The author is professor and researcher at the Department of Communications at the University of Quebec in Montreal and consultant in new information and communication technologies (NICT) for various companies and governments in both Europe and North America.
Information is fast becoming the center of gravity of the socioeconomic systems in all countries ; increasingly, it is becoming a strategic resource, a resource carried by information highways (Intemet, intranet, Web, etc.). Because information highways ignore borders and weaken the nation state, countries are obliged to reduce the services they offer: health, education, environment, etc.; thus, information highways have the potential to become innovative or destabilizing elements depending on how they are used. The field of health and social services is preparing to move from an era of infrastructures to that of infostructures. But the health sector cannot be studied in isolation; it must be examined in a larger context.
A context of rupture
Since 1990, we are no longer living as we did in the past, but we have experienced a radical discontinuity. The forces of change have become planetary in scope and, consequently, much more difficult to control. In five to seven years, our societies will no longer be quite the same; the State, politics and economics will no longer be operating in the same spaces nor in the same time as they previously did. The transition of our societies to the 21st century will depend on a body of decisions that will be influenced by several new trends shaping this new space and time.
New information and communication technologies (NICTS, information highways, multimedia, CD-ROM, etc.)
At the February 1995 meeting of the G7 in Brussels, NICTs were identified as essential to meeting the challenges of competitivity and modernization for 21st century societies which will be based on knowledge and communication.
When we analyze the past we realize that the process we are going through is developing around a technological engine which creates economic value and stimulates all kinds of growth : at the start of this century it was electricity, then electronics and the computer, and since 1990, information highways. Experts feel that these highways will be the driving force behind economic prosperity into the 21st century.
Changes in language and culture
Language and culture are the analytic tools people use to make sense of their environment. If the environment changes to become more digital, visual and interactive, as is presently the case, language and culture will change in order to help people adapt to these new mutations. Languages such as Portuguese, Spanish, French, etc. will be faced with important challenges in cyberspace.
The <<Global Information Infrastructure>>
The GII is the model proposed by the Americans at the G7 meeting in Brussels in February 1995. It is an offensive that will enable the major American entertainment corporations to take control of the world content industry by the turn of the century. The Information Highway, Internet and the Web are not technological weapons as is commonly believed, but rather, cultural arms because they deal with content. Without the local production of quality content, the Internet has the potential to become a cultural and economic Trojan horse in many countries.
The Nation State
The internationalization of technologies and markets on so large a scale creates a fusion of economic spheres which weakens political boundaries, that is the Nation State. The New World Order which is based solely on profit forces nation states to reduce their services (education, health, environment, etc.), putting jobs in jeopardy and making the poor poorer. The new lords of the world, relying on NICTs and the commodification of economies, do not recognize borders, cultures, or states. This calls the leadership of our elected representatives and planners into question.
Continentalization and Globalization
Newspapers have exaggerated the phenomenon of globalization while ignoring its timetable. The trend for the next four or five years is one of continentalization, that is the organization of markets first along continental lines, such as NAFTA in our case. This continentalization proceeds through the development of vertical alliances between various actors (content suppliers, carriers, etc.). These alliances are based not on a technology or a regional market, as was the case only a few years ago, but on a market which has become continental in scope. Only after this phase is well-established will globalization come into its own, in about five to seven years.
Most technology watch groups and think tanks around the world believe that the next five to seven years will be critical in determining our future, and that a field which is bringing together enormous energy, new alliances and investments will play a vital role: the content industry. At the present time, each country is starting to define its general strategies or its strategies in a particular sector, such as health, based on:
The information highway is an intangible and immaterial subject, a mobilizing concept that evokes strong images in our society, to the extent that it is becoming a myth: the myth of a cyberspace that gives users the impression that they are in the same room as the person they are communicating with. This myth was inspired by the novel Neuromancer1: There's some kind of actual space behind the screen. Some place that you can't see but you know is there. The social imagination constructed around information highways is actually much more significant than the reality of their implementation; information highways remain a distant objective even if we are presently taking important strides in that direction.
In this expression are concentrated, with or without reason, numerous hopes for overcoming the present crisis. The information highway has become a shared metaphor for the bonding of industries which, until recently, did not share a common language; today they all speak digital. In particular, the information highway has become a metaphor for the grouping together of economic interests that use electronic money techniques to launch a new content industry (diagram 1).
