Truth is Better than Make-Believe

I have just finished reading Henry David Thoreau's classic book Walden... a book chalkfull of famous one-liners and aphorisms. One of the lines in his conclusion is "Any truth is better than make-believe".

The quote struck me because one of the greatest barriers to the successful implementation of eHealth initiatives is a failure to see the truth of our circumstances. Lack of complete and accurate information and understanding is at the root of most eHealth risk.

Why don't we know the truth of our present circumstances? There are many reasons.

• We might not have all the facts.
• The facts that we do have might not be accurate.
• We might not understand the context well enough to be able to interpret the facts that we do have.
• We might fill in any gaps in the facts with our own best guesses, which may be wrong.
• Someone may deliberately withhold the facts, or distort them, or deliberately or unwittingly give us misinformation.
• We might be too busy or not have enough time to gather the facts, and will make decisions based on our gut instincts instead.
• Our biases and prejudices may cause us to misinterpret or disregard the facts.
• Wishful thinking may lead us to fit the facts into a conclusion that we have already reached.
• We might deliberately alter or withhold the facts to avoid blame, or to shield another person or our organization from blame.

Most people don't ignore, alter or withhold information with malicious intent (though that sometimes happens). There are often extenuating circumstances that cause people to interpret the world as they would like it to be. Wishful thinking and avoiding blame are probably the biggest reasons for this.

The first step in any risk management exercise is to understand the environment and context into which your eHealth initiative is to be implemented. This is where science helps. The scientific method is the best approach to analyzing a situation. What are the known facts (i.e. truth)? Where are the gaps? Can we develop reasonable hypotheses to fill in the gaps... and then test those hypotheses multiple times?

We don't know the entire truth about eHealth. We have some early indications of what works and what doesn't. Understanding what we know and don't know, and being honest and truthful about it, and being prepared to take risks, is what is needed to start the journey towards eHealth Nirvana.