Hodges' Model: Welcome to the QUAD: EHR

Hodges' model is a conceptual framework to support reflection and critical thinking. Situated, the model can help integrate all disciplines (academic and professional). Amid news items, are posts that illustrate the scope and application of the model. A bibliography and A4 template are provided in the sidebar. Welcome to the QUAD ...

Showing posts with label EHR. Show all posts
Showing posts with label EHR. Show all posts

Sunday, April 12, 2026

Seminar: 'MedGemma and HAI-DEF: A family of open models'

 

Dear Madam/Sir, 

We are glad to announce the following seminar: 

MedGemma and HAI-DEF: A family of open models by Andrew Sellergren, Software Engineer & Researcher at Google.

Save the date: 

Thursday, April 16, 2026 - 4:30 PM (CEST) 
Aula Pitagora - MT11 (Cubo 30B), Unical 
Hybrid Format / Live Streaming 

Link: https://dub.sh/medgemma2026

See also: https://goo.gle/medgemma

MedGemma Technical Report

My source: francesco.calimeri AT unical.it

Tuesday, February 03, 2026

Joining the digital dots across primary care and integrated care

My partner and I both received a letter today from our respective GPs. An invitation for a 'FREE LUNG HEALTH CHECK'.

Overleaf is an information sheet in landscape about the health check, plus three more sides of A4, similarly formatted - inviting trifold presentation.

After the 'Re. ......' an opening sentence asks: 'Have you ever been a smoker?'

Suddenly, I was dragged backwards through his-tory (some things don't change); not one history, but several:

INDIVIDUAL
|
    INTERPERSONAL    :     SCIENCES               
HUMANISTIC --------------------------------------  MECHANISTIC      
SOCIOLOGY  :   POLITICAL 
|
GROUP
My personal and life experience 
and not just since my teens . . .

The letter states:
**If you have never smoked, you are not eligible for this service**


My mother and father 
smoked when I was a child and my siblings. 
 
They got the message early 1980s.
  
'Society' smoked back then!  
 
Once old enough, I refused to go to the corner shop.
 
Into the 1990s, patients, smoking (some chain-smoking) on admission, long-stay and other clinical areas. As a community mental health nurse, I learned diplomatic and health promoting skills when in the car, giving a patient a lift to hospital. And, when visiting their home where I was, of course, usually, a guest.


I wondered what has happened to the GP's records? To the primary care clinical record ? The custodians of my health record, that they should need to ask that question? 
 
Or, does confidentiality tie some bureaucratic knots?
 
Where is 'integrated care' and its driver 'clinical informatics'? 
The letter included the NHS Number.
 
 Don't get me wrong, I/we appreciate the obvious effort here, even if the chronology is confusing, or,  speaks of afterthought? The letters are dated 19/06/2025. I must admit I haven't accessed my GP record, checking it for accuracy.
 
If anything, this is a prompt to do so. And seek a general medical. 


Previously: 'smoking' : 'winwick'

Monday, September 08, 2025

Online: Artificial Intelligence (AI) in Healthcare - Weds 17th Sept 2025 BCS Coventry Branch

Online event organised by British Computer Society (BCS)

Full details: 
https://www.bcs.org/events-calendar/2025/september/webinar-ai-in-healthcare-neural-ai-v-symbolic-ai-why-we-need-neuro-symbolic-ai/

*** Agenda (UK time) *** 

18:30 - Meeting opens
Welcome and Introductions
18:40 - Hand-over to speaker
19:30 - Questions
20:30 - End

Scope of workshop

This is to support you in putting together your application for the FEDIP application and the workshop will focus on:

  • What level you should apply for
  • How to work with the Standard
  • How to map your evidence
  • Putting together context
  • Preparing your evidence in the best way 
  • What the assessors will look for
Free-of-charge registration to obtain the Zoom link

https://www.eventbrite.co.uk/e/ai-in-healthcare-neural-ai-v-symbolic-ai-why-we-need-neuro-symbolic-ai-registration-1383661000299?aff=oddtdtcreator
___________________________

My source: Dr Mercedes Arguello Casteleiro.

