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MIE2009 Tuesday keynote – health enabling technologies September 1, 2009

Posted by peterjmurray in conference, EFMI, Europe, speaker.
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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 – Monday morning keynote – Ed Hammond August 31, 2009

Posted by peterjmurray in conference, EFMI, Europe, Plenary, speaker.
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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.

Session 6F ‘Virtual Reality’ SINI09 07.24.09 Friday July 24, 2009

Posted by Scott Erdley in conference, education, future, health informatics, SINI2009, speaker.
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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. IMG_0157 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 >>>

Presentation SINI2009 07.24.09 Session 5A July 24, 2009

Posted by Scott Erdley in conference, health informatics, nursing informatics, SINI2009, speaker.
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Presentation is recipient of practice award from SINI (see @m2hansen for tweets of this session). About 50 attendees in the main lecture hall, which also means this is webcast. Title is “Leveraging technology for nursing handoffs” presenters are from Northwestern Memorial Hospital. Authors are Stephanie Kitt, MSN, RN, Marilyn Szekendi, PhD, RN, and Kathleen Linn BSN, RN. Northwestern Memorial is a magnet hospital with over 900 beds total. Organization is reported to be about 99% digital / emr throughout. Provides background information regarding the need for nursing handoffs and impact on patient care and safety (aka ‘communication’). Effective handoff elements include f2f verbal with verbal report + hardcopy summary; current/up-to-date info, predictable / stable presentation format, minimal interruptions of report & unambiguous transfer of responsibility (cited from Patterson ES et al 2004 study; difficult to read so more not included). Cites 2 studies of handoff failures (Arora V. et al (2005) and McCann, L. et al (2007). Primary cause of failure was communication. Overall key factors of failure outlined (failure of communication primary).

NMH uses SBAR format (paper-based). Second presenter reviews what SBAR is and the actual paper-based form used by the organization. Stands for Situation-Background-Assessment-Recommendation. Deployment was piloted in medicine, surgery, oncology to one unit in each of these areas for 6 months. Implemented in med/surg and oncology units; training consisted of job aide document; train the trainer & coaching support available at change of shift. Described the deployment of this during the workflow process, which also includes prioritization of ‘next-to-go’ areas. During these processes the organization also underwent a model of care change (this tool reported to facilitate / aid the care change). These presenters did follow-up research of this implementation. Overall the shift report decreased to a 5-15 minute timeframe versus longer reports (still individualized based on patient and nurse). Suggestions by nurses to improve the report process included more specificity but at the same time more freespace; more accurate information (get rid of old information); viewable online to eliminate use of dead trees, and, get all units onboard with SBAR. Lessons learned is e-report format is preferable but not a panacea; stakeholder lead is imperative and nurse involvement is key! Nice presentation. Completed early so long time for Q&A session (about 15 minutes).

Friday Opening Keynote Session SINI 2009 07.24.09 July 24, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, patient safety, SINI2009, speaker.
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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

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 Scott Erdley in conference, education, nursing informatics, SINI2009, speaker.
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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 Scott Erdley in conference, education, health informatics, SINI2009, speaker, USA.
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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.Presentation

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 >>>

Thursday 07.23.09 Full Day July 23, 2009

Posted by Scott Erdley in conference, education, nursing informatics, SINI2009, speaker, Uncategorized, USA.
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Recap of yesterday. Good start to conference. Well-received keynote by James Cimino. Intimate networking session during early evening. Today is first full day of conference. Day starting with planning committee meeting (of which I & Peter are members). A little early to be sure, too. And, post composition, good thing as the rain is really coming down by 0830! Pics from last evening will be posted under separate heading.

Opening distinguished lecturer is Marcelline Harris, PhD, RN, Senior Associate Consultant, Departments of Nursing & Health Sciences Research, Division of Biomedical Informatics, Mayo Clinic. Title of her presentation is ‘Pathways to Translational Informatics for Nursing’. Introduction supplied by Judy Ozbolt. Marcelline provided a bit of background about her place of employment – Mayo Clinic.

Initial talk begins with definition of translational informatics – what is it as a concept. Shift to applied aspect in ’07. Earlier demonstrated with grants for use of IT to help with or optimize utility and or use of information. National efforts, currently, now looks at it as linking with practice of informatics. Uses CTSA abbreviation – missed what this stands for. ’08 was first summit for translational bioinformatics – heavily genetic focus. Shared include translating research into practice / application. Informatics is the engine for translation (data, information, knowledge).

