ATIC in the Press
No wonder BC's
health record system has problems [Letter to the editor]
Sun, February 26, 2010
Krueger, Know it All
Health, March 3, 2009
Communications in Health Care
Krueger, Know it All
Health, December 29, 2008
Health internationally recognized
News, November 27, 2008
Research Used to Help Healthcare Consumers?
Krueger, Know it All
Health, November 25, 2008
Downside to Technology in Health Care?
Krueger, Know it All
Health, November 12, 2008
The Future of
Canadian Health Care
Krueger, Know it All
Health, November 5, 2008
Health Sites - Our Tax Dollars at Work?
Krueger, Know it All
Health, October 7, 2008
Krueger, Know it All
Health, September 24, 2008
Cost Cutting on
Krueger, Know it All
Health, July 29, 2008
Does Your Ethnicity
Affect Your Access to Health Care?
Krueger, Know it All
Health, July 7, 2008
How Best To
Deliver Your Drugs - Man or Machine?
Krueger, Know it All
Health, May 1, 2008
Help You Get Better Health Care?
Krueger, Know it All
Health, April 22, 2008
Bendall, CBC.ca. December 10, 2007
A new niche for a
new university: The creation of distinctive ICT programmes at Simon
Michael Stevenson, SFU President's Speech, presentation to the
International Forum for University Presidents on Information
Communications Technology Education (IFUP-ICT Education), Beijing,
China, October 17, 2005
in Health Care
Thinking, Factulty of Applied Sciences, Simon Fraser University,
University - 2004 President's Report: Multicultural health videos
Fraser University, 2004
with Ellen Balka: Medical technology vs. tacit knowledge
Werden, CJSF Ideas and
Issues. March 31, 2004
health - from the Internet
to the "placebo effect"
taking a close look at technology in health
Haley, The Medical Post. February 17, 2004
focuses on technology
Meadahl, Simon Fraser
January 08, 2004
education research draws $11 million in new SSHRC grants
Fraser University Media and Public Relations. December 8, 2003
Fraser University Media and Public Relations. December 9, 2003
awarded three major grants
Vancouver Sun. December 9, 2003
innovative uses of
technology in health care
Sciences and Humanities Research council of Canada, December 9, 2003
investigator wins major award!
Vancouver Coastal Health Research Institute,
December 9, 2003
Balka honoured with YWCA
Simon Fraser News,
June 25, 2003
Library helps people
access online health info
Balka to study
technology, women's work in health care
Meadahl, Simon Fraser
May 18, 2000
Spinsters take to
Meadahl, Simon Fraser
March 20, 1997
wonder BC's health record system has problems [Letter to the editor]
February 26, 2010
A report by
B.C.'s auditor-general found that little guidance had been provided to
information technology support staff to tell them what security
controls should be implemented.
Providing health care can
involve many people who have a legitimate need to view a patient's
information, and restricting access to it without understanding the
complexities of caring for patients can result in compromises to care.
Perhaps the Campbell government should restore the funding to agencies
such as the Michael Smith Foundation for Health Research so that
research addressing who should have access to health information, under
what circumstances, can continue. Or perhaps the Harper government
should reinstate the funding it withdrew from Health Canada for
projects concerned with the governance of electronic health records.
Professor, School of Communication, Simon Fraser University, and senior
scholar, Michael Smith Foundation for Health Research
© Copyright (c) The Vancouver Sun
HIV/AIDS Information Exchange
March 3, 2009
According to Health Canada there are an
estimated 56,000 people living with HIV/AIDS.
More than 2500 people actually diagnosed in 2006.
Not all live in cities. How these people obtain and exchange
information in rural communities provides some interesting insights on
how these marginalized and still stigmatized people seek information
and use technology.
This Action for Health research was published in The Canadian Journal
of Information and Library Science in 2006. The lead author was Dr
Tiffany Veinot of the University of Western Ontario with help from a
team consisting of Drs Roma Harris, Leslie Bella, Irving Rootman and
To set the scene, the authors outlined their assumptions: that
individuals with HIV/AIDS would go to other people first (as opposed to
going online), that there would be seeking emotional support in
addition to the information they were looking for, and that they
whenever possible they would not go to strangers, such as someone in an
We tend to simplify our ideas about how people obtain help and
information about their disease conditions. So for example, we think of
one person, going online, obtaining what they need for themselves. The
reality is quite a bit more complicated. We know that people often go
online on behalf of others (a mother looking for help for her children,
or perhaps her partner). But people with HIV/AIDS have additional
problems. They want privacy, particularly in rural areas.
They need reassurance, sometimes even to the point of being told no,
you’re not going to die from this flare-up. And they need emotional
support. HIV/AIDS is not a problem that’s going to go away, people live
their entire lives with the diagnosis.
While one might expect that medical experts would play a key role in
the delivery of this kind of information and support, Veinot and her
team found otherwise. They identified social workers and counsellors as
key people—ones that could not only provide the facts but could
empathize deeply. Even friends were not always helpful. Many have a
so-called “cure” or perhaps they are misinformed, motivated by
commercial interests. Good intentions perhaps, but not the kind of help
those with HIV/AIDS need or want.
One of the most interesting aspects of the study was that private
citizens, often people with HIV/AIDS themselves, acted as gatekeepers
in rural areas. One person assumed the role of gathering information,
and then went on to inform others in the community, even their
families. This was the person that was plugged into the Internet,
something researchers term an “information intermediary.” But these
people did much more.
Veinot and her team found that gatekeepers arranged things such as
referrals to medical care. They helped with information about income
support, provided reading material, gave advice on home remedies that
seem to work for specific problems, and even introduced one person with
HIV/AIDS to another. This gatekeeper was a trusted person at the hub
with others like the spokes of a wheel. The authors of this study said
that they act as sources of health literacy for others.
So why would someone assume the role of gatekeeper? The authors suggest
that these people are motivated, good at obtaining useful information,
are organized at maintaining personal libraries, and skilled at
developing networks of useful contacts.
Unlike other forms of health care information which stay relatively
constant, the specialized nature of HIV/AIDS requires a lot of
background information and an ongoing effort to keep up with new
developments. Not even family doctors know the score, the may refer to
a specialist in the disease. This is why AIDS service organizations are
so valued, and the gatekeepers—experts of a sort– used those services
While this system seems to work well, it does not solve all the
problems these individuals face. For example, obtaining information
through this type of gatekeeper network doesn’t help with breaking down
stereotypes about AIDS. People in the community never get educated. The
strengths and weaknesses of this type of social networking have yet to
be well understood, a ripe area for research.
The key issue appears to be able to understand how and why people
develop patterns of information and retrieval through connections with
others, something this research uncovered. Then, building on
those models might help us understand what’s going on which in turn
might improve the lives of the many forgotten people living with this
illness in rural pockets everywhere. Just because these gatekeepers
exist, doesn’t mean that people connected to them are benefiting as
much as they could be. Everyone is a part of a family, has a circle of
friends, and belongs to a community. Only when all are involved will
people living with HIV and AIDS benefit fully—no matter where
What is qualitative research software?
People have long used mathematical type software programs to analyze
numerical data in research studies. But qualitative research which
deals with more descriptive results—for example an interview as is the
case in this study—is a little harder to plug into a computer. But it’s
being done. The software develops patterns, helps researchers
understand themes and concepts, and synthesizes what is going on in the
process under study in ways that would be hard to do by simply reading
and re-reading the material. It can also enhance credibility, as two
researchers go through the same data and come up with the same answers
to research questions.
Questions? Contact Guenther directly at: firstname.lastname@example.org
Communications in Health Care
December 29, 2008
Communications systems are vital in the
life and death dramas that take place in hospitals.
Perhaps the most used are the telephones that staff use to contact
patients along with the call system that helps those in bed get help
when they need it. Like your phone at home these call systems have gone
wireless. But implementing them can be challenging. The story of how
one system was introduced in a large hospital is told by Dr. Casper
Bruun Jensen who was a postdoctoral fellow on the Action for Health
Jensen’s paper which was published in 2006 in Computer Supported
Cooperative Work tells a fascinating tale of just how troublesome it
can be to replace an older telephone system with something that is
supposed to be modern, innovative and do far more. The Rauland
Responder IV system was certainly state of the art, and part of
Jensen’s role as both expert and researcher, was to help staff
understand and incorporate the new system into their busy routines.
That’s the whole point of computer supported cooperative work (CSCW) in
which academics and users work together to understand each other’s
activities and help individuals and groups (such as health care
professionals) implement technology seamlessly.
Of course switching from one system to another was anything but
seamless. To Jensen’s surprise, people working on the hospital ward
where the new phone system was to be implemented couldn’t even agree on
how the old system worked. No one had ever asked nurses what a “green”
call with its distinctive ring meant. As it happens, it meant different
things to different people. Even a little test demo didn’t quite solve
the problem. It was a good thing that the ward was being used as a
pilot study and that the whole hospital wasn’t going to adopt the
confusing new telephones all at once.
So suddenly there were issues. How would a new system that did many
more things be used, when it turns out that even the old system was not
handled in the same way by everyone. In fact, there were certain alarms
incorporated into the system that no one had ever used. Staff were
thrilled to learn that they could finally do without these false alarms
that meant nothing more than a nuisance, not a real emergency or even
We have all encountered the problem of switching from one technology to
another—who hasn’t had to upgrade their computer? It’s always supposed
to be easier, better, faster. But often it’s also problematic. In
health care systems the problems can be much more critical. If your
word processor doesn’t work the way you expect that’s one thing. If a
patient can’t get a nurse that can be far more serious.
