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InfoLAC, Pilar, Argentina October 30, 2008

Posted by peterjmurray in education, health informatics, IMIA.
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Moving around Argentina – if it’s Thursday, it must be Pilar, near Buenos Aires. After the IMIA Education WG conference earlier in the week, we moved yesterday to Pilar, where the InfoLAC 2008 conference is being held (http://www.infolac2008.com.ar). Due to meetings, I am not going to be at much of the event to report it, but a here for the opening session and my talk on open source and open access.

The event was opened by Dr Marcelo Villar, Rector of the Universidad Austral, who gave an opening address/welcome. He noted the gathering of different disciplines that are coming together to give a series of interlinked events under the InfoLAC2008 umbrella (primarily the Second Argentinian Congress on Medical Informatics, Third Latin American Congress on Medical Informatics, and Second Argentinian Symposium on Nursing Informatics). He sees basic science as being very important, but it needs to be linked to practical implementation, and the changes in speed of introduction of developments from basic science into technological change is resulting in new ways for science and technology to interact and influence decision-making on management of innovation.

Registrations, he says, have exceeded the expectations of the organisers, and a large number of organisations in Latin America are co-operating to deliver the event, which also has support of several local and national government organisations in Argentina. He says that in medical informatics we need to work together to be more than the addition of individual elements.

Dr Juan Carlos di Lucca, President of AAIM and of InfoLAC 2008 also welcomed participants. He talked of the need to redesign processes to improve efficiency in health care, and the important role that informatics has to play in these changes. He asked how do we measure the mission statements that many organisations have? – many organisations have such statements, but have not thought about issues of measuring them. Cultural issues in transformation can result in marked resistance effects in implementation of informatics systems.

The opening keynote address was given by Reinhold Haux, IMIA President, on ‘eHealth and patient-centred care’. He began by highlighting the importance of interdisciplinarity, with different disciplines working together. He began by giving an overview and introduction to IMIA, and on the Peter Reichertz Institute, named after a pioneer of health informatics in Germany. He talked about the hospital information systems circle, of planning, directing and monitoring, through systematic management, monitoring of projects and good information processing practice in a continuous circle of interaction. Today, hospital information system management and architectures are well-established for physical institutions such as hospitals. We are now moving to eHealth and the need for trans-institutional systems, and need to develop professional approaches to the wide range of issues that arise due to sharing information between independent healthcare providers, but working to achieve a common purpose; need to move to patient-centred care and not institution-centred approaches to care. He suggests that basic information management principles remain relevant.

Moving to global health information management issues, he highlighted the important of the WHO eHealth resolution of 2005, and noted the IMIA-WHO collaboration communique agreed at medinfo2007, with its focus on working together on the Global Observatory for eHealth and other projects.

I participated in an open source panel that drew a full room and was chaired by Jorge Rodriguez, from the Biolinux Group in Argentina. My presentation was on wider issues of open access and overcoming the digital divide – I will add a link to it when I upload it to Slideshare later.

The second presentation was about the PESCA project, from Julio Lorca from Spain. The third talk, about open source and thin clients in hospital networks, was presented by Abel Cardenas, from the Grupo Biolinux in Argentina. The final presentation was from Alberto Menini on the use of the i-Path open source telemedicine platform.


IMIA Education WG – updating IMIA recommendations October 30, 2008

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In the final session, John Mantas from Greece, Co-chair of the IMIA Education WG, presented ‘New Recommendations of the International Medical Informatics Association (IMIA) on Education in Health and Medical Informatics’. He reported to results of the work that the IMIA taskforce has been undertaking over the past year to revise and update the IMIA recommendations, which were first published in 1999. He explained that as a result of development of a new knowledge core, and the development of new domains, environments and requirements, it has been necessary to update the recommendations. The revised document will shortly be sent out to WG members and to IMIA Academic members to invite comment.