Asks is informatics a discipline and science providing support (sorry, missed her reasons) for postulating it is both. She then describes commonalities of different definitions of informatics. One is both science & discipline; focus on modeling of data, information, knowledge. Need to exchange data as a requisite concern or focus. Illustrates with Shortliffe’s graphic of scope of biomedical informatics, basic research to applied research. Also indicates informatics folks are vertical people & shows adaptation of C. Lehmann’s work on this (focus on modeling data, information & knowledge across layers).  Circular process of clinical practice and integration of information, data, knowledge at Mayo depicted as graphic of circle; scientific research similarly depicted. Stresses need to pull both together for translational with informatics as the middle / engine. Marcelline uses a lot of graphics to demonstrate or visualize for the audience. Sorry but not taking pics to post. Will be accessible later via link from Marcelline. Competencies outlined; informatic roles trying to promote / identify at Mayo include academic research (easy one); applied / professional roles (primary fxn is operational informatics), liason roles (nurses, MDs, in practice, delivery system & technology experts), and translational roles (primary fxn bridging from research science to applied). Nursing issues / priorities for cis’s include technology & usability, data retrieval / analysis and terminology uses.

Problems for nurses re: tech & usability issues. Reports of such include ’07 (Klas Report), ’08 (Advisory Board Reports) and ’09 (AAN study). Common theme is systems don’t support work of nurses (instead introduces complexity and such things do not coordinate, but fracture, care). She also depictes tne ’07 EMR Adoption Model (no translational concepts as well as no nursing visible). Shows 8 stages (0-7). Included as a follow-up is Gartner’s Hype Cycle (may be able to locate with a net search). Huges, AHRQ, 2008, report / book about nursing & technology an integrative review (free 3 volume book). Findings show chaos of implementation among others impacting nurse practice and perceptions. Data analysis / retrieval issues include unmet expectations, inspite of storage unable to find information and or generation of new knowledge. Touch briefly on the ‘meaningful use’ definition work. Policy priorities recently published on 07.17.09. Content issues include nursing terminology systems; maybe refocus on translational requirements and or meaningful use issues. Offers a slide showing, based on HIE work, offering the idea of content representation enabling translational informatics. Data/information/knowledge life cycle (Chute & Harris) is proffered as her understanding of what nurses may actually want as related to translational informatics. Offers examples of Mayo Clinic is doing in this overall area of translational informatics. Organizational culture of Mayo plays a big role in ‘what’ the clinic is. Mayo has an integrated medical dossier where ‘everything’ is related (diseases, medications, tests, life habits, and so forth). Current state is a big genetics initiative by Mayo; clinic keeps / stores a lot of stuff (included is clinical data as well as tissue ‘data’). Mayo has 100 years worth of all of this data. Very detailed graphic demonstrating the individualized medical record / care provided by / at Mayo. A highly ‘committee’ized’ organization with another graphic depicting this; chartless for about 5 years now (as a clinic). Practice convergence pathway depicted, too, demonstrating tech & practice integration. Modeling May Knowledge is underway. Various endorsed models depicted (concept, knowledge, etc.). All are available to all staff on their organizational website. Unified nursing assessment model depicted, too. Building own vocabulary and then mapping to other systems (ICNP, SNOMED, etc.). LexGrid as core model. Very detailed enterprise model of pain illustrated. Have an enterprise data trust in place. Closes with key lessons regarding vocabulary (use one that works); structured documents are not helpful (typicall organized from user perspective, not standardized), and so on. Does translational informatics work? Yes with standardized models of nursing knowledge guide retrievals / analytics somewhat independent of constraints in source information. Nurses are well prepared for translational informatics. If interested email speaker (harris.marcelline@mayo.clinic) for additional information.

Off to break and then session reports blogging!

UPDATE: Link to video clip courtesy of Eric Rivedal (recorded on iPhone): >>>

Opening session SINI 2009 Wednesday 07.22.09 July 22, 2009

Posted by Scott Erdley in conference, Keynote, Plenary, SINI2009, speaker, Uncategorized, USA.
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Photo by Heather Sobko.

Official welcome and introductions by Patricia Morton (Professor & Associate Dean for Academic Affairs, UM School of Nursing), Judy Ozbolt, Program Chair, SINI 2009, Professor & Program Director of Nursing Informatics, UM School of Nursing, and Amar Kapadia, Director of Acute Care, AccuNurse by Vocollect Inc. Overall casual scanning of the attendees at the opening indicates a good number in attendance. However, number of in-person attendees given by Judy Ozbolt indicates a fair decrease from previous years (this year quoted as 350 in-person attendees). Judy also announced her retirement at the end of this year. New co-chairs for next year include Marietta Mills & Marisa Wilson along with Judy until her retirement on December 31, 2009.


