- provides a space devoted to the conceptual framework known as Hodges' model. Read about this tool that can help integrate HEALTH, SOCIAL CARE, INFORMATICS and EDUCATION. The model can facilitate PERSON-CENTREDNESS, CURRICULUM DEVELOPMENT, HOLISTIC CARE and REFLECTION. Follow the development of a new website using Drupal (it might happen one day!!). See our bibliography, posts since 2006 and if interested please get in touch [@h2cm OR h2cmng AT yahoo.co.uk]. Welcome.

Monday, October 31, 2011

What's the difference between 6 and 7? About 11 years ...

Gradually over the past few months I've checked the care domain links. Deleting those where the domain is now "For Sale", broken, or the content is plain out of date. The final domain was the SCIENCES. It's the largest still and while the links are monsters, it is interesting working through them occasionally.

One change caught my eye last month in the 'Environment, Sustainability, Ecology & EcoSystem Health' listing. I clicked on Six Billion and Beyond and duly found that it has been retired from pbs.org. A few weeks ago I'd shared with students and have included on the CARDI conference poster the fact that today it is believed that the Earth's human population reaches 7 billion.

Looking back Six Billion and Beyond aired in 1999. So in 11-12 years there are an extra billion souls. You have to ask:

  • What will we all drink and eat?
  • Will we all have a (dry) home?
  • Will we all read? (Have access to information and info technology)
  • What will this latest generation believe in?
  • Whose beliefs will they be?
  • Can the 7 Billionth human being of Earth be a true citizen?
  • Before that - for how long will they be allowed to be a child?
  • Will they pray? Who to and why - choice?
  • Will they have to fight (in a uniform)?
  • What will their sense of quality of life be?
  •  Will that 7 Billionth person and their family have access to:
    • health information?
    • basic health care?
    • education?
  • What space is there for their human rights?
  • Can technology finally deliver Socially?
Checking the links this time around proved quite a lesson in global demographics - how long till the next...?

Additional links:

National Geographic Special Series: 7 Billion

The world is home to 7 billion people but how far has it come?
The population milestone is a reminder that there is much work to do on sexual and reproductive health and HIV if we are to meet the millennium development goals by 2015, The Guardian, Monday 31 October.

Stumble Upon Toolbar

Sunday, October 30, 2011

Public health: Whole society, whole government - whole medicine

The Health Service Journal isn't cheap so here every issue as a subscriber is a valuable resource.

In a September issue (1st) there were some really good opinion pieces and articles. One by Graham Burgess (p.17) concerned the coherence of public health. He started with the struggle that has been public health in England for the past 50 years; it has failed to define the problem to be solved.

Things may be set to change with the shift to local government that helps define public health on a social level, not just as a medical preoccupation - a distraction in fact from the disease health service perspective.

The word holistic that we all band-about was brought into stark relief by Mr Burgess as he nailed some w-holistic ecologies in referring to the 'whole of society' and 'whole of government' approaches necessary to build on the finding by the National Audit Office that only 15-20% of the inequalities in mortality rates can be directly influenced by health sector interventions.

There is a need to look further field than the supposed macrocosm that is the NHS: physical health - mental health.

Mental health is a whole world so frequently set apart from 'medicine'. Mental health contains a range of services that all shout: 'I am Cinderella!' So, Mr Burgess both frames the public health line up; and as I see it highlights the holistic scope of what are crucial and still emerging concerns. Still emerging ...? Well in the sense of having new - local authority - legs and thus endowed - how much further can public health run - and what tools are needed?

