Monday, September 29, 2008

RCN advertising for a E-Health Nurse Adviser

The Royal College of Nursing is currently advertising for an E-Health Nurse Adviser.

They are offering £48,336 per annum pro rata (Including London Weighting) for the Part-time, 21 hours per week post

This role is permanent but secondments for one year in the first instance will be also be considered Flexible UK base.

Leading this UK-wide specialty, you’ll influence and shape policy and practice in eHealth, one of the most exciting developments in nursing practice for many years. You will champion the benefits and opportunities presented by new technology, advising government on its impact and engaging nursing professionals with its possibilities.

This is a high-profile role for a qualified nurse that demands a sound practical understanding of information governance and the use of digital information and communications technology within nursing practice and its potential for improving service delivery and patient care. This is also very much a communicating and influencing role, for which excellent interpersonal skills are a must.

If I hadn't already got a full time + post myself I would be applying for it - but if you are interested take a look at: and get your application in by the closing date of 16th October 2008.

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Friday, September 26, 2008

T-Mobile, Android, and Google Health?

I'm excited about the new T-Mobile G1 coming with Google's Android on it. That means we'll have a full, open source web compliant platform to develop not only health, but other applications. The browser and built-in tools will be fun to play with! T-Mobile is expanding its network to address deadzone or low service issues. One prognisticator claimed that at least 10% of the cell market would be on Android by 2010. That could be because of the other, supposed inside rumors.

That is the other good news, though rumor: The G1 is going to have a much lower price than iPhone, perhaps as low as $79 with a 2-year plan, and be sold in Sam's Clubs, Targets, Walmarts, and a few others, with even pay-per-minute plans. That could boost a lot of people getting and using them, especially the lower-income folks. Keep in mind these would be the people we'd want to target for health applications, especially, since the poor are unfortunately tied to more health issues (for lack of resources to manage).

I have little doubt it means GoogleHealth will be avialable on it. Imagine the things we can do for healthcare then... a true, mobile personal health record!

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Tuesday, September 23, 2008

Medical bloggers - a survey

The Journal of Medical Internet Research (JMIR) has just published a interesting survey of medical bloggers by Ivor Kovic, Ileana Lulic & Gordana Brumini "Examining the Medical Blogosphere: An Online Survey of Medical Bloggers" - not sure I recognise everything described, but it does give some useful insights into a motley bunch.


Thursday, September 18, 2008

Acess to health records - two major announcements

The last 48 hours have seen two major announcements about changes to access restrictions for patients records in the UK's National Health Service. The first will require staff are to seek patients' specific consent before reading their electronic medical records, the second was an announcement of a consultation with the public and healthcare professionals on the use of patient information for purposes such as health research and managing and planning care.

Connecting for Health, the agency charged with the delivery of the NHS's National Programme for IT has finally bowed to pressure from a wide range of patient and professional groups and changed the "consent model" which will be used in an attempt to protect patient confidentiality when dealing with electronic health records uploaded onto the "spine". As has been noted on this blog and elsewhere the original model assumed the consent of patients to upload and share the information they gave to healthcare professionals, unless they actively "opted out", and proposed the use of sealed envelopes for particularly sensitive information. This has been challenged in various ways and was criticised in the evaluation of pilot projects by University College London, published in May.

According to The Guardian 638,000 patients in the five trial areas were written to about plans to share their GP records, only about 2,500 opted out and 500 said their records could be uploaded with conditions. However many thousands in the trial areas were unaware of the public information campaigns, and NHS staff were often unaware of an obligation to patients who wanted to be notified when staff wanted access to their file.

According to the report on E-Health Insider Professor Patricia Greenhalgh, the lead author of the UCL report, said she was delighted by the decision.

“The most consistent and disturbing finding from the UCL evaluation of the SCR was concern from NHS staff, patients, professional organisations and civil liberties groups about the original ‘implied consent’ model,” she said.

According to the Health Service Journal this new approach provides a simplified model which has the backing of the BMA, Royal College of Nursing, medical defense unions, chief information officers and the General Medical Council.

