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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

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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).

NI2009 workshop on PHRs, Health 2.0, virtual worlds June 30, 2009

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Scott Erdley, Peter Murray and Heather Strachan are leading a workshop titled ‘Personal health records (PHR), Health 2.0, Virtual Worlds (and more!)’. The workshop aims to exxplore increasingly patient-driven, as opposed to provider-driven PHRs, and to explore issues and ideas around the implications of Web 2.0/Health 2.0, and also of virtual worlds such as Second Life.

We will be making our slides available later on Slideshare.

Peter gave an overview of some models of PHR that exist; he covered AHIMA, HIMSS and Markle Foundation views, as well as covering issues around Google Health etc.

Heather Strachan presented on eHealth in Scotland – about 2.5% of NHS Scotland budget spent on ehealth. Scotland has some of worst health problems in Europe, and has many inequalities. There are issues in devolved government and having a different political party running Scottish government as opposed to UK ruling party. Vision for ehealth is around expoiting the power of electronic information – also aim to improve health literacy so as to support individuals maintaining their own health status. Scotland not creating one single large database due to security/privacy issues – so architectural vision is based around a virtual electronic record gathering data from different sources. ‘Windows’ into services and communications systems and single sign-in system; also use unique patient identifiers. Patients and providers contribute to content of the health record, and there is inter-relationship between patient and clinical portals. Patients want self-management tools for long-term conditions, decision support to manage health as well as health information.

Heather presented examples, inc. www.clinicaldecisions.scot.nhs.uk, the Babylink special care baby unit portal in Edinburgh, ‘my diabetes my way’, renal patient view, NHS 24 (telephone triage system), etc.

Peter then covered descriptions of Web 2.0 and Health 2.0.

Scott presented some uses of Second Life for health. He gave an overview of what Second Life (SL) is, and some other virtual world tools. He gave examples of ways in which people see themselves differently in SL, its use for health conditions, and repositories of information and links.

After the presentations, there was a a very good, dynamic discussion, with interactions from many of those attending the workshop.

Twittering from NI2009 June 30, 2009

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We have added a number of krew members’ Twitter streams to the blog (see right hand column). A number of other colleagues here have signed up with Twitter and are providing tweets about the sessions they are attending. They include @pattifbrennan, @NewRNPhD (thanks, Jane, for participating in the discussion in the session we were in), @SusanPhDRN.

You can follow the Twitter stream @ni2009 (www.twitter.com/ni2009) or search Twitter for #ni2009

Papers on ‘human computer interaction’ June 29, 2009

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Kathy Dallest, from Scotland spoke on ‘The online managed knowledge network that shares knowledge for ehealth in NHS Scotland’ – http://www.nmahp.scot.nhs.uk

Nurses, midwives and allied health professions are 72% of clinical workforce in Scotland – largest group who will use electronic systems to support delivery of healthcare and information management. She described the portal that has been developed to provide a managed knowledge network; the model builds on the idea of communities of practice, with communities operating across disciplinary boundaries. The project found a large diversity of roles among the staff working in ehealth; they often felt isolated, with a need/desire to share information.

The nmahp site uses topic rooms and expert searches on subject areas. Kathy also mentioned the ‘using information’ website, and international collaboration – http://www.usinginfo.org and the clinical ehealth toolkit. The MKN site is open to anyone to join.

Elina Kontio from University of Turku in Finland spoke on ‘Key elements of successful care process of patients with heart symptoms in an emergency care – would an ERP system help?’ She says healthcare has been slow to use process-oriented systems for decision making. The research she described has looked at identifying the key elements of care processes of patients with acute heart problems; used a critical incident technique to collect data on the nurses’ roles and interactions with patients, with a sample of 50 nurses across 3 hospitals in southern Finland. The study developed recommendations on development and use of enterprise planning systems to provide alerts, decision support etc. in care continuum.

Debra Wolf presented on ‘Nurses using futuristic technology in today’s healthcare setting’. She talked about voice-assisted technology to do point of care documentation in a community hospital in USA. The system is wireless and used for charting, reminders and prioritising tasks. The system comprises a wearable computer and headset, speech recognition engine and software to send and receive patient orders and to do real-time documentation using speech-to-text. The system has reduced documentation time (by up to75% – but also found little diffrence in completeness of the documentation) and to provide proactive reminders about issues (such as fall risk) pertinent to individual patients. It has improved adherenece to policies and so enhanced quality of care. The pilot study found there was reduction in potential for infection, as nurses only touch one device once a day, as opposed to mutliple touches with other computer systems (eg mouse, keyboard, etc).


