Handbook of Research on Electronic Collaboration and Organizational Synergy
    Janet Salmons Vision2lead, Inc., USA Capella University, USA Lynn Wilson SeaTrust Institute, USA
    
    Volume II
    
    InformatIon scIence reference
    Hershey • New York
    
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    Published in the United States of America by Information Science Reference (an imprint of IGI Global) 701 E. Chocolate Avenue, Suite 200 Hershey PA 17033 Tel: 717-533-8845 Fax: 717-533-8661 E-mail: cust@igi-global.com Web site: http://www.igi-global.com and in the United Kingdom by Information Science Reference (an imprint of IGI Global) 3 Henrietta Street Covent Garden London WC2E 8LU Tel: 44 20 7240 0856 Fax: 44 20 7379 0609 Web site: http://www.eurospanbookstore.com Copyright © 2009 by IGI Global. All rights reserved. No part of this publication may be reproduced, stored or distributed in any form or by any means, electronic or mechanical, including photocopying, without written permission from the publisher. Product or company names used in this set are for identification purposes only. Inclusion of the names of the products or companies does not indicate a claim of ownership by IGI Global of the trademark or registered trademark. Library of Congress Cataloging-in-Publication Data Handbook of research on electronic collaboration and organizational synergy / Janet Salmons and Lynn Wilson, editors. p. cm. Summary: "This book presents a collection of empirical work that examines techniques, strategies and effects of electronic collaboration across disciplines and sectors"--Provided by publisher. Includes bibliographical references and index. ISBN 978-1-60566-106-3 (hardcover) -- ISBN 978-1-60566-107-0 (ebook) 1. Educational technology--Research. 2. Information technology. 3. Research--Technological innovations. 4. Research--Methodology. 5. Telecommunication. 6. Intellectual cooperation. I. Salmons, Janet, 1952- II. Wilson, Lynn, 1954LB1028.3.H3555 2008 371.33072--dc22 2008014458
    
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    Electronic Collaboration Toward Social Health Outcomes
    Rakesh Biswas Manipal University, Melaka Manipal Medical College, Malaysia Jayanthy Maniam Sunway College, Malaysia Edwin Wen Huo Lee Intel Malaysia Innovation Center, Malaysia Shashikiran Umakanth Manipal University, Melaka Manipal Medical College, Malaysia Premalatha Gopal Das Manipal University, Melaka Manipal Medical College, Malaysia Sumit Dahiya Manipal University, Melaka Manipal Medical College, Malaysia Sayeed Ahmed Manipal University, Melaka Manipal Medical College, Malaysia
    
    Chapter XLVII
    
    abstract
    This is an illustrative process description of a collaborative project utilizing a multidisciplinary approach. The requirement for collaboration originated in an attempt to optimally answer the needs of individual patients and health professionals for information to allow them to achieve better health outcomes. This chapter introduces the problem statement through the auto-ethnographic reflections of three project developers. These reflections illustrate individual experiential agendas that initiated electronic collaboration among diverse stakeholders in the health care network. Each reflection also illustrates the
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    Electronic Collaboration toward Social Health Outcomes
    
    sequence of events in a collaborative process beginning at the individual level and growing through the interaction of multiple individuals including patients, their relatives, health professionals, and other actors in the care giving network. This chapter describes how collaboration was sustained and further developed into an operational model.
    
    introduction
    To arrive at a correct diagnosis, a health professional requires an accurate account of the illness history from the patient or her/his relatives. Active collaboration with a patient to determine what the patient values most are necessary for a health professional to select an appropriate therapeutic option. Medicine is thus a collaborative effort in problem solving between individual patients and health professionals. The collaborations also involve others who are directly or indirectly related to the patient and health professional (for example, the patient’s relatives and the physicians’ institutions) who provide the necessary support to the two primary collaborators. In the medieval past medicine was a similar problem solving effort between patients and health professionals. With time and globalization there have been major changes. From an approach where clinical decision-making was driven by the expert opinion of a local physician (as a first step to medical problem solving) the collaborative process has evolved to a global evidence-based approach that uses generalized information for the benefit of the individual patient (Biswas, 2007). As clinical information is, to a large extent, available on the Internet, patients and health professionals have rapidly learned to use Internet services to solve their clinical problems. All these users and their information needs drive health care to a considerable extent. The traditional patient and health professional clinical encounter has tended to become an informational collaborative process persistent in virtual space and time. A
    
