AMIA 2009, San Francisco November 15, 2009
Posted by peterjmurray in USA, conference, education, health informatics.Tags: AMIA, conference, education, health informatics
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Peter is at the AMIA 2009 conference in San Francisco (http://symposium2009.amia.org/). I will be trying to blog some of the action from here – but may end up with most of my reportage being on Twitter – look for #amia2009sf
As of Saturday, 5:30 pm – Registration is now open – after a minor hiccough – and there are lots of people queuing to get their badges etc. A nice sunset over San Francisco at the moment, as viewed from the 35th floor of the hotel. I have been here for two days – done some of the usual tourist bits – some photos are uploaded at http://www.facebook.com/peterjmurray and I’ll try to add more in due course.
Any other tweeters or bloggers, let me know and I’ll add you a link/mention here. I know Kevin Clauson is on Twitter (@kevinclauson), as is Chris Paton (@DrChrisPaton). AMIA is now on twitter at http://twitter.com/AMIAinformatix
MIE2009 – final day September 2, 2009
Posted by peterjmurray in EFMI, Europe, education.Tags: conference, Europe, health informatics, MIE2009, Sarajevo
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Today is the last day of MIE2009. I won’t be reporting much, as my flight home is at lunchtime. Last night was the gala dinner, held in a restored beerhall near Sarajevo town centre. A good time was had by all; Izet sang and ended up losing his voice, he told me this morning. I will upload some photos later, if any have come out OK.
The final keynote speaker is Silvia Miksch from Danube University Krems, Austria, talking on “Computer-Based Medical Guidelines and Protocols: Current Trends”. She is a computer scientist, and is addressing the issues from this perspective. She outlined the problem areas from a user perspective, of information overload, transfer of information and knowledge, and assessment of the quality of care. She notes that there are many different definitions of clinical guidelines and protocols, with varying views in different countries. The guidelines tend to be free text, flowcharts or algorithms – they are used with the aim of improving quality of care and consistency of care, as well as cutting down on costs.
My final bit of MIE2009 is Luis Fernandez-Luque’s presentation on “Challenges and Opportunities of Using Recommender Systems for Personalized Health Education” – related to the work he is doing for his PhD. Tailoring health information is an important aspect of medical informatics. Health education has to do with aptitudes and knowledge relating to improving health – can tailor information to the needs of the individual. Traditionally, tailored health information has been in related to specific diseases or health issues – have been 3 parts, ie gathering information on the users, knowledge of the health information available, and then giving the tailored information to the user, often via rule-based systems. Much web-based work in this area, is still based on the traditional methods. One problem now is the plethora of resources available – and it can be difficult to find good quality content.
Now moving into area of information retrieval tools – search engines or recommender systems. Three types of recommender systems – collaborative (based on gathering knowledge for similar users), content (based additionally on items as well as user information) and hybrid. Some examples of health-related systems – HealthyHarlem (community of patients who tag resources); Cancer Sites Recommender (University of Toronto); MyHealthEducator. Such systems do not rely on experts (although some input from them can help), but derive information from the users. Many recommender systems rely just on popularity of items/resources, and may be skewed due to interests of heavy users. Are no ethical guidelines governing development and use of recommender systems, and the sorts of profiling they are doing on users. Recommender systems have potential for use in health – cannot rely just of popularity as a guide, and quality control is needed. Audience question – what is the role of ‘reputation’?
MIE2009 – Sarajevo August 18, 2009
Posted by peterjmurray in EFMI, Europe, conference, education, health informatics.Tags: conference, EFMI, Europe, health informatics, MIE2009, Sarajevo
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We be blogging, tweeting etc from MIE2009 in Sarajevo at the end of the month.
MIE2009 (www.mie2009.org), the XXII International Conference of the European Federation for Medical Informatics (EFMI) will be held in Sarajevo, Bosnia and Herzegovina, on 29 August to 2 September, 2009. Full information, and the preliminary programme, are on the MIE2009 website.
If anyone else will be there and wants to link up blogs, tweets, etc., please tweet @peterjmurray. I suggest we use #MIE09 to help in searching tweets (thanks, @CiscoGIII).
SINI2009 – TIGER usability panel July 25, 2009
Posted by peterjmurray in SINI2009, conference, education, nursing informatics.Tags: Baltimore, nursing, SINI 2009
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The TIGER (http://www.tigersummit.com/) usability collaborative is presenting a panel of recommendations on ‘Creating usable systems for nurses’. The four speakers are Greg Alexander, Cheryl Parker, Nancy Staggers and Denise Tyler. Nancy Staggers outlined the work of the TIGER initiative, and the nine collaborative teams working on various areas – the usability and clinical application design collaborative was the one that attracted most interest from nurses wanting to be involved in activities.