From Helsinki; 25 June June 25, 2009

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I arrived in Helsinki for NI2009 (www.ni2009.org) yesterday. As we had to cancel our Friday tutorial due to ow numbers regsitered for it, have a little more free time than anticipated. I decided to do some of the touristy bit this morning; so, after wandering down from my hotel, past the city centre, to the south harbour, I did the 1.5 hour cruise round the harbour and islands. A very nice morning, sunny weather, lots to see. My first set of photos (some still to be captioned) are at http://picasaweb.google.com/peterjmurray/HelsinkiJune2009

Med-e-Tel 2009 – Friday miscellany April 3, 2009

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A shorter report this morning, as I have been more actively involved in the workshop I attended, and so taking less notes. For the first part of the morning,  I attended the workshop on “Sustainable collaborations in healthcare open source software”, run by Etienne Saliez and Thomas Karopka. Etienne introduced the session, and the first draft of the website developed to discuss the issues – www.chos-wg.eu Thomas introduced a range of issues, which have also been previously discussed at a meeting in Portugal earlier this year – http://mimwiki.med.up.pt/images/a/a0/Osehc-thomas_karopka_text.pdf

A new proposed strategy is being explored, to include:
(1) FLOSS-HC inventory – What is already there?
(2) FLOSS-HC communication platform and software repository – Where to find applications and information
about FLOSS-HC
(3) FLOSS-HC use case data base – What is really needed?  These use cases and may be workflows
should describe the use cases from the health professional view point.
(4) FLOSS-HC knowledge base – Description of modules and their capabilities

The discussion focused on different needs in different parts of world, the possibility to develop regional collaborations among groups woring in free/libre and open source in health(care), and whether it might be possible to develop some kind of  certification process for FLOSS-HC products. The example of the EOS (enterprise open source) directory – http://www.eosdirectory.com/ – was introduced, and we discussed whether a similar area is needed for healthcare OS.

I then went to try and listen to another telenursing session, but the speaker had not turned up. However, I caught  good presntation from Maurice Mars (University of KwaZulu-Natal, South Africa) on his experiences of delivering a telemedicine training course in Rwanda. His summary of things to take into account when teaching in such areas echoed my own recent experience of teaching in South Africa, including not to rely on the infrastructure (Internet, electricity) always being reliably avaialable, to have materials available on CD-ROM, and to focus on ‘key lessons/issues’, rather than trying to teach too much in a short period.

Med-e-Tel 2009 – eHealth in space April 2, 2009

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There are several sessions about eHealth in ‘extreme environmental conditions’, which are mainly about health and space weather; the sessions are in co-operation with the Belgian Institute for Space Aeronomy (www.aeronomie.be), part of Space Pole. They sound interesting, so I thought I would attend a few sessions. the first talk is by Norma Crosby, titled “Health issues and space weather: an introduction”. She started with an introduction to space weather and its effects, both in space and on earth, and a look to the future. Space weather touches everyone directly or indirectly; mobile phones rely on satellites, for example, and solar disturbances in space, for example, can cause problems. Space weather is about conditions on the Sun and in the solar wind and the layers of the atmosphere on earth, which can influence space-borne and ground-based technological systems – how solar activity can have unwanted effects. The Sun is the driver of local space weather; Sun has an 11 year cycle of activity, although solar flares can have influences at any time. Space weather induced effects include damage on satellites, increased radiation to airline passengers, etc.

Health issues relate to ‘space biology’ – how gravity (or lack of it) affects cells, gravity can affect development of cells, and radiation biology. Radiation sickness can be a problem for astronauts having long exposure on space missions; sometimes airlines have to change routes if are high levels of solar activity, esp. on polar routes. There will be increasing numbers of people affected with rise of space tourism. There can also be affects on earth’s magnetic field, in particular at higher latitudes. ‘Indirect indicators’ include temporal and spatial variations in epidemiological data.

Long space voyages, eg to Mars, will mean the need for telemedicine; there will be problems due to long communication delays, and also due to loss of geomagnetic shielding from solar wind problems.