NAO Department of Health:
Tackling inequalities in life expectancy in areas with the worst health and deprivation

Stumble Upon Toolbar

Saturday, October 29, 2011

Abstract translation (100 words): Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model

I need to produce translations of an abstract into French, Spanish and Russian with a 100 word limit. At present I'm relying on Google translate; any suggestions to improve what follows (the English too!) greatly appreciated. 'Glocal' should prove a bit of a test. (h2cmng at yahoo.co.uk):

Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model

Abstract
This paper introduces Hodges’s model a conceptual framework as a means to explore the  concept glocal and the more familiar terms local and global. Actual and speculative definitions of glocal are offered. Discussion will also deliberate on the compound meanings of these terms. The model's four knowledge (care) domains facilitate discussion of the physical, social, political and individual dimensions of local, global and glocal. The paper draws upon health, anthropology, history, science, informatics and geopolitics – especially the themes of globalization, literacy,  information technology and communication (voice). The purpose is exploratory with additional resort to philosophical reflection.

Explorar varias dimensiones de locales, globales y glocales utilizando el modelo conceptual genérico Hodges marco de

abstracto
Este trabajo presenta un nuevo modelo Hodges es un marco conceptual como un medio para explorar el concepto glocal y los términos más familiares locales y globales. Definiciones reales y especulativos de glocal se ofrecen. El debate también se tratará sobre el significado de estos términos compuestos. El modelo de cuatro conocimiento (atención) dominios de facilitar la discusión de las dimensiones físicas, sociales, políticos e individuales de los locales, globales y glocales. El documento se basa en la salud, la antropología, la historia, la ciencia, la informática y la geopolítica - especialmente los temas de la globalización, la alfabetización de tecnología de la información y la comunicación (voz). El objetivo es exploratorio con recurso adicional para la reflexión filosófica.


Exploration des dimensions de plusieurs locaux, mondiaux et glocal utilisant le modèle générique de cadre conceptuel Hodges

Résumé
Cet article présente le modèle Hodges un cadre conceptuel comme un moyen d'explorer le concept et le glocal termes plus familiers local et mondial. Définitions réelles et spéculative de glocal sont offerts. La discussion portera également délibérer sur les significations composé de ces termes. Les quatre modèle de connaissances (soins) domaines de faciliter la discussion de la physique, les dimensions sociales, politiques et individuels des locaux, mondiaux et glocal. Le document s'appuie sur la santé, anthropologie, histoire, sciences, informatique et de la géopolitique - notamment les thèmes de la mondialisation, de l'alphabétisation technologies de l'information et de communication (voix). Le but est exploratoires avec station supplémentaire à la réflexion philosophique.


Изучение нескольких размеров локальных, глобальных и глокальные использованием модели общих концептуальных рамках Ходжеса

абстрактный
В данной статье рассматривается модель Ходжеса концептуальную основу в качестве средства для изучения концепции и глокальные Наиболее известные термины локальные и глобальные. Фактические и спекулятивных определений глокальные предлагаются. Обсуждения будут также обсуждать соединения смысл этих терминов. Четыре модели знаний (ухода) области содействия обсуждению физических, социальных, политических и индивидуальных размеров локальных, глобальных и глокальные.Статья основана на здоровье, антропологии, истории, науки, информатики и геополитика - особенно темы глобализации, распространения грамотности, информационных и коммуникационных технологий (голос).Цель поисковой дополнительные прибегать к философской рефлексии.

 

Stumble Upon Toolbar

Friday, October 28, 2011

CARDI conference ageing globally - ageing locally: Poster

The last poster I completed in June for the Health Literacy conference in Manchester was made up of four A4 pages. It was OK, but suffered next to the University produced presentations - maybe it was an imposter. So, I determined that the next would be a more professional A1 - A0 effort.

Thanks to George Kernohan - Prof. of Health Research in the Institute of Nursing Research at University of Ulster - next week's CARDI conference in Dublin will see this realised.

Nine A3 pages were produced in total (too many for insurance). The final 'composition' was not straight forward. George suggested Powerpoint and that clinched it after much aggravation. This will be easier next time! With a week to spare I forwarded the draft to George. As before I've tried to strike a balance between graphics and text. There are three diagrams of the model in total that hopefully capture some of the main conference themes:

Title, author details & acknowledgement
Introduction to Hodges' model with basic model graphic axes and domains
h2cm matrix including the 4P's and Global & Local aspects of ageing
h2cm matrix Glocal and notes, the future and bibliography

The overlap here is quite something: I believe that the 4,400 words on local, global and glocal now has some coherence and merit. The context for that 4K is community informatics. The poster has drawn on that draft and in turn a further paper on this theme but specifically addressing older adults, health care, nursing ... will take things further.