FEDIP: https://www.fedip.org/

Thursday, July 03, 2025

AI Health 2025 Friday November 7th 2025

AI Health 2025

Friday November 7th 2025

At the BCS London Office
Ground Floor, 25 Copthall Avenue, London, EC2R 7BP (near Moorgate underground)

Organised by BCS-SGAI

BCS-SGAI, the British Computer Society Specialist Group on Artificial Intelligence was founded in June 1980. Its mission is: "To foster achievement, capability and awareness in both business and research in Artificial Intelligence, and to promote the interests of the related community". It is one of Europe's longest established groups working to support the community of artificial intelligence developers and users and is the organiser of one of the longest running annual series of AI conferences in Europe: the AI-20xx series.

In England, 189 out of 208 (91%) hospital trusts are using electronic health records (EHRs) bringing opportunities and challenges and for Artificial Intelligence (AI). In the morning, there will be a session about EHRs with speakers from UK (animal health records), France (European Health Data Space infrastructure for the use and exchange of EHRs), and Spain (personal health records). Before lunch break, there will be a brief 101 hands-on tutorial about Neuro-Symbolic AI with short exercises. In the afternoon, there will be a session about clinical decision support, exemplifying the use of AI-based healthcare technologies. Come along if you are interested in AI and its potential in healthcare.

There will be Certificates of Attendance for those who register and attend the event.

We hope that you will come and join us, and that you enjoy this new offering from the BCS SGAI.

Dr. Mercedes Arguello Casteleiro (BCS SGAI)*

Please see link above for programme and speaker details.
*.. And my source - BCS SGAI.

Saturday, April 05, 2025

Exhibition: Manchester (and online) “Our Lives, Our Privacy” c/o ICO

This a.m. I heard on BBC R4 Today 07.41.30... news (and interesting discussion) -

https://www.bbc.co.uk/sounds/play/m0029rg4

- of an exhibition in Manchester that may be of interest, if you're local, but it is also accessible online:

https://ico.org.uk/about-the-ico/media-centre/news-and-blogs/2025/04/come-and-visit-manchester-s-latest-exhibition-our-lives-our-privacy-to-celebrate-the-ico-s-40th-anniversary/

Our Lives, Our Privacy
'A digital exhibition featuring 40 items that tells the tale of how privacy has been at the centre of some of the biggest events and milestones we remember over the past four decades was launched last Autumn, but now a physical exhibition has come to Manchester. 
From 2 April to 30 June, we will be displaying the exhibition at Manchester Central Library in the first-floor exhibition space. Members of the public are welcome to pop in and see the items that have shaped our lives and our privacy.  
 
The ‘Our Lives, Our Privacy’ exhibition highlights poignant events in history including the launch of social media, the News of the World phone hacking scandal and the Covid 19 pandemic to name a few. It also looks at technological advancements like smart devices and raising questions about the future, including how accurate the episodes of ‘Black Mirror’ really are.'
==== Previously:

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.
https://www.academia.edu/3555654/Humans_information_and_science

Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal,2,1,28-34.

Jones, P. (2004) Viewpoint: Can informatics and holistic multidisciplinary care be harmonised? British Journal of Healthcare Computing & Information Management, 21, 6, 17-18.

Fryer, Jon. “Information Literacies – Learning, to Thrive in a Digital Age” IRMS Bulletin 230 (2022): 16-21.

As listed in the bibliography in this blog's sidebar.

I visited Manchester Central Library about two weeks ago, it is quite a building and full of public, cultural, and local information resources. Must do likewise in Liverpool.

Monday, February 17, 2025

Harnessing the Power of Artificial Intelligence to Improve Outcomes for Patients with for Long-Term Health Conditions

 Dear Colleagues and Friends,

We are organising a Special Session: Harnessing the Power of Artificial Intelligence to Improve Outcomes for Patients with for Long-Term Health Conditions

(https://aiih.cc/lthc/) in the International Conference on AI in Healthcare (AIiH), 8-10 September 2025, Jesus College, University of Cambridge.

