Informaticopia

Friday, August 24, 2007

Medinfo Day 5

The final day of the conference started with plenaries presenting the state of ehealth development in 3 different countries. Sarah Cramer (Cancer Care, Canada) described the developments in her country with an emphasis on Ontario. She talked about a risk averse political system that introduced change driven by concerns about access and waiting times. They set out from a very low IT base an established a unique patient identifier as the first step towards enhanced information sharing. She listed the key sucess factors and outlined future implementation plans.

Ian Reinecke (CEO National E-Health Transition Authority, Australia) described the reasons for a national approach to support interoperability, infrastructure and good governance related to privacy and confidentiality. He described the work programs being undertaken, including the adoption of SNOMED CT, and how the ehealth agenda was needed for clinical process reform.

The third presentation provided a similar overview of developments in New Zealand.
Francois-Andre Allaert
After coffee I attended a couple of papers relating to secure data transmission. The first, by Francois-Andre Allaert set out proposals in France for a unique health identifier, interopable at a European level. He highlighted issues of data protection and confidentiality and listed the key faetures as being: content free, longevity, permanence, unambiguous and unique, public and irreversible. He described the one way "Hash Coding" of the social security number, name and date of birth to enable secure tranmission of non identifiable data for epidemiological research. This session produced the longest Question and answer session I've seen at the whole conference with issues around the hash algorithm and different formats being interspersed with social issues around immigrants, name changes due to marriage etc.
Michael Spritzer
The second paper was by Michael Spritzer from Germany who talked about a DICOM supported teleradiology system and the approaches taken to separating the content (xray and CT images) from patient identification information which is only recombined within the secure web browser of authorised users.


Ken RubinThe final closing ceremonies opened with a presentation by Ken Rubin (Chief Healthcare architect - EDS) who was given the unenviable task of summarising lessons from the conference. He admitted this was beyond his abilities and carried on to give his prepared presentation outlining "What is a sustainable system and what does it mean for healthcare".

Jan van BemmelNancy Lorenzi presented the IMIA Award of Excellence to Jan van Bemmel who gave his presentation reflections on curiosity in which he covered the history of astronomy and knowledge, using quotes from Einstein to explore the meaning of science and research with several nods to religion.

The ceremony included lots of "Thanks to..." comments and Charles Saffrin presented the awards for best paper, poster etc with sponsorship from Pen Computing.

Nancy then handed over the presidency to Reinhold Haux who described the IMIA-WHO communique signed this week and the IMIA strategic aims for the next 3 years of his presidency (including a ?planned? slip replacing humility with humidity - which got a laugh after a wet week in Brisbane). He also gave a plug for MIE2008 in Goteburg.

Medinfo2010 teamThe final actions were to "handover the gavel" to the team who will be running Medinfo 2010, in cape town. There was then a short opportunity to say farewell from the convention centre to friends and colleagues new and old, before people started departing to get various flights all over the world.

I hope to post a final piece with my reflections on Medinfo but it may not be until I get back to the UK.

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Thursday, August 23, 2007

Medinfo Day 4

Thursday was another wet and windy day in Brisbane, but at least the rain held off for a few minutes while I walked to the convention centre for the opening plenrry sessions.
Richard Murray
The first was by Richard Murray (James Cook University) who described his history of working with Aboriginal Primary Health Care Services. He talked about the needs of the population being influenced by the widely disparate population with a major burden of disease and environment which leads to high death rates in childhood and middle age. He described the need for improved preventative health with the integration of clinic and outreach work.

He described the Healthspace technological solution which has been supporting this work for the last 20 years and the newer Project Ferret. The emphasis is on building and people actually meeting patients needs rather than It to collect data for funders.

Robert KolodnerThe second keynote speaker was Robert Kolodner (CIO of National Health Information Technology Co and now Director of the US governments National Coordinator for Health Information Technology). He talked about the US healthcare expenditure as a share of GDP, the ageing population, the insurance based system and the number of medical errors being drivers for the improvement of health IT. The importance of standards and the role of the Nationwide Health Information Network (NHIN) were emphasised.

He then went on to describe the role of the Office of the National Coordinator for Health Information Technology (ONC) and the American Health Information Community.

Ritamarie JohnAfter a coffe break (spent speculating about the presence of Richard Granger in Australia, and whether he would be trying to get a job here after his role in the UK NHS's Connecting for Health) I attended a session about Professional Education - Nursing Informatics. The first speaker was Ritamarie John from Columbia University who described a project to evaluate the use of a PDA based screening tool for paediatric depression and the results of a small pilot study with APN students.