The conference is much more than the posters of course. There are some excellent sessions and speakers too. Apparently the poster has arrived across the Irish Sea and looks OK. The boarding passes are printed - Dublin next stop. I'll also find out what Guinness really tastes like and catch up with James Joyce on Friday.

Stumble Upon Toolbar

Thursday, October 27, 2011

National photography competition KT-EQUAL & Age UK: 'Left to Our Own Devices'

Dear KT EQUAL Supporters,

A national photography competition launched by KT-EQUAL sets out to challenge our preconceptions about how older people interact with technology now and in the future. Entitled 'Left to Our Own Devices', the contest is run in partnership with Age UK.

Entries will be judged not only on their photographic merit but also on how they address issues related to the central theme of older people's interactions with technology -- perhaps by challenging stereotypes, defying expectations or delivering a powerful message.

The most successful images will be selected from across four categories:

• Gadgets and Gizmos
• In the Home
• Out and About
• Open category

All the selected images will be included in a touring exhibition that will visit the Parliament at Westminster and the Assemblies at Cardiff and Stormont, and finishing at the Scottish Parliament next spring.

One image in each category will also receive a cash prize of £250.

The judging panel will consist of:

• Christina McBride, Lecturer in Photography at Glasgow School of Art
• Professor Trevor Cox, a member of the KT-EQUAL consortium
• Phil Rossall, Research Manager (Knowledge Management) at Age UK

Professor Gail Mountain, Director of the KT-EQUAL consortium, said:

"For older people, as for all of us, technology can be exciting and empowering -- but it can also seem baffling or even threatening at times. So we’re challenging British photographers to come up with images that capture different aspects of the complex relationship between people and the devices they create."

Phil Rossall of Age UK said:

"Technology for older people can take many forms. It’s not just computers and smartphones, it’s anything which can make later life more comfortable, more rewarding or less arduous.
"At Age UK, we’re interested in new technology less for its technical merits than for its tangible benefits for quality of life – something we hope this competition will help to promote."

The contest is free to enter at http://lefttoourowndevices.org.uk, where users can also browse other entries and take part in online discussions on the thoughts they provoke.

The closing date for entries is 31 January 2012. Entries are welcome from both amateur and professional photographers. Judging criteria and other rules of entry are listed at http://lefttoourowndevices.org.uk.

Entrants retain copyright over the images they submit, subject to acceptance of standard terms and conditions for entry.

Regards,

Heather Williams
Project Officer (KT-EQUAL)
Department for Health / Research Development & Collaborations
University of Bath
Bath
BA2 7AY
Email: H.Williams at bath.ac.uk
www.bath.ac.uk
www.equal.ac.uk

Stumble Upon Toolbar

Monday, October 24, 2011

h2cm, Bortz's Next Medicine and self-efficacy

Here on W2tQ I've written about the primacy of the individual within the health care domains model. The person, the unique human being is at the center of the nurses' focus and values.

I had a gut instinct with Bortz's book Next Medicine which I am now half-way through. This book is a real gift to me searching for evidence that supports the model's original creation and its purposes. As the book's title attests I'm also seeking evidence that highlights the model's potential today. On page 92-93 Bortz writes:
Self-efficacy. It sounds like an erudite, vacuous, scholarly term of little relevance. But just a moment's reflection leads to the recognition that self-efficacy is the centerpiece, the keystone on which all other body and mind functions depend. Self-efficacy: self-sufficiency, intactness, wholeness, autonomy, independence. These concepts embody the essence of what it means to be fully alive, fully functional.  ...  Self-efficacy, he [Albert Bandura] says, is health. Health is self-efficacy. Rather than being a remote scholarly label, it comes close to being the central axis for health and Next Medicine.
(My emphasis.)
Bortz also highlights Bandura's notion of self-efficacy and self-efficacy prescriptions.