We would like to accept both full length papers (12 pages plus references) and short abstracts (up to 5 pages including references) for special sessions. Submission guideline can be found here, including paper templates in both Word and LaTeX: https://aiih.cc/paper-submission/

The accepted full papers and abstracts will be published in the Springer LNCS volumes.

Full Paper submission deadline:            Friday 11 April 2025

Abstract submission deadline:               Monday 30 June 2024

We are looking forward to meeting you.

Best wishes

Shang-Ming Zhou

Professor in e-Health | Faculty of Health | University of Plymouth | PL4 8AA | UK.

Email :  shangming.zhou AT plymouth.ac.uk; smzhou AT ieee.org

https://www.plymouth.ac.uk/staff/shang-ming-zhou

https://www.plymouth.ac.uk/research/centre-for-health-technology

Wednesday, October 23, 2024

Register for Free! AI for One Health and Planetary Health: Where Are We?

Friday 8 November, 9:30am GMT – onwards

BCS, The Chartered Institute for IT, Ground Floor, 25 Copthall Avenue, London EC2R 7BP

Join BCS SGAI in London for an engaging full-day event featuring a line up of exciting talks. Attendees will have the opportunity to participate in a hands-on tutorial on low-code/no-code AI and Certificates of Attendance will be provided.

* Speakers & Agenda
https://www.bcs.org/events-calendar/2024/november/ai-for-one-health-and-planetary-health-where-are-we-artificial-intelligence-sg/

* Invitation for Free Registration
https://ArtificialIntelligence081124.eventbrite.co.uk


100% Discount Code: AIHealth24Committee

--------------------------------
Hope to see you there - in London 6th-9th November.

Sunday, June 30, 2024

Learning Health Systems/AcademyHealth 2024 SUPPLEMENT now available

 Dear Readers of Learning Health Systems,

We are pleased to announce the first-ever Supplement Issue of Learning Health Systems! 

 

You may view the complete Supplement online at:

https://onlinelibrary.wiley.com/toc/23796146/2024/8/S1

 

Guest Editors for the 2024 Supplement were: 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

 


The LHS/AH Supplement is the result of a collaboration and memo of understanding between Learning Health Systems (University of Michigan), AcademyHealth, and John Wiley & Sons.

 

***********************************************************

 

Guest Commentary

The Right Stuff:  Getting the right data at the right time and using that data to drive evidence-based practice and policy

 

Lucy A. Savitz,  Sarah M. Greene,  Michael K. Gould,  Harold S. Luft

May 27, 2024

 

Experience Report

Leveraging data to support health equity in an integrated delivery and finance system

 

Jane Kogan, Joan Eichner, Hyagriv Simhan, Erin Dalton, Alex Jutca, Beth Quinn, Jennifer Chaney, Anna Patterson, Donna Keyser

April 15, 2024


Continued...

Tuesday, October 29, 2019

Future - History: Information Systems or Care Records

Brian Warboys Professor of Software Engineering at Manchester University has stated that clinical staff lack the skills to make working information systems should leave it to IT professionals. A consultant physician and cardiologist at Bloomsbury and Islington agreed, the HSJ quote as saying:
"The fault lies not with the IT experts but with ourselves as clinicians. If we do not tell them what we want, how can they come up with the answers? ... There is a case for evaluating every IT solution available now and scrapping some of them". p.8.
Health Service Journal, 101:5259, 4 July, 1991.

'Coroners have warned the NHS on dozens of occasions that its record-keeping is so poor that patient's lives are at risk, an investigation by The Times has found. ...
Coroners have issued 62 warnings since 2013 in which they identified failings in record-keeping that could lead to the deaths of other patients.' ...
 'Simon Eccles, of NHSX, which is responsible for improving digitalisation, said that all of England should be covered by digital records by 2024 so staff could access the information needed to provide patients with the best possible care.'
Greenwood, G. Lost notes and illegible records 'risking lives of NHS patients'. The Times, October 2. 2019. p.16.

Sunday, January 06, 2019

The Art & Science of Health: [conceptual scraps ii]

The contrast here within health care is quite stark, we can distinguish between scraps of paper in two ways ...