This change is seen as moving the system in England towards the one chosen in Scotland and Wales, more of a consent to view - however it could be argued that consent to share is still implied as patients will not be asked directly whether they are happy for their records to be shared via the national spine.

The second independent but related announcement, concerns a 12 week "consultation exercise" being run by Tribal Consulting for Connecting for Health giving patients and the public the opportunity to comment on the ways in which their information is used for research and planning purposes and examine the potential benefits, legal safeguards and practical steps available to meet confidentiality and ethical obligations. This follows various criticisms of the ways in which the "Secondary Uses Service/NHS Information Centre" operates, and criticisms of the Care Records Guarantee.

Some of the questions included are:

* Who should have access to patient data?
* For what additional or secondary uses should data be used other than direct care?
* What process should govern access when individual patients can or cannot be identified?
* Who should control and manage access to the information?
* What consent options and safeguards should there be for patients?
* What concerns do people have about secondary uses and how can they best be addressed?

The public consultation covers the use of patient information for uses such as:

* Research into prevention and treatment of diseases
* Improving public health
* Managing and planning future health services
* (Health) planning screening
* Quality control (clinical audit)

It will be interesting to see how much involvement there is from the public and health professionals, although the impressions given by the "experts" on the news release page suggest that the benefits are a given - and runs the risk of suggesting that a decision has already been made to share the information - and that the consultation will only affect how this might be done. According to E-Health Insider Professor Michael Thick (chief clinical officer for NHS Connecting for Health) said people would not give explicit consent to their information being included in the new service, which will collect data automatically from the NHS CRS, Choose and Book, and other national systems. He also indicated that patients would not be able to opt out, although they will be able to apply under section 10 of the Data Protection Act to prevent use of data that would cause them distress.

As discussed on this blog when the report, entitled the Data Sharing Review by Richard Thomas, the Information Commissioner, and Mark Walport, the director of the Welcome Trust, came out in July, there is a major difference between anonymous and identifiable personal data. When Connecting for Health say that " while patient identifiers will “normally” be removed from the information “sometimes” these will be required", alarm bells should start ringing.

The safeguards provided by NHS Research Ethics Committees need to be very carefully examined if they can grant access to pseudonymised and in some cases patient identifiable data, as well as anonymised records.

According to PULSE the consultation will also raise questions over the extent to which the NHS should be sharing data with external researchers. Last year Connecting for Health’s subcontractor BT suggested in a written submission to the Health Select Committee that pseudonymised patient data could be shared with pharmaceutical company researchers to earn the NHS cash.

The invitiation to consult along with supporting documentation can be found at and I would encourage everyone with an interest to get involved.

I feel these two announcements suggest that the balance between patient confidentiality/privacy and the demands of governments and other organisations which trawl personal data need to be very carefully observed.

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Top 50 Health 2.0 Blogs

RNCentral has just published its list of its top 50 blogs related to Health 2.0.

Thankfully Informaticopia is on it along with 49 other good ones.

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Deadline for submissions for NI2009 is approaching

The deadline for submissions for the NI2009 Congress is nearing!

The 10th International Nursing Informatics Congress Nursing Informatics - Connecting Health and Humans, will be held in Helsinki, Finland on 28 June - 1 July 2009. It aims to present a forum to discuss recent advances and future directions on the nursing informatics and related fields.

The deadline for submissions is September 30, 2008. Final copy of accepted contributions must be submitted before January 31, 2009.

The submissions page with the details about the call for papers is at:

I hope this is going to be an excellent conference showcasing a range of innovations world wide.

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Wednesday, September 17, 2008

Latest edition of HI Now

The latest edition of HI Now (Volume 3, Number 1), the quarterly journal from the Health Informatics Forum of the British Computer Society, is now available online.

The articles include:
* Round-up of this issue
Debates on security, privacy and patient safety.

* Industry news
A selection of articles outlining recent IT-related news in healthcare.

* BCSHIF responds to Health Informatics Review
BCSHIF, ASSIST and UKchip joint response to the DH's Health Informatics Review.

