Launching a Center for Consumer Health Informatics Research

We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.

@kevinclauson

 

UPDATE: The dedicated site is up at www.CCHIR.com

Texting for Diabetes @ Medicine 2.0’11 Stanford

For Medicine 2.0 (#med2) at Stanford this month, I am excited to be delivering a Research in Progress presentation of our study,  “Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in Type 2 Diabetes Mellitus”. The study, supported by the McKesson Foundation Mobilizing for Health grant program, aims to help a diverse and largely uninsured and underinsured population in South Florida improve adherence to the medications they take for type 2 diabetes mellitus. Our study intervention is designed as a simple series of text messages through treatment targeting one of the primary hurdles to optimal medication adherence – reminders. I will also be sharing our plan for integrating health literacy assessments and disease state knowledge into the clinic EHR as a means to provide more patient-centric counseling and support. Our hope is that we produce an effective intervention to improve health which is also low-cost and thus ultimately scalable. There are a lot of scary numbers being bandied about for diabetes such as its $174 billion annual cost and forecasts that as many as 1 in 3 Americans could develop diabetes by 2050; it would be massive if this contribution could assist in stemming the tide.

Beyond being surrounded by a great study team, I have also been fortunate that providers at our primary care clinic partners have become very enthused about the study. We actually amended our original protocol to account for the fact that physicians at other clinics within the Memorial Healthcare System approached us and volunteered to help recruit participants.

Over the years, Mednet and its offspring, the Medicine 2.0 Congress have been among the most ambitious, surprising, and practically beneficial conferences I’ve attended.  Every year I see new attendees from seemingly disparate areas and sectors that come and then find commonalities that produce stimulating discussions, research collaborations, business ventures, and even friendships. This year will continue that tradition with the pre-conference lineup at the Stanford Summit on September 16, 2011 and the two-day Medicine 2.0 conference proper that follows on September 17th and 18th.  I will be there to share our research to date and eager to participate in the other sessions. I hope to see you there too!

@kevinclauson

Pharmacy: Is there an app for you

The 45th Annual Meeting of the Florida Society of Health-System Pharmacists (FSHP) was held in Orlando during the weekend. Since it is a state organization conference, it is much smaller than gatherings like the ASHP Midyear Clinical Meeting. This allowed for a streamlined set of programming tracks and a more relaxed atmosphere. There were also some interesting individual sessions (and necessities) on medication errors, pain management, etc.  I particularly liked the presentation on “Cyberhealth”, which focused on issues with Internet Pharmacy. Additionally, I had the opportunity to present “Pharmacy: Is there an app for you” at the meeting.

@kevinclauson

 

Knowledge, Skills, and Resources for Pharmacy Informatics Education

The most recent issue of the American Journal of Pharmaceutical Education featured a Technology in Pharmacy Education section.  There is some really interesting reading in this section including, “Use of Twitter to Encourage Interaction in a Multi-campus Pharmacy Management Course” by @Brent_Fox.  Brent actually authored several articles including, “Knowledge, Skills, and Resources for Pharmacy Informatics Education“, which he wrote along with the newly installed Chair of the ASHP Informatics Section Allen Flynn, informatics luminary and frontliner Chris Fortier (@FortiPharm), and I.  With this article, we tried to summarize the baseline informatics knowledge that pharmacy students should possess upon graduation, framed within med use processes.  My hope is that it will be of real practical use to educators and others as specific recommendations are provided regarding activities and resources for class and curricular integration, rather than just observations made from 30,000 feet.  Also, as with all articles in AJPE, this one is open access (OA) in that it can be accessed free, full-text by anyone.

@kevinclauson

Source: Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, skills, and resources for pharmacy informatics education. Am J Pharm Educ. 2011;75(5):Article 93.

Community pharmacists’ use of language access services

One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare.  The issues surrounding it can almost be insidious in nature.  Despite this, health literacy is typically only given superficial coverage in traditional training programs. 

Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP).  It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients. 

In part to address this, there was actually an Executive Order mandating “meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?).  Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments.  However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue.  What, if any, impact has this had on reimbursement or outcomes?  The jury is still out.  However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).

Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’.  Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they “never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS).  Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings.  Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages.  Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app.  My understanding is that a future update will (ahem) include pharmacists in the introductions section. 

Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.

@kevinclauson

Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study.  Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists.  Separately, this JAPhA LAS study was funded by a NSU President’s Grant.  Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.

 

Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.

Mobile Health 2011: A Look Back at What Really Worked

Stanford Guest House

Mobile Health 2011: What Really Works at Stanford University (#mh11) is over, so it’s time for a quick look back at the conference.  To borrow (steal?) from conference organizer, Stanford Persuasion Technology Lab director, and quick-change artist @BJFogg – I am going to take a retrospective look at my experiences there through the device of ‘home runs’.  For full speaker slide decks, you can click here.

Conference Atmosphere Home Run
I have been to a lot of conferences…pharmacy conferences, medical conferences, informatics conferences, and social media conferences.  However, I have never been to a conference that seemed more along the lines of an ‘event that happens to be interspersed with speakers’.  This is not an indictment of the quantity or quality of the speakers; somehow there were >50 of them smoothly shoehorned into two days.  The comment is more about the carnival-like atmosphere surrounding the conference that made it fun and exciting, and contributed to a very collegial vibe.  One of the best aspects of Mobile Health was the extended breaks.  They were just plentiful enough and twice as long as an average conference.  If you think about the old chestnut ‘the best value at a conference is the hallway conversations’…voila! Those breaks doubled the value of the conference.  Also helpful was Fogg’s “giving permission” to all attendees to go up to anyone there and say hello, reinforced by the speakers largely making themselves available after panels concluded.  I’m still undecided about a few things (e.g., the birds and the bees); however, balancing all the West Coast wackiness was the fact that the conference was timed and chimed down to the minute.  Seriously.

Lodging Home Run
It’s almost like this place is a secret or something.  I stayed at the Stanford Guest House for their conference rate of $109.  You can barely stay at a Roof Rouge near a major city for that.  The rooms and hotel were basic and a little Spartan, but the beds were comfortable, the place was immaculately maintained, and the staff was gracious and knowledgeable.  The deal-maker was that the Stanford Shuttle (Marguerite) had pick-ups ~ every 20 minutes to take you all over the campus.  There was also a Guest House shuttle that could be reserved (e.g., to take you to the Alumni Center‘s conference venue).  The only drawback was that there were no dining options in-house or within easy walking distance.  Definitely will stay here again next time I’m at Stanford.

Almost Made Me Apply for a Job in Public Health Home Run
Sharon Bogan.  You just have to love somebody with that kind of spirit, fighting the good fight, excerpting Monsters, Inc., innovating in resource-limited settings, and inviting litigation (for others).  Everyone I’ve met from King County Public Health going back to the mhealth Summit has been a gem.

Goosebump Home Run [tie]
Green Goose and Proteus ingestible event markers.  Check them out.  Seriously.  They *literally* gave me goose bumps in thinking of potential applications of their technologies during their presentations.
Honorable mention: Google Cow presented by Google’s Chief Health Strategist (@rzeiger).  Technically he was focusing on Google Body, but since I had already seen Body I was pretty happy to see the bovine version.

Reunion Home Run
It was great to see @chiah @EndoGoddess @JenSMcCabe  KarenCoppock  @LarryChu  @SFCarrie  @SusannahFox and loads of others again!

New Peeps Home Run [misc]
If you are worried about our future, know that we are in good hands with people like @hcolelewis coming on the scene
Most likely to isosceles with regarding mHealth, PAHO, & Uruguay @JuanMZorrilla
Most likely to invite for Skype in guest lecture in my Consumer Health Informatics course @QpidMe
Most likely to explore the mHealth studies based out of our campus in Puerto Rico with @MarcosPolanco
Most surprised to find in my back yard Vic Shroff
Note: any conversations that included words like NDA, lawyer, or launch are not listed here for obvious reasons.

Failed to Connect at All Strikeout
I would have liked to have spoken with @enochchoi

Conversationus Interruptus Strikeout
The Keck and and PHI guys

Best Laid Plans Strikeout
Climate control and the janky A/C resulted in groups of attendees going to the outer hall and watching panels on a screen and/or going outside to cool off.
(Dis)honorable mention: minimal power outlets/juice available was surprising.  This problem was offset somewhat by the length of the breaks which allowed for both networking and recharging.

