Tag Archives: collaboration

From VCR to PVR: A retrospective on interface design and affordance

Posted by on December 28, 2011 No comments

Recently I found some written instructions I had prepared several years ago to help my parents program their VCR. It took me three pages to write out the steps to record a program.  Where applicable each step included a hand drawn representation of the button the VCR (and/or the remote) to ensure clarity and understanding.

The first page explained how to bring up the menu to record a program in the future. The second provided further details and discussed potential troubleshooting strategies. The third included the final steps and introduced the steps for recording a program currently being viewed.  Even with these detailed instructions mistakes were made and recordings were missed. We will never know if the error was occurred in the programming stage or if show never actually aired.

I believe I also wrote out similar instructions for my grandmother. As she was even less inclined to adapt she opted to use her own technique. My grandmother would start recording a program hours in advance of its airing before leaving her home by putting the television on the desired channel and pressing the record button on the VCR. It may have required hours of rewinding but it worked for her. Since this time technology has evolved and we now “one touch” programming through the use of on-screen guides that list program dates and times. However, I’m pretty sure if my grandmother were alive today she would use her old system – start recording on the PVR when she went out rather than using the on-screen guide.

In 1988 Donald Norman wrote about this issue in “The Psychology of Everyday Design“. He made reference to digital watches and microwave ovens as well as VCRs as examples of devices that were difficult to operate. Yet they were supposed to be for an average person to use on a daily basis. Why were they so difficult to use? One theory suggests that the skill set required to design such devices doesn’t necessarily translate in a way that is evident to someone who does not have a similar background or training. What is apparent to one is not necessarily so to others. A lack of applying design principles (human-computer interaction) or examining how the device works in real use (e.g. usability testing) were provided as possible reasons. One resolution was to utilize technical writers, those skilled in interpreting complex electronic interfaces using plain language written material  Some things are made to be obvious or intuitive – you use the sharp edge of the knife to cut. Others have developed over time with common usage – it is universally understood that turning the knob is a necessary step in opening a door.

Human behaviour is like running water. It always finds the path of least resistance. But can we ‘afford’ this type of affordance in health care?

 

Physician schedule thyself

Posted by on November 10, 2011 No comments

Accidents happen. Often when we are tired, overwhelmed with too much information and too much to do we make mistakes. Many of us work long hours, interacting with complex machinery and in noisy environments. Few of us, however, are required to work 36 or more hours in a row, with little or no sleep. Physicians do this on a regular basis and patient safety is at risk as a result.

Why does this happen? Many years ago I asked a senior staff physician who worked in a large metropolitan hospital this question. He told me there were three reasons: (1). A physician needs to learn how to make decisions no matter how they feel physically (2). We are short-staffed and (3). It was done to us before therefore it will also be done to those who come after us.  I’ve since heard another reason: the more hours you work the more opportunity you have to learn new things. I don’t know how effective this latter strategy is for physicians-in-training. Or whether it is used as a fear tactic. For example, someone might be told: “if you don’t treat enough cases of X you will not have enough knowledge to pass the board exam in your specialty”.

This clip (1:23 minutes) from the television show “ER” in which Dr. Elizabeth Corday explains at a weekly M&M (Morbidity and Mortality) meeting reasons why and ways in which the system could be changed.

Her concluding marks are quite poignant.  I don’t think the situation is much different now then it was when this show aired in 1998. Or when I asked a physician ten years previous to that. But I do think her point is valid. Who would want to fly in a plane in which an air traffic controller co-coordinating its take-off and landing had worked 36 hours in a row without sleep?

But I think the real question is whether you would want to fly in plane with a pilot who had worked 36 hours without sleep. However that would never happen. Pilots (and the airline industry) know that if they had people flying jets for many hours in a row they would likely make a mistake. The plane could crash and many lives would be lost. Including the pilot. Not quite the same scenario for a physician. Maybe the rules regarding work hours would change if their lives and not just those of the patient were also in danger. For this to be achieved we need more collaboration between everyone involved in providing care.

