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

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

 

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

Issues with translating prescription information into other languages in pharmacies

(Click image above to view larger version)

There was a recent news item taken from an article in Pediatrics examining what happens when computerized language assistance services (LAS) are imperfect.  It focused on the erroneous translation of prescription information from English to Spanish in pharmacies in New York and possible consequences.  That was similar to an aspect of our LAS research we highlighted in an interview in The Oncology Pharmacist several months ago.  We are examining related problems as well, including low- and high-tech solutions to varying issues with LAS (e.g. automated LAS kiosks, natural language processing, pictographs).  In December 2009, we presented a poster of the results of a national survey of the use of language assistance services (sometimes called language access services) in community pharmacies.  One of the major concerns in using LAS cited by pharmacists (52.1%) in our study was about mistakes made with translations (written) and interpretations (verbal).  Their concerns appear to be at least somewhat justified based on the results of the Pediatric study.  This is a contributing factor as to why almost half (49.8%) of pharmacists in our survey who have LAS fail to notify their patients of its availability.

@kevinclauson

Federal Pharmacy Forum, PAHO, OAS, APhA and Other Acronyms

 
 

I love living in South Florida, but after this week DC may be my new mistress.  I find the magnitude of what is going on here bordering on unbelievable.  I’ve been here previously, but have never really had an opportunity to take a look around.  I was also struck by the sheer volume of living history in DC.  There are some pretty good restaurants as well from Matchbox (introduced to me by @lostonroute66) to Zaytinya.

Having just returned from a health promotion conference in Puerto Rico, I was able to visit with several folks at the Pan American Health Organization (PAHO) to explore opportunities during this visit.  Some I had met here previously and some were new to me.  There was a common thread throughout the PAHO folks in that they are driven, but warm people…and it is always nice to see the face behind @eqpaho.  I also learned a lot about the Organization of American States (OAS).  I met with a couple people there as well to discuss some upcoming projects.  Finally, I had the opportunity to open the second day of presenters for the Federal Pharmacy Forum.  The Forum directly precedes the American Pharmacists Association (APhA) Annual Meeting (thashtag #apha2010).  The Forum was very much an eye-opening experience for me as the attendees were primarily military pharmacists and technicians with other representatives from the Federal sector as well.  I presented “Debunking Myths About Generational Use of Social Media and Healthcare“.

The keynote on the first day of the Forum (Ginny Beeson) did a great job of laying the groundwork for a dialogue about generational considerations in military pharmacy.  There were also several other topics particularly of interest to me including telepharmacy in the Navy (apparently each branch has a different certification body making widespread rollout across branches almost impossible), pharmacoeconomic studies, medication therapy management (MTM), deployment of pharmacists and the current state of practice of US military pharmacy in Afghanistan.  It definitely made me more thankful for the setting I operate out of and appreciate the challenges of this segment of the profession.

Overall it was a great visit, I learned a lot (including how little I thought I knew), and am looking forward to my next visit.

@kevinclauson

“The Internet Makes Us Sick”: A Classic Revisited

I recently gave a lecture on meta-analyses as part of a Drug Literature Evaluation course.  One example I typically use to illustrate the importance of critically evaluating literature combined with the potential impact of the media is, “Is Cybermedicine Killing You” – The Story of a Cochrane Disaster.  It is an editorial published back in 2005 in response to a fatally flawed Cochrane paper that was ostensibly published as a review of, “interactive health communication applications” (IHCAs).  The review’s plain language summary described it as “computer-based programmes for people with chronic disease”.

In my mind, there are four key observations about that situation:

1. The nature of the research being reviewed was mischaracterized from the beginning.
As pointed out by Eysenbach and Kummervold, the studies included in the meta-analysis were all interventional in nature (i.e., in addition to an informational piece, there was an accompanying, structured aspect of decision support/behavioral change).  However, most of the media headlines generated from that Cochrane review omitted the interventional aspect and presented it in terms of consumers passively looking at health-related information on the Internet.

2. The authors of the Cochrane review arrived at a flawed conclusion and admitted it.
The authors of the JMIR editorial pointed out several “stunning” mistakes in the review including: data extraction errors, and that conclusions about positive outcomes from the eHealth interventions were misinterpreted as harmful.  The editorial re-examined the work and actually found that only 2 of the 11 study interpretations were correct.  Some of them were startlingly basic errors such as classifying a reduction in hemoglobin A1c (HbA1c) in the intervention group and an increase in HbA1c in the control group as a bad outcome.

3. The retraction acknowledging the erroneous findings barely caused a ripple.
After the flurry of media stories about the supposed dangers associated with looking online for health information, very few news outlets publicized the retraction.  This is despite the retraction being issued in only 13 days.  Further, the revised conclusion archived in the Cochrane Library stated the opposite findings from the original that, “IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users.”  Nothing nefarious here; it is pretty common to see sparse coverage allotted for retractions versus the “if it bleeds, it leads” initial coverage.  But it is still regrettable.

