Stanford Medicine X: To inform and inspire

Skinny jeans are a surrogate marker, Nick Gross was not who I expected, and the e-patients are even braver than I thought. Listening to the Club Med X play list (selections at bottom), I found myself reflecting on the things I learned, who I spoke with, and what inspired me at Stanford Medicine X.

The Things I Learned
Bringing the science/citizen science
Scientist and wine aficionado Ian Eslick (@ieslick) was the first winner of my daily ‘Bringing the Science’ (BtS) award at Med X. He explained how his own condition of psoriasis informed and affected his approach in creating the first MIT-run authoring experiment. The purpose of the experiment is to study “how patients think about self-experimentation and figuring out how making changes impacts them” at PersonalExperiments.org. He also opened the door to the n-of-1 vs epi debate and the idea of future sampling.

The next day CEO of Asthmapolis David Van Sickle (@dvansickle) claimed the coveted (albeit fictitious) BtS award with his fantastic marriage of humanizing the process of research with almost zealous inquisitiveness. He shared the origin of his obsession of “stalking asthma” from Navajo villages to Alaska and then to the CDC where the limitations of public health data and the role of technology were crystallized for him. Van Sickle went on to describe his excitement about the role of mHealth in preventing diseases in populations. Acknowledging that I may have sipped the Kool-Aid when it moved into mHealth for prevention, you must watch his 15 minute talk. “The hardest cause to identify is the one that is universally distributed.” Indeed.

Rhiju Das was the very next speaker discussing EteRNA, which necessitated creation of the ‘Bringing the Citizen Science’ faux-ward. His Das Group at Stanford in conjunction with Carnegie Mellon challenges citizen scientists and gamers to create RNA sequences that fold into target shapes via the interface they’ve developed. Interestingly, in part due to Das’ involvement as part of the team that created Foldit, EteRNA is seen as its successor by some.

Role of design and UX
So, it turns out design isn’t just for architects and frogs anymore. I had some feel for the roles of human-computer interaction and behavioral health design from working with researchers and others like Tonic. However, I was blown away by the roles of design and UX ranging from the seemingly mundane (e.g., hospital equipment) to the ambitiousness of the IDEO Design Challenge Workshop to its potential in transforming children’s fears about nebulizer treatments into nurturing moments.

Self-trackers and Quantified Self
Before the Med X Self-Tracking Day, I was peripherally aware that people like @FredTrotter were hacking away at things and tweeting their weight and that Ernesto Ramirez (@e_ramirez) was causing waves in something called Quantified Self. But I definitely did not realize how widespread self-tracking is until @SusannahFox debuted her new Pew data (re-defining it for much of the crowd), nor did I appreciate how creative (@nancyhd; Winner: Best smile-powered LED headdress) or dedicated (@bettslacroix) some of those involved are. This is an area worth exploring for future research and I’ll be curious to see what comes of some of the specific efforts such as MyMee.

Who I Spoke With
Surprises and plans
Just because it seems cliché to say that the best part about conferences are often the hallway conversations doesn’t make it any less true. In this case, the Medicine X First Look video archive of the entire conference goes a long way for those who couldn’t make it…but being surrounded by the attendees of this conference conferred an entirely separate set of benefits and opportunities. I had a series of eye-opening impromptu meetings and promising conversations. One was with Nate Gross (he of the minimalist Twitter handle @NG; co-founder of Rock Health and Doximity) at a group dinner. As I have zero feet in the business world and most of my business savvy comes from having watched the movie Wall Street in 1987, I was sort of resigned to sitting next to a brusque, bottom-line type. Instead, I found him to outwardly be a more contemplative sort who spent more time observing than speaking…or maybe he was just happy to be seated next to someone who didn’t have something to pitch.

Most of my other notable conversations portended more specific possibilities. I found myself in one sitdown listening to opportunities described on the fly between AMIA Fellow and researcher Qing Zeng-Treitler, Medify’s Derek Streat, and Alliance Health’s David Goldsmith (@dsgold). Later I enjoyed an intial exploration with Sarah Kucharski (@AfternoonNapper) about extending the role of the patient in research design. That was a conversation I suspect will continue.