Journals: you can’t publish without us so please work with us

Posted by on September 30, 2011 No comments

A couple of great posts from other bloggers on the peer review process, journal publishing and the open access movement:

I’m excited that others are sharing their thoughts on this issue. I’ve written about this before (see “Access to peer reviewed journals“ ). Petermr’s piece specifically advocates for patients (among other groups) to have access to this information and uses the Human Rights code as a foundation to make the argument. Brilliant work!

It should be noted that JMIR has adopted two unique methods for open access publishing. The fast track fee provides the option of paying a fee for a three week turnaround. I believe the money is used to compensate the reviewers for their time. There is also an Open Peer Review Articles process, which allows JMIR users to review articles who have yet to undergo peer review. Abstracts for these articles are posted at the site so please take a look if you are interested in engaging in this process.

Update: Monday October 3rd, 2011

I recently found out about a repository, arXiv that has been used for pre-publication papers in the sciences since 1991. It was started in physics and later expanded to include other fields such as computer science, mathematics and astronomy. Although the papers posted are not peer reviewed moderators do review the submissions to ensure they are relevant topic-wise. We should consider this unique model to disseminate information when considering changes to the current system.

Technology, the knowledge economy and how academia should respond

Posted by on September 17, 2011 No comments

Computer with networked attachmentsWe need not look far for examples of the massive change the Internet has brought upon us. Take the music industry for example. Like water finding the path of least resistance people started to find ways to create and exchange copies of songs for free. There has been much speculation as to why this occurred. Some say it is because no one wanted to buy a whole album when they only wanted one song. It became simple to share music, one song at a time, online. Peer to peer file sharing ensured no one would be required to store songs on their server and risk getting caught providing copyright material for free.

Why wouldn’t the record companies sell new material online? Did they just not “get it”? Some bands began to sell their songs online or provide them for free. Others found innovate, “pay what you think it is worth” business models. Music fans will always buy music. Just make it available in a convenient and fairly priced format. Same goes for the film industry. People didn’t even wait for the film to be released in a digitized format before they were recording it in the theatre and distributing these versions online (in some ways this is similar to bootleg concert recordings). Now this industry is suffering. But it has learned from the mistakes of others and now offers other channels of delivery. Soon films released in the theatre will also be available for viewing online at the same time.

Another medium experiencing great threat from the Internet is journalism. They also ignored the signs. People wanted their news in an online format. They wanted to be able to provide comments instantly by posted their opinion at the web page below the story. Who would write a letter to the editor using paper, an envelope and stamp when you can instantly post online? Print subscriptions to newspapers have plummeted. Some say this is because the news is outdated once it arrives. Others prefer to save on costs and view it for free online. Other threats also arose. Bloggers, some of whom write about events experienced in person and others who share their own opinions have become a serious threat to credentialed journalists from well respected newspapers and magazines. Suddenly the monopoly these industries had on what, when, how and by whom news was reported became threatened.

Then HIN1 happened and some very smart journalists at The Guardian UK learned it was much better to create the story then just sit back and report it. They found data about the reported incident rates at the Center for Disease (CDC) web site. They took that information and put it into a Google Docs spreadsheet. Using the Google Maps API they did a bit of programming to connect the location from the outbreak data to the map. This created an interactive rendering of where the current outbreaks of the pandemic were in real time. This incredibly useful and informative tool goes beyond writing a story that H1N1 is spreading. It provided us with up to date information professionals and laypersons could use in an easy to access format with complete transparency of how the information was developed. This field is now called data journalism.

In the future all workers will need to adapt and change their job on the fly in this fashion. It is no longer about learning how to do a task or set of tasks – it is about learning to identify what the task is then adapt, acquire or even create the skills to complete task. This is the knowledge economy.

Teacher with brief case and light bulb for head

 Many of those already in the work force won’t have the skills to work in this type of environment. They want to stick with what they know, what they were taught and have been doing for years. They don’t want to learn anything new. In part the academic system in which they were schooled is to blame. The emphasis on memorization and testing of rote knowledge is out of date. What can we do now to change this for the next generation?

