2nd
Version of Letter of August 15, 2003.
Online Tele e-Health Research
Collaboration through the Internet and other ICTs
Rodolfo J. Stusser, MD,* Robert L. Kriel, MD,** Richard A. Dickey, MD, FACP, FACE,# Linda E. Krach, MD$
*Researcher, Clinical Biostatistics, Primary Care Research Unit, Vedado Polyclinic, Plaza, 10400 Havana, Cuba. stusser@infomed.sld.cu, rodolfo_stusser@hotmail.com
**Professor, Departments of Neurology, Paediatrics, and Pharmacy Practice, University of Minnesota, Minneapolis, MN, 55414, USA. kriel001@maroon.tc.umn.edu
#Clinical Assistant Professor, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-0001, USA. mdrad@charter.net
$Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, 55414, USA LKrach@aol.com
Corresponding Author: Rodolfo J. Stusser, MD.
PC Research Unit, Vedado Educational Polyclinic,
Calle 18 #163 y 15, Plaza, 10400 Havana, Cuba
Tel. & fax (537) 832-3461
stusser@infomed.sld.cu,
rodolfo_stusser@hotmail.com
http://familydoctor.org/myhavananpolyclinic/
Abstract
The aim of this communication is to complement the worthy review "Using the Internet for Surveys and Health Research" by Eysenbach and Wyatt in the Journal of Medical Internet Research 2002, with its current use also in online tele e-health research collaboration since the mid-nineties. It is suggested that use of this health research tactic on scientific and humanitarian bases could improve health research collaboration between Cuba, a less developed country, and USA a more developed country. This type of research collaboration, strengthened with new developments, seems to offer some of the most robust application of the Internet and other information and communication technologies, for the global health research of the future.
Introduction
In the review "Using the Internet for Surveys and Health Research", the authors summarise:
“This paper concerns the use of the Internet in the research process, from identifying research issues, through using the Web for surveys and clinical trials, to pre-publishing and publishing research results”. Although literature searches using databases such as MEDLINE are obviously an important and integral part of every research process, this is not considered in this paper.[1]
The Eysenbach and Wyatt paper does not mention two uses of the Internet as a research tool, namely, a) in the discovery support system ARROWSMITH of recombinant scientific hypothesis using the MEDLINE Internet databases,[2,3] and b) in the online interactive real-time full e-health collaborative research process by a virtual team of researchers.[4-10]
The performance of online tele e-health research collaboration between countries of differing development is still a potential and untested use of the Internet and other information and communication technologies (ICTs). The aim of this comment is to point out the use of the Internet and other ICTs for online tele e-health research collaboration, suggesting the benefit of performing this type of collaborative research between Cuba and the United States of America (USA).
Collaborative Health Research in North
America and Europe
Since the mid-nineties, research collaboration at a distance within a centre linked by a national or international project with one or more centres, is a reality. This is done by using virtual teams of researchers through Internet and other ICTs’ network-based “collaboratories” (laboratories or centres without walls).[4-10]
Such collaboration has had two tactics: 1) the research and development (R&D) of the own Internet and other ICTs’ tools, middle and placeware, scientific methodologies, virtual environments, and legal basements, to perform secure and ethic online tele e-health research (the US InterMed for Health Informatics Project, and the European ETAN Project);[4,10] and 2) the assimilation of that Internet and other ICTs’ infra and superstructure to research concrete health scientific problems (the Great Lakes Regional CFAR for HIV/AIDS, the Northern Rockies Regional BRIN for Coronary Disease, among others).[5-9]
The Internet and other ICTs interfaces, platforms, and research servers, are used to make online interactive real-time tele research factual observations, measures for description of images through remote operation of modern digitally controlled and automated unique instruments, and advanced dynamic digital visualization devices,[11-13] of all types of physical and/or virtual scientific objects or processes, and simulations for explanation and prediction.[4-15] The tele research could have physical and/or virtual goals, materials and methods, in any basic, clinical and epidemiological field of biomedicine, dentistry, nursing, technology, and public health. New Internet and other ICTs’ generations will continue to evolve quickly, spawning new technology applications for “hands-on experimentation”,[6] first for virtual netlabs [4-9] in institutes, universities, and then, for virtual netclinics in hospitals and communities, developing new tele research robotic tools to handle real objects.
