mHealth Summit 2010 ATF Part 1

I already miss the sound of the techno music from the Walter E. Washington Convention Center at the 2010 mHealth Summit.  Because I’ve seen a number of questions about what mHealth is, here is my preferred definition from lecture courtesy of @mHealthAlliance: “the use of mobile devices and global networks to deliver health services and information”.  One reason I like this definition is its emphasis on the ‘network’ piece.  It allows for a much broader application.  I understand the desire by some for the term uHealth (u=ubiquitous) and others, like one presenter at AMIA 2-3 years ago from Rockefeller, who yearn for everything to eventually just be ‘health’.  While recognizing that the types of labels like mHealth can definitely be problematic in the long-run, they also can be really useful in the short term for conveying a basic context, getting people to the table, and creating rallying points…which brings me to my next point.  One of the oft-parroted comments of the Summit was that there was too much hype about mHealth.  Unfortunately the word ‘hype’ was being used interchangeably with ‘excitement’ in many cases.  Of course mHealth isn’t a panacea and there are serious obstacles to navigate.  But let’s not lose sight of the fact that it is really hard to motivate people, to excite people, and to generate momentum…and mHealth is accomplishing those things.  So please let’s not be so terrified about overpromising and under-delivering that we squash genuine enthusiasm.  Of course there are speed bumps and as @joncamfield noted, there are definitely some mobile parlor tricks to be wary of out there (he also had the fantastic idea of an implementer track for next year).  In the interest of being fair and balanced, here is an example of a public health/mHealth app featuring augmented reality that may mean well but has questionable execution [EDIT: yes, the video below is for an actual app].

Onto the conference proper…David Aylward, Executive Director of the mHealth Alliance, began with a pseudo-demo of wearable body area networking for basic vitals.  Side note: Aylward closed the conference while wearing a Bugs Bunny tie that I speculated was an ode to Ted Turner and his Cartoon Network.  This remains unconfirmed.  Slightly more relevant, the conference was livestreamed and h/t to @planetrussell who noted that videos from the stream are starting to appear in various YouTube channels.

 

The first two WOW moments of #mhs10 for me included the announcement of the 2011 NIH Summer Institute on mHealth Research, which will provide specialized training opportunities for 25 researchers.

 

The second was during a panel presentation by @JoshNesbit in which he shared a word cloud of the tweets from Haiti following the earthquake.  The wow moment was when he pointed out that the second most tweeted word was ‘please’.  That revelation definitely gave me pause. 

End ATF: Part 1

@kevinclauson

 

Part 2 may or may not highlight snarky entrepreneurs, bedsore-preventing robots, keynote Star Wars quotes, and actual data.

Two Billionaires, The White House, The Rockefeller President and mHealth

The title of this post is shorthand for four of the keynote presenters at next week’s mHealth Summit (follow at #mhs10) in Washington DC.  In addition to these four keynotes by Bill Gates (@BillGates), Ted Turner, Aneesh Chopra, and Judith Rodin, there is a great lineup of speakers and moderators.  There is a dizzying array of tracks and talks to choose from, but for me there are a handful that are particularly relevant.  These include  Najeeb Al-Shorbaji, who directs KMS at the World Health Organization, @SusannahFox of Pew Internet & American Life and e-patients.net, who is asking the right questions and always has cool new data right around the corner, Matthew Holt (@boltyboy), who is behind THCB and Health 2.0 [and who will hopefully be bemoaning Chelsea dropping points the Sunday prior], @JoshNesbit whose video about Frontline SMS I regularly use in my informatics course and who presents one of the most compelling cases for mHealth [seriously, you may be dead inside if it doesn’t speak to you on some level].

