, but is now really becoming an essential element of cure and care, due to the rapidly increasing bandwidth and applications like Skype which allow real time monitoring and performance.
Another aspect of telemedicine is the development of mobile health, commonly known as mHealth. mHealth is becoming booming business, but there are a couple of hurdles to take. Most applications are made for smartphones, which are only accessible in the developed world.[8] Recent reports show that not only in the developing world but also in our smartphone world simple SMS messages have a strong user preference[9]. A second point is the reliability of data. As long as there is no gold standard to which these applications can be calibrated, the data can never be completely trusted.
This is also the case with the output from “classical” medical devices. We want to avoid repetition of exams, one of the reasons for the creation of medical records. You can only ask a doctor to trust data from exams performed by colleagues if he can check the quality of those data. So calibration data should be provided as well.
So far I have covered a couple of the how aspects of digital care. But the most important “how” question still remains. How do we get stakeholders involved? How do we make people aware of the paradigm shifts that are ahead of us?
From recent studies we know that the majority of patients is not willing to take an active part in their health path. The more than hesitant uptake of personal health records, records completely maintained by the patient, is a good example. Not only because it is far too much work, also because caregivers are not happy about it. A personally maintained record will never have the guarantee that it is complete. Patients are not aware which medical data exist from them. They will forget details, or leave them out on purpose.[10] The Spanish way of linking the various parts of the record is a good, valid and secure approach.
I said that all stakeholders should be made aware of the upcoming paradigm shifts. Those financially responsible (insurance companies, governments) will have to stimulate the use of telemedicine and mhealth, as it will bring a shift in budgeting possibilities and personnel management.
Governments should make rules and agreements on the use of standards, also on an international level. Standards will enable the exchange of information and might link record data to appropriate health information. An extra benefit in regions like Andalusia is that if a tourist comes to you with a medical problem, you will be able to access his record and understand it, regardless of its original language, for a proper standardisation will enable you to do so.
Caregivers will have to start accepting that their patient is a partner, who might be willing to be better informed and to take part in decisions made about their cure and care path. And they will have to help them by giving them directions to that information. Once information platforms have been standardised in the same way as health records, this process of information on prescription can be partially automated. Recent research with a group of cancer patients in the USA shows a high patient satisfaction when provided with appropriate information as well as full access to their records .
Patients will have to start realizing that they do have a shared responsibility. They will have to accept that many actions previously performed by medical professionals will be done with the help of devices. They will have to become aware that many contact moments with their health providers will be replaced by data exchange or videoconsultations.
Digital care is new to most of us. But once our children, growing up with computers and mobile phones, will have reached the age of seniors, digital will be an unbreakable part of our lives and lifestyles. Till then we will have quite some work to do.
Thank you.
Lodewijk Bos
Delivered 3 June 2011.
[1] Bos L. et al. Digital Homecare – an Introduction. In: Yogesan K, Bos L, Brett P, Gibbons MC, editors. Handbook of Digital Homecare. Heidelberg: Springer; 2009.
[2] Hannan A, Webber F. Towards a partnership of trust. In: Studies in Health Technology and Informatics. Amsterdam: IOSPress; 2007. p. 108-116.Available from: http://www.icmcc.org/pdf/recordaccess/hannan.pdf.
[3] van Deursen AJAM, van Dijk JAGM. Internet Skills Performance Tests: Are People Ready for eHealth? J. Med. Internet Res. 2011 Apr 29;13(2):e35.
[4] Mezquita, E. In: El médico debe guiar al paciente al usar internet, 2011 May 27. Available from: http://www.diariomedico.com/2011/05/27/area-profesional/gestion/el-medico-debe-guiar-al-paciente-al-usar-internet.
[5] Medinilla Corbellini A, Giest S, Artmann J, Heywood J, Dumortier J. In: eHealth Strategies, Country brief: Spain. 2010 Oct. p.19. Available from: http://www.ehealth-strategies.eu/database/documents/Spain_CountryBrief_eHStrategies.pdf.
[6] ES: Andalusia – Newborn babies to have their own medical records at hospital discharge. 2010 Oct 1. Available from: http://www.epractice.eu/en/news/344320.
[7] Medinilla Corbellini A, Giest S, Artmann J, Heywood J, Dumortier J. In: eHealth Strategies, Country brief: Spain. 2010 Oct. p.29. Available from: http://www.ehealth-strategies.eu/database/documents/Spain_CountryBrief_eHStrategies.pdf.
[8] Mobile health: why should it just be for the rich people with expensive smartphones? mobiThinking. 2011 May 3. Available from: http://mobithinking.com/blog/mobile-health-is-a-right.
[9] Gold J, Lim MSC, Hocking JS, Keogh LA, Spelman T, Hellard ME. Determining the Impact of Text Messaging for Sexual Health Promotion to Young People. Sexually Transmitted Diseases. 2011 Apr;38(4):247-52.
