Mobile Computing For Decision Support and Learning While You Work!

Michael P. D'Alessandro, M.D.!University of Iowa College of Medicine / University of Iowa Children's Hospital!

Jeffrey R. Galvin, M.D.!University of Maryland and American Institute for Radiologic Pathology!

James J. Choi, M.D.!Musculoskeletal Radiologist, Iowa Radiology!

www.slideshare.net/michaeldalessandro!

Who We Are, What We're Up To, Some Ground Rules!

•  3 generations of medical educators with long history of creating digital teaching tools!

•  Hands on tour of mobile computing educational resources that are mainly free!

•  We use these tools in the course of our work!•  We have experience + opinions + material to cover!

•  But - we want this to be an interactive presentation!We want to learn from you:!•  Demographics of audience: 50% outside US + 50% in private practice!•  You have experience + opinions as well and we want to hear from you and

we want you to ask questions!•  So we're going to make this a Web 2.0 presentation taking advantage of

mass collaboration and the wisdom of the crowds!

Learning Objectives!•  Learn to perform decision support on a mobile

device at the point-of-care to answer questions that arise during clinical work and thus tie learning to practice and receive point-of care CME for it !

•  Learn to read Ebooks and educational apps on a mobile device!

•  Learn to stay up-to-date with radiology journals and society news on a mobile device!

•  Learn to manage a library of journal articles on a mobile device!

•  Learn to view podcasts and vodcasts on a mobile device !

•  Learn to maintain a learning portfolio / teaching file on a mobile device!

Our Philosophy Learning is an Apprenticeship!

"In what may be called the natural method of teaching, the student begins with the patient, continues with the patient, and ends his studies with the patient using books and lectures as tools, as means to an end."!

- Sir William Osler!

•  Learning at the point-of-care!•  Is best way to change

physicians' knowledge, attitudes, and behaviors!

•  And thus improve patients' care, outcomes and lives !

The Post-PC Era Ubiquitous Computing!

"In the beginning, there were no computers.!Then there were computers.!

Then they disappeared." !! ! !- John Seely Brown, computer scientist, Xerox PARC!

•  Post-desktop model of human-computer interaction in which information processing has been thoroughly integrated into everyday objects + activities!

•  Can be defined as machines that fit the human environment instead of forcing humans to fit the machines' environment!

•  Father was Mark Weiser of Xerox PARC in 1988!"Ubiquitous computing names the third wave in computing, just

now beginning. First were mainframes, each shared by lots of people. Now we are in the personal computing era, person and machine staring uneasily at each other across the desktop. Next comes ubiquitous computing, or the age of calm technology, when technology recedes into the background of our lives." !! ! ! ! !- Mark Weiser!

•  Popularizer was Steve Jobs with iPod + iPhone + iPad!

What To Choose?!

•  Platform / Ecosystem!•  Android (Wild West) vs. iOS (well managed, "it just works", in-person support) vs. Windows

Phone / 8 / RT!•  Consider: App store, upgradability, security, fragmentation!•  Business model!

•  Apple makes money on hardware, does not make money on services!•  Google would give away hardware, just to make money on services!

•  They are becoming more similar!•  Apple diversifying in form factor + price!•  Google asserting more control over Android software + hardware (own Motorola)!

•  Form Factor!•  Phone, phablet, tablet, (watch)!

•  Plan!•  Subsidized vs. prepaid!

•  For Android consider Google's Nexus 5 phone + Nexus 7 tablet!•  Run pure Android with latest + greatest version of OS!

Quick Survey!

• How many Android users?!• How many iOS users?!• How many Windows Phone / 8 / RT users?!

Decision Support - Browser Situating Learning in Practice + Receiving CME!

Safari (iOS) Chrome (Android) Explorer (Win)!

•  The browser is the killer app!•  Use radiology-specific search engines to bring

together in Google's interface the best free Web resources!•  www.searchingradiology.com!•  goldminer.arrs.org!•  myrsna.rsna.org!

•  Receive 0.5 AMA PRA Category 1 CME credits / question (up to 20 hours / year) !

Decision Support - Apps!

Medscape (Android+iOS) IASLC Staging Atlas (Android+iOS) e-Anatomy(Android+iOS)!

•  Textbook-like!

Education - Apps!

Radiology 2.0 One Night In The ED (iOS) Ctisus iQuiz (iOS) Radiology Assistant (Android+iOS)!

•  Teaching files!

Ebooks!

Kindle (Android+iOS+Win) Google Play Books (Android) iBooks (iOS)!

Formats - Kindle [.mobi /.azw /.kf8] (All), EPUB [.epub] (All), iBooks2 [.ibooks] (iOS), PDF [.pdf] (All)!

2,225 educational radiology Ebooks were found in the Kindle (1,955), iTunes (170) and Play (100) stores!

Questions!!What is the difference between an Ebook and an educational app?!!Will educational apps be replaced by iBooks2 Ebooks?!!What is the advantage of an Ebook over a PDF?!!What is the advantage of a dedicated Ebook reader?!

Staying Up To Date With Societies Social Media!

Twitter (Android+iOS+Win)!

•  Subscribe to the news feeds of the ACR, ARRS, RSNA, subspecialty societies!

•  Stream of news ~ Filter with lists!•  Facebook is an alternative !

Staying Up To Date With the Literature Really Simple Syndication (RSS)!

RSS Feedly (Android+iOS) Radiographics (iOS)!

RSS !Is a newsfeed generated by a Web site when it is updated!! ! !Lets you subscribe to Web site + be notified when it is updated!! ! !Lets you take control + filter fire hose of information!