I am also really eager to hear from @HajovanBeijma from Text to Change and Susan Dentzer, who has been very forward thinking as EIC at Health Affairs, as well as to meet Walter Curioso, whose work I have long admired.  Since some of the biggest issues facing mHealth deal with scalability, policy, and interoperability, the mHealth Summit promises to be particularly useful as this conference brings together most of the stakeholders necessary to enact change.  I am looking forward to it.  I plan to be livetweeting and possibly liveblogging some, but I may very well get caught up in the presentations and discussions so I can’t make any guarantees.

@kevinclauson

The secret of great scientists? They don’t watch TV.

I have been re-examining how to best manage my time. My goals have been to find a better way to squeeze out every last ounce of productivity from the time alotted for work (during ‘regular work hours’, nights, and weekends) as well as how to harvest even more time from my day for work (without completely destroying any hope of balance).

During my proscribed organic problem solving time, I came across a suggestion to check out The Secret Life of Scientists, which seems like something @2020science may have recommended. What a great show and idea to get people to look at science differently! The basic premise is that they show a garden variety scientist, but then they reveal their ‘secret’ life or interest as well. A couple of faves include Microbiologist/Professional Wrestler, Game Developer/Clarinetist, and Biochemist/Pageant Queen. If nothing else, you should at least check out some of the clips and ’10 Questions’ such as for Mark Siddall. Unsurprisingly, they asked this leech expert: Twilight or True Blood? His answer? “Are these movies? I don’t have TV.”

Ok, that’s not *that* unusual. I went to pharmacy school with a guy who didn’t own a television. He and his wife, a physician, thought there were better ways to spend their time. Sure, he was easily one of the top three minds of the entire class, but he totally missed out on some pop culture references during conversations! I also saw this same TV deficiency in a couple other Scientists videos like Climatologist/Juggler Gavin Schmidt who was asked: Al Roker or Willard Scott? His Answer? Who?

Perhaps I need to rethink my TV approach, in which I don’t even count watching Arsenal or Titans games because…well, that’s watching sports, not television shows. I’ll watch some TV shows telling myself it’s a way to unwind or disengage and relax. I do think there is some legitimate truth to that. However, we are still (for now) in the era where TV has replaced religion as the opiate of the masses…so perhaps I should book a brief stay in television rehab. In the meantime, I am going to go finish another manuscript and wonder if I could finish twice that many in the same time were I sans television.

@kevinclauson

ULP Digital Pharma Nine Notables

Two-thumb typing on telephone at twenty to thirty thousand feet while things are still fresh in my mind from Digital Pharma East.

Digital Pharma was the first Pharma-centric conference I’ve attended.  My usual professional meeting haunts are either focused on HCPs or are a blend of healthcare industry and technology.  I wasn’t completely certain what to expect other than I would likely be among the minority as a ‘representative’ from academia and pharmacy.  That’s plenty of preface, onto the Notables

Notable Keynote
As much as I enjoyed keynotes by Ian Talmadge, Dr. Bertalan Mesko (@Berci), etc., the one that completely floored me was delivered by Dr. Ian Morrison (@seccurve).  It was the perfect blend of style (his seamless comparison of Pimp My Ride to the state of US healthcare) and substance (holistic view of drivers of medication non-adherence).  Spot on observations, great timing, and natural, unforced humor.  The clip on his site does not do him justice. 

Notable Conversation
@LenStarnes is just a really interesting cat. I found him to have a fascinating global perspective, wealth of experience, and he is a darn good storyteller in his own right as well as being a fellow ZX81 owner.

Notable Attendee
Phil Cranch (@cranchtweet), MSPharm, MComm at The Crystal Agency.  He was the only other self-identified pharmacist there who I saw and tied for my fave Aussie.

Notable Anniversary
Congrats to the folks at Pixels and Pills who are a very precocious, collective one.  Remarkable energy, nice approach, no doubt headed for great things.

Notable Recruit
You just watch, I am totally going to figure out a way to poach @Shwen Gwee and get him back to academia where he belongs. Academia needs more driven people who are also savvy.  Don’t worry; I’ll still let him help the ExL Pharma folks.