Least Favorite Panel
The Partnerships panel was my least favorite.  It definitely had eye-opening moments for some attendees and there were interesting discussions and placements (e.g., possibly the least and most idealistic two people at the entire conference were seated next to each other).  However, most of the discussions were pretty familiar to me from having gone through many of the processes described.  So my bias/preference would have been to have instead heard more specifics about MedPedia from James, Medic Mobile or Social from Josh, etc.

Overall Favorite Panel
Very tough decision as there were several really outstanding ones.  I considered a tie here but was able to pull the trigger and name “Methods and Measures for Research and Evaluation” as my favorite overall panel.  The moderator and panelists all had great content to share and illuminated a lot of the challenges in conducting research in this space.  Plus the Open mHealth initiative is so encouraging!  I think this panel is a ‘must view’ for everyone as it can help in introducing a common language that could lead to better coordination and scaling of efforts as well as providing guidance for individuals.  Overall, the quality and detail of this panel was exemplary.  I ended up choosing it in part based on the criteria of ‘if I could only have the full video of one panel’ because of its high utility for me and in sharing with multiple audiences.  Many of the slide decks from this panel are here.

Final Verdict
I am definitely happy I attended both the pre-conference workshop by @BjFogg (although it mostly served to whet my appetite for the full Boot Camp) as well as the conference proper.  I have been to some good conferences that were one-offs, but will absolutely figure out a way to make it back to Mobile Health next year.  My two most substantial takeaways were that the construct of this conference was singular in nature and that it was probably easier to connect with potential collaborators here than at any other conference I’ve attended.

@kevinclauson

Update: other perspectives on the conference have previously been posted here by @thulcandrian of AIDS.gov and a take on mHealth by @geoffclapp here.

Update 2. Here is a new conference highlights post by Craig Lefebvre (who I wish I had realized was @chiefmaven when I met him there)

Update 3: ‘Text in the City’ founder Katie Malbon has written the most ambitious mh#11 wrap-up to date

Update 4: If @TextInTheCityNY had the most ambitious/complete post, @geoffclapp has added the most thoughtful and thought-provoking review to date

Update 5: From the ‘people I wish I had a chat with’ file at #mh11, @AndrewPWilson has now provided his main takeaways from Stanford

Update 6: Patient-centric thought bubbles and more from e-Patients.net rep @msaxolotl at #mh11

Update 7: Jeff Kellem (@slantedhall) provided a tech-focused list of quick hits from the conference

Update 8: David Doherty (@3GDoctor) has added the most contrarian view of the conference to the conversation here

Social Media & the Role of the Patient

Our College of Pharmacy recently held its annual student seminar night. A semester’s worth of P3 student work culminated in over 100 podium and poster presentations. There were a number of outstanding student efforts; however, I am featuring this one is it fits the theme of the blog and the student group made it available on Slideshare. The work represents their preliminary analysis and has some interesting findings. Congrats to them and to all of our students. I look forward to seeing a final version of this and several others at the FSHP Annual Meeting.

@kevinclauson

ULP Review of Asus Slate EP121 (TabletPC)

Ill try to get a better picture uploaded soon

While I am fully entrenched in the iPhone bandwagon, I have not purchased an iPad (or a TabletPC)…or really anything else other than a standard laptop since I tried a LG Phenom, and a ZX81 (Timex Sinclair 1000) prior to that.  However, I recently took the plunge and picked up an Asus Slate EP121.

It is important to qualify my review by stating my intended purpose for the Asus Slate is as a laptop replacement with tablet functionality, *not* primarily as a tablet.  This unit is to be a work computer.  As such, it has to be powerful enough to run a full Windows 7, the complete Microsoft Office suite, etc.  I anticipate about a 70/30 mix of ‘laptop’/tablet usage in my everday work activities.  This, of course, subject to change during periods of travel like conferences and the like.