Stumble Upon Toolbar

Saturday, October 22, 2011

Information Prescriptions: Just don't say "job done" or "next!"

The information prescription (IP) is not new. It is what should be a routine intervention that benefits from such initiatives as the specific IP project in 2007, which also produced a final report in 2008.

If people today are expected to self-care, there are recognized problems when they self-information prescribe (or is that paternalism at work?). The provenance of information on the web is a key concern.

In the 1980s and 90s the prescriptions and the management of benzodiazepines in community mental health gradually emerged as a problem. Today (for our children and their children) there's an acute problem with the frequency of antibiotic prescribing. Listen to the informative and sobering BBC Radio 4 programme:


As people are directed to validated and creditable information resources we need to consider the bigger picture that a prescription ('plan') of any sort represents.

A response in the form of a drug/treatment or information prescription does (of course) not mean "job done".

Some follow up may be needed (duh!) as to what has been done with said information. When we speak to people we quickly make global assumptions about their understanding, literacy, motivation and the constraints within which they can operate when outside the clinical encounter. General Practitioners usually have the benefit, and in this context - a great benefit, of having known the patient and the family for many years. Other practitioners may not have that informational reservoir upon which to draw. General practice may itself see changes - pressures on the established patient - family doctor relationship.

The quote below is from the information prescription website:
Information prescriptions contain a series of links or signposts to guide people to sources of information about their health and care – for example information about conditions and treatments, care services, benefits advice and support groups.

Information prescriptions let people know where to get advice, where to get support and where to network with others with a similar condition. They include addresses, telephone numbers and website addresses that people may find helpful, and show where they can go to find out more. They help people to access information when they need it and in the ways that they prefer.
Working in nursing homes I know how demanding and challenging information exchange can be. While the above quote lists suggested content, I've had to signpost in person, once, twice, three times before the time was right for a carer to approach a specific agency for a resource.

Whatever your lingo, personalised information prescriptions are really cool - and hot. We need them.

After all isn't a prescription for drugs just another form of information prescription, molecular, biochemical? One that is also destined to become more personalised and yet on a different informational (genetic) level. More than anything else though we need a public, citizenry who can understand the value, potency of the infoscript in their hand. Is there an antidote for advertising?


 Although the informational exchanges in nursing homes and elsewhere are challenging: we keep trying. To do that the prescriptions should not be used as a means to say "Next!".

Crossroads have historically been meeting places. A space of choices (information) and signposts, make the right choice don't hurry.

Quality outcomes take time, but then I would say that ...

Stumble Upon Toolbar

Saturday, October 15, 2011

The International Health Protection Initiative (IHPI) - Resolution Sign-up



The International Health Protection Initiative believes that health care MUST be protected during armed conflict.

The International Health Protection Initiative (IHPI) is a collective movement of individuals, organisations, institutions and charities (including non-Governmental Organisations-NGOs) who have agreed to help to lobby the United Nations to act to uphold the Geneva Conventions, especially as regards safe-guarding health facilities/equipment/transport, and workers.  The Resolution was agreed following a meeting of the International Child Health Group held in November 2010.
 
Your support is urgently needed for an international resolution to protect healthcare during armed conflict

The resolution will ultimately be submitted to the United Nations (General Assembly, Security Council, and World Health Organization).

In order to achieve the objectives outlined in the resolution, we need the majority of the world’s healthcare organisations, institutions, NGOs and civil society, especially those in conflict afflicted countries to sign up to this important resolution.

We know that you are aware of the urgent need to protect healthcare during armed conflict, that is, to uphold the Geneva Conventions and we would be most grateful for your support.

