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Using Wikis in Hospitals?
An anonymous reader asks: "A friend who is a medical doctor in a hospital in Europe is interested in promoting wikis for sharing medical research notes in his community. Does anyone have experience with how to approach this? Most of the targeted users will not be particularly computer, or Internet, literate. I've used wikis in several software companies but never in a medical environment. What would be the best way to overcome resistance? How should my friend present it so that it makes sense to them?"
We made one for non-technical users. We use the "Kronos" time clock/door lock system, and we made a documentation project with a wiki. We locked the main pages made by us, and created an unlocked page for additional notes branched off of that that can be modified by anyone. We used wiki tikki tavi. Works well, and installs fast.
/* oops I accidentally made a comment, sorry */
I have an excellent flu remedy I'd like to include. It involves gun powder and a swing-set.
I've used wikis in several software companies but never in a medical environment. What would be the best way to overcome resistance?
The standard course of action would be to use a broad-spectrum corticosteroid. If unsuccessful, more targeted immunosupressives can be used.
Ba-da-bing! Thank you! I'll be here all week!
Serious:
/. tolled with goatse links, else you will come out of your appendectomy with an asshole you could use to carry bowling balls around.
Before you consider wiki, describe what you need? a loosly organised fast changing refinement of data? highly structured secure and minimally changing data? something for what? wiki isn't a good for all solution.
Some wikis support some cool features like templating, but if you are serious about an extensible, knowledge management solution that works on PC's, Mac's, TV's, Mobile phones, PDA's etc, then reply here and I will get in touch with some suggestions.
Joking:
You are just about to go under, and the youthful looking doctor fires up wikipedia.org and starts searching for 'brown wobbly bits' and 'blood'... just hope it hasn't been
#hostfile 0.0.0.0 primidi.com 0.0.0.0 www.primidi.com 0.0.0.0 radio.weblogs.com
As a medical doctor and software developer I can tell you that this is will be hard to do from several aspects. First of all, "Wiki" is unfortunately just a very whimsical name that is hard for hospital admin folks to take seriously- It just sounds like a major security risk to let something like that have access to HIPAA protected patient information- You can talk till you're blue in the face that it can be securely deployed through SSL, etc. Serious people don't do Wikis will be a knee jerk reaction that you will find hard to overcome. Maybe if they had given it a serious name like "MicroCollaborator" or something instead of Wiki, this wouldn't be a problem.
Another problem with Wikis in a hospital is that people are horribly busy and will never, ever want to take the 2 minutes it takes to learn just how convenient a Wiki system can be (Sure, you'll always have a doc or nurse who is a gadgeteer and will love to play with it, but unless everyone is aboard, Wikis aren't very useful)
Someday, Wikis or a similar technology will be on the cover of Time Magazine or somesuch and then every hospital administrator will be falling over each other trying to install Wikis... but until then, it is a hard sell, I think...
On the other hand, if your medical doctor friend is in a position where he/she can force the other residents, nurses, etc. to use the system, it could be a great asset to the practice of medicine, I think, even if people will only grudgingly participate at first- whether you use it for interdepartment communication, patient notes, etc. it could be useful for all of these.
If your friend can pull this off, he/she would be doing the kind of innovative thinking that all clinicians should be getting involved in and that will make medical care better for all of us.
"How should my friend present it so that it makes sense to them?"
Based off of samples from my doctor's handwriting for prescriptions, may I suggest the Linux font 'scribble'?
The trouble with all Wikis is the startup. When there is no info on it the Wiki is useless and it is hard to get people interested in it or even to give people an idea of what it is. Users only embrace them once they have become a valuable source of information.
Before ever showing it to anyone it needs to be seeded with an initial structure and as much useful info as you can find time to enter.
Of course you will have to be sure that the intended use doesn't run afoul of HIPPA. The very nature of a Wiki will give a HIPPA compliance officer night-sweats. How do you intend to ensure that no confidential data is entered and that if it is it is only viewable by authorized people?
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"You are not remembered for doing what is expected of you." - Atul Chitnis
What has worked for me in the past is to go ahead and impliment something for myself. Then, I start adding everything I can think of. After a decent framework is in place, I approach one or two others, and coerce them into giving it a try. Eventually, word of mouth takes hold. Then I just sit back and administer.
An out-of-the-box solution would be something like PmWiki (http://www.pmwiki.org) as it can be installed in minutes and comes with most of the documentation to make it worth using.
What those who want activist courts fear is rule by the people.
