Dr. 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

Social Justice in Health Care

FAS Thinking, Factulty of Applied Sciences, Simon Fraser University, July 2005

Simon Fraser University - 2004 President's Report: Multicultural health videos

Simon Fraser University, 2004

Inteview with Ellen Balka: Medical technology vs. tacit knowledge

Frieda Werden, CJSF Ideas and Issues. March 31, 2004

Enhancing human health - from the Internet to the "placebo effect"

Radio Canada International, March 5, 2004

B.C. taking a close look at technology in health

Lynn Haley, The Medical Post. February 17, 2004

Project focuses on technology

Mariane Meadahl, Simon Fraser News, January 08, 2004

Health, education research draws $11 million in new SSHRC grants

Simon Fraser University Media and Public Relations. December 8, 2003

Ellen Balka

Simon Fraser University Media and Public Relations. December 9, 2003

SFU awarded three major grants

Amy O'Brian, Vancouver Sun. December 9, 2003

Studies to probe innovative uses of technology in health care

Social Sciences and Humanities Research council of Canada, December 9, 2003

VCHRI investigator wins major award!

Vancouver Coastal Health Research Institute, December 9, 2003

Balka honoured with YWCA award

Simon Fraser News, June 25, 2003

Library helps people access online health info

Naoibh O'Connor, Vancouver Courier, 2001

Balka to study technology, women's work in health care

Mariane Meadahl, Simon Fraser News, May 18, 2000

Spinsters take to the Internet

Mariane Meadahl, Simon Fraser News, March 20, 1997

No wonder BC's health record system has problems [Letter to the editor]

Ellen Balka, Vancouver Sun

http://www.vancouversun.com/Health/wonder+health+records+system+problems/2569691/story.html?id=2569691

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.

Ellen Balka

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

Guenther Krueger

http://knowitallhealth.com/2009/03/03/hivaids-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 Judith Krajnak.

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 institution.

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 as well.

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 they live.

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: gkrueger@knowitallhealth.com

Wireless Communications in Health Care

Guenther Krueger

http://knowitallhealth.com/2008/12/29/wireless-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 project.

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 problem.

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 gkrueger@knowitalhealth.com

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ACTION for Health internationally recognized

SFU News

http://www.sfu.ca/sfunews/news/story_12300836.shtml

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 partnerships.

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 information.

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?

Guenther Krueger

http://knowitallhealth.com/2008/11/25/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 few.

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 practice guide.

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.

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What’s the Downside to Technology in Health Care?

Guenther Krueger

http://knowitallhealth.com/2008/11/12/whats-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 those systems.

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The Future of Canadian Health Care

Guenther Krueger

http://knowitallhealth.com/2008/11/05/the-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 agendas.

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 stay healthier?

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.

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Gov’t Health Sites - Our Tax Dollars at Work?

Guenther Krueger

http://knowitallhealth.com/2008/10/07/govt-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 knowledge.

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 expertise.

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 that….”

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. Everyone wins.

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.

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Waiting Times In Emergency

Guenther Krueger

http://knowitallhealth.com/2008/09/24/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 both?

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.

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Cost Cutting on Hospital Services

Guenther Krueger

http://knowitallhealth.com/2008/07/29/cost-cutting-on-hospital-services/

July 29, 2008

Who Benefits?
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.

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Does Your Ethnicity Affect Your Access to Health Care?

Guenther Krueger

http://knowitallhealth.com/2008/07/07/does-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 then?

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.

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How Best To Deliver Your Drugs - Man or Machine?

Guenther Krueger

http://knowitallhealth.com/2008/05/01/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 thing, right?

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 huge problem.

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 after.

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.

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Can Technology Help You Get Better Health Care?

Guenther Krueger

http://knowitallhealth.com/2008/04/22/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 is based.