  1. Whatever we do with care needs; confirm them from the referral and possibly (usually) identify additional care needs (and educational opportunities also..?), assess, plan, intervene, and evaluate - that scrap of paper (or its digital analogue) should initially be blank, untainted by judgements, bias and assumptions.
  2. As soon as the scrap of paper is populated - scribed-upon then its value and the responsibility of those who access it subsequently is suddenly weighed and measured by law and accountability.
In the first case, ownership is not relevant, in that there is nothing, as yet, to 'own'. Values however can still be represented, if the staff's attitude towards the new patient, client, service user or administration terms referral, contact, triage case is similarly 'neutral'.*

In the second case, when the print hits the page by whatever means the stakes are suddenly raised. The law has a say in what is expected, permissible and reasonable conduct by those gathering data, creating a record, holding, copying and transferring the record in part, or whole and its accuracy, destruction and disposal.

*Of course, even when blank, forms - templates can have proprietary value and may well be protected, copyrighted and trademarked.

to be continued ...

Related post - Part 1:
The Art & Science of Health: [conceptual scraps i]

Wednesday, November 07, 2018

Articulating the Socio-Technical and much more c/o @Atul_Gawande

individual
|
INTERPERSONAL : SCIENCES
HUMANISTIC ----------------------------------------------- MECHANISTIC
SOCIOLOGY : POLITICAL
|
group





















John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties.

Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."
Cameron ---- Gawande

"I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer.

“Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.”

It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."





Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue


Wednesday, October 17, 2018

"One-size-fits-all" Assurance of Insurance needed?

individual
|
INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
|
group
mental health problems affect

Self-employed, single
No previous history of MH problems
PURPOSE#
Psychology - Counselling
12.5 million adults - 1 in 4

PROCESSES (automated?)*

'Life cover'
Insurer access to GP record - deemed high-risk
500,000 people affected by

Untimely death of a parent
Mother killed by drug-using driver
Refused IVF treatment
PRACTICE

insurance company
POLICIES
driver jailed
Voided application for life cover
(figures) suggest insurers reject up to 625,000 people a year
By law ins. companies cannot discriminate

*Need to discuss an application with a person, fill in 'gaps' then less likely to become subjected to an algorithm and an automated rejection.

# What were the reasons for referral to psychology and counselling?

My source:
Miller, L. (2018) My fight to get life cover after mental health trauma, The Daily Telegraph, Money, 22 September, pp.1-2.

See also: https://www.telegraph.co.uk/insurance/life/get-life-insurance-mental-health-problem/

Technology can, will and is helping to 'disrupt' the insurance market.

Wednesday, April 04, 2018

Paper: IJIC - Building Competencies for Integrated Care: Defining the Landscape c/o Miller & Stein

individual
|
INTERPERSONAL : SCIENCES
humanistic ---------------- Integrated Care --------------- mechanistic
SOCIOLOGY : POLITICAL
|
group

"Transformation does not only involve gaining new knowledge and skills but a more fundamental* shift in our conceptual paradigms about our roles, responsibilities and relationships." [RRR]


Clinical integration (mental health) through person-centred care of someone's health and wellbeing

building blocks 1. Electronic health records,

Functional integration (data, information)

Uni-professional education
 
Clinical integration (physical health) through person-centred care of someone's health and wellbeing
through the active engagement of
service users as partners in care



 
 Act-ions - Practice

[RRR] social change

[ My obs.: Health literacy
- need for a generic framework -
for health education arbitration -
as there is a sociopolitical dispute]

Professional


through the active engagement of
service users as partners in care



2. Budgetary processes,
3. Governance structures

[RRR] political change (inc. policies, professional bodies...)


Organisational & Systemic integration



integration

Normative integration

*There's that word again...

Q. Reflect upon the following using the above model - not only the text but the model itself:

"To achieve the transformation required by integrated care, this means three things: we need to include the principles of integrated working into our formal education and training systems; we need to recognize that learning continues in our workplaces; and accept that we ourselves will be informal educators throughout our careers."