The first think we need to acknowledge is that it is no longer about memorizing. Information is freely available online. What is the point having the student memorize the periodic table when they can just look it up online? I know what you’re thinking, “I had to long how to add, subtract, multiple and divide and there’s no way my kid is going to get away with using a calculator”. Yes, it is important to understand the theoretical underpinnings of a concept. But we need to shift our emphasis. We need to focus more on creating academic environments that foster ways to combine collective knowledge into new forms of intelligence. And we need to do this at a younger age. It is about the co-creation of new knowledge not the memorization of old. And the sooner we make these adjustments the better off we will be. In a global economy our future depends on it.

Data Part 2 – When you can’t collect it, find it elsewhere. And get the patients involved.

Posted by on September 8, 2011 No comments

Statistics StairwellAnother way to obtain data for use in research studies is to find sources in which it has already been collected. There are many organizations that record data either for their own purposes or as their mandate. Obtaining data in the former circumstance may be difficult due to privacy issues. However, Statistics Canada as an example of the latter provides many data sets for free. Compilations that require specific variables can also be obtained but there is often a fee associated with this type of request. The advantage of using pre-existing data include not eliminating the need to obtain approval to collect the data but also obtain permission from a research ethics board, both of which can add a year or more to the process.

The two main health-related data sets provided by Statistics Canada are the Canadian Health Measures Survey (CHMS) and the Canadian Community Health Survey – Annual Component (CCHS).  Both collect information on a number of clinical indicators such as chronic conditions, medication use, medical history, nutrition, chemistry panel, disease screening as well as social support and some socio-demographic information.

Unfortunately this kind of data is not of much use to me. Questions about patient engagement, empowerment, use of social media and other technologies in diagnosis and self management are more of interest to my research. Some of this information I can get by collaborating with organizations that provide web-based forums or resources for patients. I can also scrape it directly from online sources (e.g. mining the Twitter feed). However, there are also obstacles in this process. Partnering with an organization may involve an ethical review and involve other institutional barriers. Data scraping involves hiring someone with technical and programming skills or doing this on my own.

Statistics FishbowlI think the larger issue here is how this data will be used. My intentions are to demonstrate how patients (and providers) can collaboration using technology to improve health. However, I am concerned that some technology-based patient initiatives that rely on funding will be at risk if they are unable to “prove their worth”. Some progress has been made in developing metrics for social media. But is it specific enough to health care? Patient-driven efforts like those who informally share information on message forums, through social networking and using Twitter will likely continue to thrive as they are not dependent on these funding sources. Some promising work on how patient collected data can be used is being conducted by the organization Patients Like Me. However, what is still lacking is patients’ ability to collectively use data on their health to influence change in procedures, prioritization and policy in health care. Of particular concern to me is what is being collected in electronic health records. Will patients have control over this information? Will they be able to export it for their own use? Will they be able to combine it with other patients in order to conduct in-depth analysis? In Canada we are paying for this system. Mining data is one way to have a say in its development, design and delivery. It is therefore imperative that patients maintain control over their data or it may not be used to best serve their interests. I look forward to the day when my job involves teaching courses how to mine patient-generated data to aid decision making and the class is filled with empowered, engaged people who want to be part of this change.

Data: harder to find and share than one might think

Posted by on July 22, 2011 No comments

Stack of books

An important component of my work involves publishing papers in academic journals. There are a variety of different formats but most are either original research or theoretical pieces. Original research papers result from conducting a study or experiment. This format may be easier to publish, at least in biomedical journals as many accept submissions in this format only. In addition, with the aid of powerful statistical analyses original research may be viewed as more solid form of “proof” that new knowledge has been generated and therefore be considered to be of more merit. Qualitative research yields what is commonly referred to as ‘findings’, which can also lead to new information or knowledge. Journals are ranked based on their “impact factor”, which is calculated based on the number of times a paper is cited and other variables. It is more desirable to have your paper published in a high ranking journal as it an indication of your value as a researcher.