What Inspired Me
Two people and an object
Unsurprisingly, it was the people and their stories at Medicine X that I found most inspiring. Many of the Ignite talks by the e-patient scholars were personal and touching, but I found two people particularly so. Sean Ahrens has taken his own story about Crohn’s and literally built a community for others suffering with the same struggles in Crohnology. It’s amazing to me that someone with a potentially debilitating condition refuses to cave to its daily demands and instead sources it to create a virtual bridge to connect and benefit others.

The other person is @DanaMLewis. Personal bias aside (see panel slide deck), to have a person at her age & stage create another type of virtual community in #hcsm that has such far reaching effects that it even inspires Alicia (@stales) Staley (herself quite the wow-inducer) to create #bcsm is immensely encouraging to me.

Youth. Creation. Connection. Wow.

A different kind of enchanted object
Watching David Rose of Vitality present at the mHealth Summit introduced me to the concept of the ‘enchanted object’. At Med X, I saw a more literal version of this implemented in the form of the Magic Mask. The Magic Mask used augmented reality tech and lessons from IDEO to transform what can be a frightening experience of nebulizer treatments to a parent-involved storybook time for these children with asthma. Trust me, you’ll want to read the full description of this work by @RoujaPakiman and @LucieRichter here.

Our Panel and Fin
An e-patient, an entrepreneur, and an academician collaborate to conduct research. In our panel, @DanaMLewis, @BorisGlants, and I tried to share our lessons in adopting the participatory design model for research. Hopefully we were able to inform a bit about misteps and successes and provide a dash of inspiration so that more patients and researchers will partner to capitalize on the strengths of each other.

I have been to a lot of conferences, and no one puts the level of thought and care into each detail of a conference like @LarryChu. This was a stellar experience that I look forward to next year!

@kevinclauson

Club MedX Playlist (selected songs)

Harvest Moon – Poolside
Night Falls – Booka Shade
Pharaohs – SBTRKT
4 years – Kid Savant
Rocket No. 3 – A Rocket in Dub
Skylight – Gramatik
Save the World – Swedish House Mafia
Shuffle a Dream – Little Dragon
Somebody That I Used to Know (feat. Kimbra) – Gotye [h/t @iam_spartacus who told me who the artist was, as I am old and thought the chorus was Sting]

TC (Theft Citation i.e., where I stole this post title from): I read @SusannahFox’s post on Stanford Medicine X. As with many of her posts (and I think she would agree), some of the best value is in the comments. In this case, it was the contribution by David Goldsmith who pointed out that Med X is the rarest of birds in that it managed to both inform AND inspire.

Helping Your Patients Make Sense of the mHealth Marketplace

One of my favorite developments within the Florida Society of Health-System Pharmacists (FSHP) has been membership’s growing interest in informatics. Of course, there are FSHP members who have been active in informatics for 20+ years, but the increased focus on it in the last 5 or so has been particularly encouraging.

To that end, I was asked to present this year at FSHP Annual on one of my favorite topics – patients’ use of mobile health (mHealth) apps to enhance their self-management. The expanded slide deck from my FSHP presentation is below. 

@kevinclauson

Pharmacy students’ perceptions of Web 2.0 tools in education

A new journal, Future Learning, launched this year aims to provide “the current best thinking, research, and innovation for the effective utilization of technology for educators in higher education, professional education, workplace learning, continuing education, and life-long learning”. The inaugural special issue was on Social Media and Learning, and I am happy to have been able to help contribute an article to it.  That issue (and hence our article, “Thematic analysis of pharmacy students’ perceptions of Web 2.0 tools and preferences for integration in educational delivery”) can be accessed for free via the journal’s download form here. Alternately, all abstracts from the issue can be read here. The journal arena is a crowded one, but I have high hopes for this effort by editor Dr. Lisa Gulatieri (@LisaGulatieri) and their Board.

@kevinclauson

 

Development of a residency interviewing preparatory seminar

As the profession of pharmacy continues to evolve in response to society’s health-related needs, one of the most pressing developments is the demand for more residency training opportunities. The demand currently far outstrips the supply of residency positions, and 2010 saw nearly 1 in 3 applicants fail to secure one through the Match. The onus on us as pharmacy educators is two-fold. Nationally, we need to scale up existing slots and help create new programs. Locally, we need to prepare our students as intensively as possible to help them compete for residencies that will help transform them into agents of change for the profession.

