This is the first in a series of columns that will try to provide answers to that question, by examining the results of a recently completed, landmark Canadian study – The Action For Health Project. When you encounter the health care system in any way, whether it be a visit to the doctor, the hospital, the dentist—or just surfing the net, there are two things that will happen every single time. You will interact with a person and you will interact with technology. Increasingly, this emphasis on technologies has been seen as a way of improving efficiencies into a very expensive health care system while maintaining the core values on which our system in Canada is based.
What are those core values? The Canada Health Act maintains five principles:
- public administration
In other words, we want everyone to have access in the same way, no matter where they live; we want to have coverage maintained when we move anywhere in Canada; we want all of our services insured, not just a few basics; and we want the government to run things. Of course increasingly these values are under fire, and many are beginning to question whether we can even afford to uphold them. But the challenge for all of us is to maintain as many of these values as possible while keeping costs in control. How can that be done? One way is by introducing efficiencies into the system in the form of technology.
But technology has changed dramatically in the past decade. Computers are everywhere, information is increasingly on the world wide web, lab tests are becoming more and more automated, surgery is changing as robotics and monitors replace a person’s hands and eyes…and on and on. CT scans, MRI machines, lasers—these are all terms that have entered into everyday language, but they are things that didn’t even exist a generation ago. How did they get there?
Questions, Questions, and More Questions
Usually when we think of how technology gets introduced we assume that things will somehow be faster, cheaper, or more efficiently done. Is this always the case? What about giving patients the power to have more control over their personal situation by having access to better information, in a form that they understand. Does that happen?
Dr. Balka, who led the Action For Health Project, points out that health care has become increasingly subject to computerization while use of the Internet as a source of health information continues to grow. We know that’s the case, but is that faster, cheaper and more efficient? There are issues around access (not everyone has a computer even though it seems that is the case), and the information still needs to be interpreted (perhaps you trust this web site, but we know that people don’t always believe their sources). Yes, it’s easier, cheaper and faster to put everything on line, but is that producing a two-tiered system of sorts?
Dr. Balka and her colleagues looked at multiple sources of information used by those who responded to a survey. About three quarters were women (who are much more likely to be looking for information for themselves and members of their family), over half had a university degree, and 74% spoke English. All were seeking health care information and about a third planned to visit a doctor regarding the issue or concern that they were investigating.
The investigators found that the top three most trusted sources for health information were doctors (62%), the Internet (24%) and librarians (16%). We sometimes forget just how many people still go online to the library in order to obtain their health information. And when there, they often ask for help regarding where to go and how to navigate the system.
The Internet is not yet a substitute for other forms of information for all Canadians. It is of benefit primarily to those who are affluent, educated, and can articulate their problems clearly so that they find the right answers. But also, surprisingly, librarians have an important role to play. Who ever thought of them as part of the health care system? But they are.
In the following weeks I will be presenting results from the Action for Health Project that tell us how information systems can actually help us. There are interesting lessons for all of us in how researchers have uncovered the introduction and use of technology in the health care system – so stay tuned!