    persistent clinical encounter has immense potential advantages for the patient as well as the health professional (Haggerty, 2003). However, in day-to-day practice, both individual patients and health professionals are often in situations where the information available is limited and difficult to apply to a given patient. A gap between the paucity of what is proved to be effective for selected groups of patients versus the infinitely complex clinical decisions required for individual patients has been recently recognized and termed the inferential gap. The breadth of the inferential gap varies according to available knowledge, its relevance to clinical decisions, access to the knowledge (that is, what the physician actually knows at the time of a clinical decision), the variable ways in which knowledge is interpreted and translated into a decision, the patient’s needs and preferences, and a host of other factors. Clinicians are required to fill in where their knowledge (or knowledge itself) falls short. (Stewart, Shah, & Selna, 2007).
    
    problEm statEmEnt
    Average patient data, which drives most of our present day (knowledge and evidence) information bases, is often unable to satisfy individual patient and health professional needs. In spite of an unprecedented expansion of medical information, at present we still do not have the quality of information to satisfy a given individual patient to an optimal extent (Biswas, 2008a).
    
    
    
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    Reflections of Practitioners as Data to support Project AMIN (Answering Multidimensional Information Needs)
    To expand on the problem statement, auto ethnographic reflections of individual project developers have been utilized. Auto ethnography is a recognized qualitative research method through which a researcher uses participant observation in order to gain a deeper understanding as well as to theorize about models of human behavior within a group and across different groups. Often, but not always, the researcher is a member of the group in question rather than the traditional outsider ethnographer (Ellis, 2004; Reed-Danahay, 1997). Auto ethnography has been utilized here because social networking for health outcomes begins with an individual and her/his story. It also offers valid information that drives the entire healthcare process for that individual. These stories illustrate the sequence of events in a collaborative process beginning at the individual level and growing at an intersection of multiple individuals that includes patients, their relatives, health professionals and other actors in the care giving collaborative network. Individual patient autoethnographies housed in personal health records would help to maintain the user-driven nature of the collaborative healthcare network. The development of such a network is an aim of the collaborations illustrated in this chapter. The following paragraphs incorporate selected reflections among the members of the collaborative team that provide experiential observational data in favor of the necessity of the research project. Jayanthy Maniam offers the following reflections. The human need: As a first time pregnant woman back in 2001, I was excited and wanted to know more on how I should prepare myself and my baby throughout
    
    the stages of the pregnancy. Of course, I had a lot of advice from my parents, in laws, friends and colleagues cautioning me about pregnancy. When I visited the gynecologist, he just told me to not worry about anything and take vitamin tablets as prescribed. I was not satisfied, as I had many questions for which I wanted simple answers without much confusion. I turned to Internet for pregnancy support. I was amazed to find so much information about pregnancy. Unfortunately, Web sites provided very general information and did not answer most of my questions. I was left with a feeling that there was perhaps no site specifically designed to provide pregnancy support for Asian women who live in diverse cultures with traditional beliefs and with taboos that are difficult to overcome without optimal informational support. The grip of dated and yet emotionally captivating information: It is especially hard for a first time mother to cast away accumulated information which takes form of cultural taboos (no matter how ridiculous some of this information may appear) because the taboos may create fear of losing her child in the womb. Many women are forced to rely on information that is passed down from one generation of mothers to another. There is always a nagging feeling that this information may not be accurate, but many end up following traditional advice for want of a better alternative. I was not an exception to the rule. The questions that I had in my mind were: how much of these traditional beliefs are true? And if I do not follow them, will it affect my pregnancy?
    
    
    
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    The professional need: To address this personal need (which I felt was also perhaps universal for women) I decided to build a Web-based pregnancy system model for women in Asia with my student Mr. Chang and Dr. Rachagan, a consultant gynecologist, who provided his valuable inputs for this project. The system included stages of pregnancy with weekly growth of the fetus, diets, and exercise during pregnancy, dos and don’ts based on contemporary medicine. The cultural taboos were explained to educate women on how these taboos came about, whether they were relevant to their present life styles, and if they were harmless or could have any adverse effect on their unborn babies. The system also included information about common illnesses during pregnancy, postnatal care, and when to seek help. The Web-based prototype developed with search and medical consulting functions is illustrated in Figure 1.
    