Notable Transparency
None. I detected no transparency of note. I get that it’s canine-devour-canine and all that, but still a bit disappointing.

Notable Mobile Experience
I can’t help but think if I had talked to @CynthiaNorth 6 months ago that it would have cut off about a month of prep time for our mHealth research protocols and that we, in turn, would have added perspective and experience that would have enhanced their patient adherence piece.

Notable Connection(s)
My post. My rules. Multiple parts to this Notable. @PhilBaumann of Health is Social may just end up being the first social media healthcare futurist. I feel like Dr. Mike Sevilla (@doctoranonymous), despite his notoriety, is underrated as a presence especially given his remarkable longevity. Dr. Bryan Vartabedian (@Doctor_V) simply gets the need for rigorous research in this area and authors a thoughtful, relevant blog.  After speaking to Gilles Fry (@gfry) a few times, I finally figured out a one-word descriptor for where he resides on the ‘Rage Against the Machine’ to ‘Endearing Curmudgeon’ continuum: Fierce.

Notable Omissions
See above re: rules and limits. Somehow digilicious by @JaeSelle did not fit into the Nine despite a potent combination of sculptor, visual enthusiast, and embracing the inner geek.  And where was @jonmrich curator of the Social Media Wiki?  Great googly moogly that thing is useful.  I planned to thank him for those efforts and to tell him to cheer up.  Health literacy, while not omitted from the conversation, was limited to cameos.  Civility seemed to be omitted at a handful of sessions.  Barely activated patients and hesitant healthcare professionals would have made fine additions to some panels to give a fuller picture.  I did not omit any of the stargazing targets.  However, I’ve obviously omitted at least one great connection, one great conversation, and one great find.

@kevinclauson

Stargazing at Digital Pharma East

I am really looking forward to the 4th Annual Digital Pharma East coming up on October 18th in Philadelphia.  In addition to presenting, I plan to do some major stargazing while I am there.  I don’t mean ‘star’ in the manner of the cult of celebrity.  I am defining stars as people who have something really valuable and/or interesting to say.  It feels a little mercenary to go with the express intent of cherry picking knowledge from experts given the themes around sharing – but I guess that’s just part of the allure.

I’m also very much looking forward to reconnecting with Berci Mesko (@Berci) who I have not seen in a couple years, talking shop with social media flag bearer Bryan Vartabedian (@Doctor_V) who will likely be pressed for time from Co-chairing the event, having a face-to-face chat with Phil Baumann (@PhilBaumann) whose mind works unlike any other I’ve encountered in this space, meeting Gilles Frydman (@gfry) who is the final piece of the ePatient trinity, as well as Shwen Gwee (@shwen) who has both tweet cred and does great work.

In addition to those folks, I may be most eager to see presentations by representatives from Comscore and Within3, along with Cluetrain Manifesto author Doc Searls and futurist Ian Morrison.  Needless to say, I am planning to see every single presentation on the final day, which is dedicated to mobile/mHealth.  The rest of the time, it’s just a question of which Stream.  Finally, I am curious to see how the unconference activities and #SocPharm sessions play out relative to previous HealthCamp events I’ve seen.

As for me, I’ll be presenting “Social Media Research: Partnering with Academia”.  The link to the slides on the Digital Pharma conference site will be provided here after the presentation and will be available beyond that at SlideShare as per.  I’m curious to see the reception given that the composition of the audience is pretty different than who I have been interacting with recently.  I definitely have a (relatively) longstanding interest in the subject as one of the first articles we published on the topic was “Legal and regulatory risk associated with Web 2.0 adoption by pharmaceutical companies” in the Journal of Medical Marketing.  We’ve also published several other studies on interactions between different healthcare professionals and representatives from Pharma.  Ultimately, I am banking on the fact that I actually do what I will be talking about and have some concrete takeaways for those interested in the topic.  I’m also optimistic that using an audience response system and building in time for discussion will help make it legitimately interactive.  We shall see.

