VP Thoughts

We had our second Engineering 4 Health Challenge at UVic yesterday and it was another success! Some great students who participated and some really fantastic ideas that were generated. The topic for this challenge was the same — use the OLPC (One laptop per Child) as the design platform for creating health applications for students in developing countries. One project was focusing on engaging the whole family in their health through the OLPC and the other was a health oriented game that provided health education in the form of game challenges. Really interesting approaches.

The paper storyboarding design for the event seems to be quite manageable and has generated some good results. We managed to squeeze it into a 1/2 day.

We started by having a group brainstorming session - timed, with two facilitators. Facilitators helped clarify ideas from the participants and encouraged students to speak out their ideas, often using one initial idea “build a game” to create several specific ideas about games. On of our facilitators (not me!) started concept mapping ideas, to show the linkages.

Students were then broken into small groups and encouraged to choose and idea. The small groups (4-5 students plus 2-3 facilitators) often found as they selected ideas, they not only drew out more detail, but some also merged several ideas into one package.

The next step for the students was to begin to work out the details of the design and a high level flow. We did this with the students through paper prototyping and pasting together a high level storyboard on 4′x6′ paper. We used paper mock-ups of the OLPC laptops (below) so the students could draw their rough screen sketches on them and describe some of the functional activities on the pages. This really helped quickly make ideas real and also was accessible to students — some focused more on GUI design and others more on functional description.

All the individual pictures were placed on the paper with arrows used to denote typical screen flows for users. Not everything was on the storyboard, obviously. Many of the ideas they had were quite complex and would require a fair amount of content, but the pages really did give a good idea about how the systems might work, following along a specific scenario or giving an overview of the path of a game.

At the end of the morning, each group was able to present their idea to the rest of the students.

I definitely enjoyed this project and wanted to thank all the students, volunteers, faculty, staff and teachers who made this happen.

Informatics, Medicine, Random Thoughts, Software Medicine, Random Thoughts, Software

October 15th is Blog Action Day and the topic is poverty, so I thought I would post on some activities we have been up to in regards to raising awareness of the need for better education in developing countries. Better education is a key enabler to improving people’s situations.

Two weeks ago we held our first “Engineering 4 Health Challenge” at UVic and it was a great success — the local high school students came together to think about and develop paper designs for health applications that would run on the OLPC. The ideas were fantastic, providing interesting ways to improve education on health.

It also allowed me, in my way, to support a colleague who spent 10 months last year in Tanzania treating and educating the population there on HIV and AIDS.

We will be continuing these Engineering 4 Health Challenges later this year with more local high school students and in early 2009 with University students. It is a great way to get people being creative about a real problem.

Uncategorized Health Informatics, Thinking

I have been listening to some great stuff by Dave Gray and others on thinking visually. Not about clinical information systems design, but about approaching complex situations through visuals. Dan Roam’s book The Back of the Napkin is an excellent introduction to visual thinking and how to design sketches to help think and present ideas.

Definitely regretting not having gone to Viz Think ‘08 this last year, but thankfully they have shared several pieces online (check the blog in particular).

Much of the discussion is around making a complex and chaotic world make sense. Distilling the complex whirl of information into something that can be engaged and reasoned about. A story given a sense of time and knowing that stats don’t give people. Visuals engage the right side of the brain in a way words don’t, helping to process information in a different, more holistic way. The two help make sense out of the utterly complex.

(Note the irony that this post is the first without a visual.)

Uncategorized Visual Thinking

I have been working with a friend and colleague over the past month sketching out an idea to develop software for the XO laptop, which is part of the one laptop per child
(OLPC) project. The idea is more about how to get others to design and build software for OLPC and we can help facilitate.

We are exploring how to engage students in BC to design and develop health and health education materials with partner communities in developing countries who are part of the OLPC. It is an exciting idea to get students, both high school and university students, to get together and learn about computer science and about healthcare while flexing their creative design muscles in coming up with tools to help children thousands of miles away.

Seems like we are not the only group who has thought of this, of course. There are several projects proposed and in development through the OLPC and can be found on the OLPC Wiki.

We are piloting our OLPC-Health Design Fest this month - it’s a half day paper prototyping event. I am very excited to see how it works.

Medicine, Software Health Informatics, Medicine, Software, Visual

The title of an article from Harvard Business Review keeps coming up Breakthrough Thinking from Inside the Box. While certainly not the first place to use the play on “out of the box” thinking, it is a good construct.

I read this many months ago and do find the idea pops into my head whenever I am in a meeting that stalls. Often these are my own meetings, where I realize that I haven’t provided enough structure to promote creativity.