John says that, despite the documented benefits of heath informatics, there is still a need for education, and there remain many issues over the precise name and description of the domain, the nature of the boundaries with other disciplines, and issues around certification, and recognition of the profession, among others. The revision of the recommendations is also needed due to the development of the IMIA Strategic Plan, and the focus it has on education and knowledge. The revised recommendations, as the previous version, are intended to act as framework and guide to the development of health and medical informatics education programmes, courses etc at various levels of education and for a variety of professionals, including health informatics specialists and healthcare professionals who need varying levels of skills and knowledge in informatics.

IMIA Education WG – Tuesday afternoon papers October 28, 2008

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After attempts to take an ‘official group photo’ lost several people on the walk through the hospital, we managed to get most people together; will provide links to various versions when I get them.

The afternoon session began with a further series of short paper presentations. The first paper, by  Kathryn Brillinger from Conestoga College in Canada, on ‘Intercultural Communication: A “Foundation” Competency in Health Informatics’. The skills are necessary due to the diversity of the student group in terms of gender, ethnic, generational, religious, geographic differences, and especially when they have work experience in Toronto, where 1 in 2 people are from another country. Intercultural communication (ICC) and competency in it are seen as important for health informatics students to work in teams and on projects; teaching team looked at over 150 definitions of culture, and came to a short definition of ‘shared meaning’. Her team have found that health informatics tends to be Western-centric in terms of what is covered in health record systems, and that many of their students are often not aware, when they come to the courses, of many wider ‘political’ and cultural differences between different parts of the world.

Jeannette Murphy presented on ‘Designing an Induction Programme for a Blended Learning Postgraduate Program in Health Informatics’. She reported that both online and face-to-face inductions were needed, due to lack of experience by both teachers and students in online learning; they wanted to prepare students for using the virtual learning environment, and to foster a supportive learning community. Study skills were seen as important due to many of the students having been away from education for some time.  Jeanette described the sequencing and rationale for having face to face induction before online induction; her team’s evaluation, from student feedback, is that face to face feedback is necessary.

Fernando Martin Sanchez, from Spain, on behalf of Victoria Lopez-Alonso, presented on ‘NBIOTIC, an Educational Resource on Convergent Technologies (NBIC) for BioMedical informaticians’. Around 2000, the team began to look at the potential impact of increasing amounts of genomic and bioinformatics data on all levels of health informatics. He says that a new wave/trend that will impact medicine is regenerative and nano medicine, for example development of drugs that bind to nanoparticles. However, as these nw developments are being explored, possible toxic and pathological effects are emerging and need to be explored (eg possibility of carbon nanotubes having similar deleterious effects to asbestos fibres). He described nanoinformatics as ‘ a new discipline to organise, standardise, share, compare, analyse, etc. the vast amounts of data being gathered at the nano scale’. This potentially adds a new level to the spectrum of health/informatics from the nano to population levels, and provides for converging technologies that complement each other at difference levels/scales. The Spanish team are developing a new educational resource to bring together information; part of this work is the EU-funded ACTION-Grid to provide EU-Latin American co-operation.

Paula Otero, from Hospital Italiano in Buenos Aires, presented on ‘Variables and reasons for student’s dropout in elearning courses at the Virtual Campus and distance education in medical informatics’. She says this is the first part of a larger project, and she will present the initial findings.
She summarised the pro’s and con’s of elearning, with the latter including poor local Internet access and lack of motivation. The Virtual Campus was created in 2004, and has 9,000 students registered; Moodle is used as the VLE and there are 80 courses. Drop-out rates in postgraduate courses (health informatics, healthcare management, epidemiology and medicine) in 2007 were explored; informatics courses had one of the lowest completion rates. Older students tended to have higher dropout rates, males had higher rates, as did non-Argentinian students. Further work is going to be undertaken to explore in more detail the reasons for dropping out of courses.

Joanne Valerius, from Oregon Health Sciences University (OHSU) in USA, presented on ‘Workforce Development and Education of Professionals in Health Information Management and Health Informatics’. OHSU developed a graduate level certificate, through an analysis of established biomedical informatics and health information management programmes and courses.