This issue of dependability was an important one for Jensen and he
analyzed it in multiple ways. Everyone plays a role in the
implementation of new technology including those that make the product
(the vendors), those that help install and get things up to speed (the
researcher in this case along with information technology specialists)
and the health care professionals (the users). How these people
understand the telephones and how they expect to use them all factor
into the mix. Jensen unraveled it all but the process was not always
very satisfactory. But then again research can be a messy business.
The good news is that people like Jensen analyze processes while
simultaneously helping implement them. That’s the nature of CSCW and
part of the researcher’s special expertise. Hopefully then those people
who need to implement new technologies in the future won’t
have to reinvent the wheel, they can learn from experts like Jensen.
There is no doubt the new wireless telephone system offers advantages.
A few of these pluses were even unanticipated (and not really
approved); for example patients quickly found out they could use the
new phones to call their families.
There might never be a really easy way to move from one system to
another. But new technologies and the systems they replace are a fact
of life. We can only hope that people like Jensen will ease us through
the bumpy transitions.
Questions of comments? email Guenther at email@example.com
ACTION for Health
November 27, 2008
Earlier this year, communication professor
Ellen Balka and her international research team completed a mammoth
four-year project, ACTION for Health, which investigated the challenges
of computerizing the health-services industry.
In October, the project received an Artful Integrators award from
Computer Professionals for Social Responsibility. The award recognizes
outstanding achievement in the area of participatory design for
information and communications technologies as well as the research
team’s continuity and commitment, and the range of its participants and
Among the project’s many initiatives were a study of B.C.’s Healthguide
website; a collaboration with a major Vancouver hospital to introduce a
new process for implementing technology; and a pilot project with a
community health centre to learn how patients search for online health
Project outcomes included two books, hundreds of published papers and
numerous meetings to discuss findings with health-services
decision-makers across the country. While both technology and the
health-services environment changed significantly over the project’s
term, Balka says high information-technology (IT) failure rates in the
health sector remain all too common.
"Hopefully, we’ve explained why some of these failures exist and where
expenditures may be appropriate beyond hardware and software," Balka
says. "We are confident that highlighting the extent to which social
and political contexts play a role in healthcare IT will improve the
success of future implementations."
More kudos came this month at the Bi-Annual Computer Supported
Cooperative Work Conference, which awarded Balka and colleagues
Pernille Bjorn (a former SFU post-doctoral fellow) and Ina Wagner of
the Vienna University of Technology a best-paper award for "Steps
Toward a Typology for Health Informatics". The paper drew on
ethnographic case studies, conducted in six health-care settings in two
countries, which identified possible sources of variation in
health-care work practices that can affect IT systems implementation.
ACTION for Health was funded by the Social Sciences and Humanities
Research Council of Canada through the Initiative for a New Economy
Collaborative Research Imitative funding program.
How is Research Used to
Help Healthcare Consumers?
November 25, 2008
Just what happens to research findings
- how are people kept informed?
The Action for Health Project was a large research project that
included many aspects of health care and technology including things
such as the way people seek and use health information, how technology
impacts people and settings, and how communities are affected by the
implementation of an electronic patient record system—to name but a
There are a number of things Dr. Ellen Balka, the principle
investigator of the project attempted to do once individual projects
were finished and findings established. All researchers attempt to
disseminate their findings in a number of ways. One is to try to reach
a wide audience such as this column series. But the gold standard for
research dissemination is publication in a scholarly publication and of
course this was done whenever possible.
The reason that this avenue of publication is so important is because
it is subject to peer review. This means that other experts in the
field read and approve the findings before they are published,
something that adds to the strength and credibility of the findings by
placing them under the scrutiny of experts. Usually these experts in
the field make suggestions and comments that must then be incorporated
into the final document so that the published article is credible and
valid. This is an important way in which our understanding of research
outcomes—in this case the impact of technology on the health care
system including professionals and lay users—is advanced.
However there are other ways in which research findings are
communicated. An important component is presentations at conferences
and meetings. These are numerous, varied and often international with
key players in a certain discipline coming together to present the
results of research in a common field (although things are becoming
increasingly interdisciplinary). Experts present their findings in
short presentations followed by discussion so that interested audience
members can ask questions and follow up on key areas. At these
conferences the opportunity to meet and talk to other researchers is
invaluable, and many ideas and concepts have originated in these
informal types of hallway interactions. Conference proceedings are
often published so that a permanent record is made available and people
can find out what was said and who said it, but there is still
something to be said for face to face meetings.
Research findings also find their way into practice guidelines. These
are designed to help those working in the field (for example nurses,
doctors and other health care professionals) make better decisions, or
perhaps improve their diagnostic abilities or manage their treatment o
fpatients in a more expert manner. The Action for Health project
explored areas of health information seeking as was mentioned, but also
did so in the context of rural women’s needs, those with HIV and AIDS,
as well as specific concerns of young people. Hopefully, these findings
would then benefit those people who are involved with these target
groups and situations. Everyone is always striving towards better and
more effective health care.
Specific practice guidelines were developed by research associate
Corlann Bush who developed clear and concise good practice guides. For
example, one of these guides dealt with what made for an effective
health care website and was based on findings from others in the
project. This is yet another example of research dissemination in which
results from numerous projects become synthesized into one overall
One other important way that research becomes situated in the real
world is through the development of policy. These are plans that help
people make decisions, whether it be government, users,
manufacturers—in fact almost everyone. Any organization will have and
use policies, and health care is no exception. Policies are based on
evidence, and evidence comes from research. There always has to be a
rationale in order for everyone to accept what it is they have to do.
Policies are not the law of the land but do form a framework on which
to conduct daily activities.
An emerging issue related to all of this is the new field of knowledge
translation. There is always a difference between what is known through
the research process, sometimes also referred to as research evidence,
and what is done in the real world. The process by which research
findings reach their way into actual behavioural change in terms of how
people do things or understand them is a fascinating trajectory and one
that is being examined more closely all the time. The fact that we know
something to be true based on clinical knowledge does not always change
health outcomes. Gaps remain.
In the real world, research findings would quickly and efficiently find
their way into improved health care outcomes so that you and I could
benefit. Of course the real world is not like that. Nevertheless, all
researchers take it upon themselves to move knowledge forward, even if
it’s in smaller steps than they would like.
What’s the Downside to
Technology in Health Care?
November 12, 2008
Throughout this series the introduction
of technology into the health care system has been framed as something
positive, with benefits for patients, health care providers and perhaps
even a potential for saving money. But technology can also contribute
to adverse medical events and is even the cause of accidental deaths.
The issue of patient safety exploded into public consciousness in the
United States with the 1999 publication of the book To Err is Human.
Not only were thousands of people dying unnecessarily each year due to
mistakes within hospitals and clinics, but no one really knew what was
going on and what the actual numbers were. Dr. Ellen Balka, the
principal investigator in the Action for Health Project has had a
long-standing interest in the new healthcare discipline of patient
safety, which looks at the reporting and prevention of medical errors.
Balka and Doyle-Waters point out that Canada—as elsewhere—does not have
good processes to gather information about these problems. We don’t
even really know what’s going on.
Balka, along with Information Specialist Madeleine Doyle-Waters,
examined issues in technology and patient safety in an article
published in the International Journal of Medical Informatics in 2007.
They developed this argument, namely that something that was developed
to reduce error can actually result in the opposite effect. There are
many reasons for this, some obvious, some not.
So what causes health care errors? Human error obviously. People are
inadequately trained, inexperienced, tired, in an unfamiliar setting,
or perhaps they just don’t admit they did something wrong.
Technological problems however do not occur in isolation. They are part
of the larger landscape and culture of systems which can of course go
off beam for many and varied reasons. Balka and her colleagues argue
that it’s unfair to automatically blame users. If the equipment itself
is faulty or outdated, there may be other factors at play.
Technology is a wide-reaching area of concern. It does not just refer
to medical devices, although these are obviously of concern to
patients. High risk devices such as anesthesia units and infusion pumps
are carefully controlled by regulatory agencies because failures are so
frightening. But technology also incorporates electronic medical
records, drug dispensing systems, and even Internet usage, seemingly
benign systems that can actually start the process of introducing
errors can causing something terrible to happen.
A number of potential sources of error have been identified with
corresponding responsibilities. For example the manufacturer may be at
fault with unclear labeling or packaging, inadequate instructions or a
poor manual accompanying the device—like those cryptic Ikea
instructions. The person selling the product may not offer proper
support or evaluation of how the technology is going to be implemented.
The user may operate the product improperly and might even re-use
things incorrectly. For example, some medical devices can be used over
and over again but must be properly sterilized in between patients.
Another way of looking at the problem of medical device failure is to
divide it into five categories: device errors, user errors, external
factors, support system failures, and errors related to tampering and
sabotage—a truly disturbing thought. There are many ways in which
things can go wrong, and it’s really a systems issue, argue Balka and
her colleagues. Mistakes do not occur in isolation and there are
usually multiple steps involved in a scenario where a patient is harmed
or killed by errors. So for example, what appeared to be a device
failure may really relate to poor communication among staff, unclear
channels of authority, or the impression that someone else has taken
responsibility for something.
One of the first things that could be done is to better standardize
reporting and make sure it’s done properly and by everyone. We also
need to take a systems approach and look at all aspects of device
errors to see what can be improved. Who makes the decisions, who has
the power to do so, and what processes are part of management and
leadership are all areas of concern. These issues all relate to what
Balka and Coyle-Waters refer to as governance and it is these processes
that need to be examined. It’s not just one technology and one user
making a mistake.