The following dimensions are listed in the editorial and above :
  • Dimension 1. Person-centred care (i.e. the improvement of someone’s health and wellbeing through the active engagement of service users as partners in care)
  • Dimension 2. Clinical integration (i.e. care services are coordinated and/or organised around the needs of service users)
  • Dimension 3. Professional integration (i.e. existence and promotion of partnerships between care professionals that enable them to work together)
  • Dimension 4. Organisational integration (i.e. the ability of different providers to come together to enable joined-up service delivery)
  • Dimension 5. Systemic integration (i.e. the ability of the care system in providing an enabling platform for integrated care, such as through the alignment of key systemic factors like financing and regulation)
  • Dimension 6. Functional integration (i.e. the capacity to communicate data and information effectively within an integrated care system)
  • Dimension 7. Normative integration (i.e. the extent to which different partners in care have developed a common frame of reference of vision, norms, and values on care integration)

Miller R, Stein KV. Building Competencies for Integrated Care: Defining the Landscape. International Journal of Integrated Care. 2018;17(6):6. DOI: http://doi.org/10.5334/ijic.3946
 

Sunday, December 10, 2017

EHR Individual - Group: Aggregator

People probably look at Hodges' model and see something that is simplistic. There is a great power, however, in the scenarios that the structure of Hodges' model can readily encompass. Not just in the hospital, but across all care contexts.

"Where is the great value promised by the transition to EHR [Electronic Health Record]? Where is the huge surplus from all those lives saved? Without an actor who can find it, and deploy it to shift the doctors into surplus, nothing will happen. 
If the ecosystem* includes just the five traditional players, EHR will remain an academic dream. The answer, then, requires introducing a new player - an aggregator. Because the odds of mistakes are so low, the benefits of EHR are invisible to the individual patient. They become material only when we aggregate outcomes over a large enough number of patients. We need to find an actor whose surplus is affected by patients not as individuals but as a group, and who is able to both capture and distribute this benefit; insurers, health-care systems, and governments all fit the bill. And the larger the group, the larger the surplus." p.130.

*The ecosystem illustrated by Adner is simplified and includes:
Payer/ Insurer, IT Provider, Hospital Administration, Hospital Department, Doctor, Nurse, Patient
(I have added Nurse)

Adner, R. (2012). The Wide Lens: A New Strategy for Innovation. London: Portfolio/Penguin.

Monday, September 05, 2016

Editorial: Assuring the Capture of Standardized Nursing Data... Ponte, Somerville & Adams (2016)

In their editorial Ponte, Somerville and Adams (2016) focus on the US nursing care situation and contrast with the UK experience from the outset:

As the U.S. health system moves toward value-based care, chief nursing officers (CNOs) are pressured as never before to demonstrate nursing’s contributions to improving the cost, quality, and efficiency of care, key elements of the value equation. The shift from fee-for-service to value-based care and reimbursement has been made possible through the implementation of electronic health records (EHRs), and the emergence of Big Data analytics, in which payers and healthcare organizations mine the streams of data produced by clinical and administrative systems to understand and evaluate care inputs, processes, and outcomes (Westra, Clancy, et al., 2015).
The contrast is implicit and is not the purpose of the editorial: Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. From a still summery Lancashire the above really does seem a continent away, if not a world. It should not be this way. Questions of value for money, the quality of nursing care and outcomes are also central here and digital aspirations are ongoing: NHS Digital.

Perhaps Hodges' model lacks appeal not just because of its historical (mid-1980s) qualities, but a 4x4 checkbox appearance that seeks to standardize care concepts and the nurse's approach? Not only that but maybe the model dictates where they should be placed? The push for data to 'let the light in' and make nursing visible, can also seem a major, externally driven and intrusive distraction from nursing care. That is, doing the job, being a nurse, nursing delivery, caring ...