* Data safety and clinical care
The balance between keeping patient data safe and not hampering clinicians in delivering effective care was discussed at a BCSHIF meeting in July, led by Edward James, a consultant working with the Imperial College Healthcare NHS Trust.

* BCS reshapes HC for 2009
BCS is re-launching Healthcare Computing as a fully integrated, BCS-managed and run event.

* Another year full of activity
BCSHIF has produced a report describing its initiatives and activities over the year.

* Tool to aid privacy decisions
A research team has been developing a tool to help professionals make privacy impact assessments.

* Hang on tight to the information revolution
Delegates at the HC2008 conference were given an 'invitation to the future' by Ian Neild from the group chief technology office of BT.

* MIE2008 highlights exploitation of research
From gaming's use for doctors to technology to support older people living independently in their own homes, MIE2009 covered a wide range of topics.

* Forthcoming events
A selection of BCS health informatics events.

* Apply now to enter for Dame Phyllis Friend Award
The Nursing Specialist Group is seeking entries for the annual Dame Phyllis award

* Mind the gap
Following the Primary Health Care Specialist Group (PHCSG)'s summer conference, the group is now preparing for its autumn annual conference.

* ePrescribing to cut error rates
Where electronic systems have been tried in prescribing medication, they have dramatically cut error rates.

The full issue is also available as a PDF at:

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Wednesday, September 10, 2008

A life-changing internship

The Acumen Fund fellowship is the most coveted, competitive job I know of. If it's not for you, consider telling an extraordinary friend about it.

Saturday, September 06, 2008

Reflections on the Medicine 2.0 Toronto experience

One of the criticisms made during the bloggers panel was that instant reporting/blogging of this sort of conference doesn't give much opportunity for reflection. Therefore as I have some time before flying back to the UK and its raining today in Toronto I thought I would do some general comments on the conference and the wider experience, including some of the social events, of my trip to Toronto.

Travel and accommodation

Getting here was a long flight - with a sting in the tail. Work had booked me onto a FlyGlobespan flight as they have recently started doing direct flights from Bristol to "Toronto". A delayed take off was followed by a long period on the tarmac at Dublin to take on more fuel and passengers. The flight itself was fairly standard cattle class - and eventually arrived at Hamilton International Airport. I had no idea that it was so far from the city itself or that I would be landing on a bank holiday (Labour Day), and therefore many of the transport links were not working or were infrequent. Two buses and several hours later I arrived in Toronto and found the Delta Chelsea hotel - that largest hotel in Canada with 1700 rooms. The time zone differences meant that it was about 03.00 for my body but only 22.00 for the people around me! The hotel staff and just about every other Canadian I have met has been very friendly and welcoming and the city feels very safe.

Sightseeing & social

I spent a day wandering around Toronto while acclimatising. My second day was the highlight of my sightseeing as I'd book a guided tour of Niagra Falls with Toronto Tours. Judy the slightly eccentric guide/driver took a party of about 20 people along the (bumpy) expressway to the Niagra district giving a humorous, and possibly scurrilous, commentary along the way. We stopped at the picturesque (ie set up for tourists) town of Niagara on the Lake and wandered about before the coach drive towards the falls themselves. Several people were dropped off for a helicopter ride - but the cost of 100 dollars (about £50) for a 9 minute flight put me off. Those not on the helicopter went to the Whirlpool rapids before continuing to the town of Niagara Falls, Ontario, which is a bit like Blackpool on the lake but we had a nice buffet lunch at the Sheraton - included in the tour price. After lunch we got closer to the American falls and had a boat trip on the Maid of the Mist which takes you very close to the much larger Canadian Falls. This and the time for wandering, on this very hot day, gave me areal opportunity to try out my new camera & I took loads of pictures & some video of the falls from just about every angle. The ride back to Toronto was broken with a trip to Lakeview Winery for a tasting in the vineyard.

Back in Toronto Peter introduced me to the C'est What Brew Pub/restaurant to prepare for the conference itself. On the Thursday evening Peter and I were joined by Margaret Hanson (US) & Chris Paton (NZ) for a nice meal at a little restaurant close to the hotel and on the Friday a larger group eat in the revolving restaurant at the top of the CN Tower, which provided some spectacular views over the city and the lake while enjoying excellent company.