4. What could have been an early blow to eHealth and empowered patients was avoided.
Given the authority of Cochrane reviews, the unease of many clinicians with patients seeking health information (even more pronounced five years ago), and the relatively early stage of consumer health informatics – this inaccurate condemnation could have proved detrimental to the advancement of the specialty and efforts by what are currently referred to as e-patients.  Fortunately, a few researchers, authors, and advocates discovered the situation and acted swiftly to correct it.

It always surprises me that this story is not related more often, especially among those involved with its related fields or movements.  There are not a lot of situations that can serve so aptly as both a cautionary tale and one of promise and encouragement.

@kevinclauson

 

References

Links for all relevant, full-text publication are embedded in the text.  Here are the written citations just in case.

Eysenbach G, Kummervold PE. “Is Cybermedicine Killing You?”–The story of a Cochrane disaster. J Med Internet Res 2005;7(2):e21.

Murray E, Burns J, See Tai S, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev 2005; (4):CD004274. 

Teaching a Course on CHI & Web 2.0 in Healthcare

Last year I developed a course titled “Consumer Health Informatics & Web 2.0 in Healthcare”.  It was an excellent learning experience for me and hopefully beneficial for the students as well.  The course was offered last semester in our College of Osteopathic Medicine – Biomedical Informatics Program.  I plan to offer a similar course next semester in our College of Pharmacy tailored for those students and capitalizing on the lessons learned from the previous version.

While my course was a hybrid of consumer health informatics (CHI) and Web 2.0, the very first Web 2.0 and Medicine course was created by Bertalan Mesko, MD.  Dr. Mesko (perhaps better known as @Berci) pioneered it when he was still a medical student.  Berci was quite helpful in the early stages of the conception of my course and even went on to contribute a brief guest lecture on virtual worlds.  Additional resources have since appeared in the literature detailing experiences teaching Web 2.0 in other disciplines.

My course covered basic CHI terminology and subjects like health information seeking behaviors and the evolution of participatory medicine as well as related topics like open access and digital health literacy.  Additionally, it touched on some ‘classic’ informatics tools and technologies like telemedicine, mHealth, and electronic/personal health records.  The course also featured a second guest lecture by Joan Dzenowagis, PhD, who spoke about Internet safety, governance issues, and the dotHealth initiative.

One of the main things I wanted to accomplish with the course was to have the students use the actual Web 2.0 tools and technologies that we discussed in practical ways.  To that end, they completed a series of mini-projects including: editing health-related Wikipedia entries, creating Twitter accounts to follow thought leaders in their subspecialties, and creating RSS reader accounts to help manage their flow of information.

Overall, the course was well-received and I was relatively happy with its maiden voyage.  My plan now is to continue modifying, customizing, and retooling the course based on the needs of pharmacy students and the previous students’ feedback and then submitting to the College of Pharmacy curriculum committee in the coming months.  In the interim, I welcome your comments and questions.

@kevinclauson

Meet the Consumer Health Informatics Subspecialty!

Pharmacy is a profession in healthcare.  Pharmacy informatics is a specialty within this profession. It is not yet one of the recognized specialty areas by the Board of Pharmaceutical Specialties, but it is a specialty nonetheless.  Consumer health informatics is a subspecialty within informatics, and can be integrated with pharmacy or any other profession in healthcare.  My path has led to immersion in the possibilities associated with consumer health informatics.

Consumer health informatics (CHI), like medical informatics, health informatics, and pharmacy informatics, suffers from a bit of an identity crisis – or at least a lack of consensus terminology.  The two working definitions for CHI that I am particular to are:

“…analyses consumers’ needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers’ preferences into medical information systems.”

British Medical Journal article by Eysenbach

“…studies from a patient/consumer perspective the use of electronic information and communication to improve medical outcomes and the health care decision-making process.”

American Medical Informatics Association’s

CHI Working Group

One of the most attractive elements of CHI was also summarized quite nicely in the review by Eysenbach:

“Consumer informatics stands at the crossroads of other disciplines, such as nursing informatics, public health, health promotion, health education, library science, and communication science…it is paving the way for health care in the information age.”

There is much to appreciate in the inherent collaborative and participatory nature of the CHI subspecialty.  Because of its characteristics, aspects of Web 2.0/social media are also frequently included under the CHI umbrella.  The interdisciplinary approach of CHI was born out of necessity and offers the chance to capitalize on the strengths of multiple professions and ultimately improve outcomes.  I look forward to exploring the promise of CHI and its potential impact on the constantly changing world of healthcare.

@kevinclauson

[Note: Thanks to Chad Hardy (@pillguy) for the invitation as a blog contributor at RxInformatics.com]