There are various steps associated with conducting original research. The first is generally to conduct a literature review. This is done in order to ensure that your research idea has not been previously published. Over the past ten years the literature review has evolved from simply searching a variety of relevant indexed databases to the much more rigorous “systematic review”. The way in which you conduct your literature search can impact the ability for your research to be published in the higher ranked journals. The more rigorous standards you apply in your literature search increases the chances you did not overlook publications that may presents similar results as your study. There are specialists trained to conduct literature reviews. If possible you should consult such an expert during this stage of the research.

Once you have determined that your research question is viable you may need to obtain funding in order to conduct the study. This will allow you to hire research assistants, biostaticians and others to help execute the study. To obtain funding you will need to complete a grant application, which may require anywhere from ten to twenty pages of written information. Within these documents you make the case for your study, articulate why it is worthy of funding and back this up with citations from the research you obtained in the literature review. You must then wait until a funding organization announces a call for applications that fits with your research idea, apply for funding and wait again to find out whether your project has been selected.

If you are lucky (success rates vary from ten to thirty percent) enough to be granted funding you must then apply for permission to conduct the study from an ethical review board (also known as a Research Ethics Board or REB). These boards consist of volunteers who may have specialized knowledge in research, ethics or specific topic areas (e.g. expertise in clinical trials, research with specialized populations, etc.). Universities and hospitals generally have one or more REB in order to review research conducted by or within these institutions. This application process can also take many months and may involve a series of revisions.

When approved you must now find participants for the study, which can also take months, especially if you are looking for a niche population (e.g. diabetics who use social media). When the data has been collected it must coded, analyzed and the results written up. This process can also take weeks or months, depending on how much time you have available and the schedule of others assisting in this process. In some situations you may chose to present preliminary findings at a conference in order to gain feedback on your study.

After the paper has been written you must submit it for publication. This process involves a peer review in which others with expertise in this particular area read over your work to ensure it is worthy of publication. This is also conducted by volunteers and the process can take months or longer. Your article may be accepted but require several amendments. You may need to consult your colleagues who were involved in the study in order to complete these revisions. This process may go on for two or three rounds of edits before your paper is ready to be published. All of this may take months. In addition there is often a backlog of other papers that are waiting to be published so it may take a year or more before your paper actually appears in print.

To illustrate a real world example I share the following steps and time line for a research study I recently collaborated on with other researchers:

  • 2007 – Spring: I conceptualized a study involving tagging, tag clouds and how using these tools to search for health care information impact the perception and judgment of its credibility
  • 2007 – Summer: I found a funding source and assembled a team of researchers to prepare the grant application, which was due in September 2007
  • 2008 – Spring: We were notified that our application was successful in April 2008
  • 2008 – Winter: Due to scheduling conflicts we were unable to move forward with the project until the late in 2008. A programmer was hired to create the application used in the study
  • 2009 – Summer: A research assistant was hired and started in August of 2009
  • 2009 – Fall: The application for approval from the ethics board was submitted
  • 2009 – Fall: Approval from the REB was granted in early December of 2009. The study was submitted for conference presentation
  • 2010 – Winter: Data collection commenced in January 2010. The study was accepted for presentation at a conference in February 2010
  • 2010 – Spring: The study findings were written up and submitted for publication consideration in a special issue of a medical informatics journal on March 30th, 2010
  • 2010 – Fall: In September 2010 we were informed that the paper was rejected for the special issue as it was outside the scope of the topic area. It was re-submitted three weeks later to this same journal for publication consideration in a regular issue
  • 2011 – Summer: As of today, Friday July 22nd , 2011 the publication is still under review

Almost four years has passed since this study was started and we still have no idea of when the results will be published.

Update: This paper was accepted for publication in the International Journal of Medical Informatics on Monday October 3rd, 2011.