The bottom line is that it’s not the people that are at fault—everyone
makes mistakes. It’s really a case of bad systems. Once again,
researchers are going to be needed to see what can be done to improve
Future of Canadian Health Care
November 5, 2008
How far have we come since the Romanow
Report - and how far do we have to go?
Six years ago the Canadian government released the Romanow report which
made recommendations on the future of health care in Canada—a perennial
priority issue for almost everyone. This report also formed a partial
basis for the Action for Health Project. Dr Ellen Balka, the principal
investigator for the research quoted the report in her proposal stating
that “leading-edge information, technology assessment and research are
essential foundations for all of the reforms outlined.”
Kjetil Rodje, a research assistant with the project along with Corlann
Gee Bush, a research associate, examined aspects of the report in
relation to these views on information technology and health. They
described how Canada’s unique national infrastructure has contributed
to the development of a certain type of information technology but
added that the use and development of these potential tools have not
been studied or examined in any great detail. In their article,
published in the Canadian Journal of Communication last year they
suggest that the call to “think outside the box”—something suggested in
the report— is “heard but not answered.”
Most Canadians have long forgotten about the Romanow report, more
properly termed the Royal Commission on the Future of Health Care in
Canada. In fact, the entire debate about health care seems to have been
sidelined in this election year as more pressing problems of
environmental concerns and economic uncertainty dominate every party’s
But the issues addressed in the report and the technology issues
researched by the Action for Health team are as relevant today as ever.
Some might even argue they are becoming more urgent by the day as the
landscape of health care in Canada changes. Take for example the
announcement recently of 130 for-profit clinics currently operational,
offering everything from MRI scans to surgical procedures.
The parallel private debate is certainly not new and constitutes a
problem that won’t be solved easily. Here too technology plays a role,
as for-profit clinics offer the latest and best in equipment and the
publicly funded sectors make do with what’s available, outdated or not.
However, the way technology factors into solving the wait times and
access issues and the lack of enough doctors and nurses in the system
is a little more elusive.
Perhaps what’s needed is a different perspective. The Romanow report
focused on the core system, hospitals, emergency rooms, surgical
procedures. But technology can help in many aspects of the health
system, including prevention initiatives, the development of public
health policy, areas that are currently peripheral or marginal such as
palliative care. We sometimes forget that the health care system is not
just about intervention when someone becomes ill.
Reform will have to address some pretty fundamental and philosophical
concerns, issues that go well beyond whether to use technology in a
given situation or how to implement something that may save money in
the long run. We need to ask ourselves whether continually spending
more money on the system translates into better health care for
everyone. And with an aging population making increased demands on
every part of the health care budget, the counter argument for just
spending more is that eventually the money just won’t be there. After
all, those aging boomers are using the system but no longer
contributing towards it in the form of tax dollars. Technology is part
of this too, as equipment becomes more and more expensive. CT scanners
and MRI machines, now a standard part of care, cost between one and two
million dollars apiece.
When people die they no longer cost anything, a crass way of looking at
health care economics. But the very technology that is helping people
live longer is also driving up costs. And everyone wants the gold
standard in procedures, and why not? Add to that increased salaries for
everyone from housekeeping staff to cardiac surgeons and the problems
only seem to be escalating.
The role of technology as a way to save costs and increase efficiency
doesn’t really address these big picture issues.
Researchers Rodje and Bush point to the recommendation in the Romanow
report that an institute be formed to evaluate the implementation and
use of technologies in the health care system. This would work at arm’s
length and provide policy makers, funders, and health care
professionals with the information they need in order to make informed
decisions about when and how to move forward with technological
solutions. But they add that this would add another dimension to the
health care debate, namely, what are the wider implications of such a
structure? Would it translate into better care for individuals? Would
citizens be better served and perhaps more empowered to help themselves
These are questions that everyone in Western systems is asking.
Researchers will continue to play a role in attempting to find answers.
The Action for Health project began the process but it will be up to
others to continue it.
Gov’t Health Sites - Our
Tax Dollars at Work?
October 7, 2008
Are we getting the best bang for our
buck by using the Health Information Highway?
One of the consistent themes of this series has been how researchers
are determining whether health information technology is producing
results and, stepping back even further, how to go about trying to
answer that question.
Dr. Judith A. Krajnak worked on the Action for Health project as a
postdoctoral fellow unraveling this complex story. She identified the
problem this way: while almost two billion dollars have been spent in
the development of online health services in Canada, hardly any money
has been spent monitoring whether this investment is achieving desired
results. Are people in a wired world more knowledgeable about their
health concerns? And perhaps even more elusive is determining whether
they are actually healthier in the long run by acquiring this type of
Web sites with health information abound. The problem is that
“official” sites such as those sponsored by governments may not be
developed with consumers in mind, exactly the problem defined by
Kajnak. For example try finding answers to your health care questions
on the Public Health Agency of Canada site. Not only is the page
boring, but it’s also confusing and hard to search. No wonder most
people just use Google.
Krajnak developed a very interesting sequence of questions to better
understand users’ experiences with online information. She began with
awareness (do people know what’s available) followed by a determination
of accessibility and satisfaction. We’ve certainly all had the
experience of searching for something and not coming up with anything
remotely resembling what we’re looking for. But let’s assume we hit the
nail on the head. Does this then contribute to a better understanding?
More importantly will consumers make more informed decisions about what
to do once they have found valuable health information online? Perhaps,
but they’re not the only ones affected.
The most likely scenario is that people will read up on their
condition, disease, or problem and then discuss it with a health care
professional, perhaps a family doctor. While physicians purport to want
their patients well informed and ready to assume responsibility for
their own care, they are also frustrated by cyberchondriacs—those
people enjoying poor health and finding lots of evidence that there is
plenty wrong with their bodies and minds. Family doctors dread these
people coming in with reams of downloads and print-outs, all of which
they want to share. Worse yet, they might challenge the physician’s
Krajnak found many interesting themes on what people are up to online
in terms of looking for health care answers. For example, people are
divided on whether drug advertising is a good source of information.
Others like what they read on certain sites but are unaware that it is
actually sponsored by a drug company. Or, perhaps, they get up to speed
on what they think is wrong with them but don’t admit this to a
physician, but then weave it into the conversation with “I’ve heard
This then led Krajnak to introduce the question of whether access to
information affects the patient-provider interaction. As we’ve already
seen, problems can arise, but there are also opportunities for good
collaboration. In the best of all worlds patients are well informed and
physicians are satisfied that they are learning to help themselves and
manage their illness. Governments are happy because people don’t go to
the doctor or emergency room unnecessarily and costs are reduced.
Of course this ideal has yet to be achieved, but it’s a laudable goal.
Krajnak points out problems that still exist. In a society that
purports to provide equitable access we need to be careful to be
inclusive. The Internet is not a substitute for other forms of
information. Nothing beats good dialogue with an expert. Then there are
those who cannot speak the language, those who are elderly or have no
computer skills, and those in remote areas with no online access might
be left out. Even when people have access to public libraries, they
might be concerned about looking up private medical matters with
someone behind them waiting to use the terminal.
There are other lessons to be learned about consumers’ use of online
health information services according to Krajnak. Users’ experiences
need to be considered or the sites simply won’t be used. How people
respond and use sites should be considered before implementation, not
tacked on as an afterthought. Professionals developing sites do not
necessarily understand how the general public behaves.
Online health information is clearly here to stay. Determining how web
sites are used and evaluating their efficacy not only for individuals
but for large groups and even entire populations will remain a research
challenge for a long time to come.
Waiting Times In Emergency
September 24, 2008
Can They Be Improved?
One of the most controversial hot-button issues in the health care
system is waiting times in an emergency department. Everyone seems to
agree that sick people spend too long before someone sees them, but
determining how to streamline the system and facilitate better patient
care is a task that even professional researchers find daunting.
Someone who is trying to make a difference in how quickly people are
seen is Dr. Pernille Bjorn, who worked with the Action for Health
project as a postdoctoral fellow. Dr. Bjorn’s background is in
computing science within a health care environment and she spent time
examining what happens when children arrive in the emergency department
at the British Columbia Children’s Hospital in Vancouver.
Like hospitals around the world, Children’s hospital uses a way of
prioritizing patients called triage, a way of assigning degrees of
urgency to patients for the purposes of deciding who will be seen
immediately, and who can wait a bit before busy hospital staff can
examine them. It’s a system that developed in the battlefield when
something needed to be done to determine which wounded soldiers needed
attention the most.
How this translates into a busy modern emergency department is
surprisingly complicated. Dr. Bjorn was interested in whether
technology might assist the nurses who undertake the task of doing
triage work. It’s a fascinating area, since the task of triage is
anything but simple. Experienced nurses go through many steps to
determine what’s wrong with a small child who is often unable to
articulate exactly what they are experiencing. There is a type of
disconnect between the way a human being solves problems—a nurse using
all her senses to make decisions, and incorporating experience and ways
of making inferences—versus a computer that can process large
amounts of information but really can’t consider and reflect on what is
going on. The nurse can use the art and science of decision making, the
computer can just…well it can really just compute. So how can the two
work together? Maybe by using the strengths of each in tandem.
Nurses may be skillful, but things can get messy. A pile of charts with
post-it notes may not be the best way to work. Let’s face it, people
can be sloppy, those little notes can fall on the floor (which actually
happened as Dr. Bjorn was watching), and people make mistakes and have
lapses in judgment. So the question became, can one combine the best of
Dr. Bjorn began with a phone call to other children’s hospitals across
the country to determine who was doing what. While everyone
was using some form of information technology (IT) in their emergency
departments, there were a range of systems, no single one that was
commonly used. The ones that seemed to be the most suitable also
allowed everyone to see what was going on through the use of more
low-tech devices such as a whiteboard, something everyone could glance
at and see.
