In this issue, we take a special look at healthcare consumers - examining what they expect from the system; where they are going for health information; their changing relationship to providers; and the system's capacity to address their demands. We begin with a poignant discussion by Bob Rae, former Premier of Ontario, who speaks as both politician and consumer. This paper is a very thoughtful piece reflecting many years of consideration by the author about serious and persistent healthcare issues.

Next, Hy Eliasoph focuses the discussion on the impact of the Internet by profiling the typical "healthcare web surfer." Here we see a well-educated female, about 40 years old, reasonably well-off financially, who has been checking in "on line" for several years. Does she sound familiar? Eliasoph goes on to describe why such people search the web, what they are looking for and what they do with what they've found. Earl Berger follows with a discussion of the major factors influencing the system - educated consumers, limited resources, aging workforce and the Internet. His evidence is solid, coming straight from the Berger Population Health Monitor surveys. Finally, Dale McMurchy and Marko Vujicic describe the changing relationship between patients and their providers - a change, again, fueled by the Internet. Providers will need to develop a better understanding of what this all means for the delivery of appropriate services and meeting the constantly changing needs of today's consumers. We must also ask: Is there a role for hospitals in helping make the connections between consumers' needs and their relationships with the healthcare system? Can hospitals partner with professional groups/associations to help bridge the gap to better-informed consumers and more coordinated care?

Still on the theme of consumers' needs, Pamela Spencer offers a legal overview of federal legislation associated with ensuring privacy of consumer information. This is a topic of growing importance as different levels of governments push for greater use of electronic communication to facilitate exchange and transfer of health information. But there is a catch - consumers do not want just anyone to have access to their health record. They are anxious to ensure that providers have access to their health information in a timely fashion, if (and only if) they need it.

Steps to advance the use of telehealth and telemedicine are rapidly being implemented across Canada. These important strategies have the potential to improve primary healthcare services day and night to all Canadians. Telemedicine/health is a set of strategies naturally suited to Canada's geographically dispersed population. Now, in many parts of Canada, a consumer can pick up the phone and receive expert nursing advice. Carolyn Moore describes how the nurses in Nova Scotia have also capitalized on the opportunity to integrate telehealth technology with clinical education.

We are fortunate in this issue to have an excellent paper by Hirdes et al. describing the development and use of an assessment instrument for individuals with mental health problems. This instrument is being tested across several provinces, and we have comments from several early users. A systematic evaluation of the tool is providing excellent substantiation of the need for evidence-based healthcare.

This issue offers readers two profiles of healthcare leaders - Lynda Cranston, CEO of Canadian Blood Services and Kevin Keough, who was recently appointed Health Canada's Chief Scientist.

Other highlights in this issue will whet readers' appetites for future issues of HealthcarePapers. First, Michael Moralis provides a web review of available material on Adverse Medical Events. This information serves as a useful stepping-stone for our Spring 2001 issue of HealthcarePapers on the subject of Medical Errors, a topic receiving a great deal of attention internationally. Second, we provide a review of the book The Ethical Canary by Margaret Somerville the well-known Canadian ethicist that we hope will stimulate your thinking about other thorny ethical dilemmas. This review will alert you to an in-depth analysis to be provided this spring in HealthcarePapers about the ethics of bedside rationing - so stay tuned!

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