Practical Application ofInformation Technology

Zhenhong Qu, MD. PhD.Department of Pathology

William Beaumont Hospital – ROOakland University

Michigan, USA

Disclosure

I do not have any financial interest to disclose.

Disclaimer

This presentation is NOT about strategy of IT application at an enterprise or large organization level. On that topic, the following book is recommended

John P. Glaser: The Strategic Application of Information Technology in Health Care Organizations” Publisher: Jossey-Bass

n Subheading¨Note text in dark blue color

n Hyperlinks in blue with underline

Practical Approach >> Data Organization

Section current topic

Note: Demo videos on the Web will be updated through September. Some demo videos are only shown during the course.

A guide to slide layout

Outline of Presentationn Introduction

¨ Words on Informatics &. Information technology (IT)¨ Definition of “Simplicity”

n Principles of IT application in pathology¨ General principles #1 - #6

n Working scenarion Comment / discussion

n Practical Approach ¨ Text management¨ Image management¨ Audio & Speech ¨ Data organization¨ Effective file retrieval (find what’s needed instantly) ¨ Access your data from anywhere¨ Web collaboration

n Informatics vs. information Technology (IT)¨ Informatics: the study of the processing,

management, and retrieval of information¨ IT: the tools (software, hardware) and their design,

development and implementation for the electronic information management

n Why the “general principle”?¨ Too many choices (i.e. resources &. opportunities)

on the Internet cause decision paralysis.¨ Guidelines can facilitate decision-making process &

effectively aid correct decision.¨ Experiences in specialized domain (i.e. pathology)

are not readily systematically available.

Introduction >>

n Definition of “Simplicity”¨Reliable and Predictable¨Cheap (i.e. cost-effective)¨Useful and effective (= value)¨“Building blocks”

Ref. George Whitesides (at http://www. Ted.com/): “Toward a science of simplicity”

Introduction >>

n #1 Simplicity RuleChoose simple technologies (i.e. tools/methods) that are effective.

n CommentThe value of a technology is not determined by its novelty, complexity and brand name but by the magnitude of the problem that it can effectively solve. If a free technology tool can effectively solve a real clinical problem that otherwise costs a million dollar, then the technology is worth $1,000,000!

General Principles >> #1 Simplicity Rule

n Work scenario – select an image software:

Features \ Software A B C

View & simple edit Yes Yes Yes

Multiple image formats Yes Yes Yes

Special effects (e.g. cloning) Yes No Yes

Image size limit > 5 M Yes No Yes

Image tagging No Yes Yes

WaterMark Yes Yes No

On-Line sharing Yes No Yes

Layers Yes No No

Tech support Yes Yes No

Price (single user) $199 $89 $0

For more examples (click): 1. 2.

General Principles >> #1 Simplicity Rule

n Work scenario - question:¨Which would you choose and why?

n Software An Software Bn Software Cn None of the above

n Comment ¨“Everything should be made as simple as

possible, but not simpler.”¨What separates the “simple” and

“simpler”?

General Principles >> #1 Simplicity Rule

n #2 Need/problem Rule

Problem-originated search for & selection of a technology.

n CommentLook for a technology that can solve existing problem instead of finding application of a new technology. Failure to follow this principle is probably the most expensive and most frequently recurring mistake in IT application.

General Principles >> #2 Need/problem Rule

Work Scenario AAmazing visual illusion

by Street arts

Question: What application to your field can you think of for this?

General Principles >> #2 Need/problem Rule

Start with a problem / need, you’ll find real meaningful application, but often a creative modification makes all the differences as in this example.

Answer … …None, unless you (already) have a problem or need for that as this highway speed control staff.

General Principles >> #2 Need/problem Rule

n Work Scenario B: survey by a vendor¨How will softMedia fit into your workflow?¨Will images be used in report?¨ In SoftPath, there are 6 place holders at the

end of the report. Where will the image go?¨What kind of cameras do you have?

n Question¨What’s your answer / response?¨Do you see anything wrong with it?