[10] Poll: Many Patients Withhold Health Data. In: Health Data Management Magazine. 2011 Jun 1;19(6). Available from: http://www.healthdatamanagement.com/issues/19_6/poll-many-patients-withhold-health-data-42547-1.html.
Presentation (pdf)
6 June 2011 | No Comments »
Categories: Speeches
De Digitale Patiënt.
Dames en heren, goedemorgen.
Mijn naam is Lodewijk Bos. Ik zou allereerst de organisatie van dit symposium en vooral mevrouw Boeschoten willen bedanken voor de uitnodiging om hier te spreken.
Ik ben voorzitter van de stichting ICMCC, de International Council on Medical and Care Compunetics. Daarnaast ben ik hoofdredacteur van het enige wetenschappelijke tijdschrift dat in de volle breedte aandacht besteed aan alle aspecten van gezondheid en technologie, zich daarbij richtend op alle mogelijke gebruikersgroepen, zowel professioneel (artsen, verplegers) als wetenschappelijke als patiënten. Dit tijdschrift is een samenwerking tussen Springer Verlag en de IUPESM, de internationale koepel van biomedische ingenieurs en medische physici. Verder ben ik eindredacteur van onze eigen boekserie bij Springer Verlag.
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16 May 2011 | No Comments »
Categories: Speeches
Lodewijk Bos, ICMCC
Patient 2.0 Empowerment: Information Dissemination and Awareness
30 November 2010
Ladies and gentlemen,
Good afternoon.
I am Lodewijk Bos and I give this presentation wearing two hats, one as president of ICMCC, the other as patient.
In 2004 I became founding president of ICMCC, the International Council on Medical and Care Compunetics; a foundation dealing with the social, societal and ethical aspects of the use of computing and networking (compunetics) in medicine and care.
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1 December 2010 | No Comments »
Categories: Speeches
Lodewijk Bos, ICMCC
Ladies and gentlemen,
Good afternoon.
First of all I would like to thank the organization and more specific Dr. Madis Tiik for their invitation to present at this event.
The title of this presentation is “Patient expectations in the digital world”. And I give this presentation wearing two hats, one as president of ICMCC, the other as patient.
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18 October 2010 | 1 Comment »
Categories: Speeches
Lodewijk Bos
Ladies and gentlemen, good morning.
Welcome to the seventh annual ICMCC Event. Like many other events that are not commercially focused we have a smaller audience than usual, but still offer a very interesting and high quality event. And I would like to thank each and every one of you for participating. And of course I would like to express my gratitude to the University of Westminster and in particular Professor Benton for hosting this event.
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14 June 2010 | 1 Comment »
Categories: Speeches
Lodewijk Bos, ICMCC
Ladies and gentlemen,
Good morning.
I would like to thank the organizers of the World Congress and especially the IUPESM president Prof. Joachim Nagel for inviting me to deliver this presentation.
Allow me to introduce myself; I am Lodewijk Bos, President of the International Council on Medical & Care Compunetics, one of the 5 transnational members of IFMBE.
The title of this presentation is “Compunetics, the Other Side of Technology”.
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9 September 2009 | No Comments »
Categories: Speeches
Ladies and gentlemen,
First I would like to thank the WHCC Europe for this opportunity to talk.
Allow me to shortly introduce myself. My name is Lodewijk Bos and I am president of ICMCC, the international council on medical and care compunetics. Most of you will not know what compunetics means.
It stands for the social, societal and ethical implications of computing and networking. It’s a term I introduced in the preparation of our first annual conference in 2004, which was also the starting point of our foundation.
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14 May 2009 | No Comments »
Categories: Speeches
More details on the conference.
View the speech.
Ladies and Gentlemen,
First of all I would like to thank the organisation and Dr. Amir Hannan for inviting me to address this conference.
Secondly I apologize for not being here myself.
This conference deals with sharing and caring and I was specifically asked to highlight the international aspects.
ICMCC introduced 4 years ago the word Compunetics and we were the first to link it to healthcare. Compunetics defines the social, societal and ethical aspects of the use of computing and networking. So we already realised the importance of these issues before Web2.0 and Health2.0 appeared on the horizon. The use of the word compunetics directly and urgently implicates the patient as one of the main focussing points of our foundation. More specifically we concentrate on awareness and information supply. To serve the patient in the best way, we also have to concentrate on the health professional.
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1 July 2008 | No Comments »
Categories: Conferences, Speeches | EHR: EHR | Tags: BAN, Compunetics, Digital Homecare, Internet, Ontology, Platform, Telemedicine
Ladies and Gentlemen, friends,
Welcome to the 5th ICMCC event.
