Alejandro Alex R. Jadad, MD DPhil FRCPC

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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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The gap according to me
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• Massive exodus
• Record public unemployment
• Physician unemployment
• ? for health (lt8 B)
• 70 under poverty line

• Massive immigration
• Record employment levels
• Shortage of physicians
• 100 Billion
• 10 under relative poverty line

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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
  worlds 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

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Globalization, equity and uncertainty
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What is the role of eHealth?
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• The richest fifth of the worlds 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

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Mind the (widening) gap!
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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
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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 Ba
hamas 5.1 Chile 4.1 Costa Rica 4.0
Least connected Haiti 0.09 Ecuador 0.15 Hondu
ras 0.33 Paraguay 0.36 Nicaragua 0.42 Boliv
ia 0.43 Guyana 0.43 Guatemala 0.51 Cuba
0.54
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There is also a language gap!
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Mind the (widening) gap!
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Should we be looking at all this differently?
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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
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Can we overcome barriers together?
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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.
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What can (should) we do?
E-mail is no substitute for vaccines, and
satellites cannot provide clean water
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Bypassing bureaucracy
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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
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Creating a mini-model of the world
The Global eHealth Innovation Network
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Toronto An ideal starting point

• Communities from over 170 countries
• Single health care system
• gt 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

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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)

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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)
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Research platform
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A health usability laboratory
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A multi-tasking flexible environment
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Group collaboration

• Tools for research collaboration
• Distance education suite
• Tele-health support

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Living laboratories
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Overall Network Structure
Health knowledge
Simulation Laboratories
eHealth Collaboratory
Living laboratories
Social sciences
Technology
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EGALITÉ!
E Ensuring G Global A Access to L
Links, I Information and T Technology to
promote É Equity in health
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Instant access to information
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With no wires!
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Anywhere!
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Enhancing the relationship!
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Telehealth
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Virtual coaches
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Improving literacy
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Making it fun, when possible!
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Beyond keyboards and mice!
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I hope it is possible!