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MIE2009 is over – onwards to Toronto September 3, 2009

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MIE2009 is now finished, and people will be returning home from Sarajevo today, if they have not already done so.

Peter will be blogging from the Medicine 2.0’09 event in Toronto, Canada on 17-18 September (http://www.medicine20congress.com). There will also be an official blog for the event this year – http://medicine20congress.blogspot.com/

In addition, he hopes to be able to cover the Healthcamp Toronto (http://healthcamp.ca/) – I have not been to a Healthcamp yet, so I am looking forward to learning.

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MIE2009 – final day September 2, 2009

Posted by peterjmurray in education, EFMI, Europe.
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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 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 – 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

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.

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).

Last day of SINI2009 – Saturday 07.25.09 Morning Keynote July 25, 2009

Posted by Scott Erdley in conference, education, Keynote, nursing informatics, SINI2009.
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This is my last entry for the conference, readers. Had a great time. I have to catch a flight back to home base (Buffalo, NY) and with the weather such as it is these past few days (traditional Baltimore – h3 (hzy, hot & humid)) as well as in Buffalo (humid & stormy) there’s a chance I’ll be parked at BWI for a while. There’s also a chance I won’t. Either way, given transit time to the airport via the Lightrail, I will be departing for BWI at 10am local (end of opening presentation, too).

Introduction is provided by local STTI chapter president because this chapter, in honor of 50 years of service, is sponsoring Dr. Staggers’ presentation. Opening keynote is Nancy Staggers, PhD, RN, FAAN, Professor & Director for Nursing Informatics, University of Utah College of Nursing. Title of her presentation is “Optimizing the usability of clinical systems: Past work and future directions”. Start time is a little behind normal most likely due to this being the last day of the conference and participants are a bit tardy arriving for the morning food before the session. Nothing unusual here with this, to be honest. Good attendance in spite of the last day of the conference. Discussion will cover usability, synthesis of usability research, future directions and then example (from her research).

Usability deals with solutions, context/environment, and specific goals. Related to human facotrs, ergonomics, HCI and usability (demonstrated via a modified Venn-type diagram. Talks about usability and cpoe in health care practice (Leapfrog Group cited). Reviews systems penetration due to ARRA $’s and Brailler’s (09) talk about need for specialist. DaVinci surgical system cited as tech example. Continuum of info & tech in nursing practice is depicted related to Essentials of Baccalaurate Education (AACN). Need for usability of phr’s, too, reviewed. Also provides a review of past usability research with her doctoral student, Greg Alexander. Search was extensive with exclusion criteria outlined. The process is described in detail from beginning to end. Bottom line, out of more than 11,000 citations, only 34 relevant articles (with 50 studies). Organized into effectiveness, efficiency and satisfaction. A lot to do with information searching, potential error with device designs (e.g.: IV pumps), and so forth. Satisfaction results indicate users want knowledge worth of mention (dense screens, graphic designs, etc.), heuristic evals of devices, remedy the no apparent rationale for selecting products to evaluate. Future directions include expansion of types of devices to study (Only 2 IV pums, PCAs and 1 EHR studied), settings & participants, integrated displays and the type of study outcome variables. Need to examine cognitive burden workflows, need for national db for study results, and, EHR comparative studies re: usability. Additional future directions include administration, education & research areas, look at actual clinical settings (vs. simulated labs), and study interdisciplinary teams. Now she launches into her work on change-of-shift report as example of the issues encountered during this literature review. Employed a variety of methods of research (observation, audio-taped with qualitative analysis after transcription). Results of this study are part of this example discussion. 4 themes are ‘the dance of report (largest percentage), just the facts, professional nursing practice and lightening the load’. Professional practice involved actions, reasoned judgments, care decisions, problem-solving, and such. Context of report issues included noise level, interruptions, patient loads, and report from 2-3 separate nurses. Overall discussion includes issues of ‘speed bumps’, high level of jargon, no report structure and ehr not any part of shift report.  Nicely done.

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): >>>

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!

Morning Keynote NI2009 07.01.09 (0800-0845) July 1, 2009

Posted by Scott Erdley in conference, health informatics, IMIA, Keynote, NI2009, nursing informatics, speaker.
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Evelyn Hovenga titled “Milestones of the IMIA-NI History and Future”. As this is closing day, as well as the session moved up 1/2 hour, the number of attendees is a bit sparse. Evelyn’s presenting style is to expound on the slide content. Opening setting reviewed is ‘having a vision’ begun in 1987 in Stockholm – nursing competencies. Key activities cited include reference term model, with ICN, begun in ’99 among others. Key facets of ’09 vision of IMIA-NI include EHR (using & informing nursing knowledge), clinical data standards dev’t, decision support & ebc options among others. Reviewed what IMIA-NI promotes (I’m guessing what she showed is from the website (http://www.imiani.org/). She discusses a national e-health record using a graphic (spoke-wheel design) with phr as the hub. Next up is discussion of integrated ehr (see ISO TR 20514:2002 Health Informatics – EHR Scope, Definition and Practice). EHR needs to be perceived as foundation of sustainable health system infrastructure, therefore requiring adoption of a set of HI standards along with comprehensive governance infrastructure. A description of ehr architecture is drawn from the open ehr foundation’s content. The bottom line is discrepancy between model (nicely structured) and proprietary systems with different reference models. Graphic of ehr structure is available at open ehr website (http://www.openehr.org/home.html). Clinical knowledge manager is next up and again seems to be also a component of the open ehr website (see ckm (clinical knowledge maanger) at site in previously mentioned link). Clinical content models, and the need for such, outlined at this point and the need for said models to relate to the structure (then dictates how data is used). Clarity is necessary for functionality – key point stressed by Evelyn.

Clinical knowledge repositories discussed with national examples cited (Singapore & Sweden with federated approach); need for repository hierarchy versus ‘flat set’ (need for interoperable for sharing via silo without sharing).  Terminology needs to be in context and should have national governance.  Future directions of IMIA-NI includes leadership for dev’t of standards of nursing clinical content knowledge. Collaboration with ICN needed to move forward with mindmaps of content, documentation of nursing processes, clinical templates (see Derek Hoy’s work in Scotland) and global nursing knowledge governance infrastructure. Other items needed to move forward range from national mtgs, recruitment of expert nurses and sharing / participating via technology and in-person. That’s all for now.