What are those core values? The Canada Health Act maintains five principles:

universality
accessibility
comprehensiveness
portability
public administration

In other words, we want everyone to have access in the same way, no matter where they live; we want to have coverage maintained when we move anywhere in Canada; we want all of our services insured, not just a few basics; and we want the government to run things. Of course increasingly these values are under fire, and many are beginning to question whether we can even afford to uphold them. But the challenge for all of us is to maintain as many of these values as possible while keeping costs in control. How can that be done? One way is by introducing efficiencies into the system in the form of technology.

But technology has changed dramatically in the past decade. Computers are everywhere, information is increasingly on the world wide web, lab tests are becoming more and more automated, surgery is changing as robotics and monitors replace a person’s hands and eyes…and on and on. CT scans, MRI machines, lasers—these are all terms that have entered into everyday language, but they are things that didn’t even exist a generation ago. How did they get there?

Questions, Questions, and More Questions

Usually when we think of how technology gets introduced we assume that things will somehow be faster, cheaper, or more efficiently done. Is this always the case? What about giving patients the power to have more control over their personal situation by having access to better information, in a form that they understand. Does that happen?

Dr. Balka, who led the Action For Health Project, points out that health care has become increasingly subject to computerization while use of the Internet as a source of health information continues to grow. We know that’s the case, but is that faster, cheaper and more efficient? There are issues around access (not everyone has a computer even though it seems that is the case), and the information still needs to be interpreted (perhaps you trust this web site, but we know that people don’t always believe their sources). Yes, it’s easier, cheaper and faster to put everything on line, but is that producing a two-tiered system of sorts?

Some Answers

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!

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Cyberchondriacs

Rising numbers are Googling their aches and pains
By Lisa Bendall
The author is a Toronto-based freelance writer.

http://www.cbc.ca/news/background/health/cyberchondriacs.html

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 Barrie, Ont.

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 what's rare."

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 human."

The internet just cranks it up by offering easy access to huge volumes of information.

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 self-diagnosis.

"Now you can buy pharmaceuticals and other things on the web without prescriptions. That can lead to unfortunate effects," points out Asmundson.

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 available."

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 connection.

A new niche for a new university: The creation of distinctive ICT programmes at Simon Fraser University

Dr. Michael Stevenson, SFU President's Speech, presentation to the International Forum for University Presidents on Information Communications Technology Education (IFUP-ICT Education), Beijing, China

http://www.sfu.ca/pres/president/speeches/20055.html

October 17, 2005

Excerpt related to ACTION for Health project:

Communications

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.

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Social Justice in Health Care

FAS Thinking, Factulty of Applied Sciences, Simon Fraser University, July 2005

http://www2.fas.sfu.ca/FAS-Thinking/articles/FAS-Thinking-2-2small.pdf

July 2005

A 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 significant discoveries.

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 surprise.

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 concern.

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 limitations.

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 network.

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.

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Simon Fraser University - 2004 President's Report

Multicultural health videos

http://www.sfu.ca/report2004/community/sfu_28.html

2004

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 Chinese-speaking community.

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.

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Inteview with Ellen Balka: Medical technology vs. tacit knowledge

Frieda Werden, CJSF Ideas and Issues. March 31, 2004

Listen to Dr. Balka's interview with CJSF Ideas and Issues

Note: in order to listen to the mp3, click either "podcast" or the red button

March 31, 2004

Medical Technology vs. Tacit Knowledge
Series: CJSF Current Affairs
Subtitle: Hospital Labour in a Changing Environment
Program Type: Interview
Featured Speakers/Commentators: Ellen Balka, interview by Frieda Werden
Contributor: CJSF-FM [Contact Contributor]
Broadcast Restrictions: For non-profit use only.
Summary: Professor Ellen Balka of the School of Communications at Simon Fraser University heads an international team researching the human-technology interface in medical settings
Credits: 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.

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Enhancing Human Health - from the Internet to the "placebo effect"

Radio Canada International

Listen to Dr. Balka's interview with Radio Canada International

Note: 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 professionals.

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.

BC taking a serious loook at technology in health

Professor given task of studying success, shortfall and impact on health care

Lynn 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:

Issues arising for lay users of information technology (IT) as they consume online health information;
how health 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 benefits."