Specs as purchased ($1099, free shipping, free Microsoft Signature install)
Windows 7 Home Premium, Intel i5 Dual Core, Intel HD graphics, 12.1″ Gorilla Glass screen, 4GB Dual DDR3 RAM, 64GB SSD,  weight of 2.5 lbs, two (2) USB ports, mini-HDMI output, SD Card reader, 2MP (videoconferencing) camera.

Also came with:
Folio case (doubles as a stand as depicted above)
MS Mobile Bluetooth Keyboard 6000
Wacom Pen/Digitizer w/Eraser
Power supply with extra embedded USB charging port

Pros
*It is faster than my current (old) laptop Dell XPS M1530 in every measurable way, so its a clear upgrade for me
*I am already trying ways to incorporate the added Tablet & Stylus functionality into teaching, taking notes in meetings, etc. I really like the seamless integration of MS Office/PDFs/OneNote with the enhancements of the Wacom pen and the sprawling screen size to write comments, notes, etc. in an unobtrusive way (vs trying similar with touch laptop where it is a little less natural and you get the occasional arched eyebrow).  We will also be using tablets in some of our studies for consenting patients, getting baseline data & scores, etc.  and I anticipate fewer issues with data conversion and related issues since both systems are Windows-based.
*I haven’t had any problems with its touch interface so far…then again, my only real long-term comparator is the iPhone4
*Boot time is much faster than anticipated (<30 sec from pressing button to surfing the net) and hibernate mode works really well as it consumes almost no battery and launches in about 3 seconds
*I can’t imagine having any handheld device without a webcam for videoconferencing (e.g., meetings and teaching classes), as well as USB ports, and a video out…fortunately, this is not an issue with the Slate
*Turns out 2.5 lbs is lighter than I thought
*I can’t believe I am excited about a keyboard, but the one that came with it is *really* good; similar sentiment for the folio
*Embedded USB in power cord is nice touch, can plug in and simultaneously charge iPhone with just one plug at airport…minor issue, but appreciated
*The ArtRage software & stylus should allow for creation of some nice infographics

Cons
*The battery life is terrible. I mean, I knew it was low based on reviews and that in order to run 7 and to power the gi-normous bright screen that it would take juice, but…I tried a couple of different tests and read about similar online. Streaming Netflix over Wifi only yields about 2.5 hours.  Performing low demand work tasks, I can get about 4 hours out of it.  This is normally ok as I am using it as a work computer on my desk, but for travelling, etc. it would have been nice to have been able to get in two movies.
*64GB is nice and Asus offers free ‘unlimited’ cloud storage with it (and there is always SkyDrive, etc.); plus it has USB and SD, but I have 10GB on my laptop just in licensed stock photos – so no way the Slate will comfortably holding all my files.
*Had to get a Bluetooth mouse to fully replicate workstation
*If you are expecting instant-on, power-up you will be disappointed
*HDMI is nice, but will have to navigate the plentiful VGA machines

Verdict
It’s early days, but so far I am very happy with the Asus Slate.  I suspect people looking for a serious work machine with 7, Office, etc. plus the benefits of Tablet functionality will be happy with the Slate too.  Others simply looking for an alternative to the iPad to surf, read, and play Angry Birds on probably will not be.

Other People’s Opinions
The Aussie ZDNet/cnet site has a pretty good video review of the Asus Slate.  I think it was overly harsh on some aspects and I have no idea why they encountered any difficulty with connecting the Bluetooth keyboard – but they give a fair appraisal overall and had some glowing words about it, summed up by “this thing’s pretty damn good”.

Click to launch to video review

Elsewhere, one ‘enthusiast’ created the most comprehensive audio/video review I have ever seen for ANY product, luckily it is for the Asus Slate.  He has also been trying to answer questions about it, even prior to release in Canada.  My review will give you an indicator, but his site and Product Tour is a must visit if you are seriously considering purchasing an Asus Slate EP121.  Actually, even if you are not that serious, you should check out the thoroughness of this guy’s review.   Amazing.

Hope this helps. Obviously, I would be very interested to hear if you get an Asus Slate and/or about your experiences with one.