Once you have read the resolution we respectfully urge you to sign up to it online, as an individual, or preferably, on behalf of your government, institution, or medical organisation. We also encourage you to state your reasons for supporting this resolution in the appropriate box.

So please Sign up now!

Many thanks for your time and attention and we look forward to working with you to help make this life-saving resolution a reality

The IHPI Team
info@ihpi.org

"War... is when some adults who don't know what good is and what love is, are throwing dangerous war toys which injure innocent people" 
Tamara aged 10 years during the war in Bosnia and Herzegovena.

My source: Prof. David Southall via HIFA2015

My thoughts upon signing up:
This resolution saddens me: that we should need it in the 21st century after millennia of human conflict.

The resolution is an essential course of action that I will help to publicize. Resources by way of legal enforcement, financial and personnel as declared in the resolution to protect basic human rights and health care provision must be assured and enforced globally. As per #5 the trend of pursuing those who commit crimes against humanity should be escalated as the means to record and furnish evidence also increases. This is imperative as a deterrent to those who supposedly 'lead' and those who invariably follow. In this sense 'education for all' is also crucial to help prevent indoctrination - with the additional health dividend that education affords.

Stumble Upon Toolbar

Friday, October 14, 2011

ERCIM News No. 87: Special theme "Ambient Assisted Living"

Dear ERCIM News Reader,

ERCIM News No. 87 has just been published at http://ercim-news.ercim.eu/

Special Theme: "Ambient Assisted Living"

Guest editors: Michael Pieper (Fraunhofer FIT, Germany), Margherita Antona (ICS-FORTH), Greece) and Ulyses Cortes (UPC, Spain)
http://ercim-news.ercim.eu/en87/special

Keynote by Constantine Stephanidis, Director, ICS-FORTH
http://ercim-news.ercim.eu/en87/keynote/

This issue also features a section on FET Flagships, introduced by Mario Campolargo, European Commission Director, Directorate F: Emerging Technologies and Infrastructures, Information Society and Media Directorate General.

The six FET Flagship Pilots - "Graphene", "Guardian Angels for a Smarter Life", "FuturICT", "IT Future of Medicine", "The Human Brain Project" and "Robot Companions for Citizens" present their vision and what they would like to achieve in the next ten years.
http://ercim-news.ercim.eu/en87/es

Next issue: January 2012 - Special Theme: "Evolving Software"
(see call at http://ercim-news.ercim.eu/call)

Thank you for your interest in ERCIM News.
Feel free to forward this message to others who might be interested.

Best regards,
Peter Kunz
ERCIM News central editor

Stumble Upon Toolbar

Wednesday, October 12, 2011

Report - Guiding patients through complexity: Modern medical generalism RCGP & The Health Foundation

Evaluation report

PUBLISHED: October 2011   Download

Report of an independent commission for the Royal College of General Practitioners and the Health Foundation

An independent commission, chaired by Baroness Finlay, has concluded that more of the most talented doctors must be encouraged to make careers as generalists rather than specialists to meet people’s changing health needs.

The Commission was set up by the Royal College of General Practitioners and the Health Foundation to examine the state of general medicine. It had the following terms of reference:

  • Define medical generalism, with particular reference to general practice;
  • Explore the intrinsic values of medical generalism;
  • Define the role and value of medical generalism in contemporary clinical practice.
  • Formulate a description of the medical generalist that:
    • Is widely recognised
    • Defines what patients and the public should be able to expect
    • Clarifies how the medical generalist interfaces with other health care professionals
  • Make recommendations about the future development of medical generalism.
Understanding and developing the role of the generalist alongside specialists is important for the quality of patient care, particularly ensuring the health service provides patient centred care and supports people with co-morbidities well.

Read more ...

Stumble Upon Toolbar

Monday, October 10, 2011

WHO Mental Health Atlas 2011

Forwarded to the GANM from Ana Lucia Ruggiero at PAHO


Available online PDF [82.p] at: http://bit.ly/rocbFH

10 October 2011 – “…..New figures from the WHO Mental Health Atlas 2011 indicate that while the need for mental health care is large, with up to 25% of the population requiring it at some point in their lives, there is underinvestment in the sector.