Before I start my scheduled presentation on the power of information I would like to mention the fact that for the second time in 2,5 years one of our board members has passed away. After the death of Swamy Laxminarayan, one of our co-founders, we now lament the loss of his replacement at the board, Brian O’Connell. To commemorate Swamy we installed an annual lecture in his honour. Ironically it was Brian who gave the first of these lectures, two years ago. He joined the board at the beginning of 2006, but unfortunately fell ill with cancer shortly after the ICMCC Event that year. He was a kind man, but with strong ideas, a very vivid spirit and a great sense of humour. I remember the only board meeting in which he took part where we were discussing my speech for the 2006 event. In that speech I wanted to mention Chinese medicine, and he strongly opposed, so in the end I had to change it into alternative medicine. Due to this kind of discussions with him I came to realise that Americans have a quite different view to certain things from Europeans. I’m grateful for that insight. I visited him last November, when he was still in treatment and I recovering from mine. It was then that I discovered that he was a great amateur not only of books and cats but also of robots, up to the point where he built them himself. Unfortunately neither of us was in a condition to seriously talk shop, but in one of his last mails he told me that he was making plans again. It is sad to say that at the age of 47 he was not able anymore to realise those plans. He will be missed dearly.
Despite this sad start, this is a moment to rejoice, as it is the 5th ICMCC Event. In those 4 years we have established ourselves out of nothing. We run a yearly event that, although small, is of the highest quality and standard. We launched the first, and so far only, internet knowledge centre on Patient Record Access, which helped to put the issue on the map in a number of countries, and our news page has become one of the leading sources of information on medical and care ICT, with a still growing number of visitors. We had over 133.000 hits just for the month of May which means that every minute 3 items of information are viewed either directly or via an RSS feed.
I am very grateful and happy that we can offer you this year a very interesting and challenging programme, thanks to the help of many. First of all I would like to thank the Westminster Business School for hosting this event. I also would like to specifically thank Denis Carroll and Andy Marsh who have done most of the work for this event, allowing me time to cope with the recovery of my chemo treatment. And I also would like to thank Prof. Bernd Blobel, who for the fifth year has organised a fabulous workshop, which will take place tomorrow.
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25 June 2008 | No Comments »
Categories: Conferences, Speeches
Ladies and gentlemen,
Chris Gibbons asked me to talk to you today about the concept of compunetics. Compunetics started as a kind of a word game for a new international conference in 2004 dealing with health and care from an ICT angle. The word was the contraction of computing and networking. The main reason for organizing this conference was to avoid the reinvention of the wheel by exchanging information and knowledge between the various medicine and care fields.
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2 November 2007 | No Comments »
Categories: Speeches
Empowering the Patient – WHO Recommendation On Patient Record Access
Presentation at the WABT General Assembly, 26 August 2007
slides
26 August 2007 | No Comments »
Categories: Speeches
Medical and Care Compunetics – The Future of Patient-Related ICT
Ladies and gentlemen, dear friends,
Welcome to our fourth event.
Thank you Andy, especially for chairing this session, which normally would have been my job. But as some of you know I’m still recovering from a quite serious chemotherapy and my energy level is not yet back to what it should be.
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11 June 2007 | No Comments »
Categories: 2007, Conferences, Speeches
Technology does not determine society, it embodies it. But nor does society determine technological innovation: it uses it.
Manuel Castells[1]
ICMCC – The Future
Ladies and gentlemen, friends,
Welcome to the third ICMCC Event. An Event different from the previous ones because we are missing one of our key players, Swamy Laxminarayan, scientific chair of the previous two events who passed away last year September.
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10 June 2006 | No Comments »
Categories: 2006, Conferences, Speeches
Medical & Care Compunetics and Patient Safety
Good afternoon ladies and gentlemen,
allow me to thank Prof. Nagel for the invitation to speak here and for the support that we as a young organization receive from the IFMBE from the very beginning, our first conference in 2004. Your presence, together with the IEEE president-elect, the IEEE-SSIT president and the Unesco-WABT president at our 2005 event was very much appreciated. And ICMCC considers it an honor that the IFMBE has granted us an observer membership status.
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25 September 2005 | No Comments »
Categories: Speeches
Towards knowledge societies: Implementation on healthCare – medical and care compunetics: e-health, telemedicine and telecare
Good morning ladies and gentlemen.
First of all I wanted to thank Prof. Tritto for the invitation to speak here.
On his request, the title of my presentation is: “Towards knowledge societies: Implementation on healthCare – medical and care compunetics: e-health, telemedicine and telecare”.
Allow me to first introduce to you ICMCC, the International Council of Medical and Care Compunetics, the foundation of which I have the honour to be the founding president.
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20 September 2005 | No Comments »
Categories: Speeches
Ladies and gentlemen,
Although this is not the official opening of the ICMCC 2005 Event I want to wish you a heartily welcome to our second event. It is a great personally pleasure to me to see that we once again have brought together such an excellent program. I am especially proud of the fact that we host a symposium on Patient Empowerment.
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4 June 2005 | No Comments »
Categories: Conferences, Speeches
Ladies and gentlemen,
In April 2003 the idea was born to start an event that would look at information technological developments in the world of medicine and care in a different way.
And soon we agreed to use a name that would indicate that different way, compunetics. Compunetics, as you will have realized in the meantime, indicates both computing and networking.
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6 June 2004 | No Comments »
Categories: Conferences, Speeches
