Saturday, August 30, 2008

Update on the XO OLPC

Hopefully others will get together and form groups in their areas too and support health education projects and even personal health record projects on this platform.

Thanks for sharing all your wonderful "ramblings." I was particularly intrigued by your first idea about using the XO to teach health concepts. I am aware that the infant and child mortality rates in developing countries is a huge problem and that so many of the deaths would be preventable if proper hygiene were practiced. Health Education is certainly a critical piece of the puzzle.

This week our support gang group is going to be discussing possible ideas for educational content and this is certainly something we will look at.

You are correct in saying that the main focus of OLPC is education.There is, however, a lot of interest in using the XO for health applications. You will want to visit this page on our wiki:

And you will want to sign up on the health mailing list where you can discuss your ideas with others:

OLPC does not do fundraising. However, there is nothing to prevent you from doing something at Vanderbilt as you mentioned. In fact, you might want to start a campus interest group that could get involved in making many of your ideas a reality. We have a guide for starting a campus group on our wiki at:

One problem with your ideas is that OLPC doesn't sell XOs for anything other than education projects at this time. However, later this year weare planning to have another Give One Get One (G1G1) program. The donorsin this program are free to use their own XO in any way they choose.You can watch for news of the next G1G1 on our wiki at:

Now, let me just address a few of your other ideas...

Actually, both items 1 & 2 are education projects....maybe, if you could interest a group of schools in participating in a pilot project with these as a focus, you could do a regular deployment.

#3 Would be dependent on having wireless Internet service available which is a problem in many developing countries.

#4 Great idea

#5 Don't count on the hand crank being available. Solar panels however,are ready to go. If the workers are too far apart, you will need to have a server to allow them to communicate.

#6 A great idea. The American Red Cross Disaster Relief could use this one too.

#7 Alas, scabrous requires Windows. Most XOs will not have Windows available.

#8 Others have had some of these ideas too. Someone has already found away to hook up a stethoscope. Check this wiki page:

#9 Another good idea. Actually the Red Cross plans to have laptops with built in satellite Internet access soon. However, the XO wouldn't work for them since it does not access satellite Internet signals and doe snot run Windows (all of their programs are Windows based).

So the answer is, your ideas are good...not wild ramblings at all.

Please use the links I have given you to make contacts with other like minded folks and see if you can make some of your ideas happen!

Caryl OLPC Support Volunteer


Friday, August 29, 2008

XO Laptop, or One Laptop Per Child Project: An Extension Idea for a Sturdy Tool

I woke up at 4 a.m. thinking how great it one be to apply the One Laptop Per Child (OLPC) XO Laptop ( to several ideas.
  1. Educating children on health: It already has education as a mission, but I wonder how much of that is devoted to evidence-based health education practices? It uses gaming too, so it could also be adopted by groups such as Games for Health ( And, projects such as Re-Mission ( could be a model for how it teaches children compliance and self-care with other diseases.
  2. Medication Tracking and Compliance: In the US and other country rural areas, it could have something similar to the My-Medi-Health project, which aims to investigate and research methods for improving compliance among children. What about a module within it that has a personal health record? Or even one which encourages the child to document vital signs, medications, and treatments and then can beam it back to a provider's computer in the clinic? (
  3. A Remote Healthcare Provider Computer: This computer has incredible potential for remote areas for having a more robust electronic medical record. It could act as a repository for data until the healthcare provider could get back to a central computer and then, using its wireless abilities, beam them back into the main database (sync them up).
  4. Home Health Care for Rural Areas: As above, especially with nursing modules it could bring about cheaper care and bedside documentation for nurses in the field.
  5. Disaster Relief Use: What about developing a special model of this very durable PC for use in mass casualty disaster situations? Especially since it comes with a hand crank, and after disasters we often don't have battery and networking capabilities, note that it has a hand-crank to recharge and it has wireless social networking software built in. So, it could not only tell you where other healthcare providers are in the command zone, but share information on triage and treatment. Just a little retweaking of the system and it's ideal... especially because it is designed specifically for sturdiness, including water and sandproof and dropping and so on...
  6. Transcultural Care: The team using it are experts at symbolization and crossing language barriers. They could help develop a universal standard, or even several language algorithms, for helping international aid workers work together in mass casualty.
  7. Special Needs Children: I wonder how well it would work for autistic children and others within that spectrum, especially combined with
  8. Accessories: Could other equipment be developed to accompany it? For instance, a Wii Fit board to measure weight in the field, or something sturdier and just as cheap (the board itself is $87 retail or so bought directly, not through marked-up online vendors). Or, blood glucose monitoring devices and such? A blood pressure cuff?
  9. Field Database: Could a more remote version be created for use as field command centers? Even have database server versions, using the peer-to-peer wireless, to collect data? Not just for mass casualties, but healthcare in remote areas? Again, a sturdier, server version, but bring it back to the main computer and sync it up, perhaps in a healthcare truck, van, airplain, or helicopter or such? Valued data could be used for research, health care improvement, disease tracking, and even fundraising. Think of the value to groups like the Red Cross and Red Crescent Societies. The CDC could really benefit from point-of-impact data collection.