Having a limit or constraint to work with provides a foil for creativity and this article does a good job of providing some examples that can be used. The full article is available for purchase but the 21 question sidebar is accessible, I believe.

Pulling people out of their comfort zone is a good way to stretch the brain and let some creativity happen. Describing the box, drawing on other areas of experience, etc are key to pulling people out of their zone into a new area.

The trick is, of course, to pick the right box(es) to use. You want to stretch people enough and to stretch them in the right direction. Too far out of their range is as bad as having two many options. It would be like asking my grandmother to consider quantum mechanics…you would have gotten a blank stare and be “tsked” out of the room quickly. But asking people to imagine their parents as patients using a personal health record, is something that a developer could probably stretch into.

Software Health Informatics, Software

Well, Henson, once again, was ahead of his time.

Kermit Learns Visual Thinking

Random Thoughts, Visualization Visual Thinking

So not directly informatics related, but a few conversations and articles have come across my path that seemed worth sharing on the importance of taking time.

The Slow Leadership blog recently posted When Procrastination Works Better Than Action. While I don’t necessarily agree with using the word “procrastination” to describe thoughtful pauses, I do agree with the importance of thoughtful pauses.

People do feel rushed to provide an answer. Immediately. As a physician, I am trained to have the answers before the end of a visit - even if the answer isn’t readily apparent.

In Praise of Openmindedness discusses the idea of taking time to make sure you do not always follow your knee jerk reaction. The pressures of not having enough time makes the knee jerk reaction all too easy, and that might just mean you miss something grand.

And Roger Martin makes this the tenant of his book:

“The Opposable Mind: How Successful Leaders Win Through Integrative Thinking” (Roger L. Martin)

Holding onto opposite or contrary thoughts and taking a bit of time to explore each option to see what the impact might be comes natural to some. Cultivating this skill is a key to good leadership, according to the book. That action requires time as well.

Stephen Covey, puts it like this:

Between stimulus and response, there is space.

In that space lies our freedom and power to choose our response.

In our response lies our growth and our freedom.

I quite like that one.

Uncategorized Thinking

I came across an article today in the BML, Continuity of Care: a multidisciplinary review. This was a good summary of some of the Canadian work and use of the continuity of care term. Their redefinition of Continuity of Care in to three broad categories is a useful way to organize my thinking as it relates to Clinical Information Systems. Starting from the bottom of the figure:

1. Informational Continuity – links patient specific clinical information between providers and between events. This is related to past information. A provider can review previous blood work, etc.
2. Management Continuity – Describes sharing and modifying future goals and care plans for a specific patient.
3. Relational Continuity – Bridges past, present and future care through on going human relationships. This includes relationships to a group practice. Relational continuity can, I suppose, also include proxy relationships to extend a sense of continuity (which I use in my practice, e.g. “I’ve known Sandra for over 20 years, she’s excellent”).

I have mapped examples of tools to each level of continuity in the figure.

1. Informational Continuity – Includes paper charts and records stored electronically in EMRs, EHRs, etc. This is what we typically think of when we talk about interconnected records. Our standards are focused on information - labs, medications, DI reports, etc.
   Are there tools that can support the other two levels of continuity?
   
2. Management Continuity – Includes care plans as well as Clinical Decision Support in EMRs / EHRs and it also include paper-based clinical practice guidelines that can help direct care. Patient specific guidelines, care directives, etc can help to ensure that providers are not working at cross purposes to patient goals. Clinical Decision Support Systems can provide reminders and alerts at the point of decision making to ensure informational continuity can translate into management continuity. Patient specific care plans / goals are important to capture and share (e.g. advanced directives) to ensure patient goals are addressed. Here, we need standards and distribution mechanisms to synchronize patient specific care plans and goals between disparate clinical systems. There are several gaps in current pan-Canadian standards at this level.
   
3. Relational Continuity – How can clinical systems help with relational continuity? I think that this is a key question to ask.
   • Telehealth – the classic tools of telehealth / telemedicine can extend the reach of the face to face relationship through video conferencing. This helps span distances for rural / remote / specialty care especially. Group telehealth visits can extend relationships and trust by having a (kn)own provider in a visit to share knowledge and to lend credibility to the new provider(s).
   • Electronic Patient-Provider Communication – with your (kn)own providers, electronic communication (e.g. secure email) provides better access and thus continuity.
   • Electronic Provider-Provider Communication – between providers, quick, secure communication (or phone) can extend aspects of the relational continuity to a surrogate provider.

Thinking about how to achieve benefits in continuity at each of these three level, through technology, is a useful exercise for an organization during planning and design of programs and initiatives.

Medicine Health Informatics, Medicine