Over the past several weeks the discussion has taken place at multiple levels with the focus moving across several topics. This presents a challenge for trying to understand the impact of TIC, for knowing what to research, and for identifying policies to support a positive social impact. I will comment on what I have read in member messages. I will then present some analysis in this area with a focus on (a) distance learning, and (b) telehealth.

It is important to start by remembering that the social concerns in this discussion are very old, although some wear new clothes. They include justice and peace, decent work and income, and issues of culture and community. The marriage of digital information and communication technologies is very new. At its center are those technologies that allow us to move digital objects across time and space. Previous mass communication technologies centralized control. Listeners and learners were passive and only had very indirect participation in the process.

The new TIC have the capacity to have multiple centers of control and participation. With wise policies and efforts then can give more democratic and equitable access and control to individuals, organizations and communities.

So, the first question is: "What is new about this combination of old concerns and new technologies?" Let me give a working answer and explore it in an example. The new technologies are an electronic space which is more than a place for information highways' and information bodegas'.

This space is a place to do work, to build organizational structures, and to carry out social processes, and to do these things asynchronously, across time and space. That space can be a global space, a community space, an organizational space, or a personal space.

This collaborative workspace and social process venue will become a built electronic space just as cities are build literal spaces and communities are built human spaces. The challenge becomes how should we build this space to serve our social concerns? Since there is disagreement and struggle in the literal world, we should expect the same disagreements and struggles to spill over into this virtual world. The challenges becomes can we do better working across the literal and the virtual than have done in the absence of the electronic venue.

Consider the example of globalization. One member listed it as a ideological challenge, another said this was not new, a third said take it as a fact of life. Whatever, there are two issues here. Where does one stand in terms of the implications of globalization, and where do TIC fit into this? There are several possible threads for MISTICA to follow with regard to TIC & globalization. They range from "How do TIC serve the proponents of globalization?" to "How do TIC serve the opponents of globalization?". One thread is how TIC increase the managerial, administrative, production and marketing capacity of smaller more community based organizations relative to global organizations, in any of the economic, political or cultural arenas. Another thread could be about the uses of the electronic venue is the struggles of the small against the large.

MISTICA, in collaboration with other like minded projects in Latin America and the Caribbean, has the dual task of research and capacity building. Of supporting a learning environment. To do this MISTICA is first and foremost a collaborative work effort. MISTICA will help build a culture in the electronic workspace that promotes learning through collaborative effort and critical discussion.

This points to what else is new in the coming knowledge age. It is not, as some think, that knowledge is the new scarce resource. Knowledge has always been scarce. What is new is that much knowledge is either quickly obsolete or new. What is new is the need for a culture of continuous learning combined with a larger role for wisdom and evidence in policy decisions.

Consider the issue of health, or the lack of health. The issue of health is only partially a function of genetics or age, to be addressed by medicine. It is largely a function of income, occupation and environment. Each of these in turn is a function of other individual and social factors. The TIC created electronic venue presents us with the change to build telehealth as part of the built electronic environment.

If we want to study, understand, and formulate policies which use telehealth we have to organize our thoughts, our tools, and our tasks. We have to distinguish between telehealth, and the subset called telemedicine. We need to distinguish between health as a process and outcome and telehealth as an expanded venue for health as a process and outcome. We need ways to describe electronic presence, or persona, of the individual, the organization, and the community. We need evaluation measures that allow us to identify the value added, or value subtracted, as telehealth and telemedicine are added to the landscape. Consider resources are devoted to telemedicine based research or treatment for the ravages of tobacco. If done to the neglect of community health promotion, tobacco control policy and research, the result may be less health equity and less healthy outcomes and a failure to confront the real challenges coming from a corporate tobacco agenda.

Research, knowledge sharing, and good policy for a positive social impact in this area depend on understanding the ways in which TIC change the rules of the game for learning, work, organizational structures, policies and social processes. The advantage of this MISTICA supported collaborative venue is that we can draw up a list of research targets, research approaches, and research tasks and operate as a virtual learning organization, focused on research and policy implications. In the final analysis that will require us to divide into teams covering different tasks. In telehealth these could include TIC and health promotion, TIC and community health, telehealth in telecenters, TIC and just-in-time health training for professionals, TIC and the structure of health organizations, TIC and health policy, TIC and health promotion/policy dialogue, and TIC and health transparency and accountability.

Lastly, it is very important to separate out the impact of TIC on the social process being researched from other forces operating on that social process. It is also important to understand that TIC operates at multiple levels within each social process. One can study it as an aid to management and administration. One can study how and where services are delivered, or how it is used as a vehicle for increased, or reduced, transparency and participation. My closing observation on the dialogue in this MISTICA discussion is that two things unite the participants and one thing divides us. The two things that unite are (a) the desire to better understand the social impact of TIC, and policies to shape that impact, and (b) a willingness to work together on that task. The one thing that divides us is (c) which particular issue or social impact we are interested in and at what level, individual, group, or community.

This suggests that at the next stage we should self organize ourselves into distinct task forces or work groups, based on issue or social impact interests. Beyond that, each work group would share a commitment to continue a dialogue within MISTICA around methods for evaluation and analysis. There would also be a common obligation for transparency and openness, including a dialogue around how to achieve those objectives.

Sam Lanfranco
Distributed Knowledge, York University, and Bellanet