What would it take to raise the money for it? Could the XO team help raise the money to form a separate group to investigate using it this way? Maybe even the Vanderbilt School of Nursing faculty and staff could be involved and find grants to make this happen? Maybe a research project for a grad student or two? Are there others who are interested in seeing this happen? Is it visionary?

Just some thoughts. Thanks for listening! - Richard Aries, MSN, RN, EMT

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Friday, August 22, 2008

"Independent" report into NHS IT

Yesterday it was announced that The Conservatives have commissioned a review of NHS IT to be led by Dr Glyn Hayes of the BCS.

The review intends to focus on practical ways to to get the maximum patient benefit from IT and informatics in health and social care over the next five to ten years.

Written evidence is invited from any individual or organisation with an interest in the area by the end of September. Oral hearings will then be held in October and November, with a first draft expected in December and the final report is to be published by the end of March 2009.

The Review Group's remit, which is set out in full in a letter published on E-health Insider is to:

1. Establish how clinical, public, and management needs can most effectively be met by information technology
2. In the light of the developments and progress of the last few years, establish a vision for IT in the NHS, health and social care
3. Set out a strategy for achieving that vision including a workforce strategy
4. Advise on action for the current Government to take
5. Advise on the policy options to be considered for implementation by an incoming Conservative Government.

I have some concerns about the independence of the review, because of the political sponsors, however I respect Glyn's integrity enough to believe that he will do a good job and produce a balanced report. I can't see him as the tories Ara Darzi but do believe the review has something to offer and I will be contributing to it as soon as I get some time.

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eHealth Canada

It is always interesting to compare eHealth developments around the world, and a recent report from Ontario caught my eye, particularly as i shall be in Canada in 2 weeks for the Medicine 2.0 conference for which the final programme has just been released.

In Ontario their Smart System's for Health Agency (SSHA) has undertaken a range of new initiatives, in their province-wide information technology infrastructure.

These include:

* 63,295 new ONE Mail users, 15% above target, added at 58 organizations for a total of 116,739 accounts province-wide

* 1,541 new ONE Network sites added for a total of 7,213 sites connected

* 60 per cent of Network Refresh Project sites transitioned to SSHA’s upgraded network, significantly expanding current and future bandwidth requirements, while also improving reliability, security, privacy and overall quality of ONE Network

* 2 complex initiatives, Ontario Laboratories Information System and Enterprise Master Patient Index, transitioned to SSHA for ongoing application maintenance.

It would be interesting to see how these developments are affecting front line care, and if any readers from the area would like to comment please let me know.

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Wednesday, August 13, 2008

Open access - how well do our areas do?

We've discussed quite a few aspects of open access on this blog over the years, so a recent email from BioMed Central ( lead me to looking into our areas of interest - nursing, health informatics, e-learning, etc. - to see how well we scored in the open access stakes.

The 'Open Access Quotient' (OAQ) was introduced on the BioMed Central blog in July 2007 (>>>); the OAQ aims "to quantify just how open a particular research field is – i.e. what fraction of the research in that area is available with open access immediately following publication". It does this through a search of PubMed citations from the past 60 days - a metric you can argue with, but maybe as good as any other.

At the time, I did a quick look on nursing and found it then had an OAQ of only 2.55% - not a very good score, and well below the PubMed average of 6.8% at the time. Well, nursing, as many other areas (>>>), has improved a bit in the past 12 months - it now scores 4.3% - but only, I suspect, due to the effect of the increasing number of BioMed central journals, rather than any conversion to the open access model or philosophy by other publishers.

A comparison with some other subject areas of interest shows:
health informatics = 9.64%
medical informatics = 19.44%
e-learning = 26.67%

However, when 'nursing informatics' returns a result of 66.67%, then I start to suspect the reliability of the algorithm - although it is on a sample of 3 articles.