The challenge for researchers like Dr. Bjorn is attempting to
understand how a complex human activity such as becoming an expert
triage nurse, can be translated into the rules and protocols. Hopefully
these can then be somehow incorporated into software design that
further helps those same people making all the decisions. Obviously if
the system were perfect using only flesh-and-blood nurses, no
technology would be needed. But as we have seen throughout this series,
hospital administrators are constantly fighting the forces of increased
emergency department usage, higher expectations, and the need for cost
containment. The nurses need help.
Experts such as Dr. Bjorn have a unique set of skills that they bring
to this type of task. With a background in computing science, she was
able to understand some of the software problems involved. And, as a
researcher, she was able to design ways to observe the interactions
that occurred in a real-life situation as parents came into the
emergency department with their children and interacted with an expert
triage nurse. She was then also able to see how those nurses used the
hardware and software to make decisions, change the work practices
accordingly, and then use her observations and conversations with staff
to tweak and adjust things. One of the things that became very apparent
to her was that any implementation of an electronic triage system
requires extensive customization. In one hospital in Canada this has
been going on for years and is still not perfected.
The system is far from perfect and still evolving, but there are
elements that have improved. One of the interesting spin-offs was the
working relationship that evolved as a researcher came in to observe
what was going on. Busy hospital staff could easily have become
non-cooperative as they felt judged and evaluated. However, what
actually happened was a spirit of collaboration as everyone pulled
together to solve common problems.
Cutting on Hospital Services
July 29, 2008
As hospital budgets become ever more squeezed, administrators and
policy makers are increasingly looking for ways to achieve more
efficient and less expensive means to keep things running. Housekeeping
services are an interesting component of health care. When things
function well, no one notices. When the place is dirty, suddenly
everyone is complaining. This invisibility extends to the workers as
well, often poorly paid immigrants cleaning up bodily fluids and worse,
with little say and a clear place at the bottom of the health care
worker hierarchy. And, perhaps most importantly, they are mostly women.
As part of the Action for Health Project, Nicki
Kahnamoui looked at how cleaning services were outsourced in
one of Canada’s largest health care facilities. Kahnamoui took all of
this into account as she spoke with not only the people busy mopping
but also others within the hospital. She thinks that outsourcing—and as
we know it’s certainly not just happening in health care—can create as
many problems as it solves. But perhaps the most distressing concern is
that by undermining the value of cleaning work and its contribution to
overall patient care, there is an artificial divide that occurs, where
cleaners are no longer part of the team. They come and go all over the
building, never being in one place long enough to get to know the
staff, the patients, or the routines.
Housekeeping services are more than just esthetics. Infections can (and
do) become life-threatening, and a dirty environment is dangerous, to
say nothing of demoralizing. Privatizing this important component may
reduce costs as people are forced into situations with much lower
salaries. They operate at the beck and call of a centralized
administration system and perhaps that is more efficient. But a
hospital is not a factory plant, where one assembly line can become
replaced by another. Hospitals are not in the business of making cars,
they are in the business of patient care. Kahnamoui finds
that privatization of cleaning services, as one of the
components of patient care, has the potential to impact the functioning
of the whole system. And hospitals are more than the sum of its parts
as she so eloquently puts it.
Cost savings are achieved by paying people less (a lot less). Whether
that’s what we want in our society is perhaps a bigger question than
even Kahnamoui can answer. She does outline a long and impressive list
of reasons why this is happening. Right wing ideologies, international
policies that are impacting everyone (think globalization), and the
separation of distribution and production. Everyone it seems wants less
government involvement, more productivity, more fiscal accountability,
less expensive services. That’s all fine, but there are other costs,
harder to quantify.
As a result of outsourcing, there is now minimal direct communication
among the nursing staff and housekeeping. In the new privatized system
a call is made to a central agency that pages the cleaner. The system
itself doesn’t always work as calls remain unanswered, nurses are
placed on hold, and perhaps end up just doing the task themselves
because it’s easier and faster. Even when someone appears, it’s not
necessarily someone that’s been there before, since people are no
longer part of the ward team where they can learn the routines, get to
know people, interact with patients and staff and generally
improve the team effort of helping people become well again.
This fragmentation has a human cost as well. Nurses don’t like having
to deal with a supervisor rather than the person standing in front of
them. They feel sorry for the underpaid, overworked cleaning staff, who
are of course mostly female doing work that many of us would shun. And
the workers themselves resent being treated as stupid automatons,
arriving like a robot with a broom ready to sweep up. It is simply
assumed by everyone that you don’t need any intelligence to scrub
toilets. Their place on the bottom rung of the hospital hierarchy is
assumed. And it’s even easier to do now that you don’t really know the
person anyway. It’s a different one every day. Their work is invisible
and they themselves are invisible.
In a complex hospital system where things never quite go according to
plan—let’s face it, sick people are unpredictable—Kahnamoui argues that
more flexibility and a softening of the rigid boundaries on who does
what, when, and for how long could go a long way towards meeting
everyone’s needs. Everyone needs to feel valued and respected for the
part they play in health care. But more importantly, it’s just common
sense that a safe, hygienic environment where good communication among
all team members is the norm would go a long way towards patient care.
It really is what patients want and deserve.
Note: The Action for Health project was run within a team created by Dr
Ellen Balka in order to facilitate research in many different areas.
Working within that group was research assistant Nicki Kahnamoui who
developed her master’s degree thesis looking at how cleaning services
were outsourced in one of Canada’s largest health care facilities.
Your Ethnicity Affect Your Access to Health Care?
July 7, 2008
Like it or not, our cultural
backgrounds play a not insignificant role in our access to health care.
The Action for Health project focused on technology, but also examined
other issues impacting health care delivery. One of the most important
of these is the relationship of ethnic groups and health status.
Research assistant and doctoral candidate Kjetil Rodje spent time
unraveling the complexities of defining ethnicity and why it is such a
challenge to undertake research involving diverse ethnic groups and
their access to and utilization of health services. Why are they so
often disadvantaged and what can be done about it?
You might be surprised to learn that when immigrants arrive in Canada
(and many of these factors are true in any country) they are generally
healthy, even more so than the general population, but this advantage
is lost over time. Perhaps it is because of unhealthy lifestyle
choices, but it may also be that they are disadvantaged in society
because of their lower income and worse living conditions. This then
compounds the stress they face in struggling to integrate and adapt.
But the situation may become worse. Immigrants from different cultures
may interpret their health concerns differently causing communication
problems even beyond the obvious language issues. They may be
intimidated by services designed for the mainstream, and they may have
little concept of preventative programs or even know about them.
Researchers addressing these problems begin with a huge stumbling
block—what exactly constitutes race and ethnicity? They are not the
same thing. Ethnicity is a category used to explain a sense of cultural
belonging and identity, but race is a category used to explain genetic
characteristics and other biological factors. Nevertheless, even
researchers confuse the two.
One of the things we do instinctively is to begin with a standard
(white—us) and define everyone else in relation to that
(nonwhite-them). The problem is that even this Caucasian white standard
group doesn’t really exist. So we have the added dilemma of defining
something in relation to something else that is all pretty subjective.
What exactly is a “white” skin tone? Just where would you place Barack
Obama on a colour scale? To a white person he’s dark. To an African he
might be white. Even the terms are loaded. Some have criticized the
terms Caucasian and white as racist.
Different categories exist to try to standardize ethnic groups. But
even that becomes messy. For example, in the United States one might
think of people who come from a European ancestry as constituting a
distinct grouping. But there is also a clearly defined
Hispanic American group that we hear so much about as they eclipse
African Americans in size and clout. But wait a minute—isn’t Spain in
Europe? Why is it the only one singled out of the European Diaspora
In addition to accurately defining someone’s ethnicity there may also
be confounding effects of confusing this with socio-economic status
(SES). We know that low SES is a strong correlate of poor health so
perhaps it’s just that ethnic minorities are generally not as well off.
But even that doesn’t match the evidence. There do appear to be two
separate issues. When health outcomes are examined and SES is taken
into account, ethnicity still plays a role. Ethnicity must be addressed
one way or another if we are to give everyone the same services.
There are four approaches that have been suggested to consider
ethnicity in relation to health services. The first is to encourage
people in these groups to adapt and assimilate into the established
system. Then it’s just a matter of getting the right information to the
right people, perhaps in their own language and through their local
cultural channels. But this really downloads everything onto the people
themselves and some might call it grossly unfair.
The second thing we could do is to assume that everyone has needs and
problems that must be addressed, regardless of their race or ethnicity.
We do our best to simply make sure everyone is included. But this
returns us to the “Caucasian white” as the gold standard approach.
Everyone else runs the risk of getting care and health care services
that relate to that. Again, it might not be just.
The third suggestion is to target every specific group. We do this
already in providing services for those with HIV or groups that are
more likely to engage in risky behaviour such as smoking. It sounds
like it could work but it’s a very top-down approach. And of course it
might exacerbate discrimination as everyone is forced to define that
elusive categorization problem. If you can’t define the group, you
can’t target the services
The final approach is diversity. The system is open, flexible, and
allows for multiple ways to meet health care needs and services.
Individual groups have input and policymakers determine what everyone
needs. The problem? It’s very, very expensive to offer this much
training of personnel, response to feedback from consumers, provision
of technical resources that are flexible, and on and on.
Whatever we decide however, needs some thought. Increasing
multiculturalism is a global trend as people move, merge, and
incorporate into existing societies. Whether it’s Asians in Canada,
Hispanics in the United States, or Turks in Germany, the health care
system must evolve to includes these people not because it’s the right
thing to do but because it’s the only practical solution for everyone.