General Principles >> #2 Need/problem Rule

n Scenario C - a case study¨Touch-screen & E-grossing manual

n The grossing stationn The problemn The attempts & resultsn The solution (?)

n More examples¨TX telepathology¨Lytro Camera (Ren Ng)

General Principles >> #2 Need/problem Rule

E-Grossing Manual (a case study)General Principles >> #2 Need/problem Rule

Put a touch-screen PC at specimen grossing station for quick and easy look-up

From restaurant cashier to

Pathology grossing bench

Changes in Add-on Blocks & Total TAT in 2002-2005

Parameters \ Year 2002 2003 2004 2005

Total # of Cases 9300 9343 9309 9297

Total # of Add-on block 1996 1190 1345 1125

Add-on block per Case 0.2146 0.1274 0.1445 0.1210

Reduction % Rate N/A 40.65% 32.68% 43.62%

# of Block Reduced N/A 815.2 652.9 870.4

$ Saved at $15/ block N/A $12,228.4 $9,193.97 $13,055

TAT by 2 day 64.66 77.94 81.74 86.78

P value N/A <0.001 0.0011 <0.001

# = number; $ = dollar; TAT = total turn-around time; N/A = not applicable. Whenever applicable, the data in 2003-2005 were deduced by comparing to those in 2002.

Z. Qu et al.: Human Pathology 38(3):420-425, 2007.

How does the E-Manual affect service?

General Principles >> #2 Need/problem Rule

n Lesson learned¨Start with specific need / problem, THEN look

for technologic solution -- i.e. problem-originated NOT problem-oriented nor technology-originated.

¨Without a specific problem target, the operation will be aimless. Without a specific goal, the technology will not have a meaningful application or a truly innovative use.

¨As users, tech-driven approach is costly and frequently fruitless.

General Principles >> #2 Need/problem Rule

n#3 Granularity RuleKeep structural & functional granularity(i.e. relatively independent on others).

nComment1) Not mutually exclusive with system integrity2) Can perfectly co-exist with system functional unity3) Depends on simplicity4) Easy to manage. 5) Minimal negative impact on system operation. 6) Fast to apply, test, implement and fix. 7) Cost effective.

General Principles >> #3 Granularity Rule

#3 – A working scenario: MobileAJCP

General Principles >> #3 Granularity Rule

Video demo

#3 – A working scenario: MobileAJCPGeneral Principles >> #3 Granularity Rule

n #4 User/client RuleBe the user or always keep the users/clients in mind.

n Comment¨Users = key factor for success of any IT

application¨Good IT does not always = willingness to

accept by users¨Not necessarily means users decide

what’s the best

General Principles >> #4 User Rule

nKey aspects for user adaptation¨Education: demonstrate (to both users &. leadership)

the advantage and benefit of a new IT. Benefit = incentive.

¨ Support: help easy & comfortable adaptation. Video tutorial vs. conference training (IT is largely a skill by nature – needs hand-on practice)

¨ Strategy: gradual transition (from simple to full-function, from few to group), non-exclusive approach.

¨Patience: give time for old habit to die and for gradual transition. Quick / drastic change is invariably a recipe for failure and very often disaster.

General Principles >> #4 User Rule

n #5 Impact RuleKeep eyes on trends in IT & issues

in your professional field.

n Comment¨ IT application is investment for return¨ Investment return = ratio of impact/cost¨ Impact = time x extent (users)

General Principles >> #5 Impact Rule

n Work scenarioWith a lot of materials for a educational project, you decide to have a strong Web presence.

n Question¨What is the major format of the project (e.g. web site, podcast with RSS feed, etc) ?¨If a mobile Flash Web is considered, what are the key aspects to take into consideration?