The time has come to spearhead a transformation from the classic logic and methodology of health research. The Web will not only enhance the usual reductionist scientific strategy of differentiation, but also the still rare but necessary emerging strategy of integration, due to its great power to ease e-correlation of ideas and facts matrixes, in qualitative and quantitative research by more integrated scientists than ever before.
e-Health Research Collaboration Program between Cuba and USA
By such a collaboration program, outstanding professionals from Cuba could engage in research with their counterparts in USA, with scientific benefits for both Cuba and USA. This idea of an “American Network of Scientific Brains”, has been discussed with delegates on the US People to People Ambassadors Program Initiatives to Cuba since May 2001, and with the Global Forum for Health Research since October 2001 at Geneva.[16] However, the establishment of such a program will demand the achievement of great strategic, ethic, sociological, and juridical feats [5,6] by the US and Cuban research communities.
Professionals in Cuba could actively participate in the most advanced level of US research without having to leave and weaken their scientific communities. Cubans could be enrolled in electronic graduate programs in US virtual universities. Initially, financing for the establishment of networks for this online e-health research in coordinated US projects could come from the Cuban government and US non-government organizations (NGO). In return for the concept of “scientific collaboration”, Cubans could receive information, experience, and financing for some local and regional projects, as well as personal and team grants from the US NGO. In the future, hopefully the funding could come from the Cuban government and NGO too.
Active participation of Cubans in US top research using secure remote operation of unique lab or clinic equipments over the Internet with real-time audio, tele and low-cost video conferencing, remotely controlled laboratory cameras, real-time computer display sharing, Web-based electronic laboratory notebook, satellite TV, and other e-support, to see and converse the researchers, could help encourage and improve Cuban researchers working and living conditions, while discouraging the emigration of talents. The duality to allow the Cubans simultaneous high level research of the problems of more and less developed countries will strengthen Cuba’s scientific capacity developed over the past 200 years.
Initial e-health research initiatives could be directed through the “Vedado e-Project”, a development of one of the authors [RJS] at the Vedado Educational Polyclinic, with assistance of the Family Medicine Department of the University of Washington, Seattle, or of other university affiliated programs. This is an informatics, telemedicine, internet, and other ICTs’ R&D project still unbudgeted in the heart of the “primary care system” and “family medicine program” of the Cuban National Health System.[17]
The “Vedado e-Project” has the goal to introduce the digital systems in a primary care polyclinic and its family practices in a health area of Havana. The expected benefit will be the development of the highest quality clinical care of the patients, as well as of the clinical education, research, and management of the Vedado Polyclinic and its family practices. If the expected benefits are realized, it could be expanded to 440 policlinics and more than 30 000 practices, in close relation with 280 hospitals and institutes throughout Cuba. Its briefcase of research projects with collaboration of five national research centres are as follows: Tele ECG and other Tele Clinical Systems; Polyclinic and Family Practices' Web Sites; APUS and SIDAPS’s Health Management Systems for the Polyclinic and 64 Family Practices; Health-Passport and Unique e-Medical Record Systems; and own Network-Based Research Collaboratory Development Program between Cuba and USA.[17]
Another starting point with unquestionable scientific and humanitarian bases could be the inclusion of the Vedado Polyclinic in clinical and epidemiological studies, clinical and population trials in some US research initiatives, i.g., HIV/AIDS, coronary disease, cancer, Alzheimer’s disease, cerebrovascular disease, depression and disability of the elderly, violence and terrorism; imaging; and health policies and systems.
In addition, clinical and surgical computer-interpretable guidelines and consultations of challenging patient care and advances in diagnostic, therapeutic, and surgical technology could be shared also and discussed using the current and new Internet and other ICTs.
Conclusion
Online tele e-health research collaboration in North America and Europe is a current use of Internet and other ICTs, and its use to improve research collaboration between Cuba and USA is suggested. This type of research collaboration, strengthened with new developments, seems to offer some of the most robust applications of the Internet and other ICTs for the global health research of the future.
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