    2D and 3D animations, video clips and other multimedia elements were added to keep the user interested during the visit to the Web site. The Web-based prototype won the Multimedia Super Corridor Asia Pacific ICT Awards (MSC-APICTA) 2003 Merit Award under the tertiary institutions multimedia content category in Malaysia. Reaching a wider audience: This is when I realized that there were other researchers around the world who were also looking at personalized content for specific population needs. One concern was the accessibility of this valuable information to a wider population. While searching for answers, I noticed the growing trend of mobile communication in Malaysia and around the world. Statistics showed that, in 2005, the number of mobile phone users was 2.2 billion as compared to 1 billion Internet users (ITU, 2006). For example, in Malaysia the Internet penetration was about 13 percent only as opposed to mobile phone penetration of 60 percent. Later data suggests that almost everyone in Malaysia has a mobile phone. (MCMC, 2006) This growth
    
    Figure 1. Shows the main menu of the prototype model of Web-based system called “Pregnancy and Baby care e-guiding system”
    
    
    
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    in mobile phone usage has created the opportunity for localized mobile content development to reach a wider public. With higher speed and affordable rate, mobile phone subscribers are able to get multimedia content such as movie clips and news. With availability of compression technology to reduce the size of the content for mobile display, accurate information about pregnancy can be easily delivered by developers and obtained by expectant mothers at any possible time and place. This service may be easily accessed even from rural areas where transportation and medical services are limited. It was clear to me that communication technologies using mobile devices had a tremendous potential to improve education, health and economic welfare of people. This is when I shifted my focus from a Web-based system to a mobile phone pregnancy system and presented my ideas at the E health ASIA 2007 conference in Kuala Lumpur (Maniam, 2007). I also believed that this framework could be extended to chronic disease heath care support as well. At that conference I met Dr. Rakesh Biswas who was the speaker presenting before me. We discussed a possible mobile phone and Web based integrated system that could provide support to diabetic patients through virtual means. This would allow the clinical encounter to persist, even after their personal visits at which time and information availability were limited. I was excited about this idea and wanted to help him technically by extending his work onto a mobile platform. Soon Edwin Wen Huo Lee from Intel, Malaysia also joined us to collaborate in this project. Currently, we are working on the details of this framework, prototype development and testing. Dr. Rakesh Biswas offers the following reflections. The human need:
    
    Before becoming a medical student 20 years ago I was like any other human. One part of me still remains so, but, in the following years, it has never ceased to make me wonder how my life was transformed in the eyes of other humans the day I entered this old profession. I have, fortunately, been both a doctor and a patient, and I try to appreciate both sides of this professional relationship. This relationship rests on a perpetual interaction between patients and health professionals in a multidimensional clinical encounter. Stake holders in this process may include government, financial investors, patient’s relatives, and others, all of whom try to collaborate to achieve what they believe to be optimal health care. The professional need: As a physician, I felt that there was a great unmet need for optimal informational satisfaction. I felt that the lack of satisfactory information was due to the present emphasis on going by average information obtained from collective clinical experimentation on selected samples of the population. I had a hunch that I would have loved to have access to information that reflected the lived experiences of individual patients and their physicians that matched the experiences I encountered with my patients. I gradually became aware of the power of Web 2.0 to provide better access to such information; I hoped to create a Web-based solution that could reach the majority of those who could benefit from it with the help of a technical collaboration. In my clinical practice that was situated in a tertiary care hospital of a busy Indian city, I came across a large variety of patients from remote areas of India. In my eagerness to keep learning from my patients, I initially asked them to keep in touch through my Mobile phone number. I later felt this had not been a wise decision, as I had to fend off long distance calls from various locations in India often while maneuvering my car through
    
    
    
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    a busy traffic. I only wished there was some manner of helping them by means of an asynchronous network. I imagined a Web-based solution able to store all patient data generated as a result of the communication such that it became a learning solution. It was with this background and hope of finding a developer that I presented my ideas on answering multidimensional information needs of individual patients and health professionals through user driven healthcare at first in the IEEEP427 conference in UK and later in the E health Asia conference Feb 2007, Kuala Lumpur (Biswas, 2007). Thankfully, I found Jayanthy Maniam who spoke after me in the conference in Kuala Lumpur. We discussed the possibility of collaborating as soon as the conference was over. We were soon joined by Edwin Wen Huo Lee from Intel who had attended the same conference and recognized the feasibility of developing this idea. Edwin Wen Huo Lee offers the following reflections. The professional and human needs: Compared to other industries like Banking and Retail, health care has been slow to adopt ICT (information communication technologies). Only recently, HIS (health information systems) have become popular in the healthcare industry, but most HIS systems are still independently functioning systems and it is hard to build bridges between each of them for various reasons. A PHR (Personal Health Record) that can be in the hand of individuals (or at least exist in a more individually controllable manner) is still a distant dream in most countries. I was influenced by a few health-related incidents with my daughter; my aging parents and some close relatives that made me realize the importance of personal health records. I decided to get involved actively in healthcare IT. To me, this seemed a practical way I could contribute and support my society and
    