Overall, I am looking forward to reconnecting and making new connections, planting the seeds for future research collaborations, and learning from area experts that are rarely available in this concentration.  I hope to see you there, hear your thoughts, or cross paths via #DigPharm (or whatever the hashtag ends up being)!

@kevinclauson

The Beauty of Data Visualization

If you’re not familiar with the website for TED (Technology, Education, and Design) Talks, you are missing out on a great resource that also happens to be free.  Suffice to say for now that the TED events are expensive ($6000), exclusive (fill out an application just to be eligible to pay the 6K), and according to attendees – well worth it.  Fortunately, the Powers That Be at TED decided back in 2007 that if they were really about “Ideas Worth Spreading” then they probably should unshackle them.  For anyone who has to teach or present, these talks represent a mini-master class in communicating in the one-to-many model.  For those looking to see content experts, there are plenty of those.  And for futurists, think-tank wannabes, and people sincerely looking to be inspired to create change – TED has those talks in spades as well.

I recently viewed a TED talk by data journalist David McCandless on The Beauty of Data Visualization.  I decided to watch the video because we’ve been dabbling with data visualization for displaying some of our research findings.  Employing data visualization techniques appears to be growing trend in informatics as one way to help process the unprecedented volume of data that can be accumulated in a relatively short time. 

It turns out McCandless also wrote the book The Visual Miscellaneum: A Colorful Guide to the World’s Most Consequential Trivia, which a student had given to me earlier this year (Köszönöm!).  The technique is akin to a visual version of performing a content analysis to find what themes emerge in qualitative research.   In that way it can also act as its own information filter, detect patterns that are not readily apparent, give context to potentially misleading ‘facts’, and prompt further lines of inquiry.  This book has a little more modern, pop-science feel than the more precise works by Tufte, but definitely prompted me to think about things a bit differently…and that is a pretty big value itself.

The TED video was quite good and had some clever bits such as the examination of military budgets by raw numbers versus as a percentage of GDP, followed by the number of soldiers by country and then per 100,000 people.  It’s a little specialized, but if you’re interested in the topic – it is a treat.

@kevinclauson

A different kind of meaningful use

 There has been a lot of interest in the meaningful use debate surrounding electronic medical records (EMRs) of late, but I read a post by @TedEytan that got me thinking about a different kind of ‘meaningful use’.  The topic of his post was the differences between mHealth and eHealth, but what really caught my eye was the coined term “Internet’s Informant General” (to describe @SusannahFox of Pew Internet).  I had not come across the term before and I found it very striking.  I have recently been working on a project involving panels of key informants representing their respective countries and the idea of this combined with a ‘representative virtual office’ like Internet Informant General was oddly compelling for some reason….much more than another in a line of czars (little ‘c’).  The fact that this office was faux filled by someone on the strength of their research (and ability to communicate/disseminate it) made it even more interesting as an idea.  

Despite being a very competitive process, there are still volumes upon volumes of research published, which vary in quality and utility.  I think it is interesting to see when research transcends limited utility to help affect and drive other research and policy.  This is when ‘meaningful use’ of someone’s work can be said to occur (versus when it can only be harnessed by a handful of specialists who can comprehend it).  Don’t get me wrong, that type of work can be very significant as well – it simply requires a different type of translational process.  However, the efforts of the folks at Pew Research Center on the Internet and American Life Project is reminiscent of the early survey work of David Eisenberg on Complementary and Alternative Medicine (CAM) published in the New England Journal of Medicine.  Eisenberg’s survey paper was largely responsible for creating an awareness about CAM among healthcare professionals and spurring on unprecedented research in the area (and was possibly contributory to the cottage industry surrounding it).  This, too, was research that could be measured by the meaningful use of its findings to affect and drive work in healthcare.