Greg Alexander outlined the problem addressed as being that current information systems do not always meet the workflow and information needs of nurses working in clinical areas. He said that systems should be patient-centric, and evidence-based, and take account of the interdisciplinary collaboration at the point of care. Aspects of usability include efficiency/productivity (how time-efficient is the application? ), how well does the product help end users avoid errors that impact their efficiency? how quickly can a person learn to use the application?, effectiveness (how well the system matches the way users think and work? how well the system supports patient safety, preventing critical error?
Denise Tyler described a number of case studies of implementation to look at usability issues. The successful case studies had end users (multidisciplinary) involved in all processes, from system selection, to design, through testing and education, and starting with selection to ongoing system optimization. Among lessons learned were that usability is the fit between system users, their work and environments, and imperatives included engaging end users early and often, understanding users, their tasks and their environments, and conducting usability testing and redesigning before implementation (to avoid problems during implementation).
Last day of SINI2009 – Saturday 07.25.09 Morning Keynote July 25, 2009
Posted by erdley in Keynote, SINI2009, conference, education, nursing informatics.Tags: Baltimore, health informatics, informatics, nursing, SINI 2009
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This is my last entry for the conference, readers. Had a great time. I have to catch a flight back to home base (Buffalo, NY) and with the weather such as it is these past few days (traditional Baltimore – h3 (hzy, hot & humid)) as well as in Buffalo (humid & stormy) there’s a chance I’ll be parked at BWI for a while. There’s also a chance I won’t. Either way, given transit time to the airport via the Lightrail, I will be departing for BWI at 10am local (end of opening presentation, too).
Introduction is provided by local STTI chapter president because this chapter, in honor of 50 years of service, is sponsoring Dr. Staggers’ presentation. Opening keynote is Nancy Staggers, PhD, RN, FAAN, Professor & Director for Nursing Informatics, University of Utah College of Nursing. Title of her presentation is “Optimizing the usability of clinical systems: Past work and future directions”. Start time is a little behind normal most likely due to this being the last day of the conference and participants are a bit tardy arriving for the morning food before the session. Nothing unusual here with this, to be honest. Good attendance in spite of the last day of the conference. Discussion will cover usability, synthesis of usability research, future directions and then example (from her research).
Usability deals with solutions, context/environment, and specific goals. Related to human facotrs, ergonomics, HCI and usability (demonstrated via a modified Venn-type diagram. Talks about usability and cpoe in health care practice (Leapfrog Group cited). Reviews systems penetration due to ARRA $’s and Brailler’s (09) talk about need for specialist. DaVinci surgical system cited as tech example. Continuum of info & tech in nursing practice is depicted related to Essentials of Baccalaurate Education (AACN). Need for usability of phr’s, too, reviewed. Also provides a review of past usability research with her doctoral student, Greg Alexander. Search was extensive with exclusion criteria outlined. The process is described in detail from beginning to end. Bottom line, out of more than 11,000 citations, only 34 relevant articles (with 50 studies). Organized into effectiveness, efficiency and satisfaction. A lot to do with information searching, potential error with device designs (e.g.: IV pumps), and so forth. Satisfaction results indicate users want knowledge worth of mention (dense screens, graphic designs, etc.), heuristic evals of devices, remedy the no apparent rationale for selecting products to evaluate. Future directions include expansion of types of devices to study (Only 2 IV pums, PCAs and 1 EHR studied), settings & participants, integrated displays and the type of study outcome variables. Need to examine cognitive burden workflows, need for national db for study results, and, EHR comparative studies re: usability. Additional future directions include administration, education & research areas, look at actual clinical settings (vs. simulated labs), and study interdisciplinary teams. Now she launches into her work on change-of-shift report as example of the issues encountered during this literature review. Employed a variety of methods of research (observation, audio-taped with qualitative analysis after transcription). Results of this study are part of this example discussion. 4 themes are ‘the dance of report (largest percentage), just the facts, professional nursing practice and lightening the load’. Professional practice involved actions, reasoned judgments, care decisions, problem-solving, and such. Context of report issues included noise level, interruptions, patient loads, and report from 2-3 separate nurses. Overall discussion includes issues of ’speed bumps’, high level of jargon, no report structure and ehr not any part of shift report. Nicely done.
Session 6F ‘Virtual Reality’ SINI09 07.24.09 Friday July 24, 2009
Posted by erdley in SINI2009, conference, education, future, health informatics, speaker.Tags: Baltimore, e-learning, education, nursing, SINI 2009
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John Miller, MN, RN and Cathy Walker, titled “Nursing Education in 3D: Leveraging Virtual Worlds and Immersive Learning Simulations”. Using 2 screens and projectors to demo SecondLife (SL). Slides at MUVers.org and at Slideshare.com as well as SINI site for this conference as well. 
