Tuesday, September 14, 2010

Medinfo Day 2

I was a bit late this morning following a good conversation at breakfast about the health services in South Africa and then a search for new batteries for my camera (the first thing I've found here which seemed expensive), managed to attend one of the two semi-plenaries running first thing. The subject is ehealth for the developing world, particularly Africa. Various speakers gave insights into the challenges faced and some current and potential improvements (simple, cheap, solar powered & mobile devices + standards etc) with examples from Rwanda, Mozambique, Kenya, Malawi, Tanzania, South Africa etc. Particular challenges around HIV, malaria provide threats which need to be met by local ownership and development, rather than solutions from developed countries/donors.

The second session I attended had an education and training flavour. Niki Shaw from British Columbia presented a study about the effects of the EMR on primary care consultations in a large number of practices in British Columbia, Canada. She set the context and some of the difficulties involved in undertaking the work and then described how many clinicians said using the computer would interfere with patient interaction, however her team found that, in common with the paper record, most GPs didn't actually do charting until after the patient had left the room. She then talked about the lack of any health informatics education in medical courses, and suggested ways in which this could be achieved, along with recommendations for further research into the effect of real time charting on the patient interaction. The second speaker was Thomas Houston from the USA who described work using content specific email reminders to dentists to get them to encourage their patients to use a smoking cessation online resource. There finding showed the first part of the week was the best to get a response to emails and the importance of making the headlines (message subject lines) relevant to the target audience. The final speaker I saw was Bernhard Briel from Munster University who described the development of a shared module for medical and information science students who worked together developing case examples related to health informatics. He emphasised the importance and benefits to be obtained from cross disciplinary learning.

After lunch I attended a session within the theme on Social Networking and Virtual Reality. The chair, Walter Slack, introduced the session by considering virtual reality – going back to cave paintings as ways to enhance social networking. He suggested that if used well it has the capability to enhance nursing and healthcare. The first paper was by Annie Lau presenting the influence of crowds on consumer health decisions. She started with an adaptation of an experiment, with planted volunteers giving a wrong answer & then seeing if the rest of the room followed (they didn’t) as an introduction to their online prospective study to test the strength of social relationships on behaviour. An overview of some of the existing theories relating to social attachment etc was given to put more recent online work into the context of existing studies in face to face settings, including conversion theory and subjective consensus. The measures developed were opinion volume and opinion density. The study used 227 undergraduates to measure their health knowledge, then search for more information and then see what others had said and measured their responses at each point. Those who were not confident of their answer after their search were likely to change their answers after seeing the responses of others – this effect was strongest if more than 15 other people had answered the question differently to them. The more people who gave a different answer the more likely each individual was to change it. The presentation of the statistics was not particularly helpful but the discussion and presentation was one of the best I have seen at the conference so far. There was some discussion in the room, around the significance of the findings on health behaviours, but no one knew of any studies which had examined whether the number of friends on Facebook etc was a significant factor on the value which was placed on their opinion.

The next speaker was Elizabeth (Betsy) Weiner from Vanderbilt University who spoke about the use of the Virtual Reality World of Second life to Teach Nursing Faculty Simulation Management. She described her history in simulation development since interactive video disks. She described her institutions grant and overview of Second Life. Faculty staff needed development in simulation management and second life navigation and interaction. NURSIM4U Island includes a conference centre and 12 simulations (in one of several settings) meeting the “Hartford Geriatric Competencies”. They have an outpatient department, a critical care tower, a nursing home, with observation rooms behind a one way mirror to stop rooms getting crowded. Each iof the 12 cases has an electronic health records derived from anonymised real records. Tools for evaluation are from the NLN Laererdal Study. She discussed the scripting of simulations.

The third speaker was Trish Trangenstein talking about an analysis of Nursing Education’s immersion into second life. She argued for advantages of the MUVE in immersion and activity. Used searches in SL, Google, pubmed etc to find nursing education activities. Few nurse education simulations were found. A template was proposed to enable sharing & collaboration. A question about empirical research didn’t get much response apart from evaluation tools. The use of SL for patient therapeutic experiences was also discussed.

The final session I attended before escaping to get back to the hotel to change for the Gala Dinner was entitled Advances in Medical Informatics and looked at several cutting edge advances. The paper I was particularly interested in was by Gunter Eysenbach describing his 10 years experie4nce with pioneering open access publishing in health informatics: The Journal of Medical Internet Research. He started out by highlighting knowledge transfer problems as a major barrier to healthcare development and found it ironic that health informaticians who deal with knowledge management... yet we are not generally not good at doing a good job in knowledge translation. He touched on different definitions of open access and compared it with self archiving in institutional repositories. He described 7 publishing innovations, including article level metrics, an Open Source manuscript management system from the XML version of the paper, WebCite and an innovative business model. Another new experiment is open peer review and he is working on a new development where papers are put in a moderated collection which others can then comment on before formal publication which will be called the interactive Journal of Medical Research - iJMR on Knol.



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