How Best To Deliver Your
Drugs - Man or Machine?
May 1, 2008
Medications are expensive, so
introducing a machine that could improve inventory and reduce errors,
in addition to saving nurses and pharmacists time should be a good
Hospitals – they can swallow your time whole. Anybody who has ever been
to a hospital emergency knows what I mean. But it’s not just getting
seen that takes time, just about every facet of hospital care is
lengthy, and increasingly costly. Needless to say, new tools and
technologies are being investigated to try an improve efficiency within
the hospital setting.
In 2003, researchers in Vancouver, Canada, set out to find out whether
a new automatic drug dispensing system introduced into a new building
within Vancouver General Hospital (VGH) was actually delivering on the
promise of saving time for busy nurses and pharmacists as well as
improving drug inventory control and decreasing errors.
The automatic drug dispensing system (ADS) introduced into the VGH
system was designed to replace traditional medicine carts. It is an
automated cabinet with a monitor and keyboard and secure storage spaces
for patients’ medication. These machines look and feel a bit like
mobile automated teller machines, the ones you use to do your banking
and get cash. It is part of a larger trend towards streamlining the
entire drug dispensing and delivery system, which is an important
activity within hospital settings.
The researchers decided that the best way to find out how these
machines were being used was to follow the nurses, observe, and make
notes on what they were seeing. But they also wanted to make sure that
nurses could talk to them about any problems they were encountering. So
two of the researchers on site wore T-shirts that said “Technology
Trouble? Talk to Us!”
Problems immediately became evident, specifically in terms of who does
what. Pharmacists delivered intravenous solutions but were too busy to
put them into the refrigerator. The task was left to nurses who then
had to log into the system to get into the refrigerator, which is part
of the whole dispensing unit. Drug inventories had to be verified in
new ways using the new system and far from being easier, now took a
whole lot longer. When problems occurred—for example a discrepancy
between what was supposed to be in the cart and what was actually
there—a report needed to be filed. But the reports weren’t always
picked up by someone from pharmacy. In fact no one was quite sure how
the whole reporting process was supposed to work.
When people don’t use the technology the way it’s intended, it is
termed a “work around.” By observing professionals using the ADS in
ways that hinder, rather than help them get their work done,
researchers are able to give feedback on the processes and help
streamline and implement changes. While the overall objective of
providing nurses and pharmacists with systems that make their lives
easier, working out the bugs and the details in those systems can be a
There is a larger lesson to be learned from all this. Hospitals are not
only worlds of their own, they also consist of jurisdictions and groups
of professionals all with turf, boundaries, and power structures.
Planning and implementation has to involve everyone—easier said than
done as everyone scrambles to make sure that ill patients are looked
And what about saving nurses and pharmacists time and reducing
medication errors? The results are mixed. The equipment is expensive,
and cost saving projections are complicated and must be projected over
a long time period in order to determine whether the capital outlay is
worthwhile. In terms of a reduction in errors the results may also be
inconclusive. No technology is helpful if the medication was given at
the wrong time or the wrong dose. Human beings must still make
decisions and remember to carry things out properly.
Can Technology Help You Get
Better Health Care?
April 22, 2008
Since 1997 almost two billion dollars
have been invested in the Canadian Health Information Highway. Has it
been money well spent?
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
What are those core values? The Canada Health Act maintains five
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.
- public administration
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!
numbers are Googling their aches and pains
By Lisa Bendall
The author is a Toronto-based freelance writer.
December 10, 2007
Over the past few years, Rosemary Renton has
diagnosed her own infections and rashes. She's figured out how to treat
her little boy's eczema. She's analyzed his stool. When her friends
come to her with symptoms, she tells them what's wrong.
Renton isn't a doctor. Not even close — she's a school librarian in
But Renton knows her way around a computer mouse, and says she's
mastered the art of online medical fact-finding. "I diagnose myself all
the time. I'm always right."
Well, almost always.
Even a web M.D. can have an off day. When Renton was pregnant and a
doctor said her blood pressure was seriously spiking, she spent hours
glued to her computer screen, researching the symptom — and sobbing
because she thought her days were numbered.
"It absolutely devastated me," she admits. "I didn't realize that blood
pressure can be huge when you're pregnant. You really can die from it,
and your baby can die."
It turned out all was well. But Renton agrees that it's easy to get
carried away when you're armed with a modem and an imagination.
"You start planning your own funeral," she chuckles.
"Information is one thing, and knowledge and perspective is another,"
notes Larry Reynolds, a family physician in Winnipeg who sees more and
more patients coming into his office with printouts. "Sometimes you can
be too close to your own symptoms. And if you don't have training as a
health care provider, you don't have a sense of what's common and
Well over half of online Canadians — 58 per cent — search the internet
for health information from home, up from 46 per cent five years ago,
according to Statistics Canada.
Part of that rise may be due to the fact that these days, it's a long
wait to see a medical specialist. Five million of us don't even have
access to a family physician. By using the internet, we can instantly
get our hands on medical information, symptom checklists, discussion
groups, even pseudo-scientific studies and cure-all products.
"There's a huge volume of information," says Ellen Balka, principal
investigator of Action for Health, a B.C. research group that studies
how Canadians use online health data.
While it would be nice to think that we're mostly sussing out the
benefits of Pilates or the best sources of vitamin D, that isn't
happening. Balka says it seems most of us are checking symptoms and
looking up treatments.
"We tend to go online after health crises," she says.
So many folks are now Googling their aches and pains that this group
has been dubbed cyberchondriacs.
"Patients have always looked at medical textbooks," says Reynolds.
"Everybody tries to diagnose their problem. That's just part of being
The internet just cranks it up by offering easy access to huge volumes
Mary, a health educator who'd rather not 'fess up to her last name,
says she constantly investigates her symptoms online. "I've been a
hypochondriac for many years," she admits.
When she fell in love, Mary researched her heart palpitations. When she
suddenly started having migraines, she looked up brain tumours. "
"Most of the time I live under the understanding that I'm dying, I just
haven't been diagnosed," she adds wryly.
"Checking the internet is a means of seeking reassurance," explains
Gordon Asmundson, a University of Regina psychologist and co-author of
It's Not All in Your Head: How Worrying about Your Health Could Be
Making You Sick — And What You Can Do About It. "For some people, they
check everything, and they need to check it excessively."
Unfortunately, he says, medical websites often provide anything but
reassurance. "They expose a person to a lot of alarming information
about rare and lethal conditions. So people get trapped in this cycle."
Mary calls online checking a "fix" and says it only feeds her paranoia.
"Ninety-nine per cent of me knows it's in my head. But one per cent
says maybe I do have cancer."
Most of the time, suffering anxiety about a nonexistent medical
condition is about the worst that can happen to the middling
cyberchondriac. That is, until she's tempted to actually treat the
"Now you can buy pharmaceuticals and other things on the web without
prescriptions. That can lead to unfortunate effects," points out
And once in a while, a self-diagnosis can shroud something more
serious. If you shrug off the symptoms of bowel cancer as nothing but
hemorrhoids after researching it on the internet, you may be postponing
the medical attention you urgently need.
The bottom line: click responsibly.
"Overall, the internet is an enormous potential benefit for doctors and
patients," says Reynolds. "It means doctors can access the most
up-to-date information when treating patients. And I can't think of a
doctor who doesn't want a well-informed patient."
So how to do it right?
"Go to a library. Spend some time with a health librarian who can
provide support," says Balka. "Most of us need help figuring out what
is relevant. That assistance can range from finding more appropriate
ways to conduct searches, to assessing the quality of information
Or you can simply copy Renton's new strategy. When she wants to check
serious symptoms — the ones she's convinced are a harbinger of some
fatal disease — she puts her husband in front of the computer.
"I tell him what to Google, and have him read the prognosis and get
back to me," she says.
Renton, meanwhile, waits in the next room. Where there's no high-speed
A new niche for a new
university: The creation of distinctive ICT programmes at Simon Fraser
Michael Stevenson, SFU President's Speech, presentation to the
International Forum for University Presidents on Information
Communications Technology Education (IFUP-ICT Education), Beijing, China
related to ACTION for Health project:
A second development of academic
interest in ICT at SFU was the establishment of a School of
Communications. Communications consolidated its teaching and
research into three comprehensive areas: communications media,
technology and policy. Whereas computing science intensively
addressed the scientific and mathematical theory behind computing
technologies, communication studies provided an analysis and critique
of the policies, practices and technologies employed in or facilitated
by computing and other electronic media.
The School of Communications is home to several research programmes and
projects that examine current and emerging information technology use
in modern society. These research programmes include the
Centre for Policy Research on Science and Technology and the Emergency
Preparedness Information Exchange, operating an advanced Telematics
Research Lab. One of the newest additions to Communications
is ACTION for Health, a research project intended to answer such
questions as who uses provincial and federal computer-based health
information resources and with what effect; who is included, who is
excluded, who benefits and who loses when health sector workplaces are
computerized? Another example of research within the School
of Communications is research focused on the emerging wireless
information society of cell phones and wireless data networks,
exploring questions of how everyday users of these technologies are
moving things in unanticipated directions.
Social Justice in Health
Thinking, Factulty of Applied Sciences, Simon Fraser University,
team of SFU Communication researchers aims to apply fairness in
Canadian health information systems
Karen Smith is an MA student from SFU’s School of Communication
conducting an ethnographic user study. She observes where people go
online, what they look for, and what problems they have
accessing information. “There’s a real digital divide,” says Smith,
whose MA thesis focuses on the usefulness of government- produced
health information websites to patients in the waiting room of a
Vancouver Community Health Centre. “Health is such a cornerstone in the
lives of Canadian citizens and if some people have more access than
others it’s potentially not fair,” she says. But accessibility is only
one of the many social justice issues Smith has identified.