 

The crowdsourcing of tagging: a form of sensemaking

Posted by on June 4, 2011 6 comments

Peter Wylie recently wrote, “As the Internet continues to accumulate more and more information, it becomes increasingly difficult to sort and prioritize that information in a way that provides optimal relevance for each individual user”. In this post Peter also describes Blekko, a search engine that requests users to rank the relevance of their search results by using a pre-set listing of tags. I have previously suggested in posts on tagging and the semantic web that crowdsourcing is an essential element of adding relevance to search findings.

Sensemaking is a user-centred theoretical-methodological approach developed by Brenda Dervin for understanding how and why users interact with information and information sources. It is based on the premise that life is marked by a series of discontinuities. As people move through life they face information (and other) gaps that stop their ability to make sense of the world and to take decisions and actions. Gaining the needed information allows them to progress. This triad: situations, gaps, and uses/helps, is fundamental to sensemaking [1, 2, 3, 4]. Simply put, when individuals realize that they are in a situation that requires information, they will move towards closing that gap by seeking help and/or information [2].

Tagging can be considered a sensemaking activity [5] as it involves assessing and describing content. Yew, Gibson and Teasley [6] write, “Social tagging facilitates the sense making efforts of the individual and the learning community through the collective act of associating keywords with documents/artifacts and by sharing those terms with the rest of the community” (p. 1010).
The sensemaking framework is therefore well-suited to understanding the tagging process in this context.

Sensemaking in the context of tags

Tagging is intended to add meaning to the content. However, one “side effect” of this is known as tagging ambiguity [7]. For example the tag “orange” can refer to the colour or the fruit of the same name. Ways to help focus a search using tags would be the use of multiple tag searches in which case the user can use the term “orange” and “fruit” to help contextualize their search even further.

It may seem foreign to my colleagues who work in technology to consider a theoretical framework when executing an initiative such as the crowdsourcing of tagging. However, it is this type of cross-pollination of ideas that leads to interdisciplinary collaborations. Who knows, maybe these concepts will be explored by graduate students who later initiate a start-up. Like Google.

References

[1] Dervin, B. 1977. Useful theory for librarianship: communication not information. Drexel Library Quarterly 13, 3, 16-32.

[2] Dervin, B. 1992. From the mind’s eye of the user: the sense-making qualitative-quantitative methodology. In D. Glazier & R. Powell (Eds.), Qualitative methods in information management (pp. 61-84). Englewood, CO: Libraries Unlimited.

[3] Dervin, B. 1998. Sense-making theory and practice: an overview of user interests in knowledge seeking and use. Journal of Knowledge Management, 2, 2, 36-45.

[4] Dervin, B. 1999. On studying information seeking methodologically: the implications of connecting metatheory to method. Information Processing and Management, 35, 727-750.

[5] Golder, S. A., & Huberman, B. A. (2006). Usage patterns of collaborative tagging systems. Journal of Information Science, 32, 2, 198-208.

[6] Yew, J., Gibson, F., & Teasley, S. (2006). Learning by tagging: group knowledge formation in a self-organizing learning community. In Proceedings of the 7th international conference on Learning sciences (pp. 1010-1011). Bloomington, Indiana: International Society of the Learning Sciences.

[7] Breslin, J., Passant, A., and Decker, S. 2009. The social semantic web. Springer.

Two steps forward (open source, open access), one step back (open data)

Posted by on May 29, 2011 No comments

For many years the open source (shareware, freeware) movement has flourished. Linux is considered, “one of the most prominent examples of free and open source software collaboration”. Repositories such as www.shareware.com and www.tucows.com provide a centralized distribution method for individual programmers to increase the reach of their product.

The open access movement in academia is another means by which traditional distribution channels (e.g. publishing companies) can be circumvented. By inverting the payer/payee relationship scholarly journal articles were made available for free to anyone on web sites. Authors paid a fee to have the article published so that subscriptions to journals were no longer necessary.

There has also been a movement to make data more freely available . Governments are sharing data they collect and requesting data yielded from research it has funded be accessible . Providing access to information collected by the government free for analysis increases transparency. Open data has also been suggested by the scientific community. Researchers should include raw data so that secondary analysis can be conducted. This also provides an excellent way to teach students statistics: use the data set provided to replicate the published findings.

