MedBiquitous Philip Dodds Memorial Lecture 2008

What are we saying to each other?

Rachel Ellaway Ph.D.Assistant Dean and Associate Professor Education Informatics,

Northern Ontario School of Medicine, Visiting Professor, St George’s London

You want to get involved, to understand, to be part of this ... but how and why …

and what is it we are saying to one another?

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• Why?

• What?

• For who?

• Who gets to sit in all the chairs and sleep in all the beds?

• Towards a scholarship of standards and specifications …

We, MedBiquitous

• … are about interoperability in healthcare education

• Interoperability: the ability of two or more systems to exchange data meaningfully

• To exchange data systems must talk to each other

• … using common language, vocabulary and semantic intent

• S&S therefore are the basis of language and conversation

• So what is it we’re saying to one another in S&S?

SH

Language

B INGM ETP EDSP LE

What are we saying?• ‘french has become the lingua franca …’

• eCases vs Virtual Patients

• eFolios vs Portfolios

• VLE vs LMS

• Language is standard

• Language is far from standard

• Linguistics of XML and standards and specifications

• Intertextuality and deconstructing of S&S

Deconstructing S&S

What is in, what is omitted, where things are, how they’re labeled and structured:

– ‘simple’ sequencing

– ‘controlled’ vocabulary

– semantic density

– interactivity level

Preemptive design choices - what can and cannot be said

The illusion of inevitability

Metaphor

• Metaphors are a fundamental cognitive phenomena

• Essential in relating the unfamiliar to the known world

• Culture codes

• Metaphors and constructs - enabling and constraining

– IMSLD’s act/play

– Content, process, trajectory

• Once we have our language and symbols then we can use them - sequencing, challenge/response, handshaking, conversation …

In a mirror darklyDesign reflects the designer

Powerful mirrors …

S&S is no different

Subjective, interpretive, related to time, place, culture and individual oddness

So what can we do? – Recognize and champion the individual contribution– Recognize and value S&S as process, as trajectory– Many hands - crowdsourcing– Open review and use

Conversation

The Kolb Machine

SOULS

What are we saying?

• From interoperability to integration

• Degrees of coupling and dependency

• SOAs

• eFramework

• Messaging and contingent behaviors

• Not just conversation but:

– rich models and constructs - stories

– rich sequences and connections - narratives

Stories and narrative

1: finite and longitudinal time sequence

2: presupposes narrator and listener

3: concerned with individuals and identities

4: more than just unfolding of events - motive, causality

5: engaging, absorbing and immersive

S&S as narrative?

Use Cases

• narrative accounts of a system or process

• key precursor to achieving interoperability

• semantic and ontological bridges between system participants

• regularly used in development, documentation or evaluation of information systems, both technical and human

• the conversational model is intrinsic to good S&S development

Everyone needs Standards

“standards … are a kind of pedant’s potion that make the world go round”

Sam Knight, “Everyone Needs Standards”, Prospect, 144

Standards

Standards

• Swedish length based on the local vicar’s foot

• Civilization is defined by standardizing its technologies

• Language, laws, weights, lengths, time

• Science: math, statistics, units, shorthand (chemistry), graphs and other visual models

• Art: musical scales, notation, paint, film, photography

• Sport: rules, pitches/spaces, equipment

• Each tells us much about ourselves and our cultures

• S&S as weltanschauung

HETs and standards

• Healthcare is a technocratic system

• Education is a technocratic system

• HETs - no surprises?

• Standards and specifications are fundamental

• Standing on the shoulders of giants

• S&S as threat, as opportunity, as currency

• Social accountability, economic etc

• S&S as reified conversations and stories about us as individuals and as part of the system

HETs and standards• There is no them - there is only us

• Critical inquiry is essential

• Understand and appreciate impact of design choices

• Understand and appreciate S&S paradigm and trajectory

• Negotiating common purpose

• Exposing concepts, partialities and bias, commonalities and differences

• Common currency for a civilized and diverse world - “act locally, think globally”

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• Criticality of S&S

• Critical approaches to S&S - artefact and process

• Scholarship of S&S

• Openness, transparency, engagement

• Expertise of the many

• Simple, simple, simple

• Beware of the seemingly inevitable

• Foundational to a civilized society

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