She studies applications of technology for social inclusion. Her
research is part of Communication professor Ellen Balka’s Action For
Health project, a $3M four-year study funded by SSHRC (Social Sciences
and Humanities Research Council). Researchers are looking at more than
the Internet. They examine electronic patient records, computerized
data collection systems, automated drug dispensaries, and many other
information technologies employed throughout the health
sector. Now in the second year of the study, the group is making some
When the government decides to create a website, budget decisions
affect the design, content, and maintenance of the site. For instance,
content might be contracted from a syndicated corporate source operated
by a private company. “The Healthy Ontario website, healthyontario.com,
gets drug information from MediResource Inc., for example,” says Smith.
For patients or citizens who have not investigated where the
information comes from on government sites, this could come as a
Smith comes to SFU with a BA in multimedia and women’s studies from
McMaster University. After graduating, Smith spent seven months in the
Philippines working with Industry Canada’s Netcorps (like the Peace
Corps, but for Internet projects). She helped a small human rights
organization that broadcasts a radio program on human rights among
migrant workers. The digital divide was palpable.
“People worked at desks outside due to lack of space,” says Smith.
Hardware problems were of a very basic nature. “You’d leave work at
night and everything would be fine. When you came back in the morning,
you’d have to trouble shoot,” says Smith. That could mean getting down
on hands and knees to check the power cord for teeth marks. “We had
problems that were bigger than viruses,” says Smith. On returning to
Canada, she worked for over a year on content for an online banking
Smith was attracted to the Action For Health project because of the
varied group Ellen Balka had assembled. They include experts in
computer science, medical writing, nursing, counseling, communications,
multimedia, as well as women’s and liberal studies. “It’s normal to be
abnormal,” says Smith. But this powerful blending of disciplines is
what gives the team its unique investigative power. The group is
studying the interoperability of health information networks. Health
workers routinely see a lot of data, and as health information systems
become more interconnected, sometimes practitioners may see data from
several sources or locations, but due to system limitations may not see
all the data that exist about a patient. For example, records about a
patient who visited two hospitals and had x-rays may be available
through a consolidated record, including PharmaNet data, lab tests,
visits to doctors, emergency rooms, etc. Balka says, “But there may be
some tests or examination results that are not shown. So a doctor might
order an unnecessary procedure, or make a bad diagnosis because of
missing information.” A consolidated electronic record may contain much
more complete information than a paper based record, but may still omit
information. While practitioners are likely to expect that a
paper-based record is incomplete, they may be far less aware that data
may be missing from a consolidated electronic patient record.
Such a situation arises because technocrats must marry incompatible
data collection systems at different institutions. Data fields may be
shortened or eliminated to attain
cross-platform consistency. “Problems occur because people assume ‘If
it’s online, it’s fact,’” says Balka, “But if it’s only partial
information, users may still assume they are getting the complete
picture.” Balka would like to see a new standard, perhaps a warning
icon, indicating missing data in an electronic record due to system
Shortly after Balka was awarded the Action For Health grant, she was
asked to appear for a photo opportunity in a hospital unit with a drug
dispensing machine. “I couldn’t help noticing this big brown paper
grocery bag on top of the machine just overflowing with bits of paper,”
says Balka. The bag was labeled Omnicel Receipts and it was an Omnicel
dispensing machine. As an ethnographer she thought, this is
interesting. She got a couple of team members to observe how hospital
staff interact with the 27 machines scattered throughout the hospital.
It’s a problem if narcotic drugs are wasted. When
workers drop some pills on the floor, they must find a witness and
generate a missing drug receipt. At every machine
Balka’s researchers found that staff had different ways to handle these
receipts. Sometimes they were stacked on top of the machine or pinned
to a nearby bulletin board. Other times they were stuffed in a
crack or kept in a bag, and in one case they lay in a pile on the
floor. Staff were saving the receipts because drug discrepancies had to
be tracked and resolved. Before they had the machines, mistakes were
sorted out each night. The new automated system transmits data about
discrepancies to the central pharmacy automatically, and drug
discrepancy reports are issued and make their way back to the ward a
few days later. Staff didn’t realize that the data were automatically
transmitted to the central pharmacy, and as a consequence, the receipts
didn’t need to be kept. Balka likes to point out how the networked
machines removed the responsibility of immediate local resolution on
the ward, replacing it with a remote resolution process done by distant
others some days later. The brown paper bag full of receipts was
backup, an unanticipated workplace artifact of a new health information
Researchers also discovered printed drug inventories like cash register
tapes attached to some of the dispensing machines. Balka wondered why.
It turned out that the new machines introduced new naming conventions,
and staff needed a paper printout of the machine inventory to help them
determine how drugs were listed in the machines–for instance, they
needed to know whether multi-vitamins would be listed under M for multi
or V for vitamins. Staff also had to translate drug trade names to
generic names. Doctors typically prescribe by trade name, but machines
listed drugs only by their generic names. Some machines in the network
could list names both ways, but not all interconnected machines had the
capability. “It was a network issue,” says Balka. “When all the
dispensing machines were connected, system limitations required a
decision whether to use generic or trade names.” It’s an example of how
new technologies can disrupt work practices.
Almost every week the media publish a news story critical of the long
waiting times in hospital emergency rooms (ERs). One day, a Vancouver
hospital administrator told Ellen Balka that she often worried about
their published wait times. Balka asked how those times were
determined. Nobody seemed to know. As it happened, Balka’s Action for
Health team member Zena Sharman was already engaged in an ethnographic
study of the ER at the hospital so Balka simply asked her to start
paying attention to time; how people record times on patient’s charts,
which times are recorded, etc. As it turned out, six different times
are entered during an ER visit. “When I told the administrator that the
record holds all these different time values, she was tempted to simply
report different data points for time.”
Researchers and administrators often engage in data gaming like this,
the practice of consciously making decisions about which numbers are
most politically favourable. Balka calls it “looking for data in all
the wrong places.” She wondered if any standards existed for reporting
emergency room wait times. Was there consistency from one facility to
the next? She went to the Canadian Institute for Health Information,
the publisher of two databases that track waiting times in hospitals
where she learned that, in fact, there is no established standard or
definition for ER wait times. And there are other problems, “What do
you do, how do you measure end-time when someone has been cleared for
admission but there are no beds ready? Do you count the time they wait
for the bed?” says Balka. Some hospitals do, some don’t. Add to this
the differences in computer systems between hospitals (some only record
four times), human nature (staff sometimes forget to enter times
consistently), and the judgements made when combining data from
disparate systems. Not only are there variations in reporting between
institutions, but between provinces and countries, too. That so much
political debate on health care funding rests on such weak data
collection is astonishing to Balka. It’s as though decision makers are
working blind. If Balka has her way, her research will provide vision
in the overwhelming confusion of today’s health information.
Fraser University - 2004 President's Report
Communication professors Ellen Balka
and Dave Murphy helped the BC Ministry of Health develop video
vignettes and a documentary to improve the use of the BC NurseLine by
the province’s substantial Farsi-speaking community.
The programs, broadcast on multicultural channels, proved so successful
that the team is now working on similar videos aimed at the
The BC NurseLine is a 24-hour, toll-free access to registered nurses
specially trained to provide confidential health information and advice
on the telephone.
Inteview with Ellen Balka: Medical
technology vs. tacit knowledge
Werden, CJSF Ideas and
Issues. March 31, 2004
to Dr. Balka's interview with CJSF Ideas and Issues
in order to listen to the mp3, click either "podcast" or the red button
March 31, 2004
Technology vs. Tacit Knowledge
CJSF Current Affairs
Hospital Labour in a Changing Environment
Speakers/Commentators: Ellen Balka, interview by
CJSF-FM [Contact Contributor]
Restrictions: For non-profit use only.
Professor Ellen Balka of the School of Communications at Simon Fraser
University heads an international team researching the human-technology
interface in medical settings
Recorded and edited by Frieda Werden, Spoken Word Coordinator, CJSF.
Originally aired in the series SFU Ideas & Issues, on CJSF-FM,
90.1, Burnaby BC.
Enhancing Human Health - from the
Internet to the "placebo effect"
Dr. Balka's interview with Radio Canada International
in order to listen to the mp3, you must choose "save"
rather than "open" when downloading the file.
March 5, 2004
The Internet provides a wealth of information
about a virtually infinite number of subjects, including human
health. More and more people are turning to the World Wide
Web to research health information. But what are the
consequences? Are they better off or worse off as a
result? Are they in a position to weed out the legitimate
from the quackery? To get answers to those questions,
Canadian researchers have launched a study to measure the impact
computerized health information is having on patients and medical
The other side of the coin is using computer
and Internet technologies to teach health information.
Exploiting the popularity of video games and simulations, another team
of Canadian researchers will test the efficacy of those means to teach
basic health practices to children as well as more advanced techniques
to medical students and doctors.
Also on this week's show, a look at the
"placebo effect". This little understood phenomenon is about
to be studied in great detail by a large, multidisciplinary team of
Canadian medical professionals on a quest to uncover the mechanisms
which link our minds to our bodies in the healing process.
a serious loook at technology in health
Professor given task of
studying success, shortfall and impact on health care
Haley, The Medical Post
February 17, 2004
VANCOUVER - A Simon Fraser University professor
has been awarded a grant of $3 million to study the role of technology
in health-care information.
Dr. Ellen Balka (PhD), a communications
professor at the university and researcher with the Vancouver Coastal
Health Authority's research institute will spend the next four years
studying the role of technology in the production and use of health
information through a grant from the Social Sciences and Humanities
Research Council of Canada.
