Virtually Priceless Thoughts

At the Family Medicine Forum this year, I attended the OSCAR User Group Meeting. This is their second annual meeting and the first time I have reconnected with the group in a number of years.

The user group has come a long way in a few years.

OSCAR has made some advances as well. The big change is the replacement of the running text blob to track visits to discrete visits. It’s called “eChart”. It is tracking date (both actual and intended), changes per visit note are tracked and there is a form of digital signature. This also allows for locking / signing / verifying individual notes. Issues can be assigned to notes- these are coded in ICD 9. Visits have types now. The note is still text based. There are still additional, parallel “forms” and “e-forms” that can be filled out. These three streams seem to store similar data in different places inside OSCAR – I couldn’t confirm it, but it looks that way.

Part of the afternoon consisted of a presentation by an outside group recommending changes in structure to take OSCAR to the “next level” – more organization, road map, etc. This is the third time I have personally seen this type of presentation formally made to the OSCAR group. OSCAR has an active community and active development, but still does not have explicit architectural documentation, road maps, etc. The recommendations were sound, from the level that they were at. The language might have been off and the group seemed to be an “outsider” group so I do not know how much the recommendations resonated as opposed to something more “corporate takeover” (despite being presented by two University Department Chairs).

I would very much like to see an academically driven and open EMR being supported more broadly in Canada. It could allow for some amazing work – both EMR and clinical if we had a structured backbone across our campuses with consistent data models that allowed for easy recruitment of patients into studies, sharing of best practice research and guidelines, etc. I hope that one day OSCAR could grow into that — there are certainly many very intelligent people getting involved and if they could be rallied… who knows where things would go.

I’ve started reading Malcolm Gladwell’s latest book – Outliers. I’m only into chapter 3, but the “10,000 hour rule” keeps bumping around my head and has me thinking. Especially as I am spending the week at the Family Medicine Forum, brushing up knowledge.

“Outliers: The Story of Success” (Malcolm Gladwell)

Basically, it takes 10,000 hours to become an expert. Malcolm gives examples of hockey players and musicians practicing. Bill Gates programming, etc.

But, what counts in the 10,000 hours?

Bill Gates spent 100s if not 1000s of hours program a financial system – not a programming languages or an OS, but it seems to have counted. The Beatles played in Hamburg for thousands of hours, but how does that translate to the White Album?

In my recent career(s), I have two streams of work – my clinical and informatics work. How much are those intertwined into developing my own expertise?

By my calculations, I put in over 1,500 hours in obstetrical training. I don’t practice obstetrics anymore – does that still count?

I was an animator in the late 1980s and 1990s. What from there is transferable to my “expertise”? How about my biology degree?

A friend argued with me once that we mathematically cannot prove irrelevance. That is we cannot prove that one activity is not relevant to another. Is my understanding of wave theory relevant to my happy marriage?(1)

So what is relevant in those 10,000 hours? Is it game time, or just time on the ice? Is it physical action or visualization? Is it ward time or classroom time? I’m not sure.

Malcolm Gladwell hints that it is time dedicated to improving your skills. In that way reflection on action is key.

Maybe it is also how you define your expertise? Maybe Seth Godin has it right – try to be the best in the world. And the way to do that is to define our own world. Create your world and spend 10,000 hours becoming an expert in it.

My professional world consists of primary health care, clinical information systems, developing understanding of teams of engaged people wanting to make a difference, user-centred design goodness and of course lots of play intermingled. It’s a pretty good world and I’ve definitely enjoyed lying out here for a few thousand hours

1. Actually yes, as it turns out It has been – a few times just recently, in fact.

“The more things change the more time I work on my research proposal”

Perhaps that is my new slogan. Hopefully not. I am ready to get to my research.

I haven’t posted for a while about my PhD research as I have done a lot of soul searching over the summer and decided that even though I had a proposal drafted, the study was not for me. It was too far removed from the clinical coal face. So I made a change.

At the end of September, I changed topics and put my old proposal on hold.

My new proposal, just submitted in draft to my committee, focuses on exploring Continuity of Care for end of life patients. I will be looking at Continuity of Care first through interviews with providers. By leveraging work in Genre Theory and Soft Systems Methodology, I will develop some accessible models that describe communication activities of members in a patient’s Circle of Care. Using these models to structure group discussions, I should be able to guide study participants (both providers and IM/IT staff) to develop feasible recommendations to improve Continuity of Care.

This study is focused on generating the recommendations. Work after the study will be on implementing the recommendations within the communities I am working with.

It is an accomplishment, to have gotten to this point and I am looking forward to the next steps.

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.