She was followed by Tricia Trangenstein from Vanderbilt University who described with with an online clinical log and how the data extracted from a large number of encounter records enabled faculty staff to identify students who may not be achieving well in their clinical practice.

Carole Gassert then described her experience implementing the Cerner Academic Educational Solution (AES) at the University of Utah and shared some of the lessons she had learned.

The final presentation before lunch was from Laura Hofte from Twente in the Netherlands who talked about an innovative module for nursing sudents working with ICT students to develop the functional specifications of an EPR.

After lunch I attended a panel session entitled "Patient portals to support communication and information sharing between patients and care providers". Several speakers including Jonathan S Wald, Camelia Ruland, Justin Starren and Edward Cohen described the different approaches they had taken to using systems linked to the patients electronic health record to enahnce and empower patients to self manage at organisations such as Partners Healthcare, Oslo oncology clinic, Columbia university and Kaiser Permanente.

The final session of the day included my presentation on the Information Technology Attitude Scales for Health (ITASH) and therefore I was not focused on the other speakers who were presenting in the same session, but they included; Bernd Blobel describing the architecture to support a personal health paradigm, Mohyuddin from Cardiff describing a study to develop Patient Centric Virtual Organisations or healthcare providers using wirless technology, and Sarneer Antoni whose work at the NIH is about Content Based Image Retrieval and called SPIRS (Spine Pathology and Image Retrieval System) but is now also working with cervical cancer images.

The day finished with "The Great Australian BBQ" at The Hundred Acres Bar, St Lucia Golf Links - which had been moved indoors because of the weather. The meat was excellent and the evening was made better by meeting up with Jacob Weiss from Vanderbilt University and juggling together - although he is far better than I am, as you can see in his "Juggling round Australia" video. The evening was however spoit by the confusion and anxiety over the bus transport back to eople hotels in the rain.

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Wednesday, August 22, 2007

Medinfo - Conference Dinner

BCSHIF supported delegates at Medinfo 2007Graham Wright
Last night saw the conference dinner. The evening started for me with a pleasant drink with the UK delegates supported by the British Computer Society Health Informatics Forum (BCSHIF), before we all headed for the convention centre.

The food was good with several choices being placed alternately on the tables and then trading occurring - they also managed to meet the needs of those with special dietary needs - which hasn't always happened a the events. The table I sat at had toasts to just about everyone and everything we could think of - largely lead by the BCSHIF Treasurer.
The Swinging Martinis
The entertainment was provided by The Swinging Martinis a pair of comedy singers, and their supporting dancers and then a good band who performed covers of well known songs from the last 30-40 years which got the dance floor humming.

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Medinfo Day 3

Wednesday morning at the conference opened with two more plenary presentations in the Plaza Ballroom.

Marc Probst (CIO Intermountain Healthcare, USA) described the Mormon history and moved on to talk about the need for integrated approaches across several hospitals and myriad clinical specialties. He highlighted the growth in knowledge and variations in clinical practice providing drivers for the increase in automation, connectivity, decision support and data mining required by the organisation. He provided lots of figures and examples to say why the healthcare system he works for is providing the best care at the cheapest cost and described their aims for a new information systems. They could not buy one which meets their needs so, with GE they are building one over the next 10 years.

The second speaker was Yunkap Kwankam from the World Health Organisation in Switzerland. He described the potential ehealth has to make to sustainable healthcare systems, which meets fundamental rights of high standard and equity of access. He moved from the individuals needs to looking at current and future developments in a public health context.

Several of my discussions outside of formal sessions today have been about SNOMED and other terminology and classification systems. One of the participants described herself as a Snomedian - I wonder if this is the discovery of a new species?

The exhibition hall seemed busier than it had yesterday and there seemed to a stream of UK delegates visiting the IBA stand for news of their increased bid for iSoft (see next item on blog).

After coffee I attended a session with several papers on elearning and distance education. The first was from Grenoble university on how they are using DVD and web based systems to replace lectures in their medical education programme. The second speaker from Porto did not appear so we moved on to Niels Boye from Denmark who described the epistemological knowledge model which underpins their approach to mlearning for junior registrars. He also talked about the problems with the pda based hardware and software they were using. The final speaker in the session was Reena Patel form Auckland University who described the Evaluation and Assessment of the Online Postgraduate Critical Care Nursing Course. She described some of the issues for many of the nurses with little or no previous IT experience and the pre and post test methods they used to demonstrate the students satisfaction with the course and their abilities to apply their new knowledge to practice.