@kevinclauson

Disclosure: I did not receive any consideration for this review.  I did receive free overnight shipping that was available to anyone who goes to: http://www.facebook.com/windows and gets the code.  However, when I tried to use the Facebook code at the Microsoft store online, it  did not work.  So, then I clicked on the proffered Live Chat to ask about the code.  Chat told me I had to *call* customer service to ask them about it.  So, then I sent a tweet at “Matt at the Windows Social Media Team” about it and never heard back. Lost opportunity. Ironic.

Consumer Health Informatics Course – TYVM Guest Lecturers

Last semester I taught Consumer Health Informatics and Web 2.0 in Healthcare in the College of Pharmacy (COP) after having coordinated several iterations of it in the MS in Biomedical Informatics Program. At the end of the COP course, I asked the students for their opinions about the most useful and least useful lectures of the semester (with an eye towards improving future offerings). Many of the students mentioned topics that were discussed by one of the six excellent guest lecturers. While I sincerely appreciate each guest lecturer’s contribution, I thought it would be even more meaningful to share a student response about each guest lecturer/topic.

I’ll use the format below to do so (lecturers appear in the order they taught during the semester):

Student quote
Guest Lecturer
Affiliation
“Lecture Topic”

The course’s most useful lecture was Dr. Kang’s since it focused on policy and the big picture instead of just one or two tools.
Jeah-Ah Kang, PharmD
Food and Drug Administration (FDA), Division of Drug Marketing, Advertising, and Communications (DDMAC)
“Promotion of FDA-Regulated Medical Products Using the Internet and Social Media Tools”

Most useful was Dr. Gualtieri’s because it may be the only one that really looked at things from the patient’s side.
Lisa Gualtieri, PhD, ScM
Tufts University School of Medicine
“Blogging for Health: Communicating the Experience of Illness”

Most useful lecture was Dr. Dyer’s lecture. It was very cool seeing how healthcare was using this new tech and getting positive results. Very. Cool.
Jennifer Dyer, MD, MPH
Ohio State University, College of Medicine
“RU TAKING UR MEDS? (DR. SEZ TEXTING TEENZ HELPS!)”

I would like to see more experts like Dr. Fahrni. His lecture was most useful. It provided insight on what this breed of pharmacist does on a daily basis.
Jerry Fahrni, PharmD
Kaweah Delta District Hospital (now Talyst)
“Pharmacy Informatics – One Pharmacist’s Perspective”

The most useful topic was Dr. Mesko’s on virtual worlds because it was most forward looking. I wish we would use it more and create our own avatars.
Bertalan Mesko, MD
University of Debrecen Medical School
“Medicine in Second Life, the virtual world”

The most useful lecture topic would have to be the final lecture from Dr. Fox, it was extremely informative and I enjoyed it a lot. I’d like to see an additional lecture from him.
Brent Fox, PharmD, PhD
University of Auburn, College of Pharmacy
“The Pharmacist’s Role in Health 2.0”

 

Social media presence for the course contributors can be found here:

Lisa Gualtieri, PhD, ScM (@lisagualtieri)

Jennifer Dyer, MD, MPH (@EndoGoddess)

Jerry Fahrni, PharmD (@JFahrni)

Bertalan Mesko, MD (@Berci)

Brent Fox, PharmD, PhD (@Brent_Fox)

 

@kevinclauson

Fun with Fonts feat. Profs Perry & West

One of the best things about working in academia is interacting with a constantly changing set of students.  We have a particularly diverse group at my University in terms of background, country of origin, language, and maturity.  And while it may be cliche, it is true that in teaching them you can learn just as much from them (if you are open to it).  I have dabbled with aspects of instructional design, cognitive load theory, multimedia learning, etc., and other RxInformatics folks like @poikonen have posted about Beautiful Evidence, but I recently had a rotation student focus my attention on a seemingly simple element: font.  Mr. Salvatico opened my eyes a bit in terms of free resources for fonts and their utility.  While we didn’t see eye-to-eye on the frequency of font variation in lectures, I definitely learned from our exchanges.  In the spirt of these exchanges, I present the following Fun with Fonts ‘case study’.  Please be aware these lyrics do carry a parental advisory warning.

@kevinclauson

P.S. A good way to see if your students are actually listening in class is to introduce this clip by Katy Perry and KENNY West and see how fast it takes one of them to correct you to KANYE West.