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Looking for the MIE2011 Blog? August 10, 2011

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UPDATED, 23 August 2011:

For the MIE2011 blog, please go to http://mie2011blog.wordpress.com – Thanks to Karl Oyri for setting up this blog for the MIE2011 conference and related activities.


Blogging MIE2011 from Oslo August 8, 2011

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We will be blogging MIE2011 at the end of August.

MIE2011 – the XXIII International Conference of the European Federation for Medical Informatics – will be held in Oslo, Norway on 28-31 August, 2011. See http://www.mie2011.org for the latest information on the event.

See also on Twitter (http://twitter.com/#!/mie2011) and Facebook (https://www.facebook.com/group.php?gid=363398669412)

More information later as we get nearer the event.

OpenHealth, Belfast – morning keynotes January 21, 2010

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The first keynote talk of the morning session is from Joseph dal Molin, on “Open and connected health: a North American perspective – it’s time for the new paradigm”. Joseph is President of e-cology corporation and Director of WorldVista (http://www.worldvista.org/); he is also adviser to the Jordanian government on EHR implementation using Vista. Joseph began by saying that an open and connected health model is a patient-centric ecosystem; there is a great deal of complexity that must be taken into account; holistic perspective is needed, and all domains affecting care must be taken into account. A simple industrial model does not work; much of current health system is based in silos of information etc.

Joseph says that the US VA ecosystem delivers high quality care, and is very cost-effective; number of veterans treated from 1996 to 2003 rose by 75% (with increasing complexity of care), but the budget only rose by 32% in total over that period. Barcode medication administration has virtually eliminated medication errors in their system, and there have been many other high standards in quality indicator achievement. In most other places, legacy software industry models (based in proprietary systems) have failed to deliver, he says – reinventing the wheel is a pandemic.

Joseph outlined a summary of the open source development model, and likened it to the cycle of evidence-based medicine leading to exploration and improvement of the software. Among open source applications used in health in North America are VistA, OSCAR as EHR solutions; Indivo and MyOSCAR as personally controlled health records; NHIN CONNECT Gateway in USA is an open source project, sponsored by US Health and Human Services Department; Open Health Tools (http://www.openhealthtools.org/). But, he says, open isn’t enough, and semantic interoperability is needed, and is essential for comparability of data. Costs are often a barrier here at present, but there are open source terminology projects seeking to address the issues.

Challenges for open connected health include governments not knowing how to accept free software, not invented here syndromes, procurement processes being based in expensive proprietary software and being hindrances to innovation.

The second keynote presentation of the morning is from Gerald Hurl, from the Health Services Executive (HSE) in the Republic of Ireland, and chair of Health Informatics Society of Ireland (HISI) talking on ‘Delivering connected health in a national context’. Gerald began with an overview of the changes in delivery of health and social care in Ireland, and intentions to move from episodic to holistic care, with the implications for where health service staff may work in the shift from institutional to community-based health and social care services. This has implications for ICT, if services are integrated around the patient, and requires a focus on connectivity and connected health. The new ICT strategy reflects this new model/paradigm of care. But a key challenge will be the lack of ICT staff with the domain knowledge and expertise to support the delivery of the necessary ICT.

OpenHealth conference; Belfast, January 2010 January 21, 2010

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Peter is at the OpenHealth conference in Belfast, Northern Ireland today, and will be doing some blogging and tweeting (search for #openhealth on Twitter). Information on the event is at www.openisland.net It is being held at the Spires Centre and the Europa Hotel today, and tomorrow’s linked event will be at the University of Ulster Jordanstown Campus.

Today’s event is  a one day free conference on open and connected technologies / services solutions for healthcare and the issues surrounding them, and also includes the official launch of BCS Health Northern Ireland – a new forum for knowledge sharing in Health Informatics & Connected Health in Northern Ireland. The current interim committee for BCS Health NI also includes Jonathan as secretary, and Paul Comac as Treasurer.