I have occasionaly stumbled upon some wikis and I fail to realise what is so great about them. I think that wikis suck. Information without form and proper structure is not particularly valuable. You need a human editor to make this mess into knowledge (not just a pile of info). I suppose that wikis are very easy to maintain, but in the end you simply cannot compare the quality of a wiki with something that has proper editing and supervision. Perhaps I'm missing something here, don't hesitate to correct me. P.
There are plenty of wikis out there that provide revisioning, change logging and annotate these changes with user information --
May be good in theory, but who in a busy hospital will have the time to implement it in practice, and keep it under the needed supervision?
-wb-
It sounds to me more like you want a general research exchange vehicle than something that would actually be used in the operation of a hospital.
Wikis have to be tweaked a bit to make good *academic* research exchange systems. I emphasize "academic" because in other areas they work fine as installed, but the academic area often focuses a lot on attribution and authorship, and those bastards won't publish to wiki where other people can change it, and will fight over whether someone's edits justified their position in the author list -- I have seen grad students cry and confess to me they were contemplating suicide over 2d versus 3d position in the author list. Most academic researchers should be shot as an eugenics measure for the mental health of the species.
Anyway, given that we aren't going to that far, I think you want to model something after the old Royal Society type circulars. In the old days formal and informal clubs of scientists and interested patrons and amateurs would write letters to a secretary, who would gather them and possibly do some filtering and editting and print and forward the collection to everyone. It enabled people interested in a esoteric topic and spread accross oceans and continents to stay plugged in to their community of interest.
Start by examining http://arxiv.org/. It keeps track of drafts and revisions, and maintains authorship for the neurotic academics, and has been very successful.
Then, I would model something along the lines of a n email list to which people would submit their research, with a periodic digest and review similer to the summary of the linux kernel summary at http://www.kernel-traffic.org/.
The medical profession already has similar specialized reports. For example, doctors report strange new diseases and conditions and peculiar deaths to the Centers For Disease Control in Atlanta, which then produces a weekly Morbidity and Mortality Report, indentifying any new trends or outbreaks. It was in such a report that the reports of several doctors that they had seen gay men with weakened immune systems was first announced, giving rise to the Gay-Related Immune Deficiency (GRID), now mostly known by the Reaganites (who didn't want to admitt that gays existed) more politically correct acronym, AIDS.
A group editted kernel-traffic style digest of a higher traffic email list would be my direction.
By its very needs, supervision is a centraliced process; when the system is under heavy use by many people, it becomes impossible (see Slashdot moderation as an example).
Wikis are a tool for decentralized, incremental building of information. As anybody can edit it without prior registration and training, the entry threshold is none - so the participation is expected to be high, and knowledge (ideally) develops in a organic way.
Singularity: a belief in the "God" idea with the "demiurge" relation inverted.
Has it ever occurred to anyone that "Europe" is not a country?
With a *convenient* setup, a personal Wiki for one's projects, becomes really useful. You can start with the general outline, and slowly add details and rearrange things until you are satisfied with the content. At any one time your attention is entirely devoted to one page, so you don't get overly distracted by the clutter involved in traditional documents.
I use WxWikiServer myself; it's a good light server for Win32, and installation is just a matter of starting the server and then browsing to a local address.
Using something like FCKeditor would enable WYSIWYG editing, so users would not have to learn the Wiki markup language. I'm not sure if it has been ported to any wiki platforms, but it should be easy enough to port to something like twiki.
Say it after me: Health Insurance Portability and Accountability Act.
HIPAA.
Not HIPPA.
By the way, the questions clearly states that the interested party is a medical doctor in a hospital in Europe. HIPAA does not apply, hobgoblin.
If they have to sit down and type away on a wiki themselves, then there will be lots of resistance, especially if the hospital system is not already computerized. If you have a transcription system, then there may be more usage if the transcriptionist could type verbal notes on a commonly used webpage.
Linux at home
I echo everyone's concerns about security and having a wiki not being taken seriously because of its silly name, but the important thing to remember about the term is that it's well known in certain circles, and easy to remember. Slapping some marketing oriented name on it is not going to help, either. What kind of message does a name like eCollabWebsite get across? It looks like it wants to be bought, is all.
I use a wiki for my own personal notes, and to get into some advanced stuff, you need to really take the time to learn the markup and stuff. I think busy doctors would scoff at the amount of wiki markup you need to use, just to get things done and formatted.
What the busy person's wiki needs is a graphical text editor with word processor functions that can be embedded in a HTML form, to replace the standard entry form, something like FCKEditor.
Wiki is already very easy, especially for those of us with a technical background. The terribly unfortunate thing would be if a tool like this that could make collaborative writing so simple was avoided because of a few paltry work culture differences.