e-Health is a Facilitator Not an Alternative to Conventional Healthcare-Time to Prove e-Health Investment is Lucrative than Investment in General Healthcare : Michael Clarke, Director, Information and Communication Technologies for Development (ICT4D) at IDRC,Canada, Malaysia

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Michael Clarke, Director, Information and Communication Technologies for Development (ICT4D) at IDRC, Canada is an internationally renowned figure for his contributions to ICT programmes in development and healthcare sectors.

Clarke received his Ph.D in Parasitology from the University of Guelph, and also studied at York and Stanford Universities. He has held successive academic appointments at the universities of Guelph, Victoria, Western Ontario, and Ottawa. In the past 15 years, Clarke has held senior positions in several ICT programmes in the areas of curriculum development and medical education. As a founder of the Canadian health and clinical medicine journal, Open Medicine, he has done a remarkable service in introducing new thoughts to the healthcare sector.

Jaya Chittoor and Rumi Mallick from CSDMS caught up with Michael Clarke for an exhaustive interview during the eHealth Asia 2007 conference, held during 6-8 February 2007 at Putrajaya International Convention Centre (PICC), Putrajaya, Malaysia. The interaction threw light on a host of issues and focused more on the critical role being michael clarke : director, ICT 4D, IDRC, Canada played by e-Health, in the healthcare sector.

Q Even though lots of development has taken place in the field of medical science, majority of the people in the developing countries still do not have access to quality healthcare. What is your take on this widespread scenario?

A I think universal state subsidized system of healthcare is the answer to this problem. Developing countries should look carefully into privatized healthcare systems. Though efficiencies are to be gained in terms of privatized healthcare systems; efficiencies in terms of accessing specialized forms of care, but that access is not universal. Only those who can pay the steep healthcare costs of privatized care, or are within the health insurance net can access that system, for the vast majority state subsidized healthcare system is the answer.

For example in Canada, we have a legal framework under which the health system operates, and that framework prevents to a large extent the introduction of privatized healthcare. Under the Canada Health Act, there is however some room to manoeuvre and introduce some healthcare services under privatized schemes, but they are very constrained.

Do you think that in a country like India, where the government simply doesn’t have the resources to translate the idea of universal healthcare access into a reality, and where obviously privatized healthcare is beyond the reach of its vast majority, can e-Health serve as an effective bridge to make international standards of healthcare accessible to its underserved people?

I don’t think the application of ICT in healthcare is the solution in itself, as technology-based diagnostic systems can overlook some of the complexities of a typical case. The physician needs to understand not only the biological context, which that patient presents,but also the socio-economic context that the patient brings with him. In my view, direct doctor-patient interaction is of paramount importance to quality healthcare. We should be circumspect about telemedicine applications, as they don’t necessarily include the element of personal touch.

However, at the same time I must add that though not an alternative, e-Health has great potential to emerge as a facilitator to conventional healthcare through the provision of services to locations where conventional systems do not reach. For example, the management and follow-up of the patients through video conferencing is a very wise application of ICT, which can enable doctors to remotely monitor their patients. Internet-based web cam monitoring applications is also there. However,here also there is a catch; the patients concerned need access to these fairly high-end technologies. Then only e-Health will be a reality for them in the true sense.

Do you think ICT can act as an effective interface, where there are no hospitals or healthcare centers? It can link up hospitals and specialists who are not willing to work in the rural areas but at the same time can volunteer some time to respond to queries. And what is the role of paramedical workers like medical practitioners in this regard?

That is a great idea needing careful ution.ICT’s role as an effective interface between doctors and patients can be greatly facilitated through conduits like registered medical practitioners, which you have in India. These paramedical workers may have rudimentary medical knowledge and can deal with only very general cases, but they should be able to communicate what the patient is saying in a language that the doctor at the other geographical end can comprehend.

Physicians will find it difficult, if not impossible, to communicate through, for example, telemedicine videoconferencing, with the patient, without the intervention of registered medical practitioners. Moreover, adequate training and expertise must also be provided to these people who would be handling the technologies to interact with the doctors, on the behalf of the patients, which will help an effective transmission of medical knowledge to the grass roots level. Thus some investment in human resource is necessary to make ICT act as an effective interface. Human element must be maintained, and technology is not the driver, but can be the facilitator of healthcare.

Could you cite some examples of ICTs helping in building capacity and technical skills upgradation of the paramedical workers, which is a continual requirement in the face of fast changing medical and technological scenario?

In the project we are developing in Rwanda, based on a successful experience in Uganda, nurses will be using small PDA devices. These are used to capture patient data on a basic but very effective electronic medical record, which is then submitted over mobile telephone network to central server, where the data can be analyzed. Our role in the project will be to deliver back to these nurses accredited professional education, using the same technology infrastructure PDAs and mobile telephony networks. This will enable them to upgrade their qualification, which in turn will help them to get promoted from one level to the next, and this promotion we hope, will also be reflected in their higher earnings. We are engaged in the development and delivery of certified curriculum from a bonafide nursing training institute in Kigali, the capital of Rwanda-which enables upgradation of the qualification of nurses, without having them to be displaced from their present locations.

Do you think telemedicine can reach out to mass, or would it remain concentrated in the fringe areas? For example,we would also prefer to set up telemedicine centres in places where already some basic health infrastructure is available, and then we would optimize on that infrastructure. That leaves the possibility of setting up telemedicine centers in remote locations,where they are most needed, very bleak. What are your comments on this vicious circle of a situation?

The deployment of networking infrastructure in these remote locations would not happen as quickly as a training programme, instilling basic diagnostic and therapeutic skills. But that doesn’t undermine in any way the role of building up of new skill sets in different players in the delivery of healthcare, which remains a very effective strategy. ICT intervention in healthcare should actually happen through health informatics and health management systems.

Do you think there is a direct correlation between investments in healthcare and economic development?

If you are looking for a return on your investments, there is no better option than to put dollars into healthcare. They would yield multifold in terms of welfare, development and productivity. The returns or rewards from an effective healthcare system, simply results in development.

Is there scope of lots of private investments in e-Health in the near future?

Now the challenge is to show that a dollar invested in e-Health is more rewarding investment than a dollar invested in health in general. We are looking at centralizing specialized healthcare services in different parts of the world; certainly in Canada. We are also looking at regionalization of healthcare and in all these developments ICT can play a major enabling role. Succinctly, we can say that efficiencies that are coming into our healthcare system wouldn’t have happened in the absence of e-Health.The possibilities of investments in e-Health are forthcoming across the globe.

What is your take on our magazine eHealth, which has graduated to being a monthly from a bi-monthly mode from only its second issue?

I would like to see this journal promoted as a medium for publication of primary research in a digestible form that could influence policy makers; essentially providing evidence for informed decision making. Its complementary online presence is also noteworthy and I would be happy to support its outreach to medical fraternity in the Americas.  

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