One of the most exciting outcomes of this has been data journalism. In 2009 the UK Guardian’s journalists used data provided by the CDC, entered into the openly available Google Docs spreadsheet then mined it in conjunction with open source mapping software to create real-time coverage of the H1N1 pandemic. Various patient populations have been also been collaborating online, pooling their knowledge and resources. One in particular, www.patientslikeme.com has been sharing data such as lab results and other self reported measures of symptoms and treatments. Recently they used this data to refute a study published in peer-review journal.

Thus far both the open source and open access movements have co-existed with their profit-oriented counterparts with minimal disruption. Microsoft still profits from selling copies of Windows as Apple does from its operating system Leonard. Many journals have web-based versions in which articles must be individually purchased or accessed through an institutional subscription.

Open data has much deeper potential to disrupt the status quo. It has the ability to challenge “truth”. This is raw data. In this context data (and knowledge) is more about power, not just about money. And people are starting to notice. The first blow to open data was the threat of reduced funding for the US-based data.gov. Now I’m concerned that it will be the patient data stored in EHR or electronic health records managed by Canada Health Infoway. In this article, “Electronic health records raise privacy concerns” the British Columbia Civil Liberties Association reveals that, “It takes that health information out of the hands of the patient and the practitioner and puts it into the control of government. That’s exactly what the Canada Health Infoway is doing.”

Patients need to read the fine print before they enter or share their data. They need to understand the importance of ownership and access. This is agency at its purest and simplest form. Yes, be an empowered patient. Go online, search for anecdotal or experiential information and seek help from your peers. But don’t let go of your data and your ability to aggregate it with others. It is probably the most important of all the open movements.

Patients’ Association of Canada

Posted by on February 26, 2011 No comments

Wikipedia and education: fear or foresight?

Posted by on December 11, 2010 No comments

Since it was first cited by a student in an academic paper controversy over the accuracy, validity, truth or shall we say ‘correctness’ of Wikipedia has been debated. Before the widespread availability of information on the Internet we were relegated to what was available to us through schools, the library and media such as television and radio. Each of these institutions had its gatekeepers. Curriculum, particularly at the elementary and high school levels, was tightly controlled, libraries could chose which books they would shelve and sell. Radio, television and film were also tightly regulated both by the owners of these media outlets and government regulatory bodies. Of course we could purchase books and magazines at our local bookstores. But even this was regulated by “buyers”, who were responsible for ordering content that would sell. After all bookstores are there to make money.

It seems as though every source had an agenda. Was it ever really about providing information? Openly? One thing we know now. The free flowing information available at Wikipedia has a lot of people “concerned”. The potential for an opportunity lost is of concern. Can everyone see the incredible value this kind of basic information could have on education? Most elementary, high school and even undergraduate curriculum are focused on students forming a foundation of knowledge. They must learn to read, write, add, subtract, multiply and divide. What if they showed up on the first day of school with those skills intact? What an incredible gift sites such as Wikipedia have given us. What incredible foresight to provide basic information on almost every subject imaginable.

During my education, in particular the high school and undergraduate years, the body of truth, that which was required to demonstrate understanding in order to pass examinations was mainly contained within books and lectures. Both regulated. We could not gain access to textbooks; they were produced by special academic publishing houses and they were not available at our local bookstore. No doubt due to their lack of “bestseller” appeal.

Back then if, after a particular inspiring class in grade 10 biology, one had to wait until the subsequent semester or year to take grade 11 biology, in order to gain access to more information. Now it is a different game. I think we should encourage and embrace this. What teacher wouldn’t want a student who has already familiarized themselves with the core fundamentals and is eager to move on to a more challenging curriculum? Think of how much further advanced we could be in our understanding of the world. We might be able to focus more on the co-creation of new knowledge, not the imparting of basic concepts, which are now freely available to anyone with Internet access. What is it that people are so afraid of? Oh ya, knowledge is power.