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Tuesday, August 12, 2008

While the standards world was besotted with terminology over the last 20 years, clinical modelling remained relatively unloved and under-resourced, with the occasional exception (eg GALEN) proving the rule. It may have been obvious that terms would never 'enable' the EPR without some structures to hang them on, but it has taken a while for this to get more serious attention in the informatics mainstream.

Clinical content standards development is now a fast growing area of informatics, and is one where clinical and informatics expertise needs to collaborate closely. In the UK, most recent interest in standards has focussed on openEHR archetypes and templates- eg NHS Clinical Models.

While the standards (and the standardised models) sort themselves out, the world moves on, with everyone and their dogs developing their own content, sometimes sharing it, usually not. Clinical content remains embedded in working systems, often wrapped in licensing agreements preventing sharing and re-use. Standardised tools are used, without any attention to copyright restrictions that might apply.

There has been previous work to address this, for example, 'Tools and Rules', but there is scope for something more long-term and 'open'.

The new site has just gone live as an open source portal for various projects working on the collaborative development and sharing of clinical templates and supporting documentation.

The project offers a web ‘shell’ for each collaborative project site, supporting groups, membership, news, blogs, newsfeeds, and wiki. Within that, the project is developing a range of plugins to support template building, mappings and other project-specific tools.

New projects are in preparation and will appear on the site over the next few months- each one is a little different and should build into an interesting collection. aims to become a long-term home or point of access to template development by many groups and in many countries. It is supported by a new company setup by Derek Hoy and Nick Hardiker.

[disclosure of interest: I am a lead developer of and partner in SnowCloud]

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Wednesday, August 06, 2008

Health 2.0 and Medicine 2.0 - discussion paper

A new peer-reviewed paper just released on JMIR (Journal of Medical Internet Research - is titled "Health 2.0 and Medicine 2.0: Tensions and Controversies in the Field" >>>

I have not had chance to read the full paper yet, but it looks like a useful contribute to the ongoing discussions of the nature of the two memes - and hopefully will promote some useful discussion if it is going to be presented at the Medicine 2.0 Congress next month ( It has a lengthy reference list, which is valuable in itself, pulling together much of the recent discussion, and has used a thematic analysis of the definitions and discussions.

The major findings included:
"Four major tensions or debates between stakeholders were found in this literature, including (1) the lack of clear Medicine 2.0 definitions, (2) tension due to the loss of control over information as perceived by doctors, (3) the safety issues of inaccurate information, and (4) ownership and privacy issues with the growing body of information created by Medicine 2.0."

I will provide an update and further thoughts when I have read the paper. And just a heads-up that Rod and I, amongst others, will be at the Medicine 2.0 Congress in Toronto, and will be blogging it, no doubt.

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Tuesday, August 05, 2008

Video Games Improve Medication Compliance

Play video games can help with pediatric patient medication compliance (16% increase). From the August 2008 issue of Pediatrics, cited in a Yahoo! (Reuters):

In Re-Mission (, developed by HopeLab, a Redwood City, California-based non-profit company, players control a tiny robot called Roxxi who moves around in a 3-D environment representing the inside of the body of a young cancer patient. Players can use Roxxi to blast cancer cells and control side effects, and winning the game requires taking chemotherapy drugs and antibiotics, using relaxation techniques, eating food, and keeping up with other types of self-care.
SOURCE: Pediatrics, August 2008.


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Nurses and decision support

Peter Murray, on his Release Zero Blog, has published a useful summary and comment piece entitled Nurses' decision making and new technologies: research report related to a major report examining "Factors likely to influence how nurses use new technologies to inform their decision making, in particular through their use of computerised decision support systems (CDSS)."

Peter makes some interesting points about the report and the lack of good evidence - I wonder whether his comments, and the findings of the report will be taken into account?

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Sunday, August 03, 2008

Patient Opinion mashing up reviews and NHS choices data

Patient Opinion, a not-for-profit social enterprise web site which encourages patients to share their experience of their treatment in the NHS, has become the first organisation to mash up data feeds provided by the Department of Health’s NHS Choices web site, with that already published about local services on Patient Opinion.

This follows the Cabinet Office’s recent release of many government data sets as part of its implementation of the Power of Information Review, published in May 2007 by the Cabinet Office.

This application demonstrates the advantages that can be gained by the use of technology to merge information from various sources to provide something which is greater than "the sum of the parts", and years of campaigning for information which has been paid for by taxpayers to be made more widely available.

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