The conference was a great opportunity for academics and innovators from around the world to discuss and demonstrate the impact of Web 2.0 technologies such as blogs, wikis and social networking, on medicine and healthcare.

Many of the participants were using the applications under discussion to share information and ideas, and I’ve never been to a conference where there was so much concurrent use of blogging, twittering and electronic social networking to embellish the face to face interaction a conference such as this provides – and share those thoughts with the rest of the wired world.

Despite the hype in the promotion for the conference many of the presentations were not that different from material being presented at similar health informatics events five years ago. The areas of potential and risk have been well rehearsed and were further developed at this conference with up to the minute tweaks. I particularly enjoyed the panel discussion on Methodological Issues and Challenges in eHealth Research with Judy Proudfoot, Lisa Whitehead and Caryl Barnes from Australia as many of their comments any observations were relevant to my own research. This emphasised the international nature of the issues and showed that many of us are grappling with similar issues. The NHS league tables and star rating systems were held up by Joan Dzenowagis from the World Health Organisation as shining examples – of how not to do it.

The most challenging and therefore useful, motivating and exciting session was by Maarten Den Braber and Jen McCabe talking about the Nexthealth model trying to look at healthcare in the future as far as Web 4.0. their ideas seemed as if they had arrived from Mars when compared with the earthbound work of some others. I will be following up their ideas in other fora (or planets).

The other fora which I have identified include:
* The conference social network on Crowdvine
* A discussion on Twitter
* Peter Murray blogging on
* Berci Mesko at ScienceRoll
* John W. Sharp
* Jen McCabe Gorman at Health Management Rx
* Neil Versel
* Kate Jongbloed

and Gunther has now uploaded all of his 800+ photos to Flickr (and would help labeling all the names.

All in all I found it a useful and stimulating conference and have just heard from Gunther that the evaluations were all very positive as well so hopefully we can look forward to a similar event next year.

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Friday, September 05, 2008

Medicine 2.0 conference - Day 2

The second day starting with parallel sessions. I attended a panel discussion on Methodological Issues and Challenges in eHealth Research with Judy Proudfoot, Lisa Whitehead and Caryl Barnes.

Lisa described a systematic review of methodological and ethical issues in eHealth research.The issues fall into sampling, ethics and reliability and validity with many issues around moving these from paper systems to online systems. The size of samples may or may not overcome issues of bias. Some of the potential produced around tracking IP addresses and pages visited but difficulties in getting a random sample led to the use of propensity scoring. Unsolicited email gets low response rates which were compounded by technical issues of browsers and passwords, security measures, computer anxiety etc. Ethical issues related to obtaining consent, protecting anonymity and security particularly in opportunistic research. Particular issues arose in using forums and similar collaborative tools. Using the web as sources raise issues around the level of disguise, perceived privacy and questions about whether researcher are lurkers. Further considerations need to be given to reliability and credibility related to linguistic competence, cultural differences, repeat participation and misinterpretation of self. Further problems with construct validity based on psychometric properties were also highlighted. Some questions arose about whether online samples or "real life" samples are "real" and maintaining participation.

Judy Proudfoot from the Black Dog Institute developed further on the sampling issues, based on research she is leading on people with Bipolar disorder undergoing an online education program. The difficulties with recruiting and low response rates have led to requirements for mixed methods but still doesn't provide random sampling. They are currently looking at whether the use of mobile phones might help with recruitment. A question about unsolicited emails and texts, and compliance with regulations led to further discussion.

The next section was led by Caryl Barnes who examined ethical issues which arose as part of an evaluation study on an online support program 'HealthSteps for Bipolar disorder". The road of the study through an Ethical Committee and the underlying moral codes covering privacy/confidentiality, informed consent, randomisation, risk/benefit ratio etc and most problematically the Duty of Care which led to a "red flag" system which led to withdrawal and contact with the patients clinician if life threatening/suicidal tendencies were identified. Some compromises with the commercial company running the program during the course of the study, they also found that not enough identifying details had been collected. They found that many participants had not read the Participant Information Sheet and this led to lots of further questions.