Photo by Heather Sobko.

Keynote speaker is James J. Cimino, MD, titled “Informatics as a Bridge to Knowledge at the Bedside”. He is Chief, Laboratory for Informatics Development, NIH, Clinical Center Senior Scientist, Lister Hill National Center for Biomedical Communication, NLM.

He further divides the topic into 3 sub-topics: bedside environment, knowledge to support care and informatics as the bridge of these two. He reviews informatics research issues associated with bridging ‘problem’ as a 7 step process (information needs of users). Very personable with his presentation style; well received by the audience. Findings of observational studies are information needs occur often, often unresolved and computer-based resources are under used.

James includes a fair number of screen shots to support statements and assertions made in presentation. Patient information is not easily available to providers at bedside. Health knowledge (such as Pubmed, textbooks, and so forth) has multiple sources; needs to be included for use at bedside / concurrent with patient information access / use. Third point is procedural knowledge. All of these are under the heading of Informatics, delivering knowledge. Procedural includes or requires perhaps refreshing what one already knows, BMI calculator, and so forth.

Informatics: Integration is the bridge. One issue is workflow. One way to ascertain workflow is observational studies. Another area is in expert systems and how integrated into workflow. third area is ‘intelligent retrieval’. Infobutton and Infobutton-like systems somewhat answer this last topic of intelligent retrieval. Examples include Vanderbilt’s PC-POETS, LDS HELP system, Partner’s Healthlink, and Columbia’s Infobutton Manager (speaker’s research project). Describes, now, this project with supporting screen shots (examples include laboratory tests, drugs, organism cultures, and so forth). Information is linked to term or item. Minimal number of clicks is something strived for (2-3 clicks to get answer). 5 year use history of infobutton use shows topics (lab manual, Micromedex, Pubmed, up-to-date, Harrisons, national guidelines, patient instructions. User analysis indicate nurses are major users of patient instruction topic.

Summary of presentation findings at this point. 1st – knowledge to support care (1/3 each for patient, wellness & disease, practice). 2nd – bedside environment (patient, clinician and technology). 3rd point – informatics as bridge; understanding knowledge needs (clinician & patient); delivery of patient information health knowledge, procedural knowledge; finally about integration of workflow, expert systems and intelligent retrieval). Conclusions: (1) putting patient, nurse & tech in same room is not sufficient; (2) informatics is needed to understand the info needs and provide the resources and integrate ‘them’ into the workflow; (3) big topics – cognition, terminology & knowledge representation provide the bridges.

Q&A session, since session completed early (3:45pm with schedule to complete 4:30pm), will be ‘extended’.

Well done opening talk. There is a meet the keynote speaker session from 4:30p – 5:30p (east coast time) with James J. Cimino following this keynote opening talk. More information at http://www.infobuttons.org

OP331 NI2009 Teaching methodology 2 (1030-1215) July 1, 2009

Posted by Scott Erdley in conference, education, health informatics, NI2009, speaker.
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Sorry, folks, late arrival from panel presentation with Peter. Only arrived late for 2nd presentation (obviously missed first one). 3rd presentation is “Educating a Health Terminologist” by J. Warren. She demonstrates terminology tools educators can use; basic session to inform participants and update them so ‘they’ may have a basic understanding of the role of health terminologist, responsibilities and then help educate others about this role. Some very nice graphic slides to help understanding available in her presentation.

4th presenter – T. Indergaard (Finland) “Counseling of problem-based learning (PBL) groups through videoconferencing”. Discusses project and advice for those pursuing videoconferencing solutions.

Final presenter is J. Brixey “Creating experiential learning activities using Web 2.0 tools and technologies: a case study.” Stressing the social need of connecting with others (see Siemen’s principles of connectivism). Making such connections possible with Web 2.0 tools / platform; ‘at/ap/ac’ if-you-will (anytime/anyplace/anywhere) – aka ‘cloud computing’. Describes project at Kansas University of using 2.0 tools / technologies for facilitation of learning experiences (such as conference attending and so forth). Nice list of social software toolkit application inclusion criteria on her slide (easy to dl/install to easy navigation to user interaction encouragement; about 10 items in all). Use of MSN Live Messenger dictated by desire for concurrent communication between students and faculty. Wide range of 2.0 tools used including SL. Activities within SL range from ppt evaluations to interactive socializations. Nicely done! Off to lunch then perhaps one of the 3 final sessions (start at 1315 through 1415). Final ceremony is from 1415 – 1600. I will not be blogging the closing ceremony because one of the closing speakers requires the use of my Mac computer for her presentation. Later!