From eHealth to Open Healthcare Systems

During the last decade the Internet has been used as a tool helping the current health systems to be more efficient and sustainable. We are still in the eHealth era. The new Horizon 2020 program still promotes an area of eHealth for next years. If in previous programs, the focus was in the technology and the professional health institutions, the Horizon2020 begins to talk about citizen-centered eHealth. Accepting that this approach is producing some benefits to the patients (see the current explosion of smartphone applications), the results are still far behind the expectations.

After working several years in a highly respected hospital in Barcelona, trying to apply IT to solve health problems, we can affirm that we need not only new IT but radical changes in the health systems. The new technology has being used in support of an old social system. Like in the education system, you are applying new technologies to learn the old matters, in the old classroom, with the traditional relationship between teachers and students, and so on.

As well as the IT is not revolutionizing the educational system by themselves, you will not see a change in the health system simply by putting ePads in the hands of every doctor or nurse. The result has been quite deceptive.

What we need is to put IT in favor of a deep change of the current health systems. What we have now are hospital-centered closed health systems, with embedded-IT. What we need is citizen-centered open health systems, IT-open. The highly specialized hospital maybe is not the key driver of such new systems.

One way to open the health systems is open its knowledge. Medicine is the traditional knowledge of the chaman-monk-modern physician. This knowledge step by step is in the process of opening. It should be open to every citizen, like the literacy or science was open by the trivium and quadrivium. Internet is helping this process. The traditional role of cure-care of professional doctors and nurses is the process of opening to everyone. This is the sign of our times. It is happening with the knowledge of technologists and engineers. The same will happen with the knowledge of doctors and other professionals.

Wikipedia is the open encyclopedic knowledge to everyone. But still there is a lack of openness in the professional knowledge, like architecture, engineer or doctors. If we want a citizen-driven health system we will provide every citizen from the school a higher level of skills and knowledge about care and cure its own health.

Through appropriated changes in the curriculum, all the schools can teach their students the basic of the medicine science and art. Everyone is responsible of their lives and their health. The current health system is still based in the “illiteracy” of the overwhelming majority of the population about the basics of their own healthcare. The reason is that the healthcare tasks have been provided historically by a very specialized type of professionals, that kept close their knowledge and skills inside their corporate social group. Internet is opening up such tradition.

The generation of new IT-based health models is particularly interesting for the European Union. This continent pioneered in the 20th century a successful model of universal health coverage, considered one of the main pillars of the European Welfare System. The problem is that this system, precisely because of their success, is producing a paradox. More people live longer; more resources are required to sustain the system. 

The question now is: Can we sustain, and even augment, the benefits of a universal system of health avoiding its economic collapse? How can we do it?

Our answer is yes. If the von Hippel from MIT has discovered a current trend to democratize innovation, we see a similar trend to democratize the knowledge of the healthcare professionals: physicians, nurses, pharmaceutical researchers, biomedical professionals, and so on. It doesn’t mean that everyone should be a professional doctor. It means that every citizen in the knowledge era, in the Internet era, should learn the basic knowledge and skills to become responsible of caring and cure their own body and soul. A higher level of responsibility and opening of the healthcare knowledge, with the help of Internet, can produce a new universal and sustainable healthcare system in the 21st century.

Based on these principles, i2CAT's eHealth Area is designing and developing innovative solutions, systems and products focused on individual health based on IT. Using living labs methodologies we are able to define and select those solutions more suitable to match market and user needs as well as designing and adjusting them taking into account different views from stakeholders (users, caregivers, health professionals and managers) needs. Examples of these solutions are Patient Portal, an interactive consulting tool between professional and patients and Carismatic, a mobile launcher where apps can be customized from a third party depending on user lifestyle and health situation. 

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