    community more meaningfully, especially because the digital divide is wider in Asia. I met Dr. Rakesh Biswas when I attended E-Health Asia Conference in Kuala Lumpur in March 2007. His ideas on answering multidimensional information needs for chronic patients by leveraging common technology like mobile phone clicked very well with my interest and direction. This collaboration allowed us to extend a holistic approach to support diabetes patients by developing different means and ways for people to get medical support by access to familiar tools. The framework that I started designing to support it is called Unified Communication Framework. It combines both voice and data networks in order to support different types of users. Validating the ideas necessitated addition of a proof of concept to the operational prototype and could be best achieved with a randomized controlled trial (RCT). Dr Premalatha Gopal Das joined at this point to contribute her expertise in public health and help develop the RCT. The collaboration expanded with Dr. Shashikiran Umakanth who had contributed valuable ideas to the conceptual model, Dr. Sumit Dahiya who had furthered these ideas by presenting them in an international conference and Dr. Sayeed Ahmed who was keen to work toward making this idea into a reality. The following sections describe the plan that aims to increase inter individual collaboration among key players in the care giving and care seeking collaborative network in the present health care system in an attempt to produce what has been termed as user driven health care. It has been also described previously in a separate context as an operational model for a post EBM approach to answering multidimensional health information needs (Biswas, 2008b).
    
    
    
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    intEr-organizational collaboration to acHiEvE individual patiEnt and HEaltH profEssional collaboration for bEttEr community HEaltH outcomEs
    Every person has the capacity to, and is likely to perform the role of caregiver and the role of care seeker (patient) in their lifetime. A large volume of individual patient or health professional experiential information (that may resemble autoethnographic reflections) exists in difficult-to-search Web logs. However, most of the innumerable day-to-day clinical encounters remain undocumented. Individual users may make record their unique experiential information on a Web log. These records may reflect their learning of patho-physiologic rationale behind the disease at hand, individual patient values and preferences, health care system features including resource availability and societal and professional values. Once individual care givers or care seekers log such information, other Web users may retrieve it through search engines. The results of a search could present related individual experiences mashed up with empirical data immediately at the click of a mouse. The illness experience posts may link to related posts depending on the keyword-tags used to represent the posts. This would enable every user posting his/her individual experience to read about similar relevant lived experiences of other individuals. It would be up to the individual to derive meaning from these multiple dimensions of information. Even if one could, in this manner, collate a larger variety of experiential information on the Web, the results would still be available only to personal computer (PC) literate individuals. To bridge the digital divide, our technical collaboration emerged to develop a mobile SMS (short messaging system) portal for data entry into a Web repository. An individual, at his leisure,
    
    or even while waiting in queue to meet his/her physician, may use a SMS to log their thoughts and queries about their disease onto a forum. The information they log may then be read and possibly responded to by anyone on the Web. Although the SMS portal will be accessed remotely, and often anonymously, it may foster a sense of belonging and intimacy. Any individual user feeding input into the Web repository can receive automatic feedback that can grow as other users contribute their own data. Relying on the power of human collaborative intelligence may prove to be much more efficient than artificial intelligence.
    
    dEfining rolE of tHE primary collaborators in tHE trial pEriod
    An operational model was created to plan a trial on a sample population of diabetic patients utilizing a randomized control trial (RCT) design. One randomly selected group of diabetics was assigned to receive electronic information intervention while a matched diabetic population would receive only regular medical intervention. The results would be analyzed to see if those with access to the electronic information would improve their health outcomes in comparison to the control group. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia and elsewhere in the world.
    