Jonathan Wallace opened the event and will chair today’s conference. The first speaker is Prof. Roy Harper, chair of BCS Health Northern Ireland, who outlined the aims of the group, and the wish to be open and inclusive as far as membership of the group – www.bcs.org/health/ni

Jean Roberts followed Roy to give a formal welcome from BCS and introduction, including formal greetings from BCS President Elizabeth Sparrow.

MIE2009 – final day September 2, 2009

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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 – public health informatics session September 1, 2009

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The first paper of the ‘public health informatics’ session is “The Use of Open Source and Web2.0 in Developing an Integrated EHR and E-Learning System for the Greek Smoking Cessation Network”. The aim of developing the system was to give health professionals access to online information to support patient education, and there are 3 sub-systems – data collection systems, e-learning environment (Moodle based), and a discussion forum, developed with phpBB. The e-learning environment and forum are for use by both patients and health professionals.

The second paper is on “Comparative Study between Expert and Non-Expert Biomedical Writings: Their Morphology and Semantics”. The presentation described the research methods used, and results obtained, in a morpho-semantic analysis, using NLP tools to examine a corpus of documents, and explore the discourses within the documents, with a focus on cardiology-related materials.

The third paper (a short student paper) is titled “Designing an E-Health Application in Collaboration with Obesity Patients”. The aim of developing the ehealth application is to foster self-management. A qualitative research study used workshops and goup discussions to get end-user input to the design of the application, and those involved will also be involved in evaluation before implementation of the application. Patient participants in the process had had either weight loss surgery or lifestyle modification treatment. The patients proposed the development of ‘buddy system’ and online self-help groups, drawing on the experiences of people who had had similar issues.

The next paper (a short student paper) is “Improving Cardiology Workflow in a Hospital Using a Mobile Software Solution”.

The final paper is titled “Interoperability Services in the MPOWER Ambient Assisted Living Platform”. The MPOWER project is an EU funded project that completed in July 2009. Interoperability was an important part of the project due to the many proprietary solutions that exist in the field of ambient assisted living, and the project was aimed at developing middleware platforms.

MIE2009 Tuesday keynote – health enabling technologies September 1, 2009

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The first keynote talk of the day is from Reinhold Haux, IMIA President, on “Health enabling technologies for pervasive health care: a pivotal field for future medical informatics research and education?” He gave a background introduction to the Peter Reichertz Institute in Germany, named after one of the German pioneers of medical informatics. The institute has a research focus on eHealth, health-enabling technologies, and links to work in robotics, engineering and computer science, as well as being part of a medical school.

Reinhold introduced some of the demographic changes that will impact the future nature of healthcare delivery. There will be less working age people – will this mean that less people are able to afford quality care? Health enabling technologies (HET) and pervasive health may provide some answers. HET are designed to create conditions for sustainable health and self-care. Pervasive healthcare is about continuous care, with focus on home and outpatient care, proactive prevention of illness, assistive technologies, sensors everywhere, and being patient-centric. Saranummi’s 3 P’s of pervasive care are pervasive, personal and personalised. Enabling older people to live longer in their homes, rather than in hospital, can result in greatly reduced health costs.

Reinhold gave realtime examples of the use of triaxial accelerometer (which he was wearing) which can monitor movement, especially falls, and live monitoring of ECG (which he was also wearing). But he notes privacy issues on monitoring of the data. He reported on studies about measuring individual fall risk in people/patients by analysing gait movement; found that they could give high level of  prediction of fall risk, with about 80% accuracy, and activity levels were the most important parameter to measure.

He asked what are the consequences for or relation of HET to health/medical informatics. Is it ‘just’ bioengineering and sensor use? – he feels it is more than this, and is a part of health/medical informatics with implications for research and education. Health and medical informatics is an ever-changing field. HET will particularly have an effect on outpatient and home care. This will have impact on communications with professional and family care givers.

Search/follow @omowizard on Twitter for some further reports.

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.

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.