The Atlas shows average global spending on mental health is still less than US$ 3 per capita per year and as little as US$ 0.25 per person per year in low-income countries.

It presents data from 184 WHO Member States, covering 98% of the world’s population. Facts and figures presented in Atlas indicate that resources for mental health remain inadequate.

The distribution of resources across regions and income groups is substantially uneven and in many countries resources are extremely scarce. Results from Atlas reinforce the urgent need to scale up resources and care for mental health within countries….”

Brochure: http://bit.ly/qvV9jN

My source: GANM (Global Alliance for Nursing and Midwifery)

Stumble Upon Toolbar

Sunday, October 09, 2011

Note to Steve ... Godspeed

I never met you Steve, I wish I had and the other people still working in the circles, squares, triangles and all those chaotic - contrail - lines you moved in - and still move in - now from a step afar.

Thanks for the Macbook I use every day. Since 2008 it's been a real pleasure.


A seminal movie moment for me is that scene - the match-cut - in 2001.

You know, the one with the app - ape - early hominid - learns to kill and throws a bone to the sky and it is transformed into a spacecraft.



http://www.imaginefx.com/02287754333349729529/retro-spacecraft.html
Tell me Steve: if I throw an iPhone 4S skyward, or one yet to appear - an i7 maybe - could you and your new friends change it into a starship?

Not just for me: for everyone.


Where have you been already? I'd be off to M31 looking back every so often. What a trip that must be. Perhaps you've already seen that double Milky Way yet to appear in the night sky?

I encountered Apple at the Which Computer Show so many decades ago and in Byte, a 3D star map program for the Mac. Not being able to afford a PC never mind a Mac someone let me run the program at the Show. I still have that disc somewhere (I hope). It was a marvel that little program. Now, of course there are astro apps galore.

I really know nothing of you Steve, and yet your work, ethos, drive, and contribution is plain to see. I have not pre-ordered your biography [but if family and friends are reading this... ]. Your passing has made me reflect though.

Your commencement address to the students at Stanford on the news media made me realize I am doing what I love to do: both full-time and part-time. How to reconcile the two!

Thinking about your passing (this way) you've definitely tapped my shoulder as you've passed by.

You prompted me not to think about how much things have changed in my field - community mental health nursing and information tech since I started working; but to wonder, to project myself into the future (as we always should - as you did with the knowledge...) and ask: How much will things have changed from now. What is questionable, wrong, archaic about our current attitudes and practices?

More than anything Steve - Mr Jobs - thanks for that. You will be greatly missed.

Stumble Upon Toolbar

Friday, October 07, 2011

31st Annual International Nursing & Midwifery Research & Education Conference - Fringe Event: ‘Exploring Ideas Through Dialogue’

Faculty of Nursing and Midwifery
Royal College of Surgeons in Ireland
31st Annual International Nursing & Midwifery Research & Education Conference
2012 conference theme - "Nursing and Midwifery Practice in a Global Community:
Collaborating and Networking for the Future"
22nd & 23rd February 2012


31st Annual International Nursing & Midwifery Research Conference
 
Fringe Event: ‘Exploring Ideas Through Dialogue’

Running in parallel to our conference concurrent sessions, the fringe event will provide a forum to explore evolving or experimental ideas that are relevant to a philosophical understanding of nursing practice and research methodology.

There will be an emphasis on dialogue between presenters and their audience.

Call For Abstracts
Abstracts of up to 800 words are invited for this event and submitted with author details using the presenter profile section of the submission forms available from www.rcsi.ie/nursingconference

Closing date for Fringe Abstracts: 18th of November 2011
E-mail: nursingconf AT rcsi.ie

Stumble Upon Toolbar

Thursday, October 06, 2011

Jarvis's book 'public parts' [ii]: The sanctity of clinical data, INFORMATION, knowledge ....