Overall, it’s just very satisfying to see any type of research that ends up with this type of meaningful use.  Sometimes in the midst of the seemingly Herculean effort that it takes to get research funded, or navigated through approval boards, or even just written up – it is easy to forget how a study or a body of work can make such a direct and meaningful contribution.  Cue the old NBC music for...

[Note: I didn’t really mean for the post to end up like this, but what can I say…I can’t quite shake some measure of being an idealist]

@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

Medical Information Resource Deathmatch – A Closer Look

Last month a Letter was published in the peer-reviewed journal Medical Teacher titled, “Is Wikipedia unsuitable as a clinical information resource for medical students? “ [1].  That paper came on the heels of a Letter published in The Annals of Pharmacotherapy on a related topic, “Evaluation of pharmacist use and perception of Wikipedia as a drug information resource“ [2].  The Annals paper had some serious shortcomings (e.g., survey response rate) which likely contributed to its abbreviated publication form.  Its most eye-opening point was that only one-third of the respondents who used Wikipedia were aware that anyone could edit the entries.  This is perhaps the real value of the Letter and why it was published – it helps illustrate the need for education about appropriate online resources in that group.

The Pender, et al. paper also has some methodological aspects that probably limited it to a Letter.  For those without access to Medical Teacher, the results were initially presented as a conference case study.  Because the work of Pender, et al. was accepted for publication, and reminiscent of the Annals Letter, it went on to generate quite a bit of interest among academics, clinicians, librarians, and social media enthusiasts.  The unfortunate thing about this interesting topic is, like all Letters, the available level of detail was below what the authors envisioned and the readers sought.  However, in this case, the dialogue it has helped stimulate may be as valuable as the research itself.  Because I am in the midst of working on a follow-up study to the Wikipedia study we did a couple years ago [3], I searched for more information about the paper – some of which is discussed below.  (As an aside, the new wiki study is the first I’ve worked on that was partially driven by ‘unsolicited, crowdsourced post-publication peer review’.  More anon.)

In the Pender, et al. study, three content experts each evaluated one medical topic according to five criteria (e.g., accuracy, suitability) in Wikipedia, eMedicine, AccessMedicine, and UpToDate.  All criteria used a three point rating scale.  For example, the accuracy scale was: 1=numerous important errors, 2 = some minor factual errors, and 3 = no factual errors.  Accuracy scores for Wikipedia on this scale were 3, 2, and 2 for the topics.  Interestingly, eMedicine scored the single lowest accuracy rating for a topic (rating of 1) of any of the resources.  It did perform well for the other two topics.  Wikipedia fared even worse for suitability with all three topics rated as ‘1’ (“unsuitable”).  An example of the full scores for the otitis media topic is complements of @LKruesi and detailed below. 

 

Data resources

 

Wikipedia

UpToDate

eMedicine

AccessMedicine

Otitis Media

Accuracy

2

3

2

3

Coverage

3

3

2

3

Concision

2

1

3

1

Currency

3

3

2

3

Suitability

1

2

1

1

 

Two librarians led the project, blinded the resource entries for the content experts, and assessed each resource for accessibility and usability.  They used criteria like cost, ease of finding information, and presentation quality to support their decisions.  Wikipedia did very well here, earning the distinction as the most accessible and easiest to use. 

Ultimately, I think this study adds to the literature and has already contributed to the wider community by sparking debate and discussion.  I hope this supplemental information helps address some of the questions I have seen about this study and thanks again to Lisa Kruesi for the spirit of openness and transparency in electing to make the data available. 
 
UPDATE (7FEB10): The authors of the Med Teach letter have archived a full version with results and tables here.

 
   

 @kevinclauson

[1] Pender MP, Lasserre KE, Del Mar C, Kruesi L, Anuradha S. Is Wikipedia unsuitable as a clinical information resource for medical students? Med Teach. 2009;31(12):1095-6.

[2] Brokowski L, Sheehan AH. Evaluation of pharmacist use and perception of Wikipedia as a drug information resource. Ann Pharmacother. 2009;43(11):1912-3. 