    Role of Patients Participating in the Project
    Patients who have consented to participate in the trial period will be randomly allocated to either receive the mobile phone intervention with current standard therapy or receive current standard therapy alone. All participants in the study trial will have their baseline characteristics entered in a structured manner into a Web database
    
    
    
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    designated as personal health record (PHR). The patients receiving mobile intervention would receive weekly SMSs enquiring about their present symptom status, self monitored blood pressure, blood glucose values if any, current diet, exercise patterns, and any other complaints they would like to convey. All responses and interaction would be automatically recorded into the nonstructured portion of their Web-based record. Patients may communicate either through text or voice messages.
    
    Role of the Research Assistant/Clinical Care Co-coordinator
    S/He shall be instrumental in entry of all the individualized data into a standard format supervised/guided by the physician after ensuring a record of proper informed consent. S/He will be an important liaison between patient and health care providers, which includes physicians, diabetic educators, dieticians and even mobile Web support staff. S/He shall arrange for mobile phone based continuity of care by ensuring appropriate weekly and monthly, individualized phone and SMS reminders and discussion. These reminders and discussions with patients are primarily aimed at assessing patient compliance to treatment of which diet, exercise and drugs are equally important components. S/he will ensure this assessment is done weekly in mobile phone users apart from the standard three monthly face-to-face assessments on hospital visits, which would be same as for the matched control group. S/he may help the other health care providers to address patient queries SMSed by patients to the mobile phone support network by collecting their answers and SMSing it back to the patient with the help of the mobile network support staff. S/he shall help the mobile network Web support staff to create and maintain the individual patient’s personal health profiles by ensuring appropriate entry of proper and relevant data.
    
    Role of Physicians Involved in the Project
    Patient entries to the mobile Web database shall be reviewed by one of the physicians involved in the study and she or he shall make appropriate adjustments to the patient’s management according to standardized diabetes management protocol (ADA, 2007; Malaysian clinical practice guidelines, 2004). The physician shall also be instrumental in supervising entry of all the individualized data into a standard format which shall be later entered into a Web-based repository that can serve as the individual patient user’s standardized personal health profile. The repository may be accessed by appropriate health care givers and controlled by the patient and his or her health care provider. The physician shall also monitor the non-structured patient generated health profile for day-to-day patient queries, thoughts, and so on. The physician shall respond to patient queries and comments to the best of her or his expertise and refer appropriate information needs to medical information specialists. Information may also be referred to other health professionals who will try to enrich each individual patient profile with addition of appropriate evidence based data at relevant areas in the profile. During each visit of the patient, the physician will access the patient’s personal record on her or his computer and provide a print out of the PHR (latest version with changes) if necessary.
    
    Role of Mobile Phone Based Web support staff
    The proper functioning of the mobile phone intervention in the selected patient participants will be developed and maintained by the Web support staff who shall regularly monitor and update the individual patient Web profiles based on the data provided by the patient, health care provider and research assistant. S/He shall ensure
    
    
    
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    Figure 2. Role of various collaborators in answering multidimensional informational needs (AMIN)
    
    that authorized users only with valid personal identification, user name, passwords, and so on use the system.
    
    The Organizing of the Structured and Non-structured Information Based on a Patient-centric Model
    There are other benefits such as this system allows getting connected with users who share the same common goals and challenges (but would be otherwise difficult to locate) along with care givers who can contribute usefully at their own time. It maintains privacy and confidentiality of patient and empowers them to manage their own health. Search and other utilities will be added to facilitate fast access to information.
    
    prototypE dEvElopmEnt
    The structured and non-structured information log for patient centric support to manage and control disease allows patients to overcome limitations in the time spent with physicians. This system provides continuous virtual connection with physicians and support group. This is to allow patients to monitor, manage and control their own health at anytime and place. Support and alert messages are sent to mobile phones to disseminate and collect information from patients as depicted in Figures 3 and 4. The collected information is published in an online Web log anonymously to provide support and help to patients who are suffering from the same disease and have similar disease related problems.
    
    Network Architecture
    The mobile application is designed to interact with Mobile Internet Platform (MIP) to send and receive short messages. The initial prototype by JM was further modified by EWHL who introduced the unified communication engine that would support both voice and data inputs especially for structured data. Users could choose to use phone, mobile phone, PC/laptop or the embedded system to work with the portal.
    
    
    
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    Figure 3. AMIN (answering multidimensional informational needs) solution framework
    
    Figure 4. Technical architecture
    
    answEring multidimEnsional informational nEEds (amin)
    Patient needs: To address the problem of multidimensional information needs a novel E-learning solution being perhaps tested for the first time is described.
    
