Health Informatics and Health Professional Education

1. Health Informatics and Health Professional Education Dr Rachel EllawayUME Assistant Dean Curriculum and PlanningNorthern Ontario School of Medicine

2. Conflict of Interest • Iam an Associate Professor at the Northern Ontario School of Medicine and a Director of eHealth Ontario. • The following presentation represents my own opinions and in no way represents the views, policies or positions of eHealth Ontario or any related party or institution • I receive no material gain from any source other than the Northern Ontario School of Medicine with respect to my work in eHealth

3. When we look at e-health …

4. Overview • The world we made • Ecologies • Cyborgs • Digital professionals

5. The World We Made

6. Five dimensions of ‘e’ Acceleration Reach Integration Observation Abstraction

7. "Virtual Society?” • The uptake and use of the technologies depend crucially on local social context. • The fears and risks associated with new technologies are unevenly socially distributed. • Virtual technologies supplement rather than substitute for real activities. • The more virtual the more real. • The more global the more local. Woolgar, S (2002) Virtual society? Technology, cyberbole, reality. Oxford: Oxford University Press.

8. Deconstructing e-Health Change … • What is done • How it is done • Shift in possibilities • Shift in values • Shift in responsibility • Shift in power

9. Artifact or activity?

10. Ecologies

11. Big Projects • CH Infoway + provincial programs • UK Health IT program • VA program, other US • Swedes, Australians … • But, plurality of systems, technologies • Solutions are always BIG, technocratic • Focus is on the monolithic • Successes often tend to be smaller, local … later federated

12. A Time of Change • We are currently training the last generation of health professionals who can (just) remember a time before the web • We are currently training the first generation of health professionals who will work predominantly in an e-health environment

13. “The paradox of the future health system is that we will have much more primary care, and primary care will be more important than ever, but …” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

14. “… it will be supplied predominantly by patients and non-physicians with backup from specialized primary care providers who are mastered diagnosticians and clinical decision makers, powered by health information and organizational supports” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

15. “First, physicians will have to be smarter than ever, and they will have to keep learning throughout their careers at accelerating and demanding pace” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

16. “Second, no matter how smart they are, they will need a lot of help from organized systems of care - whether real or virtual” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

17. “Third, they will have to be trained to adapt continually to a changing informational environment and a changing health care system” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

18. “Fourth, the demand for traditional cognitive physician services will decline, and cognitive services themselves will become more specialized and harder to perform” Rothman, D and Blumenthal, D, Eds. (2010). Medical Professionalism in the New Information Age. Piscataway, NJ, Rutgers University Press

19. Are we ready in education? • Despite this there have been almost no changes to the way we teach and assess health professional learners • Teachers do not incorporate e-health • Professional frameworks do not incorporate e-health • Digital tech in education = content or tool, rarely environment or process • We need to change …

20. Result? • A generation of new doctors increasingly unprepared for contemporary practice • Doctors excluding themselves from the healthcare mainstream? • Exotic specialists but not in control, not at the centre of healthcare • In the meantime

21. Cyborgs

22. we are cyborg‘cybernetic organisms’ Clynes and Kline, 1960

23. Cyborgs • Killer robots • Androids • Bluetooth presence • Learners + devices

24. The Cyborg Professional • information technologies are cognitive prosthetics • both professional and profession are changed CC Image: Stanford EdTechhttp://www.flickr.com/photos/stanfordedtech/4911444507/sizes/l/in/photostream/

25. Clark “our tools are not just external props and aids, but they are deep and integral parts of the problem-solving systems we now identify as human intelligence …” Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5

26. Clark “… such tools are best conceived as proper parts of the computational apparatus that constitutes our minds” Clark, A. (2003). Natural-Born Cyborgs. New York, NY, Oxford University Press.p5

27. The Cyborg Professional • information technologies are cognitive prosthetics • both professional and profession are changed

28. Information prosthesis • How much do you need to remember? • How much did your teachers? • Tech extending the memory • Competence becomes knowing how to know • LCME, CanMEDS, FMEC?

29. Logistical prosthesis • How dependent are you on your device? • Calendar, contacts, maps, reminders etc • Personal information management (PIM) • Cybernetic wayfinding

30. Communication prosthesis • Synchronous/asynchronous • Redefining presence • Multiple channels and media • Trading cartels and guilds

31. Social prosthesis • ‘me in the cloud’ • Facebook is the web: 540 million unique users per month

32. Where are your learners learning? • Digital cornucopia • Learners interact with the institution and its activities – value network 1 • Learners interact and share with their immediate peers – value network 2 • Learners interact and share within their programs – value network 3 • Learners interact and share with learners in other schools - value network 4 • 1:1:1

33. Result? • Learner activity largely unseen by their institutions • Significant trading and exchange of learning resources • Different norms, checks and balances • Medical schools as necessary rites of passage but not necessarily the dominant locus of study

34. Digital Professionals

35. Net Generation CC image: x-ray delta one http://www.flickr.com/photos/x-ray_delta_one/4999806047/

36. Net Generation • Digital Immigrants and natives • Mostly spin • Youth have opportunity + very low risk • Confidence >> competence • Medical learners very atypical • But … • Last to remember pre-Internet • First to practice in a largely e-health environment

37. Digital Professionalism

38. Learners, trainees, students “many medical students seem unaware of or unconcerned with the possible ramifications of sharing personal information in publicly available online profiles even though such information could affect their professional lives” (Ferdig et al, 2008)

39. Learners, trainees, students “learners' information literacies are relatively weak but learners have little awareness of the problem” (Beetham et al 2009)

40. Digital Professionalism • A hidden curriculum of digital professionalism … • We are troubled by the digital in our learners, in our institutions • Digital ‘misdemeanors’ on the rise • Response is to regulate and punish

41. Digital Professionalism • We used to punish poor communication skills or professionalism even though we had never taught it • We like to think we are enlightened • Should we not model, assist and guide professional digital professionalism?

42. Attention Deficit Disorder • The principles of professionalism stand • The context, the environment, has changed • No requirement (yet) for programs etc to address digital professionalism • Meanwhile risks, scandals and too many near misses

43. DP#1 • Establish and sustain an on online professional presence that befits your responsibilities while representing your interests … • But be selective where you establish a profile 1

44. DP#2 • Your professional identity extends into all online communities you join, and you are still a professional there 2

45. DP#3 • Use privacy controls to manage more personal parts of your online profile • Do not make public anything that you would not be comfortable defending as professionally appropriate in a court of law or in front of a disciplinary panel 3

46. DP#4 • Think carefully and critically about how what you say or do will be perceived by and reflect on others, including individuals and organizations. • Act with appropriate restraint. 4

47. DP#5 • Almost everything online can be monitored, recorded or data mined by multiple groups. Consider every action online as permanent. • Think carefully and critically how what you say or do online today will be perceived in years to come. 5

48. DP# 6 • Pretence and deceit are inappropriate behaviors for health professionals • Do not impersonate or seek to hide your identity for malicious or unprofessional purposes. 6

49. DP# 7 • Be aware of the potential for digital attack or impersonation • Know how to protect your reputation and what steps to take when it is under attack 7

50. DP# 8 • Theft and piracy are not acceptable for any professionals • Work within the law. 8