Lisa then covered some of the measurement issues based on a qualitative and quantitative survey of the health of tertiary students, examining whether there were difference between online and postal responses illustrated with copious statistics. The online and postal groups were close in the number of respondents, gender, ethnic origin, overseas students etc. Online participants were more likely to drop out as different measures were completed page by page and some did not complete all of them, but this level was not significant. Online respondents were seen to have higher fatigue scores than those who completed the survey via a postal system.

A variety of questions and comments from the floor then widened the debates and highlighted some of the current challenges for good new guidelines setting standards for behaviour in this area.

After coffee the next session I attended was about consumer empowerment, patient-physician, relationship and sociotechnical issues. The first presentation was by Luis Fernandez Luque from Norway. He described the number of blogs, web sites, videos and social networks etc where people are sharing information about their health conditions. He has studied these to find out whether these should be recommended to other patients. Over 100 were invited to the study and 29 completed surveys were received. He found patient generated content was rated highly for emotional support, but there were concerns about drug companies and others putting information up in this format. Many of the respondents considered changing their treatment or doctor based on information their had received from sites with patient generated content. They did not consider their privacy a problem and posted photos and a range of personal information. 17% published complaints about their doctors - mostly without identifying them. Existing codes are aimed at health professionals so he suggested the need for a code for epatient bloggers. He played a You Tube video of a patient with Multiple Sclerosis who is creating and publishing a video blog who had sent a message to the conference. Questions again raised issues around protection v empowerment and arguments about the creation and compliance with a code of ethics.

The next presentation was by Joanne Mayoh a doctoral student talking about - "Will the development of Web 2.0 technology result in a preference for quantity over quality?" She set out the use of the Internet to search for health information. Issues of Information and IT literacy meant that vast quantities of (possibly inaccurate) information can lead to greater distress than in other areas. She argued that wikis blogs and social networking as well as increasing quantity could also improve quality through Darwikinism particularly through the process in wikipedia and similar sites. Becoming as accurate as encyclopedias and challenging the criteria being used to judge the quality of online health information. Therefore she is focusing on the balance between online quality or public ability enhancing peoples skills in assessing the quality of information. She challenged the points made in the Times article "Ten ways to wind-up your GP" and what the response of the GP should be to people who bring print outs from the Internet. Her work with support groups members with chronic illness have low levels of Web 2.0 knowledge and what she can do to improve this. Questions discussed different routes to education both for patients but also for GPs.

The next presentation "Women wading through the web" by Sheryl Mitchell was about a toolkit Womens College Hospital has produced to help women find and evaluate information for this target group. She demonstrated the womenshealthmatters web site, and showed how the learning from this have led to the development of the toolkit. Well documented concerns about patients ability to evaluate online information was reprised and useful tools selected and tested, and reminded me of the work we did with the NMAP project which became Intute: Health and Life Sciences.

The final presentation of the session was by Cornelia Van Uden-Kraan from Twente University who talked bout her work examining empowerment by participation in online support groups via discussion groups. She highlighted the difficulties and lack of tools for the measurement of empowerment. Her team carried out qualitative and quantitative data collection to identify what processes and outcomes contributed to empowerment amongst participants in online support groups, which were similar between different diagnostic groups although the level of activity did vary.

After lunch I attended the theme Semantic Web (Web 3.0), Open Source. The first presentation was about PRESCO an attempt to develop an open source social network and architecture. He was presenting for colleagues who had found a variety of benefits for low and middle income Spanish speaking countries.