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 quality care."

Project focuses on technology

http://www.sfu.ca/sfunews/sfu_news/archives_2003/sfunews01080412.htm

Marianne 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 several years.

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.”

Health, education research draws $11 million in new SSHRC grants

Simon Fraser University Media and Public Relations

http://www.sfu.ca/mediapr/news_releases/archives_2003/news12080302.htm

December, 8, 2003

Simon 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.

SFU 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.

"SFU 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."

SFU 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.

Communication professor Ellen 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.
A 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.
Education professor David Kaufman’s assessment and development of new technological learning techniques involving games and simulations will be applied to educating the health sector.
Assistant 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.
Marjorie 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.

"The 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."

Website: Social Sciences & Humanities Research Council:
www.sshrc.ca

Ellen Balka

Simon Fraser University Media and Public Relations

http://www.sfu.ca/mediapr/news_releases/balka.html

December 9, 2003

Technology’s role in the health sector has been a key research focus of communication professor Ellen Balka for the past several years.

Her $3 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.

The 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.

"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. "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 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.

Balka is also a research scientist with the Vancouver Coastal Health Research Institute. The recipient of a 2003

woman of distinction award, she continues to carry out research related to gender, technology and communication.

Ellen Balka, 604.291.3764/604.725.2756 (cell)

SFU awarded three major grants

Amy O'Brian, Vancouver Sun

December 9, 2003

Simon Fraser 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 Research Council.

The university will get $11 million to conduct research over the next four years intended to "advance technology's role in health care delivery and education."

The 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.

David 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 grant-giving.

"It's blowing everyone away," he said.

Kaufman 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.

The 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 good news.

"I was so shocked and so amazed," Kaufman said.

"I made a quick motion and hung up on the person by accident."

Kaufman's 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.

One of 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.

"There's been a big upsurge of interest in this area," Kaufman said.

Two 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.

Balka's 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 care system.

Winne's research team will set out to develop "state-of-the-art" software for promoting learning throughout all stages of life.

Fettes' 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.

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

http://www.sshrc.ca/web/whatsnew/press_releases/2003/ine_cura_sfu_e.asp

December 9, 2003

Putting 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) announced today.

In 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.

“New 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 health care.”

“The 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 lives.”

One 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.

“We 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.”

Several 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.

Another $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.

“There 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.

There 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.

Other 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 effectively.

SFU 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 organizations.

Balka honoured with YWCA award

SSHRC invests $11 million in BC research on health care, education and the delivery of public services

http://www.sfu.ca/sfunews/_pvw9C438741/sfu_news/archives_2003/sfunews06250303.htm

June 25, 2003

A 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 young scholars.

Other SFU nominees were Christina Ames, Sheila Davidson, student Bistra Dilkina, Malgorzata Dubiel, and Pat Holborn.

VCHRI investigator wins major award!

Health outcomes researcher gets $3 million boost

http://www.vchri.ca/s/Triumphs_Honours_Awards2003.asp?ReportID=72429&_Title=Ellen-Balka-Health-Outcomes-Research-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 health services?

Library helps people access online health info

Naoibh O'Connor, Vancouver Courier

http://archive.vancourier.com/issues01/084101/news/084101nn4.html

August 2001

When Ellen 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.

"People 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.

Julie 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.

Workshop 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.

The 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 doctor.

"As 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 advice."

The free 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.

Balka to study technology, women's work in health care

Mariane Meadahl, Simon Fraser News

http://www.sfu.ca/sfunews/sfnews/2000/May18/balka.html

May 18, 2000

As health 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 primarily women.

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 communication technologies."

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 info-structure.

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 Federation

Spinsters take to the Internet

Mariane Meadahl, Simon Fraser News

http://www.sfu.ca/sfunews/sfnews/1997/March20/spinsters.html

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 needs are.

"There's a huge number of books about the Internet, but none that deal with issues related to using the Internet in community organizations," says Balka.

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: Regendering Technology.

Last updated: June 22, 2010