Well attended with some 25 or so people in attendance. To emphasize and show better on screen the session is run with room lights off. They have created an ‘OS’ so medical equipment interacts within SL, records to off-world website, and so forth. Presentation is very verbal and demo-like to show how used and what it is all about.
Some events are scripted or the instructor can adjust as needed during the scenario. Also able to see thought / decision-making processes of student, instructor, or both if this is something desired. Interesting environment for students to experience such as monitor, drugs (administration), reading physician orders, IV pumps, and so forth. There is also a bit of ’selling’ here by the presenters about their corporation and services for hospital institutions. Question about research but there is no research ’cause they have no time (she is part of 3 companies; he is involved with full-time teaching along with collaborating other companies). A person recommended is Stephanie Stewart (formerly of UofW, Oshkosh). Otherwise very interactive with rolling ‘Q&A’ between audience and presenters. Nicely done. See YouTube clip, too, for a demonstration >>>
SINI2009 – videos and photos July 24, 2009
Posted by peterjmurray in SINI2009, conference, education, krew, nursing informatics.Tags: Baltimore, krew, nursing, SINI 2009
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Some video clips, courtesy of Eric Rivedal’s new iPhone:
They can all be viewed at http://drpeter.posterous.com/
Some photos are at http://picasaweb.google.com/peterjmurray/SINI2009Baltimore
If anyone else has photos or video clips they want us to link to, please let us know.
Friday Opening Keynote Session SINI 2009 07.24.09 July 24, 2009
Posted by erdley in Keynote, SINI2009, conference, education, nursing informatics, patient safety, speaker.Tags: Baltimore, eHealth, health, SINI 2009
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Paut Tang, MD, Palo Alto Medical Foundation, titled “Personalizing Health Care: Creating a Patient’s Health Home”. For missing pieces of this blog please consult Peter Murray (@peterjmurray) and or Margaret Hansen (@m2hansen) tweets. Interactive presenter with good audience appeal. Not medical home but health home. Defining health via proverbs and personal anecdotes. Outline of presentation is traditional health care, a definition of phr, personalizing and then creating a patient’s ‘health home’. Draws from ION 2001 ‘Chasm’ report for definition of health. Jim Collins, “Good to Great” book referenced, needs to focus on ‘who, then what?’ ’cause ‘who’ will take ‘you’ to ‘what’. How to support patient & family? So, turn to patients first. Derive a phr definition based on patient perspectives is next goal. Draws from his past research using patient focus groups as well as newer work / studies by organizations such as the Markle Foundation. Privacy is a very common and strong concern by those who participated in research studies. Utilizes example, which is included in his work flow, of patient & provider communication and information exchange. Neat part is captured into medical record, shared, of all communications between these 2 parties. Online survey yearly of patients and their use of this systems (PAMF – forgot what is stands for – sorry). Self efficacy is big point (test charts help visualize; lab results graphic; ’score card’ is in front, and so forth). It is a report card for the patient, which changes lives. Online reminders enhance adherence to health maintenance guidelines (4-fold increase in breast mammography testing due to such reminders).
Paul Tang presenting at SINI2009
Traditional disease management is protocol driven (aka – you got the disease, we got the treatment [and sometimes the same for all, too]). Asked patients, in this study, about support structure perceived by the patients / study participants. Describes chronic care model as also indicative of health care overall. To be patient centered start with (my) risk profile, then (my) disease condition and finally (my) agenda. In this diabetic study report, they created diabetes dashboard for patients. Diabetes, for example, becomes much more self management versus traditional paper-based with time disadvantage. Online allows more timely review and behavioral changes by patient and provider along with eliminating paper (also provides longitudinal view / trending to help communicate and or change behavior). A follow-up clinical trial is now planned for 400 diabetic patients (200 intervention & 200 control). Conclusions include phr/ehr integration as optimal approach. Very very personable speaker and very well received by audience. Q&A session followed.
