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From the International Medical Informatics Association

INFOLAC2011 – Day 1 Roundup

In addition to the keynote talks already reported in the previous post, a number of other internationally-recognised speakers presented at INFOLAC2011 in Guadalajara, Mexico. Some of the presentations were i English, while others were given in Spanish; simultaneous translation was provided for all presentations.

Ed Hammond, from Duke University, USA talked on “Supporting healthy independent living and medical management”. He began from the premise that currently over-65s are 12% of the US population ; by 2030, they will be 19%. This gives challenges, in particular that resources for caring for aging population will be inadequate; aging groups will saturate the healthcare system if we continue using the current healthcare model. In addition, those reaching 65 years old can expect to live another 25-40 years; what will they do with their time? People age differently – but the goal is of independent healthy living.

Ed believes that the focus should be on ‘the person’, and finds even the term ‘patient-centric’ to be inadequate. The hospital, doctor etc. are, or should be, ‘service components’ in supporting health, activity, quality of life, etc. He discussed physical communities, social networking to support interactions and community, and the possibilities of virtual reality to support virtual travel and education. Self-care, he believes, is the only way to deal with the issues – it is an affordable model to enhance healthy, independent living processes, but can be supported by real-time links to healthcare professionals to offer support. Feedback is a critical part of self-care. In closing, Ed asked how we define quality of life; it varies for different people, and probably changes over time. What defines ‘life worth living’? The challenges for realistic healthy independent living in ageing are to recognise limits – but also we need to explore how technology can help accomplish our goals.

Lyn Hanmer, from the South African Medical Research Council and IMIA Secretary, talked on “Criteria for evaluation of health information systems for low-resource settings”. She said that increasing use of computerised health information systems in low resource settings are a relative high proportion of total health budgets, and so in these countries and regions, there is even more need to make sure that they are doing what we want them to do efficiently and effectively. The context for Lyn’s talk is situations where there are limited or vulnerable resources – limited means distribution of resources can be variable, but generally quantities are not enough to meet defined system specs. Vulnerable means access to resources can be interrupted for a variety of reasons. Infrastructure issues may impact availability, as may lack of availability of skilled personnel, variability of funding (present and future) may impact long-term sustainability of systems.

She discussed multiple approaches to HIS development and maintenance – different development models may apply and vary by sector (commercial or public sector) – systems may be developed externally (for different environment) and imported – bespoke locally-developed systems are more likely to meet local requirements. Open source systems may also be used, but equally, may need localisation.  She noted that in terms of evaluation, there are multiple approaches and guidelines – GEP-HI and STARE-HI have been developed at least in part within IMIA. They are useful in planning, implementing and reporting on evaluation studies. Other examples cited were the DeLone and McLean (2003) model of IS success, which includes system use, user satisfaction and net benefits. Assessment of ‘fit’ between IS and the environment is in the ITPOSMO model (Heeks and colleagues on ‘design-reality gaps’) – the HOT-fit model  includes human, organisation and technology factors.

Hanmer (2009) has done work on a revised conceptual model (http://www.ncbi.nlm.nih.gov/pubmed/17911679), resulting in a proposed set of criteria for evaluation: criteria looking at fit with environment and needs (eg are there assumptions in the design that do not match with the local environment); resource availability and allocation (inc. identifying points of vulnerability); and decision making and contracts (need to define policy and strategy to inform decision-making).

The challenges, Lyn summarised, include identification of the appropriate HIS; ensuring availability of resources on a sustained basis; empowering decision-makers; finding appropriate evaluation tools. Low resource settings require high quality HIS implementations – many solutions can be implemented locally.

Other speakers included:

  • Yunkap Kwankam (ISfTeH) talking on organising the health profession in different countries;
  • Otto Rienhoff talking on history of medical informatics in IMIA-LAC and elsewhere;
  • Peter Murray (IMIA CEO) on aspects of social media and Web 2.0.

The day concluded with a Mexican dinner, accompanied by tequila and mariachi music, both of which are said to originate in the Guadalajara area.

May 19, 2011 - Posted by | conference, IMIA, IMIA-LAC, Latin America | , , ,

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