E-learning health solution:  Individual user driven information matching

How it may work and what results it may produce?

At present such detailed logs are difficult to generate daily with the kind of web interfacing solutions at the disposal of the average human. At best the daily jottings a patient physician may accomplish on his PDA is something like this (Copied from real personal logs made by the author on his own PDA as well as hand written):

1)   June 6, Rounds and OPD, usual dissipation to OPD at the end of the rounds.
Bed 5 felt very bad about the CML who landed up with pancytopenia. Overlooked stopping the Hydrea at 4,500. He’s having a count of 200 and CXR shows bilateral apical infiltrates…Evening:  B’s farewell with canned beer.

2) Bed 6 Old mitral valve replacement with rheumatoid arthritis. Last admission for increased joint pains and increased INR (6.5) with hemoptysis. Adjusted warfarin dose last time to 2.5 mg and also added a statin. Came back this time with possible statin induced myositis (CPK 1000) Discussed differences between myositis and myolysis with students on the rounds. Also the present INR on 2.5 mg warfarin was subtherapeutic (1.09)
 
3) June7 Great day. Bed 10 SAH with massive hge in CSF. Looked as if traumatic. Kudos to G for having suspected it and having held on to the idea that the bloody CSF was indeed not traumatic but subarachnoid hemorrhage. CML graph of treatment and progress. A’s trend analysis of the WBC counts on Xcel…Evening: shopping …good bargains.

4) Bed 11 Patient with severe pulmonary hypertension, nice palpable P2 and also AF. Had a past history of TIA for which now on warfarin 2.5 mg once daily. INR maintained (2.5)More often they are just telegraphic information:

5) Relooked Bed 11…student’s request. 50 yr Male, Neph synd with DM, with diab foot dripping pus on the bed. No dressing since yesterday?…Blood sugar values?

6) Bed 10 60 yr Male, collapsed suddenly, cirrhosis with end stage, didn’t want to resuscitate but had to for protocol as we had missed out on the dnr earlier. Students had an exercise.

7) OPD 54 yr F, undifferentiated collagen vasc disease, vasc rash, erythromelalgia, hist of raynauds, arthritis, 3 months, increased with sea food, children’s comment:  mother looks like the lobster she has eaten.

OPD 40 yr F recent Diab, Fasting sugars 7.3mmol and 6.8 mmol, mother diabetic 10yrs, started on metformin and telmisartan 40mg, sugar free cough mix
 (? Ammonium ipecac)
Relevance of daily E logs to solve individual patient/health professional user needs:
 
Around 70% of the information needs that the patient/ physician may identify from these personal logs goes unanswered due to lack of time.(Smith R,BMJ 1996; 313:1062-1068)

For example the academic physician-consultant (author of the real log example) had seen the diabetic man in example 3 earlier on his morning consultation rounds but he realized that this patient’s blood sugar control had been overlooked only after a medical student requested him to have another re-look. He made a point to inform it to his junior colleague, the medical officer who would remain in the wards (immediately after making the telegraphic note about Bed 11 in his personal diary) but at that point of time all of a sudden Bed 10 collapsed and he had to participate in a CPR that was emotionally and physically draining and he was relieved to escape to the OPD for the day.

Sharing and communicating valuable individual patient data

If this data was on a web portal as soon as he had entered it into his PDA, the data would have matched with his other colleagues data for the day regarding this particular patient (a virtual hospital filing system) and his junior colleague (Medical Officer/Senior Resident) doing just a file review on his PDA would have noticed the note and acted on the diabetic’s blood sugars if it was high. Controlling it better may have benefited the wound more than the systemic antibiotics that he was already on (which had doubtful local benefit). This technology offering a convenient local solution to improving hospital communication among in house health professionals is evolving at present in many hospitals although most health care givers still prefer the personal face to face approach (which may not be always feasible as depicted in the example).

Medical students as a vital force in E learning and improvement of patient care

The government generally thinks that it spends a lot of money in Undergraduate Medical training perhaps as these student doctors apparently do not serve while they learn. However it is the medical student who has the time to listen in detail to their chosen individual patient (they do not have to see and are not responsible for all the ward patients unlike their overworked houseman/resident seniors). Medical student logs on their individual patients can be a vital source of detailed narrative data on individual patients which their consultant might often enjoy reading and also benefit from daily. The medical student who pulled the consultant to the bedside may as well have entered his thoughts about his patient on his PDA-elog that would have automatically been reviewed by the consultant or his Medical officer (Senior resident).


Individual patient learning and communicating from global experiences

In the present proposal we are looking at a global solution for all varieties of individual users. Perhaps a diabetic patient in another part of the world on keying his concerns about his own foot ulcer would find a match in this incident and could become aware of the need for better sugar control in his own situation and may remind his own physician about his increasing sugars (the emotional appeal in narratives may make for better patient learning?). Not that his/her physician is not knowledgeable but all physicians are erring and forgetful humans as much as all patients are potential physicians (of their own systems to begin with).

Different individuals have different responses to the same drug and dose
In Example 2 and 4 the patients were taking the same drug Warfarin at 2.5 mg each day for different initial reasons to maintain an anticoagulant state (keep their blood thin…as explained in patient language). Yet their anticoagulant status as determined by their individual systems (bodies) was very different. This is just to draw an analogy emphasizing the complexity of dealing with different individuals in health care. There may be countless other examples.

Detecting an opportunity for research in the simplest of anecdotes
The fact that the children noticed their mother becoming red right after eating seafood may suggest a food allergy triggering an abnormal immune activation in this particular patient presenting with features of an undifferentiated collagen vascular disease.

Most health care professionals/individual patients can generate a lot more variety of beneficial examples in shared e-logging in health care regularly maintaining their own daily process logs for which one may still have time as it is done on the job and the information needs generated from these may be identified by web based user driven solutions.
 
Manner in which proposed E learning in E-health solution may be used

With improvement in technology these valuable data of daily processes generated by a given individual can be recorded and documented daily in web based archives. Once in the net there is technically feasible software already existing that can quickly extract themes from these individual process narratives. One just needs to send the above-mentioned case study narratives via gmail and notice the advertisements generated.
The advertisements contain something relevant to the information needs posted in the mail and it is obvious that the software used by gmail is able to locate a few of the needs in the information content sent on the mail. Although a separate study can be done on how close gmail can itself get to successfully answer the information needs in daily elogs, we need not get into that as gmail/google obviously is far from providing it at present although one can’t rule out a future possibility (5)

Once individual users (the patient, medical student, health professionals) information needs are identified using narrative analysis with available qualitative or other soft wares, another software/search engine would automatically collect the matching information available on the web from another individual patient/medical student health professional as well as any related top down theory based information content and post it appropriately to the site/mail of the individual users concerned (with web links for detailed reading.

In this way any individual user feeding input into the net can receive automatic feedback that can grow as individual users for this web based solution keep growing and feeding their own daily data. Growing feedback from multiple patients (multidimensional single loop feedback learning) would spur interest and learning in the identified area of need and can be strengthened by the user returning the feedback with more information/needs to the individuals sending him/her the initial feedback (double loop learning).