Stream of journal articles ~ Filter by subscriptions!The Old Reader browser-based feed reader is an alternative!What is advantage of using app to access journals vs. Web browser?!

Managing a Library of Journal Articles !Medical Literature Database!

Papers (iOS) iAnnotate (Android+iOS) GoodReader (iOS) / ezPDF (Android)! Dropbox (Android+iOS+Win)!

•  How to create a file system on a mobile device?!•  What is best way to handle PDFs organized in folders so you can read them when offline?!

•  Dropbox alone? GoodReader alone? Dropbox + GoodReader!•  Alternatives for cloud storage - Apple iCloud, Google Drive, Microsoft SkyDrive!

Listening to Podcasts + Vodcasts!

iTunes (iOS) Podcasts (iOS) Beyond Pod (Android)!

•  Examples - CTisUS, LearningRadiology, Radiology, AJNR!•  Simple on iOS - all podcasts indexed in iTunes Store or Podcasts app!•  Difficult on Android - find XML file containing RSS feed of podcast +

type it into podcast aggregator (feed:// )!•  DoggCatcher is an alternative for Android!

Personal Learning Environment!

Custom search engine Apps / Web sites Learning Portfolio!

•  System that help learners take control of and manage their own learning including providing support for learners to!•  Set their own learning goals!•  Manage their own learning - both content and process !•  Communicate with others in the process of learning!•  = summation of software programs / Apps / Web sites you use!

•  Learner-centric ~ "This is what I will learn today"!•  Decentralized ~ Standards are the glue that hold it together!

The Learning Continuum!

Data -> Information -> Knowledge - > Wisdom / Mastery! [acquired + organized] [reflected] [shared] !

Personal learning environment -> Social learning network![focus on individual] [focus on group]!

How the Medical Apprentice Learns!•  Diagnosis!

•  Clinical skills related to experience!•  When seeing a new case you encapsulate it

in an "illness script" which you pattern match to previous cases "illness scripts" in order to diagnose!•  Case-based reasoning / Storytelling!

•  Expert is the person who can best capture, organize, and retrieve their experience (cases)!

•  Treatment!•  Work up driven by medical knowledge!

- Schmidt HG, Norman GR, Boshuizen HPA. A Cognitive Perspective on Medical Expertise: Theory and Implications. Acad Med 1990 Oct;65(10):611-21.!

E-Memory System - Digitization Of Your Life!

•  A digital archive of your life!•  "Lifelogging"!

•  Made possible / inevitable by!•  Most memories are

digital!•  Near-infinite space

to store them!•  Ever improving

technology to recall them!

•  Captures, stores, organizes and makes retrievable your experience + reflected wisdom!

•  You become the librarian, archivist, cartographer and curator of your life!

Learning Portfolio!•  A digital archive of your medical

educational life = learning diary!•  Document + store clinical questions + answers!•  Allow you to collect evidence of your learning

from any learning experience !•  Educational construct!

•  Case-Based Learning!•  Constructionism ~ Learning by doing / Creating

learning artifacts!•  Adult learning theory = Learning situated in

practice!•  [Schon's theory of clinical problem solving /

model of reflective practice / learning cycle]!•  For each case!

•  Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used ~ Image!

•  Is a knowledge management system!

Maintaining A Learning PortfolioNotes Database!

Evernote (Android+iOS+Win)!

•  Why?!•  For Yourself - Passion + Reflection! !

•  "An unexamined life is not worth living" - Socrates!

•  For Point-of-Care CME - questions are starting point for further learning!•  For sharing - individuals in person, groups in conferences / lectures, world on Web!•  For achieving + maintaining mastery in medicine!

Note Taking!

SoundNote (iOS) Notability (iOS) PenUltimate (iOS)!

Teaching!

Keynote (iOS) Remote (iOS) OsiriX (iOS) GoToMeeting (Android+iOS) LogMeIn (Android+iOS)!

•  Mobile device as presentation device!•  Review, sharing, presentation of DICOM images!•  Collaborative review of cases with colleagues!•  Control a work computer and read images!

To Learn More Index of Free educational radiology Ebooks and radiology Apps!

www.radiologyebooks.com!Totals in November 2013: Ebooks - iBooks [4] - Kindle [0] - PDF [0] - Play [1] and Apps: Android [5] - iOS [20] - Windows Phone [1] and Podcasts: [5]!

To App or Not To AppThat Is The Question!

•  Apps!•  Pros - Facilitates content revenue stream, more polished user interface!•  Cons - Need separate app for each platform, closed garden limits

interoperability (Ex: Evernote can't clip from Radiographics app)!•  Web sites!

•  Pros - Content wants to be free, need one Web site for all browsers, open Web facilitates interoperability!

•  Cons - not-so-polished user interface (improving with HTML 5)!

Don't You Forget About Me…Index of Best Radiology Sites!

www.radiologyeducation.com!Hundreds of free high-quality radiology educational Web sites!

The Future Wearable Computing / Augmented Reality!

•  Mobile computing is but a step towards wearable computing!

•  Your Internet connection will follow you everywhere you go through wearable computing!•  Minimalist, elegant, mobile

solution!

•  You will be presented with an augmented version of reality!•  The Internet overlaid upon

what you are seeing!

Conclusion!•  This talk is a start. To really understand it, go home and review !

•  www.slideshare.net/michaeldalessandro!

•  The radiology URLs to walk away with!•  www.radiologyebooks.com + www.searchingradiology.com + www.radiologyeducation.com!

•  Radiology decision support can be done easily and quickly using Internet search engines that search authoritative free Internet resources!•  You do not need to pay for radiology decision support!

•  Tell us what apps you use that we have not mentioned!

•  Please fill out and deposit the evaluation form!