Information highways are a system of new signposts that allow their users to navigate in knowledge spaces. They represent a new way of doing things, new arenas of common action for groups. If culture is a way of expressing our identity, the information highway acts to distribute it. Because these techniques encourage diversity and the accessibility of information is increasingly rapid and less expensive, information highways multiply the sources of information, just as the printing press multiplied the impact of text on society by multiplying its physical support. These infostructures will probably not have power in the political sense of the word, but they will have enormous cultural and economic impacts on our societies. At the present time, there are a lot of near misses, traffic jams and even leaving the road ; the early days of electronic superhighway are like a rodeo, or an obstacle course. It is developing thanks to a series of convergencies which highlight certain tendencies :
The first definition of the Information Superhighway was : A seamless web of networks providing the services people want and need. The information highway can now be defined as follows, according to the three tertiary poles (technological, economic, social):
a high speed global network, created by the convergence of telecommunications, computing and audiovisual technologies, with interactivity, connecting pre-existing networks and encouraging the creation of new networks to produce, not one highway, but several (technical definition) ;
an international marketplace, composed of various distribution spheres, each of which is an electronic space in which clients consume content and professional or residential services (economic definition) (diagram 3) ;
a new circuit between the content supplier and the teleconsumer, that is between supply and demand (social definition) (diagram 2).
Diagram 1: The anatomy of information highways
The above diagram illustrates, between the carriers and the network operators, the central core or backbone of the information highway which uses a variety of technical solutions: satellites,fiber optic or coaxial cable, or telephones. According to whether they are directed to homes, businesses or mobile communication stations, information highways adapt to different environments, markets or consumers. The whole forms a new media particularly suited to residential or professional teletransactions.
This network of networks is becoming the arena for the development of the content industry and the battlefield of the major American entertainment corporations.
Diagram 2: The diffusion model
The transformation from mass media to information highways occurs as we move from a certain critical mass of information received by another critical mass of consumers , to a situation in which increasing numbers of new clienteles join already-established ones to react to another, exponential, critical mass of information. The large increase of these two critical masses requires the development of a new model which gives rise to a new consumption rationale, "client-server" technology, etc.
Another major change: in the mass media model presented above, the distribuoer controls the process, whereas the receiver is in control in the information highway model.
The Content Industry
Masked by the media hype surrounding the arrival of personal computers, consumer electronics, the Intemet and the Web between 1980 and 1994, few perceived the emergence of a new economy based on the content industry behind these seemingly diverse activities (diagram 4). The following new terms testify to the strength of this emerging industry ; they are also indicative of questions concerning definitions and particularly socioeconomic uses: digital revolution, home entertainment and information services, commercial on-line services, mass consumer market in cyberspace, electronic marketplace, value-added networks, etc.
This industry, also called the information industry, cultural industry or digital industry, ensures the design, production, management and distribution of resources which meet the needs of the emerging information society. In the future, all societies will have the responsibility of forging their collective imaginations, because if the information highway offers citizen-consumers the here and the elsewhere, without content it only offers elsewhere. Content is simultaneously both a cultural object which allows groups of people to live together and an economic good because it is consumed by these same groups ; thus, in an information society, culture becomes an economic issue. Its principal elements are services, products, applications and programs (diagram 5) :
This industry is based on "gray matter" rather than capital, raw materials or energy. Its structure is more complex and flexible than that of traditional industries ; it is based on extension rather than concentration. The industry emerges as result of the triumph of liberalism and capitalism, the liberalization of cross-border trade and the arrival of new capital investments by new actors attracted by prospective profits. Thanks to information highways, a new generation of entrepreneurs is developing. The symbiosis of new investments with so many new ideas stimulates the economy; some researchers even interpret it as the beginning of a new economic cycle.
Diagram 3: Electronic marketplaces
Diagram 4: Industrial Organization
Diagram 5 : Conditions for content development
The critical mass of information stimulates a critical mass of consumers. This is the answer to the question of the chicken and the egg : what makes an interactive service take off, the consumers or the content ? The answer is the content, but under certain conditions.
An interactive service grows through interaction between at least six elements, each acting on the others, resulting in a spiral of growth, or a "snowball" effect.
This model is based on the dynamic interaction of two critical masses, that of information and that of consumers.
The Health and Social Services Information Highway (based on a study of Quebec hypotheses)
At the present time, all eyes of health and social service planners are on technologies that could be used, but these technologies are the object of so much media hype that most analyses are skewed. The true problems are not material, they are found elsewhere : finding a satisfactory information processing modeland offering adequate training to the many people who will use these new systems (diagrams 6 and 7). Problems are exacerbated by the aging of our population and the high cost of biomedical technologies. If these two problems are not resolved satisfactorily, the health sector's information highway will lead our country to a serious administrative imbroglio and cost twice as much aspresently forecast.
Summary of the situation(context for recommendations)
It is important to distinguish between three different functions in the field of health services (diagram 7). Each should be met using a different highway with its own technological characteristics and target user groups.
A - Medical practice (doctors)
This function requires a sophisticated and extremely costly technology, based on digital imagery. It is an information highway used by doctors and other specialists that links together a fairly small number of hospitals, laboratories, etc.
