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MIE2009 keynote – augmented reality and telenavigation August 31, 2009

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The afternoon keynote presentation is by Rolf Ewers, from the Medical University of Vienna, on the use of augmented reality and telenavigation in surgery. Augmented reality is not about simulating reality (as in Second Life, etc), but about adding on information to real life situations. The first generation uses, for example, data from CT scans to assist the use of clinical tools. Using these tools, can plan operations in advance, but also evaluate afterwards how precise the surgery was in relation to the planning. Second generation telenavigation tools and techniques are helping with keyhole surgery. His team are also using telemedicine tools for teleconsultation and to teach the techniques to clinicians in other parts of the country and internationally.

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MIE2009 – open source workshop August 31, 2009

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I am in the workshop that I submitted, and we are running, titled ‘Open source and healthcare in Europe – time to put leading edge ideas into practice’. Helen Betts is chairing the session, and gave the introductions. I cannot blog and tweet while I am talking, so summary of my contributions will be post hoc – but I will try and cover the rest of the workshop.

I gave an overview of the Open Steps meetings held in 2004 and the EFMI STC 2008 meeting – see http://bit.ly/bq0TZ for Open Steps report and my slides at slideshare – http://www.slideshare.net/drpeter/open-source-workshop-mie2009-1930491

Anze Droljc from Slovenia gave a presentation on developing open source solutions in breast screening programmes. He gave an overview of Drools, a business management rule engine, and then went on to describe how the data to support the breast screening programme are captured in the central repository and are shared. They have developed an end-user application that does not need use of a mouse, but is keyboard-driven. The system being developed allows interaction of open source and proprietary applications. It seems that only open source tools are being used, and the actual solution being developed is not open source, but is proprietary.

Thomas Karopka, the new chair of the EFMI Libre/free and open source working group, talked about “Building the FLOSS-HC Community – a strategy for the advancement of FLOSS in health care”. He presented some ideas, for further discussion. He began with presenting the free software (http://www.fsf.org/licensing/essays/free-sw.html) and open source initiative definitions, and the differences between them. Thomas feels that open source has made quite a lot of progress in recent years. He covered a number of issues that might be influencing the uptake, or not, of FLOSS in healthcare – including lack of professional support for products, concerns over quality of software, sustainability concerns, and whether there is anyone to sue if things go wrong.

Thomas identified four steps to discuss that might be useful:

1. need for a dedicated FLOSS healthcare inventory to gather together a comprehensive list of FLOSS healthcare products and projects;

2. development of a collaboration platform, that might include software repository, use case database and FLOSS healthcare knowledge base;

3. setting up a ‘network of networks’ to link the various FLOSS WGs and foster collaboration between different projects and networks; and

4.developing FLOSS dissemination activities.

The latter part of session will be a business meeting of the EFMI LIFOSS WG; a report on this will be given later.

MIE2009 – Monday morning keynote – Ed Hammond August 31, 2009

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The first keynote of the morning here at MIE2009 in Sarajevo is from Ed Hammond on “Realizing the potential of healthcare information technology to enhance global health”. He began by acknowledging that challenges facing Europe also will apply to USA in terms of healthcare , and that sharing experiences are important. In all countries in developed world, cost of healthcare is excessive and rising rapidly – in part, due to technology. How do we justify use of technology if it increases costs of healthcare? Is there evidence that using technology in healthcare saves money? – this is justification often given, but is it true? why do some countries have better health outcomes at half the cost?

Technology should not be the master – but often technology drives what we do – often create solutions and then look for problems – this is not right approach? Outcomes of healthcare do not always match the amount of money. Evidence has NOT shown that increasing amount of money results in better outcomes. Need to spend the money on the right things – need to look at preventive care. Ed stresses he is not anti-technology – but need to use it appropriately. Technology usually does not save money, it costs money – misleads people and can result in problems.

Imaging costs money – but is it always effective to use more images? They can have major impact on quality and effectiveness of care, but may be overdone. With adequate data, we should be able to eliminate errors, and increase amount of knowledge about what works best. Need to improve consistency of care of patients – physicians often influenced by recent outcomes. Geo-coding can be increasingly important in management of disease – why is there geographic disparity in disease incidence and healthcare outcomes? National statistics and population data is important for many countries in managing healthcare – rather than the current strong focus on individuals.