Afternoon session 07.23.09 Session 3F July 23, 2009
Posted by erdley in SINI2009, conference, education, nursing informatics, speaker.Tags: Baltimore, nursing, SINI 2009
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Paula Procter, MSc RN, FBCS, CITP, about “Is nursing ready for the emerging new technologies for health information?”. About 25 persons in attendance. Background includes definition of nursing informatics (ANA, 2008). Of interest to Paula is the use of the term ‘wisdom’ and that there is no wisdom in nursing informatics. This is depicted via a model of the ineffectiveness of wisdom. Makes great use of humor to illustrates various points. Knotted/Unknotted (R D Laing) is a poem recited by her as an allegory for nursing and technology relationship. Another model about information, beyond the traditional one (input, process, output) is called the Humanistic information model (acquisition (information in), processing, storage, dissemination (information out with some being valued added output). Class exercise of determining 7 attributes of nursing wisdom. Suggestion by this person is to consider the thoughts / writings of Stephen Pickner. Various technologies listed for concern include cryo, nanotechnology, and others where Paula indicates a need for nursing wisdom. Biotechnology and the aging process; increase in lifespan begets questions about schooling, life-long learning and healthcare. Challenge is how to cope with public expectations of health care. Information ‘hunger’ is also a challenge (consumers and patient care).
Afternoon session 07.23.09 July 23, 2009
Posted by erdley in SINI2009, USA, conference, education, health informatics, speaker.Tags: Baltimore, Genomics, informatics, SINI 2009
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Concurrent session 2, Jim Turley, titled “The impact of genomics on nursing care”. In the nether region of the School of Nursing (7th floor). Good attendance despite weather (very rainy – pouring more like it) and immediately post-lunch (about 17 so far). This is listed in the program as being at the ‘expert’ level. It is a session to generate questions and create discussion more than inform. Future and research involve genomics in health, individuals and society. Health & lifestyle facts indicate controllable variables versus genomics. So, the question, what to focus on? We understand behavior but not how to do it ‘well’ regarding behavior. How much can we txt via genomics and what might be ‘leftover’ or influenced by environment? Fair use is the discriminating question de jour.
Genomics & new conceptualization of health & illness; genomics -> study of all the genes in human genome together. . . health & disease no longer defined in terms of function (nursing assist with functional ‘things’ of patients); predictive models of intervention before loss of function; need for targeted care; blur boundary of health & chronic illness. One impact is redefinition of nursing role. Carol Bickford offered comment of nursing as a profession that’s ‘a bit conservative’ (to paraphrase). Knowledge of ‘risk state’: a non0symptomatic state after an individual or family is aware of their genetic risk. Treatments (individual, family), communication (other healthcare providers, other family members, and others). Agreement of baseline issues logically leads to traumatic re-definition of roles (for example nurses and informatics specialists) and therefore responsibilities (for example, informaticists and mathematical models of information delivery). Describes history of genetics, therapeutics and nursing. Discussion of examples include simple and not-so-simple genetic disorders. CF is an example of not-so-simple genetic disorder.
Suggests finding a gene on a chromosome map (see NCBI website). Core data site for computational genomics. SNPs is single nucleotide polymorphisms (individual A, T, G, or C). Humans are 99% identical at the level of genetic sequence. Diversity of remaining 1% variation is mostly due to SNPs. Common examploe is apoE and Alzheimer’s incidence. Also is BRCA1 & BRCA2 & breast cancer incidence and or chance thereof. SNPs we can know women at risk for breast cancer & heart disease, risk for PCN allergy, and kids with ASA trigger for asthma. Question – at what point, or when, does this sort of testing become cost effective? How does all of this impact nursing practice? Bedside technology now includes micro-array testing at POC. Given now able to own genetic testing some of the companies currently doing this are listed as examples by Jim. Questions arise, then. Intention and or quality of science, for example. 23andme (https://www.23andme.com/) and decode genetics (http://www.decode.com/) are examples. 23andme also purchased genetic code of Iceland (entire country), which are linked to the emr of Iceland, too.
Some side effects of all of this testing include the Human Genome Project Information site covering a lot of different issues as well as various articles talking about state regulation of this sort of testing (see Wired magazine) to the UK and regulation of genetic testing. Sharing will become more common (between those who can) so eventually a fair amount will be in the public domain. Postulated questions by Jim include the following:
- How to display a genome?
- Include in an EHR?
- What does it MEAN?
- What do you do while KNOWLEDGE is evolving?
- Do companies have the right to ‘buy’ the genomic data of a country?
- Should genomic data be available without a healthcare referral?
- Does it, genomic data, covered by HIPAA?
- Should genomic data be PUBLIC? (does social good out weigh privacy?)
- Should patients be required to ’share’ genomic data with their clinicians? (family members, insurance companies, employers/potential or actual)
- Are we ready for a new paradigm of research (where consumers pay and companies reap)?
- Is it truly a generational problem? (next generation & privacy)
Understanding the human genome project dvd is a nice information resource on many of these issues. See site >>> Excellent presentation and good Q&A with audience at end of session.
UPDATE – a video from Eric Rivedal >>>