That Assuring in the title is important. It is the kernel of recursion, the crucial check that is governance and engaged management. Not remote via a screen - dashboard, but in-process - in-situ assuring that the nursing role can and is delivering. In the dash to data vision can become blurred. Socio-technical perspectives are skewed, what might be termed holistic bandwidth is constrained as per the system.
Ensuring that standardized, encoded nursing data are captured in EHRs is critical if nursing is to realize the potential of big data analytics. Having nursing data available for analysis will allow us to gain a better understanding of nursing practice, demonstrate nursing’s contributions to patient care and outcomes, and facilitate evidence-based practice and nursing research. Indeed, we will no longer be driving blind. Rather, we will be driving smart.
Somewhere in this big data lies person centered, holistic and integrated care. This needs to be transformed to self-care. Can these incremental positive changes be captured (once debated and defined)? Will nurses be empowered with access to this data: the big, little and what lies between? Where are the analysts? Who makes the decisions based on this data? Is transparency assured?

As technology advances we have much to do in the UK, lest we nurses find ourselves sat in what has suddenly become a self-driving vehicle that is bound who knows where....


Ponte, P. R., Somerville, J. G., & Adams, J. M. (2016). Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. International Journal of Nursing Knowledge, 27(3), 127.

Monday, November 17, 2014

Response to: Pros and cons of pulling behavioral and social data into EHRs [Government Health IT]

Mike Miliard Editor of Healthcare IT News posted an item:

Pros and cons of pulling behavioral and social data into EHRs

To put my reply in context here is the start of Mike's post:
Should more types of health data figure into electronic health records?

On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...

Talk about a work in progress? How long does it take to get this right? Of course health and social care data is always ongoing, as governments change, policy, medicine, local government, social care, technology and society too.

As Mike notes for many physicians the EHR is already burdensome. My context is quite different being nursing, mental health, and crisis-oriented in the community. I've defined small research-based datasets in the past and it is a fascinating pursuit. Trying to have the data defined and reporting ready before the 'door opens'. Doing this retrospectively is no fun at all.

At work when I visit someone in a residential care or nursing home, do I record this as 'home', or 'community' in the absence of the aforementioned categories? Is this ageism?

Is there a digital dividend to come to the physician's aid? Surely increasingly the physical measurements and observations in medicine, surgical... can be automatically captured, disseminated and presented accordingly? Surely, it is possible today to bring in other data as the context changes? If we can autofill on words, we should be able to auto-fill the dataset as context shifts? There are many algorithms out there already 'alive and countin-the-clickin'  in the milliseconds.

It seems Mr Miliard is writing about one way to define 'integrated care'?

It isn't just 'public health' though;
it must combine, be inclusive of - 'public mental health'.

The focus of the article is the Institute of Medicine's report:

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2

Mike lists eight domains from the report and these are mapped to Hodges' model below:

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
educational attainment, stress, depression
physical activity, stress

social isolation, intimate partner violence (for women of reproductive age)

financial resource strain,
neighborhood median household income

I've included stress twice as there are at least two forms: anxiety - internal; and environmental - external.

Wednesday, June 25, 2014

"For portals, speak patients' language" c/o Healthcare IT News

Mike Miliard's 

in Healthcare IT News is a reminder of accessibility and engagement at the level of a communities languages.

This is one of the reasons why I am committed to using Drupal, to try to make use of its Internationalization capabilities amongst others. 

Thanks to Mike's post I'm now familiar with a 'full court press' as a hospital - enterprise wide no less - seeks to achieve defined patient engagement levels by accessing their electronic health record.

This begs the question of what constitutes the patients' language? I don't just mean the purely linguistic forms of Chinese, Korean, Russian and Greek mentioned in the article. The effort is driven by the statutory demands of meaningful use, but what of the patient's general literacy, IT and health literacies? How do patients make sense of their own health (or another in the role of a carer) not just in a given language, but culturally from a medical sociological and public health perspective? What is the community's vocabulary when it comes to health?

How can we assure that meaningfulness? How can we affirm that use and critically translate use into patient benefits and self-efficacy?

You could also entitle Mike's article as

4 portals speak patients' language

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
Health Literacy, Accessibility
Measures (health literacy, patient engagement, health and well-being, clinical outcomes)


Cultural Diversity, Languages, Carer

Internationalization
'Meaningful Use', Standards, Legislation, Policy


When we focus on languages we must remember that listening is a great gift. Whether as health and IT professionals, educators, patients and carers, listening to the care domains can help us integrate diverse social, clinical, policy and technical objectives.