There is trade-off between cost of care and quality of life – often down to individual choice, but needs to be part of the debate. Many of drugs and treatments used are used globally, not just locally – need to aggregate this data to help everyone improve outcomes. Why do some electronic systems mimic paper? – this is limiting on the potential.

What is the purpose of an electronic health record?  Doomed to repeat mistakes if people say ‘that’s not the way we do it’. We often solve the wrong problem in addressing healthcare issues. Need to recognise that query is where value lies, and EHRs need to support queries. patient-centric means one person, one EHR.

EHR so far are a reflection of how data are collected – and we need to move beyond this to proper, comprehensive use of data; needs to be re-usable. Systems need to re-evaluate patient when new data are added to EHR and health IT systems. More data does not mean more information – need intelligent ways to filter data.

Public health has been a neglected component of healthcare in many countries, especially in USA. Needs to be at the forefront of IT use in healthcare. With rare diseases, affecting few people, need to aggregate global data to support clinical trials. Need to strike balance between sharing information for health and needs for privacy etc. Healthcare is a team process – but need to convince the person to engage in health behviour changes.

We need to understand what treatments are effective and what aren’t. We need to convince both patients and providers of the effectiveness or otherwise of high tech and high cost treatments; less costly tests may be better for health in the long run. Should not be rewarding physicians for simply buying systems – should be rewarding them for improving care, and making differences in outcomes. We can have perfect systems, but if they don’t make a difference, what use are they? We can afford failure in small steps if in the long run we make improvements. Need to ‘do once and share’ at global levels to solve problems, and enhance understandings of problems. Need to understand and accommodate different cultures. Need to re-examine and think out of the box; need to push the limits of the technology, so as to level the playing field for all countries. Can we take the best of outcomes from around the world and repeat, from lessons, in other places.

For other reports, see @omowizard and @CiscoGIII tweets.

MIE2009 – opening ceremony August 31, 2009

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Last night, Sunday, was the opening ceremony for MIE2009, held at the Sarajevo National Theatre, a grand building that was modeled, it seems, on the Vienna Opera House. The ceremony was started with welcomes from Prof Izet Masic, BHSMI President, Jacob Hofdijk, EFMI President, Reinhold Haux, IMIA president, and the Rector of Sarajevo University, among others. The two formal keynote presentations were from Prof. Gjuro Dezelic on ‘After three decades of medical informatics in European congresses’ and Gerard Comyn, from the European Commission on ‘EU ehealth agenda: strengthening research and innovation’. The cermony included a choir and string quartet, and was followed by a welcome reception.DSC00729

National Theatre, Sarajevo

MIE2009, Sarajevo – arrivals August 29, 2009

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Well, here I am, safely ensconced in the Holiday Inn, Sarajevo in Bosnia and Herzegovina for the MIE2009 (www.mie2009.org) conference. It looks like being another hot and humid day here. After a long day of travel yesterday, including a 5 hours wait between planes at Munich airport, finally got here last night. The pick-up arrangements were excellent (many thanks to Promo Tours for their excellent work – http://www.promotours.ba/), and so it was a quick trip from Sarajevo airport to the hotel.

The EFMI (www.efmi.org) Council meets all day today (after the EFMI Board meeting yesterday) – those of us here already and not involved will be taking the opportunity for tourism today and tomorrow. I have never been to Sarajevo before, so I am looking forward to seeing some of it – will post photos later.

Various other people will be reporting from MIE2009 (mainly tweeting, I think) – so, watch out for @CiscoGIII, @luisluque, @omowizard – or search Twitter with #MIE09

OK, enough sitting in the hotel over a laptop – off to see the sights.

UPDATE, 17:15hrs – after a wander round the old town, lunch (cevapi with onions – http://en.wikipedia.org/wiki/%C4%86evap%C4%8Di%C4%87i), turkish coffee and lemonade, and conference registration, we had a beer and chat with Ed Hammond at the conference hotel.

Some photos area at http://picasaweb.google.com/peterjmurray/MIE2009Sarajevo where more will be added later. Now the hard choices – where to have dinner; there seem to be plenty of choices.

MIE2009 – Sarajevo August 18, 2009

Posted by peterjmurray in conference, education, EFMI, Europe, health informatics.
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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).