Integrating two distinct Virtual Patient systems: Identifying challenges and the role

of the MedBiquitous Virtual Patient standard

Luke Woodham1, Matthew Cownie2, John Wright2, Sheetal Kavia1

1St George's, University of London, 2University of the West of England

A Post-PC World in Education • Learners increasingly demand access to learning

resources in a way that fits in with their own learning practices– In class– At home– When travelling

• This requires supporting a wide range of platforms and device types – web, phones, 7” tablets, 10” tablets, iOS, Android, Windows Phone, Blackberry, mobile web etc.

• This is expensive and time-consuming, beyond the means of most educational technology departments

MedAssess/MedEdCases• Developed by SGUL in collaboration

with iBOS Solutions• MedAssess

– Distributed internally for SGUL students– Staggered release of cases based

around curriculum• MedEdCases

– Publicly available version on Apple app store

– Currently includes 39 cases• Available for iOS and Android devices• Cases can be downloaded and played

offline – no need for a permanent network connection

UChoose• Developed by UWE• Internal audience

– Distributed internally for UWE students

– Being incorporated into new nursing curriculum for September 2013

• External audiences– General Practice – Acute Trusts

• Sophisticated Silverlight Case Editor• Player requires Modern Web Browser

(not IE 6)• Player (and video) works on any

Webkit compliant mobile device with continuous network connection (unless a case relies on a flash widget)

• Best mobile form factor is tablet

UChoose/MedEdCases Collaboration

• Aim: To allow learners to access their resources across all platforms

• How: By facilitating communication and transfer of case content between the two systems, ideally seamlessly so that published content can be easily pushed to both platforms.– “A standard to enable [VP] exchange across systems has the

potential to scale their development and implementation across health professions education, including resource limited settings” – MedBiquitous

The role of the MedBiq VP Standard

• Designed to enable exchange across systems• Both UChoose and MedEdCases were designed with

knowledge of the standard– Data structures provide simple mapping of branching VP

structure• However:

– MCQ elements less easily mappable, as not defined in the standard

– Requires processing overhead of constructing XML formatting– SCORM packages designed for manual transfer, requiring

human intervention

Collaboration Process so far• Stage 1 - Formalise collaboration (NDA)

– able to share and directly view each systems data structures• Stage 2 - Generate a mapping from one system data

store to the other directly– No need for intermediary XML mapping

• Stage 3 - Explore potential transfer mechanisms– Agreed SQLite for initial stages of collaboration

• Stage 4 - Implement and test exports to each system using SQLite

• Stage 5 – Consider future development plans with a view to “harmonising” the systems and data structures

Significant Challenges• Differing ways of handling MCQs– Not covered directly by the MedBiq standard so

interpreted differently• Formatting of text content– ASCII or mark-up? What tags/formatting options are

permitted?• Media items– Supported formats, multiplicity of media items

• The transfer mechanism– Seamless publishing?

Future Work

• Alternative transfer mechanisms– Use of SQLite or indexedDB or OData ?

• We used a restricted feature schema• Optional features such as mcq’s, counters, rules?

• Closer integration of systems– Potential to develop web APIs to allow content to be

pushed between systems automatically– LTI standard for moodle/blackboard LMS’s

ODataOData is a standardized protocol for creating and consuming data APIs. OData builds on core protocols like HTTP and commonly accepted methodologies like REST. The result is a uniform way to expose full-featured data APIs.

Does it translate?• Does the system impact on a case’s design? Does the

case author need to re-interpret parts of a case for use in the new system?

• The nature of the platform alters the user’s relationship and expectations of the content– Different form factor– Different interface– Different input methods– Different screen size

• Different activities, different affordance