During lunchtime I managed to take a look at some of the hundreds of posters including one produced by Jonathan Bloom and colleagues to improve communication for junior doctors within the United Bristol Healthcare Trust.

I then attended a panel session under the "Orgnisational Issues" theme entitled Relations between industry and academia: How can do better? This included speakers from around the world and from both industry and university sectors. Floyd Eisenberg from Siemens AG briefly described the global structure of the company and it's operating entities before giving examples of their collaborations. He suggested the "Agile" development model with short project delivery times has benefits over the "Waterfall" model, but that some universities may have problems with this. He advocated further work through standards organisations and similar bodies such as IMIA.

H.M. Goh provided an Asian perspective of the different drivers and characteristics of academics and commercial companies. He described various collaborative models and some of the barriers, such as IP rights, which may cause problems.

The European perspective was given by Charles Parisot from GE Healthcare who talked about the development of local relationships with 3 different models:
1)Customer relationships - research to improve the product being used
2)Science/Physicstechnology development ahead of the product cycle, and
3)Collaboratives - such as standards groups which bring academics closer to the "real world" integrating wth healthcare enterprises.
The final speaker who provided a US educational perspective was Ted Shortliffe from Arizona University. He described how different sources of funding (eg government research grants), affect technology transferand licensing arrangements. He listed some of the challenges to collaboration and illustrated them with annecdotes from silicon valley with Stanford and Berkley (private universities) having an entrepreneurial culture, but public universities having to meet the agendas of government about economic growth and employment bring different pressures. He concluded with examples of positive drivers with an example from the New York State Foundation for Science, Technology and Innovation (NYSTAR) and the Centre for Advanced Technology at Columbia University.

There was a very good question and answer session exploring how to manage the collaboration process, lots of worries about IP and consideration of the role of industry in specifying curricula.

The final session of the day I attended was entitled Searching for Answers. Gunter Eysenbach from the University of Toronto described the development and testing of the FA4CT algorithm to help consumer evaluate the quality of medical claims within web sites. He was followed by Michel Joubert who described the development and use of the WRAPIN tool (an EU framework V funded project) to help people extract text from their electronic health record in a variety of langauges and automatically check it against reliable literature sources. The final speaker was Amy Lou a doctoral student from Sydney who described studies identifying biases in how clinicians search for information from the literature and use them in their decision making.

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IBA bidding again for iSoft

The continuing saga of troubled iSoft had another twist this morning (& those of us in Australia probably got it a few hours ahead of colleagues in the UK). IBA has put in another increased bid (available from the Australian Stock Exchange by searching announcements for IBA at http://www.asx.com.au/asx/statistics/announcementSearch.do
to buy the company, following it's controversial previous attempt, and the iSoft boards acceptance.

It has certainly generated some discussion at the Medinfo conference and it will be interesting to see the response from CompuGROUP and the NHS NPIT.

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Tuesday, August 21, 2007

CW FOI case for Downing Street NPfIT papers

I was very interested to read about this attempt by Tony Collins of Computer Weekly to obtain the Downing Street papers about the creation of the National Programme for IT (NPfIT).

There are so many parallels with my long Freedom of Information request to obtain the report into the NHSu - I just hope that my eventual success is securing release of the Wells Report is able to provide some precedent in opening up the government/Connecting for Health secrecy about the whole process.

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Medinfo Day 2


After a late start opening the Ball room introductory plenaries started on a sunny Tuesday morning, on which I got a good view of the South Bank cultural centre and the roof of the convention centre from my hotel bedroom with the Skyneedle in the background.

Philip Davis- Australian Government Department of Health and Ageing

Welcomed delegates & described announcements yesterday about increasing roll out of ehealth in Australian & particularly to remote aboriginal communities

Sol Trujillo (CEO Telstra) Changing the paradigm in healthcare

He described a series of issues in a changing world with relevance to ehealth. These included;. Ageing & more mobile populations (increasing transmission f disease) transforming viruses, administration & healthcare costs & improving access to high quality healthcare.

He talked about the role of telecoms companies - & discussed his famous philosopher Yogi Bear who said “the future ain’t what it used to be”, and argued that we ar moving through a paradigm shift to integrated services. Telstra claims the fastest mobile network in the world providing the “central nervous system of Australia.