Sedick Isaacs, from Cape Peninsula University of Technology in Cape Town, South Africa, presented ‘Some thoughts on trans-national course selection in Medical Informatics’. He said that availability of courses often compels students to seek education in different parts of the world. As a result, culture and human knowledge can influence decisions made, as can differences in language, differences in mental models and traditional views. The student may become acculturated to the new culture in which they study; this may cause problems when they return to their own original culture. He suggested that acculturation may also happen through distance education. Sedick reported how one of his students explored the introduction of the same information systems in hospitals with different cultures, and differences were found in the degree of success in implementation. Professionalisation, a socialisation process, has an effect on acquisition of knowledge, and this has effect on ways in which the profession is practiced; Sedick says that while studies have been done in medicine, there seem to be no such studies for health informatics.

Sedick explored a spectrum of health informatics, from micro to macro levels; in Africa, the focus is more at the macro and sociological and population health levels, and less on the cellular level. Commodification of education/knowledge, the selling of courses, may result in imbalances of course provision and development of some professions in some African countries.

The final short presentation of the afternoon is from Ken Toyoda, from the Japan Association for Medical Informatics, talked about the ‘Certification programme of healthcare information technologist in Japan’. The Japanese association was founded about 25 years ago, as a result of the  medinfo conference held in Tokyo. A certification programme has been developed; starting in 2003, the annual certification examination focuses on healthcare professionals, and many other sectors of the health informatics community, and as a result over 7,000 healthcare information technologists have been certificated. The programme examines skills and knowledge in IT, healthcare and health information systems in Japan; textbooks have been published to accompany the certification. Issues covered include not only technical subjects, but also health information ethics, as well as communication and collaboration. In 2007, a ‘senior healthcare information technologist’ examination was developed, for those with five years experience in healthcare information systems.; this also includes an essay and interview, as well as paper-based test.

IMIA Education WG – Tuesday morning October 28, 2008

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The wireless networks are much more flakey this morning, so I will upload this post hoc from notes. The first session this morning was looking at ‘Designing an international survey on curricular needs’, lead by Harold Lehman from Johns Hopkin in Baltimore. Harold, Bill Hersh from Oregon and Julio Facelli from Utah gave some opening remarks setting the context for the workshop. Bill mentioned the need for learning more about our students’ education needs, and Julio talked about the need for a quantitative framework for assessment of effectiveness and needs in biomedical informatics.

Harold talked about a similar survey he had done in public health informatics; this had several axes, ie the essential services, the informatics competencies, and the skill levels (referring to practitioners, as opposed to informaticians).

We had a workshop discussion of a range of issues in what kind of survey to develop, and who to survey; opinion seemed evenly split on whether it was more important to survey informaticians or clinical professionals who are not informaticians. Several people gave their experiences of doing previous surveys and of what work existed on which the development of the survey might draw. An example was given of contrasting online and paper-based surveys, with the former being returned more by informaticians and the latter returned more by clinicians. Consensus after discussion was that, for the first iteration, we should focus on surveying health informatics alumni, and that members of the IMIA Education WG might form a pilot group for the survey. Work on this will be developed further following the meeting.

For the second part of the morning, Don Detmer and Alvaro Margolis presented a report on ‘Making the ehealth connection: health informatics and ehealth capacity building’, based in a report on the Bellagio eHealth meetings organised earlier in 2008 by the Rockefeller Foundation.  A session was organised by AMIA and IMIA as part of the Bellagio meetings on ehealth capacity building, and in particular through looking at the global ‘south’ components of needs and 20/20 vision for assuring ehealth capacity. Don talked about the need for surveying national readiness for developing informatics skills and knowledge, and for assessment instruments and other tool kits. He cited the idea of 20/20 ‘bits and bytes’  knowledge and skills offerings, as well as the need for executive seminars, training and advocacy to develop informatics awareness among leaders.

Alvaro summarised the goals of the Bellagio week, including defining 2-5 year actions that IMIA, AMIA and other stakeholders could undertake, the need for a network of people to support the work, and for identifying the informatics needs of developing countries. A useful and dynamic discussion explored a lot of ideas, and the attendees seemed generally enthusiastic for involvement in aspects of the proposals being explored.