This post extends the axes displayed in the previous post (i) and continues the discussion. These posts are prompted by the appearance of Jeff Jarvis's book - not a reading of it. I suppose they are an ante-review?

As before in the figure I have placed information (and the person) at the center. From (i) - transparency may be a public good in politics, local government and public life, but does the same apply for an individual person? It could be that Jarvis identifies the benefits that can be accrued from being transparent about my medical conditions.

Notable individuals, frequently those already in the public eye, have done so with an activist intent. A key example is Terry Pratchet with his disclosure and account of living with Alzheimer's disease. Mr Pratchet has been able to raise the public profile of dementia, quality of life in senior years, and also euthanasia and individual choice. If publicness effects debate in this way then that is clearly desirable. As we have seen with the internet however, there is a market for our data whether personal or merely our internet browsing habits. Where do we go? What are we searching for - a new digital camera, old book, a new HD TV?

Pre-internet a problem for people with condition 'X' or 'Y' was knowing: what to expect? (Even now due to their health and information literacy, a great number of people will still be stuck, excluded and disadvantaged.) What are good strategies to adopt? How have other people coped with this? What happens next? What are the odds? Are there other people living with this? The only opportunities to engage with other people who have something similar may be when sat in the out-patient department. An opportunity a further remove may be the medical diagnostic appointment for various forms of imaging and tests.

These days of course the whole pathway is person-centered and information focused (isn't it?). There are online communities for people living, coping and dealing with the full gamut of clinical disorders, recognized and even some as yet without a place in the medical lexicon.

Part of the debate here for me is that online communities, forums often have rules, they have spam detection and should be 'secure'. Plus of course users are usually encouraged not to use their real name, and be discreet as well as all the other points of etiquette that apply. If Facebook or LinkedIn was to include a new revision that caterred for my 'public' health record then I still wonder if this is publicness of another order. If you assume public office then it is beholden on you to be transparent. It isn't that I believe that transparency on an individual level does not apply. My job has me taking an opaque person and trying to make things transparent.

Perhaps this is the art in health care: 
learning to read that which is opaque such that it is rendered transparent?

For all that though I can't help but equate transparency with politics, companies, NGOs and the like.

There's another thing with the very public health record 4-U; will clinical terminology be affected? This may be a good thing. There are a lot of people, groups who want to shake up the medical establishment, the drug companies and modern practices. Here on W2tQ I wonder about the terms that will be needed in and around Hodges' model. Should a new website use an existing nursing classification, a folksonomy or a combination?

Medical progress has been hard won, many communities around the globe have yet to have access to basic health care, doctors, midwives and nurses. While the developed nations continue to talk about person-centered care, there remain places where ongoing community-centered care would be welcome.

Working in mental health for three decades you know of psychiatry in dissent and the debates ongoing around stigma, access to services, diagnosis and the use and abuses of medication. I am an idealist in health and informatics, both as distinct enterprises and in that yet to be fully realised combined formulation.

I worry about the trends in personal information disclosure, the rise of self-diagnosis online, and the growth of counterfeit drugs sold on the web. Effective and informed self-diagnosis can save health services time and money, but success, safety, and savings are not a given. So much depends on literacy.

I do hope at some point to read public parts - it is very timely. We have to ask however, just how far does the market want to reach? Where or what exactly are the envelopes involved? Do we really want to take advertiser's values as one edge of the envelope? If the genie is easy to get back into the bottle then no problem ...

But where do you go to my lovely
When you're alone in your bed
Tell me the thoughts that surround you
I want to look inside your head

Stumble Upon Toolbar

Saturday, October 01, 2011

Jarvis's book 'public parts' [i]: The sanctity of clinical data, INFORMATION, knowledge ....

