Networked intelligence in EDs across CanadaPatrick Archambault, MD, MSc, FRCPCClinician-scientist FRQS Junior 2 (CISSS-CA, Hôtel-Dieu de Lévis)Assistant professeur, DMFMU and Anesthesia, Université Laval

@patarchambault

Financial disclosuresNoneResearch projects funded by CIHR, FRQS, CMPA, KT Canada

Partners

Plan

1. What are social networks ?

2. What are communities of practice ?

3. What communication tools are used?

4. Why would we want to use wikis?

5. Research program on wikis

6. Future: Semantic web

4Recent history in information sharing

Knowledge sharingWeb 1.0: Single knowledge hubs

Web 2.0: distributed networked knowledge sharing

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Social networks are growing

• ER docs are increasingly connected

• Social networks allow us to share knowledge more openly and faster

Infographic created by Ivor Kovic @ivorkovic

Social networks• Social network = set of social actors

(individuals/organizations) with interactions

• Diffusion of innovations theory focuses on the spread and use of ideas from one actor to another

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John Stuart Mill“ Placing humans in contact with persons dissimilar to themselves is one of the primary sources of progress (1909) ”

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Communities of practice• Lave and Wenger coined the term while

studying apprenticeship as a learning model• “Informal group of peers/practionners that

have a common sense of purpose, a common need to resolve an issue, and/or a common need develop expertise, knowledge or innovation”

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Elements of a CoP• Community-Domain-Place to meet• Shared domain of knowledge

• Explicit knowledge (know what to do)• Tacit knowledge (know-how; experience)• There is no knowledge outside of people, only

information.

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Web and CoPs• Web has extended the reach beyond local

CoP• Expands the possibilities for community

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Virtual EM communities of practice• CanadiEM• SGEM• ALiEM• #FOAMed• The Rounds• Sermo

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Honeycomb modelEach social media have different functions

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Kietzmann et al 2012

Build a collaborative environment• Find and connect with experts• Find and connect with peers• Identify the needs of your community• Social media can support your needs• Identity (Facebook)• Conversation (Blog)• Sharing (wikis)

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What is a wiki?

• Webpage content• User-generated• Edited by whoever

has access• Synthesis of

information

• Open wiki (Wikipedia)

• Closed wiki (WikEM)

Why use a wiki?

16Archambault et al http://www.jmir.org/2013/10/e210/

A wiki for KT ?

KTools support evidence based decision making:

• Care protocols• Order sets• Decision aids

Archambault et al http://www.researchprotocols.org/2015/1/e21/Archambault et al http://medinform.jmir.org/2016/2/e18/Plaisance et al http://www.researchprotocols.org/2016/1/e24/

WikiTrauma research programProject A Wikis and Collaborative Writing Applications in Health Care: A Scoping Review: positive

potential but strong evidence is lacking (scoping review JMIR, 2013) + (protocole Cochrane, 2014)

Project B Healthcare professionals' intentions to use wiki-based reminders to promote best practices in trauma care (mixed methods survey): strong intention among health professionals to use a wiki, but there is a need for training about how to use a wiki.(manuscrit JMIR 2012) + (pre/post case study, Medicine 2.0) + (Quebec provincial survey)

Project C Development of a theory based intervention to increase use of wiki-based reminders promoting best practices in trauma care: created an online training course (Wiki101)(CIHR planning meeting May 2014)

Project D Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care (currently ongoing)(Funded by CMPA 2014)

WikiTrauma: ongoing experiment

To edit a page

Archambault et al 2015 http://www.researchprotocols.org/2015/1/e21/

Protocol published JMIR ResProtoc, 2015

http://www.researchprotocols.org/2015/1/e21/

Wikis for KT: summary• Wikis have interesting potential for KT• Savings by reducing duplication? • Continuous quality improvement?• Improved interprofessional collaboration?• Improved collaboration between hospitals? • More research is needed

Future of the Web• Semantic Web

technology will allow human-readable web pages to become machine-readable by adding metadata

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Examples of Semantic Web • Cochrane’s Linked Data project • HealthData.gov

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Semantic wiki database• Semantic wiki database could allow sharing

and reuse of information on larger scale• Linked knowledge tools would facilitate

distributed intelligence and continuous system learning

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Semantic Web• Automation• Data fusion• Continual learning• Compounding (as data accumulates)• Contextualisation (linking content to context)

25http://nofilmschool.com/2010/05/web-3-0-now-were-just-talking-semantics

The future?

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Tim Berners-Lee:

“If we end up developing all the things I can image, we will have failed.” 

Questions or comments?

Merci! Thank you!Patrick.m.archambault@gmail.com

@patarchambault

More about wikis in healthcarehttp://medinform.jmir.org/2016/2/e18/http://www.researchprotocols.org/2016/1/e24/http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9821394&fileId=S1481803514000499http://www.researchprotocols.org/2015/1/e21/http://www.jmir.org/2013/10/e210/http://www.jmir.org/2011/4/e114/http://www.ncbi.nlm.nih.gov/pubmed/22515985http://www.jmir.org/2015/2/e48/http://www.jmir.org/2011/1/e14/ 28