IMIA Education WG – afternoon papers October 27, 2008

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The first presenter is Steve Bedrick, a PhD student in Portland, Oregon, talking about ‘Non native English speaking researchers and English language information systems’, which relates to areas he wil be investigating as part of his dissertation work. He notes that much of the informatics literature is published in English, but this is not the first language of many people around the world, including informaticians. This, he sees, is a barrier to information access; machine translation tools (Google, Babelfish, etc) may help reduce the height of the barrier to access, and may be better than nothing. He is looking to build some tools and see who they might be useful for; he wants to do preliminary research to help in the design of the tools, through in-person interviews (convenience sample) and electronic questionnaires, using a well-defined population. Clinicians (including students) will be researched, along with researchers, informaticians and others, for whom English is not their first language; the primary focus will be on Spanish speakers. He wants to look at whether they perceive a need to access English language information, what electronic information systems they use and what language-related difficulties or barriers they have faced, and what tools and techniques they have developed to surmount the barriers.

Jeanette Murphy then preented on ‘Fitting  IT training into the medical curriculum’, a project she has been involved in for the past six years. Jeanette has been collecting data on medical students’ IT skills since 1996, which have shown dramatic improvement since 2001; while most have basic comepetencies in IT, they are mostly self-taught. She covered information on facilitating students’ study of ECDL (European Computer Driving Licence) to gain basic skills.

Juliana Brixey, from University of Kansas School of Nursing, presented on ‘Creating a toolkit for synchronous and asynchronous computer-mediated communications applications for online health information systems’.  She gave an overview of Web 2.0 tools that facilitate different types of social interaction and communications. CMC tools can provide for collaboration, interactivity and other benefits. University of Kansas have an island within Second Life, which can only be accessed by students or by invitation to others. It is used for a variety of purposes, including data collection activities, for poster presentations individually and in groups. Blogs and social bookmarking via del.icio.us have been trialled.

Jeanette Murphy presented a paper co-authored by her colleagues, on ‘Health informatics postgraduate education at University College London’, and outlined the development of CHIME and its curriculum, and how it meets changing UK needs.

Guillermo Lopez-Campos, from Institute of Health ‘Carlos III’ (biotic.isciii.es) in Madrid, Spain, presented on ‘Training health professionals in bioinformatics’. His department has been working on biomedical informatics since 1998, and began by discussing the importance of personalised medicine mediated through genomics. as an underpinning motivation for teaching bioinformatics in the medical curriculum. A number of different learning modes have been trialled for teaching different subjects, including face to face and online courses.

Claire Dixon-Lee, from AHIMA in the USA, presented on ‘An international academic curriculum for the Health Records Administration (HRA)/Health Information Management (HIM) professional workforce’. They are currently looking at curriculum models to develop a scalable curriculum that might be adaptable to global needs and settings. AHIMA have developed online courseware, using a co-operative model to encourage sharing and development of new materials.

The final presentation of the afternoon was from Jana Zvarova, from Charles University in Prague in the Czech Republic, on ‘Higher education program in biomedical informatics’. She described the development of the EU-funded EuroMISE project for developing materials relating to medical informatics, statistics and epidemiology, and the IT-EDUCTRA project.

The day has covered a diverse range of issues from a number of countries and disciplines. I have not had much time to reflect on common issues from the day, but maybe tomorrow – it’s been a long day.

IMIA Education WG – academia and eHealth keynote October 27, 2008

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The start of the afternoon session is a keynote from Kendall Ho, from University of British Columbia (UBC) Faculty of Medicine, titled ‘Involving academia in e-health capacity building – a Canadian perspective’. He framed questions around meeting health information needs today, and how to train today’s and tomorrow’s practitioners, how to keep up with innovations, and how we might turn today’s best practices into tomorrow’s routines. He opened with the Chinese idiom about ‘throwing bricks to get jade’.