    The following quote may explain the background to the term, multidimensional information needs: “The need for information is often much more than a question about medical knowledge … caregivers and care seekers are looking for guidance, psy
    
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    chological support, affirmation, commiseration, sympathy, judgment, and feedback. This ‘information need’ is particularly poorly explored, and yet it may well be the most important need and the biggest stumbling block to a technical solution” (Smith 1996). This problem may be addressed with maintenance of non-conventionally structured personal disease logs. Regular short messaging services (SMSes/Emails) from individual diabetics conveying their daily thoughts on their disease would be kept in a personalized repository in the Web for those in the intervention group. Thought partner matching for a learning community creation—thought partnerships in different diabetic patients with similar needs as expressed in their e-logged thoughts could be identified either by manual reading of different patient logs and inferring matches or Web based matching using text tags. This aims to promote shared learning in individual diabetics with similar needs gradually leading to an improved learning community of diabetics. Informational needs on SMS, conveyed explicitly as health queries, could be manually responded to by health professional monitors. Medical informational specialists (previously designated Medical library scientists) could monitor the discussion between patient to patients and patient to physician with valuable evidence based inputs to the gradually developing structure on the individual health record. Caregiver needs: All personalized data generated from the patient’s regular SMS/Email interaction with the mobile Web support system would be structured into a personalized health record (PHR) with the following components: 1. Structured summary of the patient’s health status (Mostly monitored/maintained/modified by health professionals)
    
    2.
    
    Basic information on identification, insurance, allergies, advance directives etc. (Format) b. Latest Problem list along with patient’s care plan (Investigations and treatment listed serially according to priority of action to be taken). c. Hospital admission discharge summaries in the past d. Present hospital record (if admitted at present) Non-structured evolving narratives inserted by the patient, thought partners or care givers at various points of time (with date). This structure would simulate the discussion structure of a wiki at present.
    
    a.
    
    pErsonal HEaltH profilEs
    Personal Health Profiles are a medical knowledgebased characterization of a user of a medical information service. Such a technology facilitates convenient and personalized access to knowledge produced by medical practice—the primary knowledge construction process. Therefore, a personal health profile enables exchange, debate, and reasoning about personal experiences with disease and the health care system, as a secondary knowledge construction process (Sittig, 1999). At present the health record structures in the Malaysian health system are predominantly paper based with its attendant disadvantages of information of a single patient in multiple paper files that are difficult to trace and maintain. The patient often doesn’t carry any substantial information about his past medical history. All this is expected to change soon with implementation of electronic health records (EHRs) in most Malaysian health care set-ups. Complimentary to this, introduction of the proposed mobile phone based PHRs in diabetics (to start with) aims at trying to eliminate the present problem of information
    
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    tracing confounding medical decision-making. These PHRs would not only be in the mobile phones of individual users but would also remain safe in a Web-based individual health record bank (IHRB) (Shabo, 2005). Apart from this particular service, the plan is to form learning communities amongst diabetics that address not just their established physical needs (for which programs like Diabetes Self Management Education DSME is more appropriate but also their psychological/multidimensional information needs that remain unaddressed in traditional learning programs.
    
    tHE prEsEnt status of diabEtEs tElE monitoring
    A recent systematic review (Jaana, 2007) identified 17 studies using diverse technologies and transmitting different clinical, medical and behavioral data with respect to telemonitoring of diabetic patients. Significant impacts were observed namely at the behavioral, clinical and structural levels. Minimal technical problems were reported. Figure 5. Overall approach to AMIN
    
    Close management of diabetic patients through telemonitoring showed significant reduction in HbA1c and complications, good receptiveness by patients and patient empowerment and education. The randomized trial quantitative data generated from this collaborative project planned is likely to replicate these findings. An important difference in this project is the qualitative strategy that hopes to create individual user (patient, health professional and other actor) collaboration utilizing minimally structured user generated free text data to generate experiential learning that otherwise goes undocumented regularly at present. This may be a small step towards promoting user driven health care for various chronic diseases and care of elderly.
    
    futurE dirEctions
    On completion of the test phase this Web-based solution to integrate healthcare e-learning needs can be opened to the world in a simple forum model already in use at present in various Web sites using what is loosely termed as Web 2.0 technology. In
    
    
    