They were followed by Maarten Den Braber and Jen McCabe talking about the Nexthealth model trying to look at healthcare in the future and the balance between patient & professional, bricks & mortar & virtual & then the 4Cs. I got so involved in this presentation and the ensuing discussion that I didn't atke many notes - but I will find links on the web and add them as I found this the most interesting session of the conference.
* Nexthealth on the way
* Next Health Elevator presentation

The final plenary was Risk 2.0 by Joan Dzenowagis,(WHO) Kevin Clauson and a missing colleague from Microsoft which used an audience response system. They highlighted the blurring of legal & ge boundaries & lack of control. The amount of poor information found by search engines led to a question to the audience to identify what people thought would help, and then moved on to Internet safety, data scandals and trust. This was then applied to health records. She used lots of examples from the UK about data risks and hospital rating systems. She also discussed Wikipedia and its rules and guidelines, and the ways in which PR/drug companies try to manipulate it. She highlighted risks of open editing & identified problems in identifying liability. She also talked about changes in publishing models and their possible effects.

Kevin Clauson then followed with risk benefit analysis for professionals and patients. He saw risks of liability for professionals interatcing with patients online. He highlighted emails and blogs as greatest risks because of the tone and the way in which specific individuals can be identified. The Dr Lindeman/Dr Flea case highlighted in the bloggers panel yesterday. He discussed ethics & blogging, social networking sites. He tried to balance the negatives and risks with potential benefits. The risks to pharmaceutical companies made up the next part of his presentation, moving from direct-to-consumer marketing (which is only allowed in the US & New Zealand) across the web, with worries about off label claims, but could be a cheap advertising option. He concluded with issues about risks for patients inherent in blogs etc being hosted by pharmaceutical companies, and using personal health information. He also talked bout a study of drug accuracy and completeness in wikipedia. Some good topics,including economic and social change issues were raised in the question and answer session.

The conference then closed with thanks to organisers.

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Thursday, September 04, 2008

Medicine 2.0 Conference opening day

The first Medicine 2.0 conference has opened today in the MARS Centre, Toronto.

After a couple of days of sightseeing (the Niagra Falls trip was spectacular) we are finally getting down to business. This post is being written "on the fly" during the day so I apologise for any typos or other formatting errors.

Thanks should initially go to Gunther Eysenbach for the organisation. He is the Senior Scientist at the Centre for Global eHealth Innovation, Toronto and Editor/Publisher, Journal of Medical Internet Research (JMIR)

The venue seems well setup with easy access to the wireless network & good coffee. It is quite interesting to meet many people face to face which I have only previously met online.

Peter opened the conference on behalf of IMIA & other hats who thanked Gunther & talked about what IMIA is, in particular the IMIA Web 2.0 Task force and CHIRAD. He looked forward to the programme with presenters from over 15 countries & the conference teams use of Web2.0 including Crowdvine &the online paper rating system.

Gunther described how he tested the Canadian healthcare system by breaking his wrist & instantly changing his status on Facebook. More seriously he used his experience to talk about the potential of getting access to his medical record & have some connectivity with the healthcare system & making contact with peers who had similar injuries. He gave a high level overview of some of the relevant systems focusing on the interaction between evidence based medicine & personal health information - and the bypassing of the gatekeeper. I'm still not sure his definition of Apomediation via collaborative filtering approaches will become reality this week - but it is certainly one of the directions we may be moving in. The idea behind a Personal Health Record 2.0 has potential for the consent to store or consent to view debates we have been having in the UK. He highlighted some questions which he challenged the attendees to address during the conference & asked what are the specific requirements in healthcare. He hoped we would provide a critical view and not blindly follow the needs of the venture capitalists. He gave the housekeeping notices and thanked the sponsors.

The first keynote speaker was Pat rich - the Director, CMA Online Content. He spoke about Asklepios & what they are trying to achieve with it. He started with an overview of the CMA & talked about their movement into online resources including and chronic disease tracking shared by patients and Doctors. He explained the rational for setting up the social networking site - many of them already blogging, posting videos etc - based on US data & then dividing the numbers by 10. He talked about the value of informal discussion - based on the doctors lounge idea - coming from surveys of their members. The rationale for a secure physicians only site was presented. The need to avoid US hosting & lay grounds rules rather than moderation eg politely criticising the president was seen as important. The initial pilot was on Ning & then opened up to 125 physicians in the pilot. They then worked with a web services company and launched it a couple of weeks ago and already have 150 members. He described how people are setting up groups on it for discussions of a range of topics. He talked about the plans for the future and monitoring systems. He finished with the unanswered questions they are still trying to find out with the site and highlighted the need for evaluative research. Questions touched on the economic model behind it and the profile of users, which included "sponsored areas",and the possibility for guest access for colleagues from other countries. A good questions raised the potential for "unintended consequences".