To that end, a couple of my colleagues developed an elective, Residency Interviewing Preparatory Seminar (RIPS), the details of which were recently published in the American Journal of Health-System Pharmacy. I was fortunate to be involved in this course aimed at developing our students’ core skills in the process including: improving their interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. As the course was targeted to P4s (i.e., completing the final, clinical phase of their education) who were at their rotation site all day, the class was held weekly for two hours in the evening and timed to be completed directly before the Midyear Clinical Meeting.

Completion of the RIPS course demonstrably improved the confidence of the enrolled students and 78% of RIPS students that cycle secured a residency. Nationally, the success rate is only around 62%, although these numbers cannot be directly compared. We have continued the course since publication and the most recent iteration saw a further increase in the percentage of RIPS students able to secure a residency position. Plans are to continue an iterative approach to course development.

@kevinclauson

King of the Electronic Health Record Prom!

There is nothing more pure, or messy, than democracy in action. Combining the idea of democratically weighing in with the oft-quoted 90-9-1 rule of social media engagement yields…

The Top 20 Most Popular EMR Software Solutions

© 2011 Capterra, Inc.

(compliments of Capterra’s @khollar & h/t @Visualmatics)

@kevinclauson

Using clickers to engage pharmacy students across multiple campuses

Click to access free full-text

When you teach at a University with multiple campuses (in our case, Fort Lauderdale and Palm Beach in Florida and Ponce in Puerto Rico) even with live, interactive videoconferencing – you have to try and figure out ways to connect with your students at different sites. We’ve tried different methods over the years with varying success, but one that worked well early on was the use of  an audience response system (aka clickers). This is something I talked about previously in the presentation, “The Science Behind Engaging Students in Class“.

Our recent article in the American Journal of Pharmaceutical Education basically describes our multi-campus implementation and measurement of its impact on student engagement, satisfaction, and opinions about projected use of clickers in other courses. We also touched on related issues, such as clickers’ possible role in helping desensitize communication apprehension in students.

@kevinclauson

Clauson KA, Alkhateeb FM, Singh-Franco D. Concurrent use of an audience response system at a multi-campus college of pharmacy. American Journal of Pharmaceutical Education. 76(1):6.

Evaluation of paediatric medicines information content on smartphones & mobile devices

One of the benefits of working at a large university is all of the different faculty you get a chance to work with. In this case, I collaborated with a group led by someone I have immense respect for – Dr. Sandra Benavides. She relayed that, “Medication safety and dosing information is often poorly delineated for paediatric patients as 75% of medications demonstrate insufficient labelling for these two purposes.” [1] So off-label or ‘unlicensed’ use of meds in peds is very common, with accompanying safety problems exacerbated by the more narrow therapeutic window in this population. Since use of clinical decision support tools is one strategy that has demonstrated the ability to help prevent med errors in peds [2] and the use of mobile devices in clinical practice has expanded substantially – we decided to systematically examine the quality of medicines information in a sample of commercially available tools. The article that came out of the study was recently published in Informatics in Primary Care.[3]

Paediatric-specific tools evaluated included: British National Formulary for Children, Harriet Lane Handbook, and Paediatric Lexi-Drugs. Generalist tools included: A to Z Drug Facts, American Hospital Formulary Service Drug Information, Clinical Pharmacology OnHand, Epocrates Rx Pro, Lexi-Drugs, and Thomson Clinical Xpert. 108 questions (e.g., Can the sudden appearance of extrapyramidal symptoms in an 11-month-old infant be attributed to administration of metoclopramide for injection?) were distributed evenly across infant, children and adolescent subgroups. Answers for the evaluative questions were sourced from established sources and (due to the high rate of off-label prescribing for which no conventional source exists) clinical guidelines.

The verdict? “The best performer [Pediatric Lexi-Drug] provided 75.9% of the answers…Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts”. Obviously the article itself goes into much more detail regarding scope and completeness of the tools and their performance based on several criteria. Hopefully the article adds some useful guidance and identifies both strengths and shortcomings with which these increasingly important tools and their nextgens can be improved upon.