In New Scientist last week another book, a brief review caught my eye. This one concerns a topic of great sociological, clinical and political interest to me. To be clear this is not a review; consider it raised eyebrows at the book's arrival and some speculations. Here is the intro from New Scientist's website:


WHEN writer Jeff Jarvis decided to tell the world about his prostate cancer he didn't spare the gory details: he happily blogged about his "malfunctioning penis" after surgery, and the adult diaper he had to wear.

Too much information, some may say. Not for Jarvis. He is an outspoken advocate for living one's digital life in the open and his latest book, Public Parts, is one of the first to analyse the shift towards more transparency thanks to Facebook, Twitter and the other big names of this new digital age.
(Niall Firth, CultureLab, New Scientist)

For quite a while I've been wondering about the informational form of 'climate' change. The existence of the NHS's HealthSpace, Google Health, and Microsoft HealthVault had me watching for erosion of the public's attitudes towards clinical confidentiality. Jarvis refers to this as publicness. Like a coast line this particular form of erosion occurs on many levels, given the vagaries of starting conditions (the patient-doctor relationship, the medical establishment), geography, tides, weather and local policies. Would the temperatures change within health care itself - professional values, disciplinary outcomes, The Royal Colleges?

Even if HealthSpace et al. are provided on the basis of being secure, encrypted, meeting the local requirements of data protection and information governance...; is this tantamount to making confidentiality soluble AND throwing it into the water? How big a step is it to the public's posting their personal health information in public online arenas: open and closed? Suddenly the patient becomes the data entry administrator, if that information can be shared and accessed by the health establishment. From a business model and policy perspective this also saves money in an Ikea flat-pack-transport-and-assemble-it-yourself kind of way.

Jarvis's book is evidence, that demonstrates the ability of social media like Facebook, LinkedIn and Twitter to alter attitudes towards disclosure of personal data. Medical details are usually restricted to the medical consulting room and centrally held clinical record. Google Health is closing down though; it has failed to have the broad impact they hoped for (see Google's blogpost). I wonder if this is reflected upon in the text? With the NHS behind HealthSpace perhaps these three 'solutions' are far from equivalent examples?

If we take information as the concept around which this debate revolves with an individual, a person also at the center ('data subject') then several dimensions can be found. Usually, I am increasingly transparent to a greater degree from my work colleagues, friends, family to my partner. This is one of the many ways that relationships are defined and differentiated. Certain things are opaque to the public and commercial world at large, because they are considered private. Clinically, such a class of information is vested in a professional relationship. This does not mean I have signed a contract to only divulge my medical history to my doctor. Even there - a need to know assumption usually pertains.

As Firth notes it is good that Jarvis is stimulating a debate about what is privacy. How has the concept changed, since the 1950s, 1980s in the media (old and new) and in health care?

Apparently Jarvis makes an analogy with Gutenberg's original printing press and its social and political effects. There may be other subtle aspects though that any such revolution must either work around or overthrow. In the first instance though I consider - without reading the book I have to add - some of the main points which are illustrated below.

Information exchange (disclosure) is always within some context or other: interpersonal, political, social; scientific (clinical) and spiritual hence the inclusion of the clinical - social axis. Tied with this is 'space'. Although the spaces defined by virtual and mobile have assumed primacy physical spaces still count: surgery consulting room, clinic, community health center, hospital ward, patient's home, nursing home. ... I've added transparent - opaque to contrast with public - private these are related yes, but analysis may reveal they are distinct in their application?

Although society has changed markedly in terms of technology and the communications it affords - the modes, tools, languages, access, networks, distribution; there is surely still a notion of what is personal and what might become social - (public)?

Technology, technological means and the arrival of social media does not itself constitute universal attitudinal change in health as Google have found (perhaps the pace of change in attitudes was not quick enough for Google Health so they moved on). Amid the hectic pace of life we should be pleased if some things - like public health disclosure - prove to be laggards in terms of change.

I'll expand on this soon with a few more axes - continua to flare.

Axes image original source from: http://dennisdel.com/?p=194

Stumble Upon Toolbar