General Principles >> #5 Impact Rule

General Principles >> #5 Impact Rule

General Principles >> #5 Impact Rule

General Principles >> #5 Impact Rule

n Work scenario (continue)

¨Based on the trend, should we move ahead to create our project with focus on mobile device and enrichment in video effect?¨What about the trend in the

mobile device per se?

General Principles >>#5 Impact Rule

iPad/Phone vs. othersWhat differences it makes?

General Principles >> #5 Impact Rule

n Working scenario (continue):

¨The final decision is …

General Principles >>#5 Impact Rule

n Mobile Learning Trends¨The rise of the tablet¨The domination of e-books¨Cloud computing¨Location-based integration¨Online collaborative learning¨Online class management¨Mobile learning in workplace training

Tina Barseghian: 10 Major Mobile Learning Trends to Watch For. NPR July 29, 2011

General Principles >> #5 Impact Rule

n #6 Alignment RuleConstantly align technical expertise with your goals.

n Comment¨ Misalignment of different expertise is very common and “natural” ¨ Stay with “I DO IT” schema ¨ Be assertive¨ The enemy of good is better.

General Principles >> #5 Alignment Rule

n The “I DO IT” schema¨ I = idea (i.e. goal)¨ D = design (the road map of project)¨ O = objective/obstacle assessment¨ I = implementation¨ T = test

Review the goal & design with your IT staff regularly. Be simple and specific in communication. Make no assumption of being understood by your IT staff.

General Principles >> #5 Alignment Rule

Summary – 1.n Introduction¨ On Informatics &. Information technology (IT)¨ Definition of “Simplicity”

n Principles of IT application in pathology#1 Simplicity rule: keep IT simple.#2 Need/problem rule: problem-originated appl.#3 Granularity rule: keep IT relatively independent. #4 User / client rule: be a user yourself.#5 Impact rule: keep eyes on technology trends.#6 Alignment rule: keeps IT aligned with your goal.

n Working scenarion Comment / discussion

n Practical Approach¨Text management¨ Image management¨Audio & Speech ¨Data organization¨Effective file retrieval¨Access your data from anywhere¨Web collaboration

n Needs / problemsn Solution / resources (software tools)n Examples / demos

Practical Approach >>

Text Management

Practical Approach >> Text management

n Management of text files¨The concept / definition¨Features of routine documentation

n Repetitiousn Voluminousn Complex

¨The needs / problemsn Keep consistency of voluminous docs (e.g.

manuals, handbooks, books, grant appl.)n Effectively organize routine documentation

Practical Approach >> Text management

n Global formatting & hyperlinking¨Headings & bookmark¨Effective navigation x 2¨The power of style and color

n From canned message to forms¨Pathology report¨Structured tumor report

Practical Approach >> Text management

E-Grossing Manual (an example)Format the manual text file with hyperlinks for easy navigation. Host it on the network or Internet

Put a touch-screen PC at specimen grossing station for quick and easy look-up

Practical Approach >> Text management

Power of Style & Color for Formatting

Practical Approach >> Text management

A Podcast – an example of text formatting

Practical Approach >> Text management

Audio script for podcast

PDF for Web view

Color-coded Screen text on mobile device

Create different derivative files for different usages from one master text document

Structured tumor reporting (an example)

Practical Approach >> Text management

Practical Approach >> Image management

Image management

Practical Approach >> Image management

n Image management¨Concept / Definition

nOrganize vs. View / Edit¨ Features of pathology (images)

nVisual sciencenOne-to-many & many-to-onenRequires metadata as tags

¨ The needs / problems

nDifficult to categorize / file imagesnRequire complex search

“I have it but I can’t find it when needed!”