@kevinclauson

1. Benjamin DK, Smith PB, Murphy MD et al. Peerreviewed publication of clinical trials completed for pediatric exclusivity. Journal of the American Medical Association 2006;296:1266–73.
2. Fortescue EB, Kaushal R, Landrigan CP et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111:722–9.
3. Benavides S, Polen HH, Goncz CE, Clauson KA. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices. Informatics in Primary Care 2011;19(1):39-46.

Consumer Health Informatics Elective: Expertsourcing

ExpertsourcingThe Consumer Health Informatics & Web 2.0 in Healthcare elective I coordinate for the college of pharmacy wrapped up in December and the ‘votes’ are in about the course. I felt the course went more smoothly this semester and was thrilled to again be able to expertsource several topics by benefiting from guest lecturers. However, the final decision (as always) rests with the students, whose opinions were solicited in the quest to improve the course.

The final exam is an all essay affair (which is not exactly universally popular) and at the end prompted the students to share their opinions on the most and least useful/interesting lectures of the semester along with other feedback.

Based on the comments they wrote, the topics that generated the most traction among students were mHealth and eProfessionalism. Students conveyed they were most intrigued about the potential of mHealth and felt like the issues within eProfessionalism were most personally relevant in their lives. Contributing guest lectures on these topics were leading social media & pharmacy thinker and University of Kentucky professor Jeff Cain (@DrJeffCain) and pediatric endocrinologist-turned-entrepreneur Jen Dyer (@EndoGoddess), who has created an eponymous app. Dr. Cain’s contribution, in particular, may end up having the most longevity of all topics within the course.

QpidMeDemoText

However, the most polarizing topic (and lively discussion) was spurred by the guest lecture “Spread the Love, Nothing Else” by Ramin Bastani (@RaminB) of Qpid.me. I first met Ramin at @BJFogg’s excellent Mobile Health @ Stanford. While I wasn’t entirely sure what I thought of the STD-notification idea initially, I certainly believed it would be a great tool to engage students about issues surrounding mHealth, the changing nature of communication via social media, and public health. It was. They were.

A sneak peek of data and a physician perspective on use of social media caught the attention of a group of our students as well. Stanford Medicine X creator and AIM Lab Director Larry Chu (@LarryChu) provided an interesting look via his analysis of 4999 online physician ratings.

The most pharmacy informatics-centric and global perspectives that resonated with students were provided by Jerry Fahrni (@JFahrni) of Talyst and Brent Fox (@Brent_Fox) of Auburn University, respectively. The course (unsurprisingly) is focused on the consumer health subspecialty of informatics, but those students who already are planning a path in pharmacy informatics clearly took to Dr. Fahrni’s lecture.

One of the new topics this semester was #SocialGood where we talked a bit about efforts like Free Rice and Kiva. It was really inspired by The Dragonfly Effect lecture from the 2011 Medicine 2.0 Congress. It was pretty primer-y and could likely benefit from a guest lecturer (suggestions?).

All-in-all, the course had some great moments, I think the students took away some useful tools and ideas, and I definitely learned an enormous amount from them and the guest lecturers!

@kevinclauson

World Health Organization eHealth Report

The World Health Organization (WHO) Global Observatory for eHealth (GOe) released the fourth volume of its eHealth series, “Safety and security on the Internet: Challenges and advances in Member States“. It was a true learning experience to serve as a lead author for this volume, which explored survey results from over 100 participating countries. Data in the publication were originally collected as part of the second global survey on eHealth by WHO. This fourth volume of the GOe eHealth series is focused on the public health implications of issues regarding:

*Online health information seeking and quality
*Digital literacy
*Internet pharmacies
*Internet safety and security

Among the findings of the report was that the most common approach by Member States to assure online health information quality remained “voluntary compliance”.

 

 

 

 

 

 

 

 

 

Also notable was that less than half (47%) of responding countries have government sponsored sites or initiatives to educate citizens about internet safety and literacy. Demonstrating that the process of legally purchasing medications online lacks a global consensus, most (66%) countries still do not have any legislation in place that specifies if Internet pharmacy operations are either allowed or prohibited.

The 86-page report fully characterizes the findings from these outlined domains. It also includes case studies that illustrate the advances and challenges in these arenas such as the Health On the Net Foundation (Switzerland) for online health information quality and the Verified Internet Pharmacy Practice Sites (USA & Canada) for Internet pharmacies. A free, full-text PDF of the WHO report can be accessed here.