Med-e-Tel 2009 – Telenursing session April 2, 2009

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It’s Thursday afternoon, so it’s the Telenursing session. I am giving a talk as part of this, but am also blogging the rest of it. The first talk, on “Telehealth’s evolution and future in Canada” (Lois Scott; presentation given by Diane Castelli), started with a geographic overview of Canada, which covers a large area, but has relatively small population, with 90% concentrated in the south, within 200 miles of the border with the USA. Canada, as with many countries, has a shortage of healthcare workers in all disciplines; average age of nurses is 46. Patient safety is an increasingly important issue, and patients are playing a more active role in decisions about their healthcare. The first telehealth era, the 1940’s, was based around the use of telephone contact, most often to give advice/help in acute situations, but often with no protocols. The second era, the 1950s to 1970s, saw the emergence of social crisis lines, often staffed by lay volunteers, and with the emergence of formal protocols. The third era, the 1980s to early 90s, saw expansion of telemedicine services, with homecare monitoring, telepsychiatry, and development of web-based health information. The current (fourth) era, the mid 1990s to the present, saw the emergence of telephone triage, telecare services and support from electronic decision support systems. Currently, most of the Canadian provinces and territories are providing 24/7 telecare services for their populations; all are mostly telephone contact centre-based, for people across the spectrum from the well to those with severe illnesses. canada has found that public uptake levels have depending on marketing of services, and most opposition to services comes from health professionals, rather than from patients, while competencies and standards for telenursing need to be further defined.

Diane then gave her own talk, “The advancement of international telenursing”. She began by defining telenursing as ‘the practice of nursing over distance using telecommunications technology” (a 1997 definition from the USA). In the USA, there are examples of nurses providing telehealth for prisoners and for rural natives in remote clinics. She then discussed the ISfTeH telenursing working group.

Elenor Kaminsky, from Uppsala University, Sweden, spoke about “Detective or educator? – telenurses’ understanding of work”; this was based on work that has been published in the Journal of Advanced Nursing earlier this year. Telenursing is a first line of healthcare in Sweden, started in 2006 and using call centres with telenurses; there are 75-90 calls per working day per nurse, and provide an opportunity to influence public health. She described a qualitative study, based in phenomenography, to study variations in conceptions among the 12 telenurses interviewed in 2004-05. Five categories were work were identified [1] assess, refer and give advice to the caller; this was a form of detective work, with the nurse listening for clues; [2] support the caller, guiding them and maintaining contact; [3]  strengthening the caller, increasing their self-confidence; [4] teaching the caller, with an emphasis on what the telenurse thought the caller needed to be taught; and [5] facilitate the caller’s learning. All nurses in the study expressed category 1, while only proportions identified the other categories within their  work; category 5 was seen as a ‘highest level’, and nurses identifying this also identified all other 4 areas. This identifies different forms of work – in effect, different health services, possibly leading to variation in outcomes, depending on which nurse answers the call. The outcome space identified forms a telenursing roadmap. My talk came next.

Annica Ernesater, from Sweden, presented “Computerized decision support systems in telenursing: how is it perceived by telenurses?” She also mentioned the Swedish call centres mentioned by Elenor, and it is similar to NHS Direct in the UK; this uses a computerised decision support system (CDSS). Telenursing is seen as knowledge-intensive work, with the telenurses triaging callers’ needs and giving advice, including self-care advice. She described a study of nurses’ use of the CDSS, which showed that telenurses found the system to be supporting, inhibiting, and controlling – the system was found to simplify their work, but there could also be disagreement between the CDSS recommendations and the nurses’ previous professional experience, with the software being incomplete; this lead to frustration among the nurses. Searching the CDSS for information sometimes lead to nurses paying less attention to the callers as they searched the system for information, although it also meant more consistency in the information given to the patients. The CDSS cannot replace nurses’ knowledge and experience, and should be seen as complementary, not competitive to their own skills.

The final talk of the session, “It’s easier to talk to a woman – aspects of gender in Swedish telenursing”, was from Anna Hoglund, also at Uppsala University. 90% of the nurses staffing the Swedish call centres are female, and all are registered nurses who act as the first line of response to callers. About 50% of calls are for self-advice, while rest are for a mix of issues, including getting appointments. Most of the callers to the help line are women (60-80%). An interview-based study of Swedish telenurses in 2004-05 found 5 themes – [1] female subordination in the family, ie females in some families are not free to contact health services themselves, especially in cross-cultural encounters; [2] disrespect in dialogue with female nurses, ie from male callers who were not valuing the nurses’ experience; [3] distrust in fathers’ competence, ie mothers being better to describe the problems with children; the telenurses seemed to trust female callers more, especially in relation to child issues; [4] reluctant male callers, ie callers needing to be encouraged by their family members to call; and [5] woman-to-woman connection, ie ‘its easier to talk to a woman’, resulting from commonalities of experience. The study concludes that gender aspects in various forms in telenursing, and there is a risk of stereotyping dialogues depending on callers’ genders.