What do these portals say to you?
https://twitter.com/MikeMiliardHITN
https://www.healthcareitnews.com/author/mike-miliard

Monday, June 24, 2013

Nursing Informatics 2014 - Call for Submissions


Please forward this message via to your own networks and contacts.

We are pleased to announce that NI 2014, the 12th International Congress on Nursing Informatics, will be held in Taipei, Taiwan, June 21-25, 2014.

The theme of the conference is “eSmart + ” where “e” stands for eHealth, “S” implies simplicity, “m” represents mobility and meaningful use, “a” denotes advanced leadership, “r” indicates revolution, “t” means translational technologies, and “+” symbolizes People Leading uCare Safely. The acronym is also used to convey the idea of adopting smart technology to help health providers deliver higher quality care.

The online submissions system is now open and will remain open until mid-September 2013. Decisions on manuscripts will be made by mid-December 2013.

You can find more information at the conference website: ...

We very much look forward to seeing your submissions and to meeting you in Taiwan next year.

With best wishes

Nick Hardiker & Heimar Marin

Co-Chairs, Scientific Programme Committee, NI2014


Saturday, April 21, 2012

Personal Health Records: Part I - revisiting Kim and Johnson 2002

When I was at HC2004 or 2005 I was given a copy of the Medical Informatics Yearbook 2003 from the British Computer Society - Nursing Specialist Group stand. Within this volume of key papers for the year April 2001 - March 2002 I found the following:

Kim MI, Johnson KB. Personal Health Records: Evaluation of Functionality and Utility. Journal of the American Medical Informatics Association. 2002. Mar-Apr; 9(2):171-180. Selected for inclusion in the IMIA 2003 Yearbook of Medical Informatics. 
The paper identified candidate Personal Health Records [PHRs], then developed criteria examining the entry and display of data elements necessary for the PHRs to serve as adequate representations of information. Then in the final third phase a selected group of PHRs were assessed for their functionality and utility (p.370). Of the 12 PHRs assessed I thought it would be interesting to check  their current status (this was a quick visit to the published domains).

Several Personal Health Records 2002 - 2012
Web Site
Record
URL
Findings
Dr. I-Net My Medical Record www.drinet.com/ A good start! Still operational domain redirects from original www.aboutmyhealth.com Continues to offer a PHR.
HealthCompass: Lifelong Health Record www.healthcompassnet.com While there are several site using 'Health Compass' the original version was not obvious.
MedicalEdge Medical Register www.medicaledge.com/ Domain currently offers support to physicians, so a PHR may be part of a package?
MedicalRecord.com Your Medical Record www.medicalrecord.com This now appears to be a directory to electronic medical records.
MedicData MedicData www.medicdata.com/ This does not appear to offer a PHR and the homepage is 'under construction'. It looks like the domain may have a new owner.
Medscape AboutMyHealth Personal Health Record www.aboutmyhealth.com/ Now leads to GE Healthcare.
myhealthnotes.com Personal Health Manager www.myhealthnotes.com/ Server not found.
PersonalMD My Medical Records www.personalmd.com Retired - leads to: www.eheandme.com/personalmd_announcement.html
TheDailyApple Health Records www.thedailyapple.com/ Social networking is vital to well-being but no PHR here.
VistaLink Health Profile vistalink.com Domain for sale.
WebMD WebMD www.webmd.com/ Very much alive and kicking commercially, but my health record / PHR not in immediately in evidence.
Wellmed.com Health Record www.wellmed.com This site leads to http://www.webmdhealthservices.com/



Kim and Johnson provide several lessons as a high quality contribution to the medical informatics literature. From the above we see that while we talk about timeliness in terms of the written record, time takes on a series of new meanings when it comes to electronic records, media, commercial companies and clearly the internet.