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    Web sites using this technology user-generated tags allow the site to evolve, enabling individual users to conduct more precise searches, make previously unacknowledged associations between facts, and explore a diverse undercurrent of themes to synthesize learning. Regular experiential informational input may be posted on to the forum along with a copy to the individual user’s password protected Web account that would function as an e-portfolio if s/he were posting as a caregiver and a private personal health record if s/he is posting as a patient. The individual user could even do this through email and every post made by mail could easily open a new post on to the forum. Most PC (Personal computer) users in recent times spend their Internet time predominantly in their mailbox and integrating this solution into the mailbox would target this population. Finally the digital divide would only be effectively bridged as the basic mobile phone is phased out and the personal digital assistant (PDA) combined with mobile phone and PC functionality takes over boosted with WIMAX (Worldwide Interoperability for Microwave Access) technology for continuous easy online access).
    
    by returning related thoughts and text with each entry made by users. It consists of a database with Diabetes Data Set to support both the patient demographic data and medical parameters. This can come from/be integrated with other systems. The Unified Communication Engine allows AMIN to support both voice (especially for structured data) and data inputs. User can choose to use phone, mobile phone, PC/laptop or the embedded system to work with AMIN. It is an integrated system to simplify and streamline the diabetes monitoring process and support users unstructured queries, thoughts and journals. The operational prototype, which still continues to evolve, has been shared with other future stakeholders particularly in the government healthcare system. The described operational model signals the beginning of a future positive collaborative venture in user driven healthcare with multiple stakeholders in public and private sectors.
    
    acknowlEdgmEnt
    The first author assumes complete responsibility for the views expressed in this. We acknowledge the technical contributions of Waqar Aziz in developing the software interface for the solution discussed and the technical liaison Lim, Chia Ni, Tan, Eng Hoo, Ang, Koon Liang, and Hon Jia Yu. We are thankful to the Ministry of health, Malaysia for having gone through our proposal demonstration and at this point eagerly wait for the next step in this collaborative venture that is executing the operational model into a validation model. This write up has been shared extensively in emails and Web portals and ideas contained within it are being considered for publication in completely different contexts in different journals and book chapters.
    
    conclusion
    This was an illustrative process description of a collaborative project utilizing a multidisciplinary approach. The requirement for this inter organizational collaboration originated in an attempt to optimally answer multidimensional needs in individual patients and health professionals to allow them to achieve better health outcomes through inter individual collaboration between multiple stakeholders in the care giving and care seeking collaborative network. AMIN, which is an acronym for answering multidimensional informational needs, is a Web 2.0 enabled and moderated forum to support users’ unstructured queries, thoughts and journals
    
    
    
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    rEfErEncEs
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    the central role that experience plays in the learning process, an emphasis that distinguishes ELT from other learning theories. The term “experiential” is used therefore to differentiate ELT both from cognitive learning theories, which tend to emphasize cognition over affect, and behavioral learning theories that deny any role for subjective experience in the learning process. Qualitative Research: One of the two major approaches to research methodology in social sciences. Qualitative research involves an in depth understanding of human behavior and the reasons that govern human behavior. Unlike quantitative research, qualitative research relies on reasons behind various aspects of behavior. Simply put, it investigates the why and how of decision- making, as compared to what, where, and when of quantitative research. Hence, the need is for smaller but focused samples rather than large random samples, which qualitative research categorizes data into patterns as the primary basis for organizing and reporting results. Quantitative Research: The systematic scientific investigation of quantitative properties and phenomena and their relationships. The objective of quantitative research is to develop and employ mathematical models, theories and hypotheses pertaining to natural phenomena. The process of measurement is central to quantitative research because it provides the fundamental connection between empirical observation and mathematical expression of quantitative relationships. User Driven Health Care: Improved health care achieved with concerted collaborative learning between multiple users and stakeholders, primarily patients, health professionals and other actors in the care giving collaborative network across a Web interface.
    
    kEy tErms
    Auto Ethnography: Auto ethnography is a recognized qualitative social research method through which the researcher documents a group by recording his or her own individual experience as it relates to social history. Often, but not always, the researcher is a member of the group in question rather than the traditional outsider ethnographer. Consumer Driven Health Care: A strategy for users/consumers to decide how they may pay for their own health care through multiple stakeholders like employers who provide the money and insurance companies who receive the premiums. Evidence-Based Medicine: Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Experiential Learning Theory (ELT): Provides a holistic model of the learning process and a multi linear model of adult development, both of which are consistent with what we know about how people learn, grow, and develop. The theory is called “Experiential Learning” to emphasize
    
    

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