 [3] Clauson KA, Polen HH, Boulos MN, Dzenowagis JH. Scope, completeness, and accuracy of drug information in Wikipedia. Ann Pharmacother. 2008;42(12):1814-21. 

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The Wide World of Peer Review

I think about peer review a lot.  This is probably because much of my ultimate success in academia will be defined by the peer review process.  My fellowship director had lots of good advice (especially in retrospect) and while searching for my first job he told me not to go anywhere that they couldn’t clearly describe how they measured success…but that is a different post altogether.  Anyway, the mantra is teaching, research, and service.  And while teaching (especially) and service are important, if you ever want to advance – you have to produce scholarly works.  Research typically requires money (or at minimum, the currency of time) and there is a prevalent school of thought that believes research does not even *exist* until it has been published in a peer reviewed journal.  Every step of the way, you are dependent on peer review.  Your grant and research proposals undergo peer review.  Your abstract and papers for conferences undergo peer review.  Your journal manuscripts undergo peer review.  Now, I happen to love the process of research – so this suits me fine.  I love the process of identifying and prioritizing which question is worth answering, figuring out a methodologically appropriate way to answer the question, actually answering the question (the step with the most mystery), and then converting the answer to some form where it can make a difference.


Being Vexed and Trends in Transparency
I love research.  I appreciate the peer review process.  But sometime peer review vexes me.  I think it is because I have seen how arbitrary and uneven it can be.  This isn’t sour grapes.  I have largely been blessed with great collaborators and decent results (decent results = stuff gets published).  Rather, it is from taking part in panels that review grant proposals and serving as a peer reviewer (and editorial board member) for a number of journals.  Most of the journals I peer review for are the usual suspects in pharmacy practice and informatics, but I have also had the opportunity to contribute in the review process for others like Journal of Immigrant and Minority Health, The Lancet Oncology, and Patient Education and Counseling.  I think serving as a peer reviewer is absolutely fantastic for ongoing professional development and I always try to encourage new faculty to seek out those opportunities.  It is a good way to get exposed to new research in the pipeline, it forces you to truly critically evaluate literature, and it enhances your abilities as a mentor.  Increasingly, due to trends in transparency, you (as a peer reviewer) will sometimes see the other peer reviewers’ comments and the final disposition of the paper after the fact.  This is invaluable.  You get to see how your peer group thinks and reacts to the same information you examined!  Did they miss something?  Did you miss something?  Did they prioritize something differently than you did?  Why?  Why not?  As an intellectual exercise, it is tough to beat.  The whole process is really time consuming if done correctly, but it is an investment.


Revenge of the Throwaway
When I review anything, the basic formula is some version of: rigor+relevance+clarity.  How those items are weighted can vary tremendously.  I think an interesting example is a JAMA study in which a half-dozen physicians evaluated clinical relevance in review articles from peer reviewed journals compared to review articles from “throwaway” journals [1].  Seriously.  Throwaway.  Look it up. (Yes, I know it is common parlance…but I still feel bad for their editors).  Anyway, their findings were that the throwaway journal articles had less methodological rigor, but significantly higher relevance (p<.001).  A bit of the ‘beauty in the eye of the beholder’, eh?
 
There are plenty of issues and controversy surrounding peer review as it is currently practiced.  Some of my favorite topics involving peer review include: open vs blinded, ethical quandaries, pre and post publication, training and consistency, and ‘peer review 2.0’.  The best overview of the topic I have read is by a former editor of BMJ [2].  It has a light enough tone to make it an easy read, but is complete enough to make it worthwhile.  As a bonus, it is available for free, full-text.

@kevinclauson

[1] Rochon PA, Bero LA, Bay AM, et al. Comparison of review articles published in peer-reviewed and throwaway journals. JAMA. 2002;287(21):2853-6.

[2] Smith R. Peer review: a flawed process at the heart of science and journals. J R Soc Med. 2006;99(4): 178–82.

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