The goal is to determine the impact of
technology on health-care professionals and the public, how to avoid
unnecessary spending and how to improve the quality of care.
New information systems are often the source of
problems when they're first introduced into the health-care system,
said Dr. Balka. Professionals often complain technology has
made their work more difficult.
Her project will focus on how to better design
programs that will make it easier to access and process information,
including Web -based consumer sources of health information.
She will focus on three areas:
arising for lay users of information technology (IT) as they consume
online health information;
technology changes the jobs of professionals as it is introduced into
their work environment; and
ethical and legal issues surrounding health
information technology, including privacy issues and who should have
access to certain information and under what circumstances.
"We're spending an awful lot of money on
information technology in the health sector," said Dr. Balka.
"Last year alone, the federal government spent $600 million on IT in
the health sector, and that's just federal spending.
"We know from past experience the technologies
themselves don't necessarily achieve the results decision-makers
desired when they introduced the new technology. We need a
better understanding of the workplace into which information technology
is being introduced, and we need a better understanding of the human
side of information technology in order to realize the potential
Avoiding unnecessary costs in IT will get a lot
of attention, too.
"Ultimately, what we're trying to do when we
introduce new technologies is to improve the quality of care.
We will try to identify areas where intervention can take place, say in
design for example, that will allow us to achieve our goal of producing
focuses on technology
Meadahl, Simon Fraser News
January 08, 2004
How technology impacts the health sector has
been a key research focus of communication professor Ellen Balka for
She is the leader of a $3 million, SSHRC funded project on the role of
technology in producing and using health information. Her goal is to
expand on that work to get a clearer picture of technology's impact on
both the public and health professionals.
The project will enable her research team to further investigate the
effectiveness of technology and influence the design of policies as
well as new technological systems.
“One of the goals of our research is to better understand the problems
that occur as new technologies are introduced into health settings,”
says Balka, who is also a research scientist with the Vancouver Coastal
Health Research Institute. “We hear far too often that a new computer
system has made work more difficult. Our goal is to learn more about
the contexts in which technologies are used, so that new technologies
can be designed to better meet users' needs.”
Balka notes that health care has become increasingly subject to
computerization while use of the internet as a source of health
information continues to grow, leading to a variety of concerns. These
include issues surrounding access and how information is interpreted.
Balka hopes to determine whether existing internet delivery of health
information and the growing computerization of health care jobs achieve
desired results, such as equitable access to health information leading
to improved health.
“The government and health providers have been actively promoting
increased use of the internet as a means of accessing health
information, in hopes that improved access to health information will
empower patients and families as they address health issues,” notes
Balka. “Thus far we know little about the challenges health information
seekers face in making sense of the information they locate on the
internet, or what impact it has on their health, their use of health
services, or their interactions with health providers.”
The project will have global involvement, with researchers carrying out
case studies in Canada, Austria, Australia the United Kingdom and
Netherlands. “Our research is aimed at filling gaps in existing
knowledge related to the development of the health info-structure,”
adds Balka, noting that the need to better understand the role of
health information technologies was identified in the recent high
profile Romanow and Kirby reports on the nation's health care system.
“Government documents suggest the increased use of information
technology in the health sector will decrease administrative
inefficiencies, increase the accessibility of health services in rural
areas and empower the public by providing increased access. We tend to
think that technology can do all of this on its own, when in reality,
the success of any technology rests on a good fit with the social
context it will be used in.”
draws $11 million in new SSHRC
Fraser University Media and Public Relations
December, 8, 2003
Fraser University researchers will use $11 million from the Social
Sciences and Humanities Research Council to advance technology’s role
in health care delivery and education.
receives three of seven nationally awarded projects funded through
SSHRC’s Initiative on the New Economy (INE), each valued at $3 million
— the largest INE grant total secured by one university. "This is
unique, a huge achievement for a single university," says SSHRC
President Marc Renaud. Funding for two other $1 million projects
involving SFU faculty will come from SSHRC’s Community-University
Research Alliances (CURA) funding program.
ranks first among Canadian comprehensive universities in SSHRC and
Canada Council grants," says SFU President Michael Stevenson. "With
these exceptional new awards, developed in cooperation with many
academic, institutional and community partners, SFU will nearly double
the annual research grant funding the university has received from
SSHRC in the past."
faculty members from the school of communication, the faculty of
education, and the department of political science and women’s studies
lead five projects that will have broad, national impact. They will
target improvements to the delivery of health information across the
country, create new technological methods for training in the health
sector, develop life-long learning tools and techniques for greater
academic success, especially among First Nations children, and
investigate the impact of government downsizing.
Balka’s project will undertake a sweeping analysis
of technology’s role in the health sector, from the impact of the
computerization of jobs to the effectiveness of the Internet’s role in
delivering health information.
team led by Phil
Winne in the faculty of education will develop
state-of-the-art software learning tools and research-backed "Learning
Kits" for promoting life-long learning.
Kaufman’s assessment and development of new
technological learning techniques involving games and simulations will
be applied to educating the health sector.
education professor Mark
Fettes will work with BC school districts and First
Nations communities on a $1 million study to investigate whether the
concepts and methods of imaginative learning, pioneered at SFU, can
help schools engage all children in effective learning.
Griffin-Cohen of the departments of
political science and women’s studies will direct a $1 million study,
together with the Canadian Centre for Policy Alternatives and more than
40 academic and community partners, on the impact of the BC
government’s public services restructuring program.
success of our researchers in the competition for these SSHRC awards is
a spectacular achievement and speaks highly of the quality of their
proposals and of their prior research accomplishments," says Bruce
Clayman SFU vice-president, research. "It builds significantly on SFU's
clear leadership among comprehensive research universities in research
in the social sciences and humanities."
Social Sciences & Humanities Research Council:
Simon Fraser University Media
and Public Relations
role in the health sector has been a key research focus of
communication professor Ellen Balka for the past several years.
million, SSHRC (INE) funded project is titled, The role of technology
in the production, consumption and use of health information in varied
settings: implications for policy and practice. The project will expand
on previous work and allow her research team to further investigate the
design, use and effectiveness of technology in the health sector, in
order to inform the design of policies and new technological systems.
need to better understand the role of health information technologies
was also identified in the recent Romanow and Kirby reports on the
nation’s health care system.
the goals of our research is to better understand the problems that
occur as new technologies are introduced into health settings," says
Balka. "We hear far too often that a new computer system has made work
more difficult — our goal is to learn more about the contexts in which
technologies are used, so that new technologies can be designed to
better meet users’ needs."
says health care has been increasingly subject to computerization while
use of the Internet as a source of health information continues to
grow, leading to concerns about how information is interpreted as well
as limits to access. Researchers will determine whether or not existing
Internet delivery of health information and the growing computerization
of health care jobs achieve desired results, such as equitable access
to health information leading to improved health, and employment
situations that make it easier to deliver high quality patient care.
is also a research scientist with the Vancouver Coastal Health Research
Institute. The recipient of a 2003
of distinction award, she
continues to carry out research related to gender, technology and
awarded three major
Amy O'Brian, Vancouver
December 9, 2003
University has been awarded more research grants in the areas of social
sciences and humanities than any other Canadian university in the
latest round of funding from the Social Sciences and Humanities
university will get $11 million to conduct research over the next four
years intended to "advance technology's role in health care delivery
council awarded three of its seven major grants to SFU, nearly double
the annual research grant funding the university has received from the
council in past years.
Kaufman, a professor in the university's faculty of education, who is
one of five recipients of the grants, said B.C.'s other major
universities were not included this year in the council's generous
blowing everyone away," he said.
is using his $3 million grant over the next four years to examine how
game and simulation technology can be used to educate people in the
field of health.
professor heard in October that he had won the grant and said he was so
blown away that he accidentally hung up on the person delivering the
so shocked and so amazed," Kaufman said.
a quick motion and hung up on the person by accident."
team includes 10 other investigators who are interested in harnessing
the current fever surrounding video games and computer simulation and
using it to teach instead of simply entertain.
the team's researchers has been working on a computer game for nine- to
12-year-olds intended to teach them about contagious diseases such as
HIV/AIDS and West Nile virus.
been a big upsurge of interest in this area," Kaufman said.
other $3 million grants have been awarded to projects headed by faculty
members Ellen Balka and Phil Winne. Marjorie Griffin Cohen and Mark
Fettes are heading projects that will receive $1 million each.
project will examine whether current Internet programs intended to
deliver health information to health consumers and the computerization
of health-sector jobs are preserving the equity of the Canadian health
research team will set out to develop "state-of-the-art" software for
promoting learning throughout all stages of life.
team will go out to different B.C. schools and First Nations
communities to investigate whether concepts of imaginative learning
that have been developed at SFU can help schools engage all children.
Griffin Cohen will use her
funding to direct a study on the effects of the B.C. government's
restructuring of its public services. Griffin Cohen will work with the
Canadian Centre for Policy Alternatives and more than 40 academic and
community partners during the study.