He described the study undertaken in 2007-08 to look a EHR training in academia, and at the opportunities and challenges; they surveyed physicians, nurses and pharmacists, and found a clinical/education gap with uneven recognition and acceptance of practices, lack of formal training in health informatics; accommodating health informatics in the curriculum s very difficult for all health professionals, due to crowded curricula; capacity is lacking in terms of faculty champions in many areas, and there is a reseach gap. Traditional curriculum approaches have been unhelpful (trying to squeeze new subjects into a crowded area), and curriculum evolution can be challenging; should health informatics be elective or required, and is it a separate discipline or not?

He raised questions around whether institutions see health informatics as the ‘burning platforms’ that are ‘must have’ developments, and how to involve curriculum decision-makers. Research and evaluation, and the attraction of research fund to the field, are often seen as strong drivers/attractors for many institutional leaders. UBC has created a new eHealth Strategy Office that Dr Ho chairs, and sees anecessary interaction between research, evaluation, and translation into routine practice.

In terms of education, he described the need for pre-med health informatics introductions, medical student EHR, residents to MD training in health informatics skills, community training based in patient-driven needs for information, and the need to develop an ehealth masters degree. Similarly, he sees the need to develop research in parallel to all of these areas, and then translating these into developments such as evidence-based policy and global eHealth developments. He sees these areas interacting and re-inforcing each other.

Dr Ho talked about some specific examples, such as PDA clinial practice guidelines, that have been in development for several years (www.clinipearls.ca); this aims to deliver 80% of the information needed by clinicians within 3 screen clicks and 15 seconds. Technology enabled academic detailing (http://www.mytead.ca/), deriving out of evidence-based prescribing, eprescribing and reporting is also being developed and researched, due to funding from several sources, including Nokia Foundation and canadian provincial government. His final example is ICT for muticultural public engagement (www.iconproject.org) in a Chinese Online Health Network.

He closed by raising a ‘wish list’ including research into the sociology of e-presence and moving from educational experimentation to standardisation, and the development of resources of expertise to aid other institutions in development of health informatic curricula.

IMIA Education WG – first papers October 27, 2008

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After a coffee break and social networking, we are on to the first set of papers. Christian Nohr, together with his co-author Marianne Sorensen, from Aalborg University, talked about ‘Career Paths for Masters in Health Informatics in Denmark’, and his course which aims to connect the clinical world with the informatics skills. 80% of the graduates stay within the health informatics fields, and few move outside the health arena, although 13% work in clinical areas but not focusing on health informatics. Half of the graduates change career paths aftet the course.

The course uses a problem-based learning approach. Some people from computer science (as opposed to health/medical/clinical areas) come onto the course

(Note: stevenbedrick on Twittter is posting there about the sessions)

Hans-Ulrich Prokosch, from Erlangen University in Germany, gave the next talk, on ‘Medical Process Management’, a new course that started its first cohort a few weeks ago. The university (which also has a campus in Nuremburg) was founded in 1743, and about one third of the population of the city is students at the university. Courses in medical informatics are taught in the medical and technical faculties at the university.

Jeanette Murphy presented a paper titled ‘Health informatics education for medical students – international Delphi study’ undertaken by one of her online students, Pupavally Ramasamy. The aim of the study was to look at learning outcomes for informatics curricula; the study drew on IMIA recommendations and other documents to develop the study questions. The study developed 48 learning outcomes, grouped into six themes; two groups of participants had to look at the learning outcomes and grade them according to their views of relevance to health informatics curricula. The study looked at differences in views of informatics experts (drawn mainly from IMIA) and medical educators (who were not informatics experts). The medical educators tended to rate higher the importance of outcomes relating to patient information. barriers to introducing health informatics included lack of health informatics knowledge and skills among the medical educators, and there were differences in views on how it should be taught and who should teach it between the two groups.