Practical Approach >> Image management

n Image management¨Image software (click on the links)

¨For exhausting lists of moren www.1stwebdesigner.com/freebies/28-online-photo-editing-

websites-to-have-fun-with/n http://smashingwall.com/freebies/photo-editing-websites/n www.mediabistro.com/10000words/21-free-online-photo-

editing-tools_b182n www.hongkiat.com/blog/10-free-photo-managing-software-

you-should-at-least-know/

Adobe PhotoshopGoogle PicasaPicnikFlickrPhotoscape

MS Office Picture ManagerIrfanViewGIMP Windows Live Photo GallaryThumbsPlus

Practical Approach >> Image management

n Which image software?¨What are your selection criteria?

n General viewing (thumbnail and full image)n Simple editing (e.g. contrast, brightness)n Compatible with common image formats

(e.g. JPEG, TIFF, …)

n… …Add 3 more, or re-make your criterion list

n An example / answer ? ¨Video demo

Practical Approach >> Audio management

Audio Management

Practical Approach >> Audio management

n Audio production¨The needs / problems

nRepeated update of audio materialnDelay during info relaysnCost

¨The solutions n Text-to-speech (TTS)nSpeech recognition (CSR)

Practical Approach >> Audio management

n Software for TTS¨Some highly visible TTS software

n TTSReader http://www.sphenet.com/index.htmln flameReader http://www.flamereader.com/n NextUp http://www.nextup.com/index.htmln Neospeech http://www.neospeech.com/n Verbose (by NCH)

http://www.nch.com.au/verbose/index.htmln Neospeech http://www.neospeech.com/

¨For exhausting lists of TTS softwaren http://www.softsea.com/software/Text-To-Speech.htmln http://www.freewarefiles.com/category_9_105.html

Practical Approach >> Audio management

n Selection of TTS Software¨What are your selection criteria?

nAccept different text file formats (e.g. Word, PDF, web text)

nCreate audio in different formats (e.g. wav, mp3, etc.)

nCompatible with different speech enginesn Speech speed & pitch control.n ... ...

Add 3 more, or re-make your criterion list

Practical Approach >> Audio management

n Application of TTS¨Video demo (TTS) click here¨Comment

nTTS software =/= speech engine!!nAbsolutely nothing “out-of-box-ready-for-use”!!n Speech has multiple quality parametersnReplace complexity with quantity to make task

manageablenCreate speech profile for specialized field

Practical Approach >> Audio management

Audio Management¨Computerized Speech

Recognition (CSR)

Practical Approach >> Audio management

n Notes on CSR¨No reliable data to substantiate the claim of

the accuracy rate (>95%).¨The significance of 1% error!!¨Stratification of the accuracy rate is essential

to make it meaningful.¨SCR is by pattern recognition and follows the

rules applicable to patterns.

n CSR – should you adopt it?¨Deceptive accuracy rate (NYT article)¨CSR application (video demo)

Practical Approach >> Audio management

Practical Approach >> Audio management

Accuracy Rate for Different Components of Pathology Report by CSR

Report Component

N = N of CSR Participant

Accuracy rate (%)

Patient Name 2,873 6 31 - 46

Accession # 2,873 6 75 - 82

Diagnosis 2,873 1 91.6 – 94.4

52 5 93.7 – 97.8

Report Format 2,873 1 0.71 – 2.2

52 5 4.3 – 7.9

Z. Qu, et al: Abstract-1931. Modern Pathology. 24(suppl. 1): 454A, Feb. 2011. (USCAP Annual meeting).

Data Organization

Practical Approach >> Data Organization

n Data organization¨Concept / definition¨Needs / Problems

n Lack of time for frequent file organizationn “One-to-many” dilemma in data filingn Different data formatsn Can’t find files when needed!!

¨Why ?(- The root causes)nMultitask nature of our daily workn Temporal fragmentation of our task

Practical Approach >> Data Organization

n Data organization¨Commonly used software

n FileMakrePro (for text)n ThumbsPlus (for images)n EndNote (for references)n Zotero (for all web info)n MS Access or OpenOffice Base

¨Database application n Highly flexible record-keepingn Help collate research resultn Effective retrieval (next section)

Practical Approach >> Data Organization

nData organization¨Software Selection CriterianRequires no or minimal

programming skillnFlexible to build functionsnCompatible with diverse data

formatsn ... ...