B - Administration (managers)
This function requires the transfer of large volumes of data over a highly secure network (see the number of breaches of privacy in the United States). This information highway links together a large number of highly diverse administrative centers: hospitals, rehabilitation centers, residences, government departments, pharmacies, insurance companies, ambulance services, etc. using specialized administrative practices (accountants, lawyers, controllers) and the exchange of a large variety of forms. This implies the reorganization of procedures and operations.
C - Communication for the general public (citizens and interest groups)
This function distributes texts for a general audience using mass media strategies and techniques. Using interactive techniques, it also serves to collect the reactions of the public, particularly of the many interest groups in this sector.
The other key element of this project is the patient file (or beneficiary file). Without an adequate information processing model, multi-level consultation of this file becomes difficult if not utopic, and it would be futile to embark on such a project.
Diagram 6: The architecture of the health and social services information highway. Objectives:
Diagram 7: The three functions of the health and social services information highway
Three Types of Information Highway
We should develop three parallel information highways rather than trying to develop ONE single system for health and social services:
A- An information highway for the exchange of medical imagery between a relatively small number of facilities (hospitals, laboratories) using broadband and data compression technologies. This section need not necessarily be linked with the administrative information highway, since this would increase its development costs.
B- A high security administrative information highway that can handle massive volumes of data between a myriad of administrative centers using a central file and personalized medical smart cards.
C- Use already established public information highways for communication with the general public and feedback.
The Patient File
We must develop a patient file which integrates a structured model of information (with four dimensions) that goes beyond traditional database models (in which information has only two dimensions). Minimally, this model should include: - an informational rationale : index, sorting, classification, etc.
- a relational structure : documentation of sources or metainformation;
- a procedure for synthesis : different diagramatic and visual presentation techniques ;
- a navigational model geared to a diversity of users, operating at various levels of security and confidentiality ;
- a user interface adapted to these heterogeneous uses and different levels ;
- this new support could be the medical smart card (a sort of portable file with an access key)
The Central File
The central file should contain all present and future patient files. The information it contains will change so rapidly, even exponentially, that it will need to be developed and administered by a specialized team (an agency?) and will require an even larger team to maintain and update it.
Among other things, the cost of training managers and medical personnel to use the system should be included in cost estimates for the system's development.
The confidentiality of the central file and of patient files is not a major technical obstacle2, but it becomes an important psychological obstacle for all patients. We scarcely realize that this accumulation of all types of information (personal files, medication, exchange of bills, drugs, etc.) will attract many crooks who, by penetrating the system's security, will make users uneasy to say the least. Users will react violently to this intrusion in their private life. The credibility of the entire system depends, not on the software it employs, but on its confidentiality.
1. William Gibson, 1984.
2. We estimate that the major security problems relating to standards will be resolved within a year.
Professeur au département des communications de l'UQAM depuis 1975, Michel Cartier est aussi consultant auprès de diverses entreprises, associations et ministères dans le domaine des nouvelles technologies de l'information. Les principaux intérets de Michel Cartier sont l'étude des impacts des nouvelles technologies de l'information sur la société et le développment d'interfaces-utilisateurs et de langages médiatiques conviviaux. Il est de plus spécialisé dans les activités de veille technologique et de prospective.
Domaines de recherche:
-Impacts des nouvelles technologies de l'information
-Développement d'interfaces-utilisateurs et de langages médiatiques conviviaux
SIGRAPH Inc., SIGCHI Inc., ACM Inc., France télecom, Patrimoine Canada, UNESCO, Haut Secrétariat à la langue française (France).
Parmi les réalisations du chercheur:
L'expertise de Michel Cartier dans le domaine des nouvelles technologies de l'information est sollicitée par de nombreux organismes et ministères. Au cours des trois dernières années, le chercheur a notamment agit comme consultant das ces projets:
- Consultant auprès du Haut Secrétariat à la langue française sur les impacts des nouvelles technologies de l'information sur la langue et la culture;
- Consultant auprès du Comité Théry sur l'autoroute électronique française;
- Consultant pour le programme "Apprendre sans frontière" pour l'enseignement à distance;
- Consultant pour l'organisation d'une rencontre du G7 à Bruxelles sur les autoroutes électroniques;
- Consultant auprès de Patrimoine Canada pour un Plan d'action pour le développement des industries culturelles;
- Consultant auprès de l'UNESCO pour la rédaction d'un Plan quinquenal portant sur la place de l'information dans la société à l'aube du Xxle siècle.
Michel Cartier a aussi été consultant auprés de diverses entreprises américaines pour des recherches portant sur les interfaces-utilisateurs, les langages médiatiques et l'autoroute électronique.