Yuri Kagalovsky, from Canada, presented on ‘ A systematic approach to using case studies in health informatics education’, based in programmes at Conestoga College Institute of Technology, near Toronto. The programme focuses on preparing business analysts for health informatics projects. He looked at how to develop case studies and a framework that had been developed for the course; one focus had been on looking at underlying issues from the health care system that lead to the issues within the special focus of the case study, and looking at transferable skills and knowledge that could help with other similar cases.

Q: should IMIA Education WG look at project around developing and sharing case study materials?

Evelyn Hovenga, from Australia (http://www.evelynhovenga.com/), talked about ‘Health informatics graduates: what competencies must they have?’ She gave an overview of work on competencies, and suggested that e-health knowldge and skills needs to be based in supporting person/population health. She talked about the framework that had been developed regarding health informatics as an occupation/profession and moving towards developing career paths in health/medical informatics. She talked about the need towards recognition of health informatics as an occupational standard.

Q: is this another activity IMIA Education WG should be undertaking some activity on?

The final paper of the morning is from Alvaro Margolis, from Uruguay, talked about ‘Health information systems training for a countrywide implementation in Uruguay’, the needs of people in different roles relating to implementation projects, and training needs of interdisciplinary units to ensure success in such projects. 10% of Uruguayan GDP is spent on healthcare.

The papers all generated good questions and discussion, and raised a number of possibilities for future activities under the auspices of IMIA and/or its Education WG.

IMIA Education WG – opening October 27, 2008

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The IMIA Education Working Group (WG)  conference (http://www.hospitalitaliano.org.ar/imiawged/)has started with the opening welcomes from Paula Otero (chair of the organisers), Bill Hersh, Chair of IMIA Education WG, and Fernan Gonzales Bernaldo de Quiros, from Hospital Italiano. The meeting is relatively small as far as IMIA events go, but has a large international contingent. I don’t know if anyone else is blogging, but Steven Bedrick is on Twitter.

The opening keynote is being given by Reinhold Haux, IMIA President. He is giving an overview of the history of IMIA, the Education WG, and the Peter Reichertz Institute. He explained that Peter reichertz was a pioneer of health/medical informatics in Germany, and the institute that Reinhold works at is named after him as an amalgamation of institutes in Braunschweig and Hannover in Germany, and aims to be a regional centre of excellence.

Reinhold explained the objectives of IMIA being around promoting informatics in healthcare, and stressed the importance of education and the stimulation of research. IMIA is over 40 years old, and began as 12 founding nations in 1967; it has 52 full members, and including corresponding members has contacts with 85 countries, as well as about 50 Academic members; these represent over 50,000 people. He explained that education was a high priority from the beginnings of IMIA, and education was its first working group.

Reinhold explained that past activities of the IMIA Education WG are reflected in the proceedings of the various conferences that had been held, and well as wider education publications.This event is about the ninth event since 1970. One of the major outputs of the WG has been the Recommendations on Education in Health and Medical Informatics, which have been translated into many languages. He explained that education in health informatics is important to raise the quality and efficiency of health care, and well-educated health professionals are needed all around thw world.

He suggested that for the future, IMIA neded to look into certification, look at education in a globalised context, to learn and share knowledge, and to promote high quality education through IMIA, and especially through the Education WG.

Welcome to Buenos Aires October 27, 2008

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By way of an introductory post – I am attending the IMIA Education Working Group conference at Hospital Italiano in Buenos Aires, Argentina. I will be blogging the event over the next two days, but the first pst may be later in the day, as I am giving one of the opening keynotes shortly.

I have been here in Buenos Aires for the past week, just doing the tourist bit – but now have to pay the price and get down to the business end of the trip.

More to follow. I will try to upload my slides to Slideshare later. The hospital wireless network seems to be working fine here.

Blogging HINZ from Rotorua October 15, 2008

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Chris Paton is blogging the HINZ (Health Informatics New Zealand) conference this week, from Rotorua. His posts are on the NIHI (National Institute for Health Innovation, The University of Auckland) website, and you can subscribe to the RSS feed.

The HINZ conference website contains the full programme, and Chris has links and posts from his ‘Health Informatics blog‘.