Peter J. Murray RN, PhD, MSc, CertEd, FBCS CITP CEO, International Medical Informatics Association (IMIA) and Director, CHIRAD Africa (3/11/10, Illott, 4.00)

1. Peter J. Murray Transforming the landscape of clinical care: sharing international views and experiences for clinical networks

2. Peter J. Murray RN, PhD, MSc, CertEd, FBCS CITP CEO, International Medical Informatics Association (IMIA) Director, CHIRAD Africa

3. IMIA Board; Cape Town, South Africa – September 2010

4. Issues to explore: Nature of 'clinical transformation' The changing nature/site of 'clinical practice' Shared problems, so can we share solutions? Role of IMIA as a hub/node for sharing experiences

5. New Zealand has strong history of active involvement within IMIA and international health and biomedical informatics communities: Ian Symonds – IMIA Secretary (1997-2003) Robyn Carr – IMIA-NI SIG Chair (2006-2009) Lucy Westbrooke – IMIA-NI SIG Vice chair (current) HINZ as an active IMIA Member Society Kannan Subramaniam – IMIA Mental Health Working Group Chair (current) Chris Paton – IMIA Social Media Working Group Chair (current)

6. "In attempting to arrive at the truth, I have Googled everywhere for evidence, but have scarcely found any examples of (electronic) health records with enough interoperability to support any comparisons, aggregation, etc. If they could be obtained, they would enable us to answer many questions, including how the health budget was being spent, what evidence exists for it improving quality and care, or whether the health services were doing more harm than good."

7. "In attempting to arrive at the truth, I have applied everywhere for information but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it or whether the money was not doing mischief rather than good." Florence Nightingale, 1854

8. Clinical transformation “ a process by which practices review current operations to determine what process needs to change to optimize how work gets done.” “ has also emerged as a top technology trend that will help organizations demonstrate quality outcomes....” (Sensmeier, 2009) Is it the same in all countries? If so, can we share experiences and not reinvent the wheel continuously?

9. Clinical transformation The landscape of clinical care is changing - moves in many countries to more patient-centred, and home-centred care, supported by technologies and the emergence of mHealth. - but we still often focus just on the hospital There are some influences outside normal 'health' purview - but need to be taken into account when looking at role of informatics relative to clinical care.

10. Clinical transformation Will we be masters of the processes or be constrained by them and have to simply respond - will we as clinicians and imformaticians lead the changes or be lead by others? (as per some of issues we looked at in NI2006 post-conference)

11. Clinical transformation Clinical transformation often involves taking an innovative approach to patient care delivery - eg role of HIVE and similar in exploring innovation - Web 2.0 / social media – role of the network to explore new ideas - ehealth (mhealth) - GRIDS - PHR, PHIMS, phealth

12. Clinical transformation Issues converge around connectivity/network? - and around relationship between person and healthcare professional (inc. informatics professional)? The importance of nurses and nursing/informatics as key contributors to any aspects of clinical transformation, whatever the clinical setting; Informatics nurses also play an important role in ensuring that technology does no harm and patient safety isn't compromised. The function of an informatics nurse isn't only limited to IT; informatics nurses play a valuable role with regard to patient safety, change management, and usability of systems as evidenced by their impact on quality outcomes, workflow, and user acceptance (Sensmeier).

13. About IMIA An international, not-for-profit 'association of associations' - a 'bridging organisation' to bring together the members of the global health and biomedical informatics communities - over 55 Member Societies – contacts in over 85 countries - Academic and Corporate Members - represents over 50,000 people in health informatics IMIA has close ties with the World Health Organization (WHO) as a NGO (Non Government Organization), and with International Federation for Information Processing (IFIP) and the International Federation of Health Records Organizations (IFHRO)

14. About IMIA The basic aims of IMIA shall be: - to advance international cooperation; - to stimulate research, development and routine application; - to move informatics from theory into practice in a full range of settings, from physician’s office to acute and long term care; and - to further the dissemination and exchange of knowledge, information and technology. - essentially about the science of health informatics

15. About IMIA IMIA will fulfil its vision by: - Being the scientific informatics association through which the world’s knowledge leaders come together to effectively and efficiently create, assemble, integrate, synthesize or assimilate intellectual knowledge that is required worldwide to advance biomedical informatics in its role of improving health and healthcare. - Being the informatics association that effectively and efficiently connects people and the nations of the world to be able to accomplish the above purpose.

16. From: IMIA Strategic Plan, Towards IMIA2015

18. Some common issues in health and informatics Many countries and healthcare facilities moving electronic Development of electronic health/medical records About reducing errors, improving quality of care, benefitting patients (and clinicians?) Stand-alone systems? - (how) do they interact, exchange information to benefit patient care? Who is the driving force? - government, IT, vendors, clinicians, patients?

19. Some common issues in health and informatics Often lack of clinical engagement in developments – so, resistance The rise of patient empowerment The rise of mobile/connected devices – mHealth, etc. Global lessons that can be applied locally – or local lessons that can have global relevance Political change/expediency often gets in the way ...

20. Views from an opportunistic email discussion 1. what will be the main changes to, or implications for, healthcare as a result of Web 2.0 in the next 5-10 years? 2. what will be the main implications of these changes for the ways in which health professionals work? (discussion was mainly about medics – but ? same issues apply for nurses – what do they imply for informatics?)

21. Healthcare will be more person-centred, and more personalised Rise of e-patients will drive change – not the technology etc. E-patients' use of everyday technology (smartphones etc) will demand their use on healthcare mHealth will be the main channel of interaction We'll stop thinking of healthcare delivery over the web as divisible from healthcare delivery overall.

22. Health professionals need to recognise they will need new tools to save time, interact, and keep up-to-date Will see (have to be?) a shift in culture, where sharing and asking for opinions will be more relevant and needed Present challenges for the education of the new generation of health professionals.

23. Patients are the only node connecting all aspects of the system. As a result, human-to-human, participatory healthcare will be the 'name of the game' for Health 2.0 and beyond.

26. Further information and contact [email_address] [email_address] @peterjmurray (on Twitter)