© Copyright 2003 Vancouver Sun
Studies to probe
innovative uses of technology in health care
SSHRC invests $11 million in BC research on
health care, education and the delivery of public services
computer technology to work to improve the health of Canadians by
better educating doctors, nurses and the public is the goal of two
research projects each awarded $3 million in funding, the
Social Sciences and Humanities Research Council of Canada (SSHRC)
total, SSHRC is investing $11 million in five projects led by
British Columbia researchers under its Initiative on the New Economy
(INE) and Community-University
Research Alliances (CURA) programs.
technologies have much untapped potential and many under-utilized
applications,” said Allan Rock, minister of industry and
minister responsible for SSHRC. “These studies, with their focus on
helping health care professionals and Canadians to use technology more
effectively, hold great promise to actually help us deliver better
speed at which information multiplies is astonishing,” said
Marc Renaud, president of SSHRC. “But we need to find ways to
ensure that proliferation of health information, especially on the
Internet, gives Canadians the knowledge they need to lead healthier
project, a $3-million INE grant led by Simon Fraser University (SFU)
education professor David Kaufman, will examine the educational value
of games and simulations, particularly in the health care field.
already know that games and simulations are very engaging, not only for
children but also for adults,” said Kaufman. “So the question is how to
use these powerful approaches to make learning, which many find boring,
not only more fun, but also more effective.”
members of the research team are developing an Internet simulation game
to educate children about such contagious diseases as HIV, SARS and
West Nile, and to promote habits to help them stay healthy.
$3-million INE project will study the impact on health care
decision-making of the increasing computerization of information. It is
led by Ellen Balka, professor of communication at
SFU and research scientist with the Vancouver Coastal Health Authority.
is a tendency to think of technology as something that solves all
problems, but it can cause new problems while it seeks to solve
others,” said Balka, who points out that not all Canadians have equal
access to the Internet and that others are not equipped to fully grasp
the technical language often found on health and medical Web sites.
is already evidence that relying on Web sites for health care
information can be harmful. The greatest danger lies in self-diagnosis
based on unreliable information. Physicians are already seeing evidence
of this in their practices.
projects announced today include a $3-million INE grant to a research
team led by Philip Winne, Canada Research Chair in
Regulated Learning and Learning Technologies and professor of education
at SFU. Winne’s team is developing the “Learning Kit,” educational
software which will give students and adults the skills to learn more
education professor Mark Fettes will work with
teachers and Aboriginal educators in three British Columbia school
districts to increase children’s imaginative engagement in learning.
Partners in the $1-million CURA project include the Haida, Tsimshian,
and Stó:lõ First Nations.
SFU political science and women’s studies
professor Marjorie Griffin Cohen is directing a $1-million CURA project
to evaluate the impact of restructuring public services in BC. The
project, which focuses on understanding the effects of change on
vulnerable populations, is a partnership between the Canadian Centre
for Policy Alternatives and SFU. It involves 20 researchers from four
British Columbia universities and 23 researchers from community
honoured with YWCA award
SSHRC invests $11 million in BC research on
health care, education and the delivery of public services
female leader in the male-dominated field of technology, communication
professor Ellen Balka (left) is this year's winner of the YWCA woman of
distinction award in the category of workplace innovation.
Balka's research focuses on how information technology affects women
and on how women have used information technology in the context of
social change. Her research has helped to address sex and gender issues
in technological design.
A past president of the Women's Studies Association, she has been a
consultant on women's policy issues and is a role model and mentor for
Other SFU nominees were Christina Ames, Sheila Davidson, student Bistra
Dilkina, Malgorzata Dubiel, and Pat Holborn.
investigator wins major
outcomes researcher gets $3 million boost
December 9, 2003
Ellen Balka, an Outcomes and Evaluation
research scientist with the Centre for Clinical Epidemiology and
Evaluation and professor in the School of Communications at SFU has
been awarded a $3 million grant by the Social Sciences and Humanities
Research Council of Canada. Ellen will lead an international
research team examining the Role of Technology in the Production,
Consumption, and Use of Health Information Technology: Implications for
Policy and Practice. The goal of the study is to achieve a
fuller understanding of the complex ways health information is
produced, consumed and used by lay people, and produced and used by
health sector professionals, in order to inform the design of policies
and systems. For instance when lay people retrieve
information from the Internet, does it change their consumption of
helps people access
online health info
Naoibh O'Connor, Vancouver
Balka was a child, she suffered from hip displacia, a disease that
ultimately required four sugeries, the most recent being a hip
replacement. Along with consulting a doctor, the now 41-year-old Simon
Fraser University professor spent years doing her own research,
eventually becoming an expert in discerning accurate information. It's
a skill she believes is essential as people spend more time surfing the
Internet for medical advice.
equate the availablity of information on the computer with fact and
that's an important myth to challenge," said Balka, an expert on the
health information highway. "It is worth being concerned about, but to
me the issue isn't so much the web, that just happens to be the vehicle
where people get information today. No matter where people access
health information, they need to develop critical-thinking skills."
A key is to
ensure online data can be validated elsewhere. Librarians can help
direct people to appropriate sources, she added. This fall, the
Vancouver Public Library is offering a series of hands-on workshops
entitled Finding and Evaluating Health Information Online.
Douglas, librarian for the Canadian Health Network, said medical sites
on the Internet vary from informative to inaccurate. "It can be an
overwhelming task for health consumers to sift through a lot of
irrelevant material during their Internet searches," she said.
participants will become more Internet savvy through understanding what
to look for when visiting health web sites-such as the author's
qualifications or if the site is being maintained for commercial
purposes. They'll also be shown search techniques and health sites that
offer credible information, such as the Canadian Health Network and the
VPL's Consumer Health Information Service web site.
library's science and technology division offers other good material.
However, Douglas warns, and Bulka agrees, that all information, whether
it's on the Internet or elsewhere, is not meant to replace visits to a
librarians, our job is to connect people with information but we do not
provide medical advice," Douglas said. "The Internet is a wonderful
research tool, but it is no substitute for professional medical
workshops are scheduled for Sept. 11 from 1:30 to 3:30 p.m., Oct. 20
from 1:30 to 3:30 p.m., Nov. 8 from 1:30 to 3:30 p.m. and Dec. 6 from
5:30 to 7:30 p.m. They're being held at the Central Library at 350 West
Georgia Street in the computer training room, level seven. Class size
is limited. To register call (604) 331-3603.
to study technology,
women's work in health
Mariane Meadahl, Simon
May 18, 2000
budgets shrink, information and communication technologies are
increasingly being viewed as the means for more efficient and effective
delivery of health care services.
But despite the creation of new health information technologies,
including a Canadian health info-structure, little has been done to
address how these technologies are affecting industry workers, who are
Ellen Balka (right), an associate professor in the school of
communication, is heading a three-year study that will investigate
issues related to new technology as well as women's work in health care.
The study, funded by a $119,000 grant from the Social Sciences and
Humanities Research Council (SSHRC), will examine the development of
electronic patient record systems, focusing on patterns of ownership,
strategic alliances, as well as the relations of the technology to
government funding programs supporting it and to government policy
motivating its use.
Balka and a team of researchers will also explore how work processes
are changing in relation to use of technology, how other jobs in health
care have changed in relation to the electronic records system, and how
the introduction of the new system effects health care agencies.
"New health information technologies are designed to improve delivery
of health care services through such means as improved use of patient
information, for example, with complete records on smart cards, and
more equitable delivery of services, such as the availability of
telehealth systems in remote areas," notes Balka.
"But to date, very little is known about how work practices may need to
be changed to accommodate the use of new health information and
Because of their concentration in different jobs, Balka says women and
men have different experiences in relation to health information
technology at work. She says the introduction of computerized
technologies into women's work frequently increases the speed of
women's labour while decreasing their control over their work. "In
turn," she says, "this contributes to the decline of women's health."
The study is designed to provide new information about issues of policy
and practice associated with the development of the health
It will focus on workers' experiences of new health information
technologies, the organizational and institutional contexts into which
they are introduced, the structure of the emerging industry and its
relation to government policies, and issues related to health
info-structure, particularly those related to employment, occupational
health and safety, and training.
Balka, whose previous research has focused on the assessment of
workplace technologies, is also chair of the 7th International
take to the
Mariane Meadahl, Simon
March 20, 1997
An SFU professor publishes a
resource book on women and the Web
Feminism is alive and
well on the Internet, says Ellen Balka, author of Spinsters on the Web,
a new resource handbook on computer networking for women.
The Simon Fraser University associate professor in communication looks
at how technology is influencing women and women's organizations, and
encourages women's groups to learn how to access and use technology to
their advantage through a series of exercises.
"Popular debate about computer networking technology suggests it ought
to meet a diverse array of needs, including those of women's
organizations dedicated to feminist social change," says Balka, a
former SFU student who earned the distinction of being Canada's first
graduate of a master of arts program in women's studies. A recent
addition to SFU's school of communication, she was hired to teach and
coordinate a women's studies program at Memorial University in
Newfoundland before she had even given her dissertation defence at SFU.
Spinsters on the Web grew out of Balka's popular thesis on the use of
computer networks in the context of feminist social change, which she
learned was consistently being checked out of the library.
"The book examines the use of computer networks by women and men who
have consciously pursued the use of this technology to communicate
about women's issues and feminism," she explains. "Computer networks
should be accessible to a wide range of women, allowing them to enhance
the flow of information between members of women's organizations."
Written for novice computer users who work in feminist organizations
and have little or no experience with computer networking, the
spiral-bound handbook is published by a feminist press (CRIAW), with
financial assistance from the federal Status of Women. It includes a
history of how women's groups have used technology and provides work
sheets designed to help groups determine what their computer networking
"There's a huge number of books about the Internet, but none that deal
with issues related to using the Internet in community organizations,"
The tongue-in-cheek title came from an impromptu group of women
musicians with whom she played the flute, while at Memorial University.
Balka's interest in technology goes beyond its use. Her latest research
compares two approaches in the design of technology -- ergonomics and
participatory design (the integration of ideas of technology users into
its development) -- and looks at the incorporation of gender issues.
Balka has a new book underway on gender and technology design, which
will include gender-sensitive design guidelines, called Women Users:
Last updated: June 22, 2010