He focused on the patient experience & gave a very positive picture of how the technology would enhance care, with high resolution video based communications.& other aspects of telehealth; body area networks & biometric monitoring, at a cost one hundred times less than residential care. He argued for the benefits of Web2.0 fr support networks.

He talked about the changes for health professionals & a reduction in patient errors. Some impressive videos highlighted (advertised) various Telstra initiatives (eg NextG) supporting care delivery. Ballarat District Nursing Service use of mobile devices & time savings in their work. He talked about ways of enhancing professional development and interprofessional relationships. He also mentioned the potential advantages of RFID in medicines administration and eprescribing to reduce errors.

The questiona and answer session touched on international collaboration, privacy and confidentiality and ways of influencing makers.

The second keynote speaker was Muir Gray (NHS National Knowledge Service). As ever Muir was future scoping working from an overview of the 1st and 2nd healthcare revolutions to the currently 3rd revolution. He highlighted the 8 common problems which are common in healthcare systems in all developed countries, and needs and drivers to overcome them.

He strongly argued that the professions are out of step with current society and that the key to change was to empower patients (or punters) and they would bring about change. He used the analogy of the provision of drinking water and how that improved health to the provision of CLEAN, CLEAR KNOWLEDGE. He highlighted Map of Medicine and other ways of providing, organising and delivering knowledge as being more appropriate for busy clinicians than long complex journal papers.

He concluded with plugs for his book and his new "SoundsHealthy" podcasts and asked people to turn to their neighbour and describe where they thought we might be in 2010.

Following the plenaries and a quick coffee break and attempts to sort out the technology for our panel presentation later, I attended a panel in the Nursing Education Theme entitled: Using a Master List of Nursing Informatics Competencies in Education, Practice and Research Setting with speakers from the USA and Finland. Carole Gossert and her colleagues described how the master list was developed from existing literature and validated by a Delphi technique. The list is available from http://www.nurs.utah.edu/informatics/competencies.htm
and it's use and evaluation in undergraduate and postgraduate nursing curriculum development at the University of Utah, University of Kuopio and Ohio State university was described.

Lunch was taken "on the run" while trying to sort out various software for our presentation at 14.00 - we already knew that it would not be possible to bring in Bill live from the USA via Elluminate, which had been our original plan - therefore he sent a Powerpoint with a voice over and we used an MP3 podcast from Margaret Hansen about Podcasts! - the limited network running Microsoft office had trouble running the wide variety of applications from Macs, open office etc although the technicians worked hard to get it all up & running by the 14.00 kick off time.

Scott, Peter and I covered a myriad of topics in the Emerging Technologies theme under the title, Connection, Collaboration and Creativity: Exploring Web 2.0 Applications in Health Informatics and Professional Development - possibly an example of a human mashup on the fly - and we even managed to get a higher level of audience participation and discussion amongst the 80-90 attendees than I had seen in other sessions.

The presentation, podcast, vodcast (or whatever) will be available as soon as we have it sorted from http://differance-engine.net/krew/ or http://www.hi-blogs.info/
we also suggested that anyone blogging from the conference use the tag medinfo2007 so that they can all be seen on the technorati site at: http://technorati.com/tag/medinfo2007

After a quick recovery coffee, cigarette etc (smoking is very restricted in Australia) I attended some presentations in the Education and Training Theme. Luca Bucceliero described work in the development of a "Health Supplement" for the ECDL/ICDL. Yiyu Qiu then presented her work on a multi methods approach to assessing health information systems end users training needs, based on work more usually undertaken in usability testing.

By that point in the day I was wilting (still a bit jet lagged) and I made my way back to the hotel, in the rain, for a rest before grabbing a bit to eat and attending an "open mic" comedy club in a nearby pub. I don't know if it was a good representation of Australian humour but some bits were very funny others did not breach the cultural divide to me. I did notice there was less heckling than there would have been at a similar event in the UK, and that it finished earlier - probably a good thing so that I could get some sleep.

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Monday, August 20, 2007

Medinfo Day 1

Monday morning in Brisbane started early - waking up on UK time. Despite the heavy rain, I mooched around the city a bit and visited the Queensland Maritime Museum (most of the pictures & text on the linked wikipedia page are mine) before going to the Brisbane Convention Centre and sorting out my conference registration.