Add 3 more, or re-make your criterion list

Practical Approach >> Data Organization

n Data organization¨Video demo (click on links below)nRecord keeping in FMPronEndNote for referencesnZoster for on-line info

¨CommentnSimple solution for complex data

Practical Approach >> Data Organization

Effective File Retrieval

Practical Approach >> Effective File Retrieval

n Effective file retrieval¨Needs / ProblemsnRetrieve relevant data when needed

¨Root causesnMultitask nature of our daily worknTemporal fragmentation of our tasknDiverse file types

¨Solution / Resources

Practical Approach >> Effective File Retrieval

n Effective file retrieval ¨Video demos (click on links)nGoogle Desktop:

Find any files on your PCn Image DB:

Find any images by metadatanFMPro DB:

Find any files by text / category

Practical Approach >> Effective File Retrieval

Data Access

Practical Approach >> Data Access

n Access your data from anywhere ¨The needs / problemsnContinuity of project workn “Heavy bag” problemnData access

¨Solution & ResourcesnVirtual personal network (VPN)nCloud computing

¨Advantages and concerns?

Practical Approach >> Data Access

Virtual Personal Network (VPN)

Practical Approach >> Data Access

Cloud computing

Practical Approach >> Data Access

n Access your data from anywhere¨Examples of “Cloud” (click on links)

n Dropbox: Video tutorialn Zotero: video tutorial nGoogle Doc: video tutorial

¨Examples of VPNn PenVPN (open source)n A list of more VPN options

¨What are the differences?

Practical Approach >> Data Access

Web Collaboration

Practical Approach >> Web Collaboration

nMeeting & collaboration on-line¨The needs / problemsnNeed for different expertisenTemporal / geographic separationnEducation / teaching-learning

¨The advantage &. concerns

Practical Approach >> Web Collaboration

n Solution /resource¨Google Doc: multiformat collaboration.¨Wikispace: collaborate on writing project

with others. ¨VioVox: voice in a meeting anywhere (demo).¨Skype: more than just free web phone.¨Voicethread: attend the same meeting at

different time without missing anything.¨Facebook: social media or collaboration tool?

Practical Approach >> Web Collaboration

/

n Clinical practice¨ Text formatting: E-grossing manual, tumor-reporting.¨ Image management: ThumbsPlus database¨ Template-based speech recognition¨Data access: VPN

n Education / academic¨ Text formatting: the podcast¨ Image management: ThumbsPlus database¨ Text-to-speech¨Data access: DropBox¨Collaboration on the Web: Wikispace, Google Doc

Summary – 2.Technologies /examples relevant to

n Selected References¨Morgan Stanley - Internet Trends 2010.¨G. Solomon & L. Schrum: Web 2.0: How-To for

Educators. iste, 2010. ¨ S. E. Holzner & N. Holzner: Google Docs 4 Everyone.

QUE, Feb 2009.¨ Z. Qu et al: Web-based Tumor-Reporting System.

Available on the Web. 2005 - 2011.¨ Z. Qu et al: Pathology Journal Article Titles (an audio

podcast). Dec. 2010 – present.¨ John P. Glaser: The Strategic Application of

Information Technology in Health Care OrganizationsPublisher: Jossey-Bass, 2009.

Acknowledgement ¨ Department of Pathology & Lab Medicine,

University of Rochester Medical Center (URMC) Rochester, NY.

¨ Students of Pathology Information Technology Apprenticeship Program at URMC.

¨ Students of Information Technology Apprenticeship Program at William Beaumont Hospital.

¨ Miss Kimberley Pieters at Beaumont Health System for her editorial support in preparation of this presentation.

Questions?Comments?

Thank you!