The second keynote was by Michael Massagli from patientslikeme based on comments from the sites users, particularly those in the amyotrophic lateral sclerosis (ALS) group. He described the site and how it is used by those with particular conditions to find others who have similar experiences. The graphical representation of structured and unstructured data and the potential for discussion through forums, private messages etc. The analysis of the user generated massages showed a "hard core" of people who greet new members & others where specific phrases indicated users were basing their comments on the posted profiles & how comments fitted into wider patterns. Much of the analysis is in his paper Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another’s Data so used his presentation time to show what the dialogues were like. The latest work has examined whether patients can answers clinical questions as a group - based on having read a journal paper about lithium use for ALS - this led to new tools to track individuals experience with the use of particular drug regimens. His work has concluded that patients do look at and comment on each others data - and can potentially generate new data centered user conversations that are useful.

After coffee (which included an interesting discussion on an open access business model for videos from the Journal of visualized experiments) the conference split into several themes. I attended a sessions on blogs. Neil Seeman opened with a discussion of how opinion leaders and how those who make decisions in healthcare systems are influenced. He suggested that opinion leaders may not enjoy status as they did in the past. Social networking analysis has been used to analyse health topics on popular sites such as myspace and facebook. The groups which are most active are those about conditions which are most stigmatised. The number of contacts may not be the indicator but the level of use but more important is trust. The ideas are linked to personal empowerment in dealing with healthcare providers. Amongst practitioners the knowledge management features of a blog were the things which made them go back to the blog. The growth of the blogosphere is a factor in breaking news and can not be ignored by the traditional media. He also talked about blog governance scores and other factors which affect blog density. Both blogs & newspapers were not reporting clinically significant health stories - but the ability to engage with the audience is significant. General interest blogs do as well as newspapers. There is an inverse link between governance score and traffic. An interesting thought was that SME = Subject Medical Expetise rather than Small or Medium Enterprise - which would be more common in the UK. Questions linked to future directions and advertising/sponsorship or conflicts of interest. Companies which pay bloggers to post on particular topics need further analysis.

This presentation was followed by a bloggers panel. Organised by Bertelan Mesko who introduced speakers giving short presentations - the first was Jennifer McCabe looking at business blogging via a Ning group ho discussed Web2.0 tools for medical students. She highlighted cross-pollination as a way of patient (consumer) centered care & innovation in healthcare practice & management. She gave a range of recommendation for anyone wanting to be a healthcare blogger. Peter Murray went next talking about collaborative blogging for health informatics based on the work of the team. He blamed me for starting it all back in 1996 and gave an overview of the developments we have undertaken since. He summarised the lessons learnt and ideas for the future. Keith Kaplan was the next participant talking on digital pathology and the lessons and reflections from writing his own blog and academic blogging in general in particular within a centre such as the Mayo clinic. The next speaker was Sam Solaman a reporter and saleried bogger. He told the story, which he wrote up for the Canadin Medicine journal, of a doctor Robert Lindeman who was sued and wrote uncomplimentary comments on a blog under the name flea and draw lessons related to the risks of anonymous blogging. See the Personal Injury Law Blog and the Boston Globe for more details of the story. The final speaker of the panel was Bertelan Mesko a medical student who described his use the web for his studies. He is now running learning experiences with community sites and blog carnivals. He is now running which provides cross searching facilities, and a range of other online tools. He closed with a plug for

A list of all the others twittering or live blogging from the conference is at

After a quick lunch (because the morning sessions overran) I attended the education theme. The first presentation was by Leanne Bowler who has a background in information design and is now looking at health sites for teenagers. Not surprisingly they use the web for health information, but their skills in finding & evaluating the information is poor. She defined portals and digital libraries and was looking for what exists & what are they like. She conducted an environmental scan and tied to measure usability, findability etc. She presented various issues with many of the sites which were included. Good question and answer session which highlighted several issues about web site design and information seeking behaviours.