As I read the paper and reflected on the past decade other things fell into focus. At the end of the day a PHR should be what it says - personal. Reading Kim and Johnson this did not stop them looking at the PHRs from the perspective of doctors and informatics practitioners. There is nothing wrong with this. Although developers and political masters quite rightly seek to engage with the user, espouse usability and user testing - a system is aimed at a community.

If title [personal] follows function [record] and form [electronic] follows function then what do we have?

Don't worry if you're lost, me too (I'm musing again); let's add the fog....

It's crucial to know what's going on over the fence (similarly sometimes it helps to climb a tree). In this case the person in the form of patient is not the only consumer of the information in the record.

This is the point: systems are about a user AND a stakeholder community. Stakeholder is a much maligned word, found on the lips of those seeking to reach and engage remote ('difficult' to reach) community groups. It has a definite role here though.

Every health discipline has its record, that is a professional must. So in effect you have a series of 'X' -HRs. On paper they were - and remain in many cases - a mess. What we should have then is a hybrid health record that depending on the user morphs itself accordingly. But what is the point in pointing to users and stakeholders? Well, conceptually how far is personal from medical (nursing...) and how far again to personality? Add to the mix the question of where patient, well-being and health fit in to the management of long term medical conditions as per the critieria of Kim and Johnson, accurate entry of medicines, medical conditions, lab tests, monitoring ... and you see what is frequently a record breaking task.

This is (or was*) the challenge: to transform something that is generically personal (with the potential contradiction this implies) to something that is personalised as in 'I'.

*Part II to follow.

Friday, August 19, 2011

Top 5 worst EMR myths: c/o Healthcare IT News

I came across this post by Molly Merrill, Associate Editor and thought I could add some comments.

I'm usually wary of posts of the list of ... and top 5, top 10 variety. You see much of social media is cordial - not the concentrate form - but the dilute as observed in many of the comments. Anyway ....

You can read the original full text for each of the five on Healthcare IT News, here are some additional thoughts:

1. EMRs are bad for “bedside manner".

They can be BAD it all depends on usability, engagement, attitude, requirement, the overall environment and the extent to which the EMR is considered in all its socio-technical glory. Whatever the research does show item #2 admits the qualitative differences that exist in the marketplace - some EMRs are easier-to-use. If we expand the engagement beyond the professionals then the bedside equation demands the patient is factored in.

With the right care philosophy and conceptual framework (#h2cm?) e-health records of all varieties (EHR, PHR, EMR, Summary ....) can also support a positive, person centered bedside manner - transforming it to one that chomps at the bit ;-) to become a community based manner.

2. You can't teach old doctors new tricks.


Continuing professional development (or its equivalent) dictates that older doctors and other senior members of the multidisciplinary health and social care team can (should and must!) learn new tricks right up to retirement. Lifelong learning applies to all.

3. Only hospitals use EMRs.

I've little experience here working in the community (and in mental health), but judging from the applications and the infrastructure that an older EMR may demand, I suspect that they are indeed hospital (organisational) centered. That clearly is changing as mobile, mhealth applications mature to meet the rigorous demands of this market.

4. Having my data stored in an EMR is a security risk.

The security of electronic records cannot be assured. Data on devices that is not encrypted - is an open door, especially when those devices are portable. (If the use of encryption leads to complacency then I am uneasy.) Disciplinary measures may follow, but they are not a remedy. The human link in the chain aside - electronic records can be security assured to international standards. Far better than paper records and the photographs (anybody?) of paper hospital files sitting at the side of a corridor and other horror stories.


(Former link: The New York Times, 21 August 2011, New Data Spill Shows Risk of Online Health Records)


5. EMRs are expensive.

There are beholders, stakeholders, budget holders and tax payers. Despite the need for research findings I like the reflection of reality in item 5 that presages new players using new architectures and approaches. I've always felt that standards are essential and yet how do they relate to the scope for innovations? What is the relationship and how does that impact the market and in turn costs?

I've come across an item in .Net magazine that relates to EMRs - indeed all health informatics - I'll post on this while in London and attending Drupalcon.

Image source:
http://www.computerweekly.com/blogs/cwdn/2010/08/carry-on-doctor-your-electronic-patient-records-are-secure.html