1. Leveling the playing field: the Global eHealth Innovation Network Alejandro (Alex) R. Jadad, MD DPhil FRCPC Director, Program in eHealth Innovation Rose Family Chair in Supportive Care Professor, Health Administration and Anesthesiology University Health Network University of Toronto Alejandro (Alex) R. Jadad, MD DPhil FRCPC Director, Program in eHealth Innovation Rose Family Chair in Supportive Care Professor, Health Administration and Anesthesiology University Health Network University of Toronto

3. The gap according to me…

5. Massive exodus Record public unemployment Physician unemployment $? for health (<$8 B) 70% under poverty line Massive immigration Record employment levels Shortage of physicians $100 Billion 10% under ‘relative’ poverty line

6. The gaps across the world The assets of the top 3 billionaires are more than the combined GNP of all least developed countries and their 600 million people The income gap between the richest fifth of the world’s people and the poorest fifth is 75 to 1 (it was 30 to 1 in 1960) 10 countries account for 84% of global research and development expenditures The assets of the top 3 billionaires are more than the combined GNP of all least developed countries and their 600 million people The income gap between the richest fifth of the world’s people and the poorest fifth is 75 to 1 (it was 30 to 1 in 1960) 10 countries account for 84% of global research and development expenditures

9. Globalization, equity and uncertainty

10. What is the role of eHealth?

11. The richest fifth of the world’s population has 74% of telephone lines The bottom fifth only has 1.5% More than 50% of people in the world have never used a phone Chile, the country with the highest telephone penetration in Latin America, has a teledensity of less than 25 But, the telephone is not used efficiently even in countries where teledensity is above 90% We need more than technology to achieve change The richest fifth of the world’s population has 74% of telephone lines The bottom fifth only has 1.5% More than 50% of people in the world have never used a phone Chile, the country with the highest telephone penetration in Latin America, has a teledensity of less than 25 But, the telephone is not used efficiently even in countries where teledensity is above 90% We need more than technology to achieve change

12. Mind the (widening) gap!

13. 10 times more Internet users in North America than in the whole of Latin America Canadians have 20 times more access than Colombians …and 600 times more than Haitians 10 times more Internet users in North America than in the whole of Latin America Canadians have 20 times more access than Colombians …and 600 times more than Haitians

14. Most connected Canada 60% USA50% Virgin Islands 10% Uruguay 7.5% Aruba 5.8% Brazil 5.7% Aruba/Barbuda5.5% St. Kitts/Nevis5.2% Bahamas5.1% Chile4.1% Costa Rica4.0% Most connected Canada 60% USA50% Virgin Islands 10% Uruguay 7.5% Aruba 5.8% Brazil 5.7% Aruba/Barbuda5.5% St. Kitts/Nevis5.2% Bahamas5.1% Chile4.1% Costa Rica4.0% Least connected Haiti0.09% Ecuador0.15% Honduras 0.33% Paraguay0.36% Nicaragua0.42% Bolivia0.43% Guyana0.43% Guatemala0.51% Cuba 0.54% Least connected Haiti0.09% Ecuador0.15% Honduras 0.33% Paraguay0.36% Nicaragua0.42% Bolivia0.43% Guyana0.43% Guatemala0.51% Cuba 0.54% Use of Internet in America

15. There is also a language gap!

17. Mind the (widening) gap! Incentives for carriers to serve underserved and unserved

18. Should we be looking at all this differently?

19. We have lots in common… Populations that care a lot about health Huge expenditure in health and desperate need to increase efficiency Low levels of computerization in the system Lots of politics and big egos No incentives for providers to use knowledge or technology Confusion or denial Populations that care a lot about health Huge expenditure in health and desperate need to increase efficiency Low levels of computerization in the system Lots of politics and big egos No incentives for providers to use knowledge or technology Confusion or denial

20. Can we overcome barriers together?

21. Program in eHealth Innovation Mission: To help people access the information and services they need, when and where they need them, regardless of who they are. Mission: To help people access the information and services they need, when and where they need them, regardless of who they are.

22. “E-mail is no substitute for vaccines, and satellites cannot provide clean water” What can (should) we do?

23. Bypassing bureaucracy

24. How can we maximize success? Effective international collaboration Economies of scale Virtual and physical resources Building on leadership ‘Real-enough-time’ evaluation Strong input from all groups of decision-makers Effective international collaboration Economies of scale Virtual and physical resources Building on leadership ‘Real-enough-time’ evaluation Strong input from all groups of decision-makers

25. Creating a mini-model of the world The Global eHealth Innovation Network

26. Communities from over 170 countries Single health care system > 1000 health professionals unable to work Largest city with one medical school Innovators conducting research on technology, social sciences and health Excellent track record for international work Large funds for research infrastructure Communities from over 170 countries Single health care system > 1000 health professionals unable to work Largest city with one medical school Innovators conducting research on technology, social sciences and health Excellent track record for international work Large funds for research infrastructure Toronto: An ideal starting point…

27. Harnessing diversity 1,070 patients surveyed up to this month at University Health Network They spoke 59 languages and came from 90 different countries 60% said they have used the Internet (68% as a source of health information) 77% would like to communicate with providers through e-mail and Web sites 40% would like to participate in projects to find solutions (in 33 languages and from 50 countries) 1,070 patients surveyed up to this month at University Health Network They spoke 59 languages and came from 90 different countries 60% said they have used the Internet (68% as a source of health information) 77% would like to communicate with providers through e-mail and Web sites 40% would like to participate in projects to find solutions (in 33 languages and from 50 countries)

28. eHealth Innovation Collaboratory Research Education Idea exchange Business Management Economies of scale Downtown TO 10,000 Sq. Ft. Space for 50-60 people Support for hundreds Virtual and physical resources Completion: 1 year (Physical infrastructure) Economies of scale Downtown TO 10,000 Sq. Ft. Space for 50-60 people Support for hundreds Virtual and physical resources Completion: 1 year (Physical infrastructure)

29. Research platform Simulation environments eHealth Collaboratory Living laboratories

30. A health usability laboratory

31. A multi-tasking flexible environment

32. Group collaboration Tools for research collaboration Distance education suite Tele-health support Tools for research collaboration Distance education suite Tele-health support

33. Living laboratories

34. Social sciences Health knowledge Technology Overall Network Structure Simulation Laboratories eHealth Collaboratory Living laboratories

35. EGALITÉ ! E = Ensuring G = Global A = Access to L = Links, I = Information and T = Technology to promote É = Equity in health

36. Instant access to information

37. With no wires!

38. Anywhere!

39. Enhancing the relationship!

40. Telehealth

41. Virtual coaches

42. Improving literacy

43. Making it fun, when possible!

44. Beyond keyboards and mice!

46. I hope it is possible!