The next presentation was by Margaret Hansen about Versatile, Creative and Dynamic Virtual 3-D Healthcare Learning Environments. She defined Web2.0 & Web 3.0 and looked at their potential within education for healthcare professionals. She explained many of the issues identified in her recent paper in JMIR. She showed screen shots of Second Life and other virtual worlds to illustrate pedagogical potential, based on connectivism, for role play to reduce anxiety, enhanced competency and collaboration. ALIVE was advocated as providing an easy to use environment for elearning. Technical issues limited the access to a YouTube video of the sexual health simulation from second life from Maged in Plymouth. Margaret then outlined some theoretical frameworks from Rogers Diffusion of Innovations, Siemens Connectivism. She highlighted some of the challenges and concluded that we will be seeing the growth of 3-D in educational contexts.

The final session of the day for me was entitled Web 2.0-based medical education and learning, chaired by Chris Paton. The first speaker was Panos Bamidis from Greece speaking about the use of Web 2.0 technologies in Medical Informatics education focusing on sharing learning objects. He described how ICT supported the whole educational process from planing, delivery and evaluation. He talked about international standards SCORM etc and then how discussion forums, wikis and personal blogs, within a closed Moodle VLE, are being used to support the learning. He presented the results of an evaluation which showed positive attitudes from students who had experienced the technologies, and plans for the future.

The second presentation was by Deidre Bonnycastle from the University of Saskatchewan talking about Medicine 2.0 and Medical Faculty Development. She had found the technology had barrier and the cost of professional production was prohibitive. A second approach was to use a post workshop wiki and set up a medical education blog. A development was to create a committee wiki, and research group wikis and student wikis. She then developed a Distributed medical education site and her latest development is a Medical Education Wiki. They include RSS feeds from blogs. Another area is the use of Elluminate real time lectures with audio, interactive whiteboards etc. A question arose around the time required to keep up with social networking sites, and human filtering via fiendfeed type technologies.

This was followed by Bertalan Mesko (Berty) talking about medical education and building a reputation in a Web 2.0 environment. Inspiration and motivation were received from online environments, particularly second life, such as the Anne Myers Medical Centre for virtual case presentations, genomics exercises and other areas. He also talked about a range of other online environments, including the recently launched Medical Education Evolution on Ning. He then talked about the benefits and risks of an online reputation. He showed examples of good practice of onlie doctors, blogs community sites etc. He suggested everyone google their name to see what patients or clients will see. He concluded that we must be ready to be open and ready to build an online reputation.

The final presentation was mine.

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Tuesday, September 02, 2008

Toronto for the Medicine 2.0 conference

I've now arrived in Toronto for the Medicine 2.0 conference. The flight was long & as work had booked me a cheap flight it came into Hamilton International rather than the local Pearson Airport, which meant bus rides - which was OK, but the fact that it was a bank holiday in Canada meant that some trains etc were not running.

First impressions from the air were of a massive country with lots of lakes and very straight roads - but green and pleasant, as they have had lots of rain this summer. The people seem very relaxed and friendly - thanks to 2 ladies I met on the transfer bus who gave me an introduction to places to see and go.

Today I'm seem to be recovering from the jet lag - we shall see if I sleep this evening - and have had a wander around the city, including the harbourside, Distillery historic district, and St Lawrence Market.I've also booked myself a trip to Niagra Falls tomorrow before the conference gets going.

I'm not quite sure what to expect from the conference - the very nature of the innovative technologies may have attracted a different crowd from the usual academic conference and the papers listed in the proceedings look interesting. I'm hoping that there will be a real buzz around the potential applications and lots of new ideas and contacts being generated - we shall see.

I will be posting my impressions here and others, including Peter Murray will be posting at If there is an official conference blog I will link to this later. There has been a dedicated social networking site using crowdvine, for conference participants, but I think anyone is welcome to contribute.

On a final note I've written this entry & done the links etc using Google's Beta release of its browser Chrome - which all seems to be working well so far. I'm also playing with a new camera on this trip.

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