A quick afternoon sleep fortified me for the opening session which opened with a digeredoo player and Aboriginal dancers providing a traditional welcome, which dated from BC (Before Cook). A massive (police) lineup of committee members etc was then introduced and paraded before the opening speeches by Nancy Lorenzi (IMIA President) and Evelyn Hovenga who thanked everybody for their involvement in the conference.

Delegates were welcomed on behalf of the Prime Minister by Karen Struthers MP (Parliamentary Secretary at the Ministry of Health) who makes jokes about the rain and commented about the importance of the topics likely to be discussed in the programme in relation to the Queensland Health Action Plan. She was followed by the South Brisbane Federal Band.

The first of the keynote speakers was Paul Guilding (CEO Ecos Corporation) who described his history in social and environmental issues and current role in consulting on sustainability in the corporate sector.

The second speaker was Max Bennett (Scientific Director, Brain and Mind Research Institute, University of Sydney Australia) who provided a historical approach to the study of the brain describing in some depth Neuro Anatomy and Physiology. At this point the jet lag kicked in & I had to wander outside to stop myself from falling asleep. I met several interesting delegates and partners at the reception and ended having dinner at an Italian restaurant with Scott Turley and his wife and peter Murray's wife Liz.

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Sunday, August 19, 2007

Arrival in Brisbane



The journey to Australia for the Medinfo conference was long, but not too eventful apart from a bomb scare at Heathrow Airport Central Bus Station, major queues to pass through security to transfer at Dubai, and delays in Singapore due to the planes late arrival and missing it's take off slot.

It was nice to bump into Ian Herbert (BCSHIF Vice Chair) and his wife at Brisbane airport, where he'd got his walking boots cleaned to get through the quarantine requirements! and I then got the Airtrain into the city centre. Arriving early on Sunday morning meant that the city was very quiet as I walked (initially in the wrong direction) from the station to the Marque Hotel which is in the central business district, close to the botanical gardens, parliament building and just over the river from the conference centre.
Mangrove swamp in Brisbane Botanical Gardens
The hotel reception was already occupied by several delegates from the UK (including Ian Herbert and Carol Bond) and while we waited for our rooms to be ready Paul McCullogh and I wandered around the botanical gardens and along by the riverside to find the conference venue (who unfortunately don't start registration until tomorrow). Once back at the hotel I was able to get access to my room and a welcome shower and sleep, before venturing out again to find something to eat.

Minor niggles so far have been getting another "universal" power supply adapter to plug in my computer for Internet access, as the one I had brought doesn't fit Australian plugs, and not being able to use my cashcard in the first ATM I tried - but thankful it worked in the second.

My first impressions of the city is a clean and welcoming place - but having arrived on the first day of rain here for months means that the views etc are a bit limited.

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Friday, August 17, 2007

Leaving on a jet plane

My bags are packed and I'm ready to go.... on a long set of flights to get to Brisbane Australia, for the Medinfo2007 conference.

Assuming I overcome the climate protesters at Heathrow and stop overs/connecting flights in Dubai & Singapore I should arrive on Sunday morning in time for the pre conference meetings and tutorials.

I'm quite looking forward to the conference, as I haven't been to Medinfo since 2001 when it was held in London, and I'm hoping it will be an opportunity to meet up with colleagues from around the world as well as identifying current developments in some key areas, spotting new trends and establishing opportunities for future work.

The conference includes 290 papers, panels etc and over 300 posters. Obviously I can't attend all of these (and have to be part of a panel on Web2.0 on the Tuesday afternoon and nmy own paper presentation on the ITASH project on Thursday) but will try to report a flavour of the proceedings on Informaticopia.

Others will be reporting the events including the HI-Blogs Krew at http://www.differance-engine.net/krew/ and I understand Neil Versal of Neil Versel's Healthcare IT Blog will be reporting for eHealthInsider. Many of us will use the tag: medinfo2007 which will enable all posts relating to the conference to be seen on Technorati.

I'm hoping the conference lives up to my expectations & if you are attending please stop me & say hello face to face.

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Health Informatics Community to restrict access

The latest bulletin from the Health Informatics Community says that:
"we plan to review our policy on access to the HIC and you will only be automatically granted access to the closed areas of the site if you have a nhs.net, nhs.uk or .gov.uk domain name."

I am worried that this will limited the opportunities provided by this site for the exchange of news, views and ideas, and will mean that those from academia and others with a legitimate interest in the development of health informatics in the UK, including members of the Faculty of Health Informatics will be excluded from discussions.

I have sent an email requesting further explanation or discussion of this decision but not, as yet, received any reply.

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