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Expert Panel: eLearning and you - Impact and Possibilities in eHealth for Individuals and Organisations

By A/Prof. Terry HANNAN Moderator | 06 Jul, 2012

Education is the process of passing knowledge, values and skills from one generation to another. Learning is the acquisition of new skills, knowledge, and values.
Both education and learning are critical factors in the success of Health IT implementations and are fundamental to their maintenance, adaptability and expansion.

We are excited to have a number of panelists joining us for this important Expert Panel discussion on how eLearning affects education and learning, and the possibilities it can provide us and the organizations we work in:

• Patricia Abbott, PhD, RN; Co-Director of the PAHO/WHO Collaborating Center for Knowledge, Information Management, & Sharing (KIMS Center), at Johns Hopkins University.
• John Kemboi, Program Coordinator, REACH Informatics-AMPATH, Kenya
• Dr. Paula Otero, Hospital Italiano de Buenos Aires
• Heimar de Fatima Marin, RN, MS, PhD, Professor, Federal University of Sao Paulo

This panel will focus on:

• What is the impact of eLearning?
• What can individuals do with eLearning, how can they use eLearning internally, or for their small organization?
• What kind of courses can people take for different interests and development?

As always, we look forward to your questions and hope you will share your own experiences with eLearning during this Expert Panel



A/Prof. Terry HANNAN Moderator Replied at 3:58 PM, 12 Jul 2012

Today we open the panel discussion on eLearning with our four panellists whose short bios are listed sequentially below. Please note I have taken John Kemboi's bio details from his posting on the LinkedIn site.

A/Prof. Terry HANNAN Moderator Replied at 3:58 PM, 12 Jul 2012

Patricia Abbott, PhD, RN; Co-Director of the PAHO/WHO Collaborating Center for Knowledge, Information Management, & Sharing (KIMS Center), at Johns Hopkins University.

Patti Abbott is a nurse with a PhD in Operations Analysis. She has been at Johns Hopkins since 2003. Prior to 2003, she was the Director of Graduate Informatics Programs at the University Of Maryland School Of Nursing, Baltimore. She has been a nurse since 1977 and has been an Informatician since 1998. Patti has a joint appointment between the JHUSOM and the JHUSON and is the PI on one HITECH grant and co-PI on a second. Both of these HITECH grants from ONC are focused upon HIT Workforce. Dr. Abbott also has a NIH funded telehomecare study

A/Prof. Terry HANNAN Moderator Replied at 3:59 PM, 12 Jul 2012

Paula Otero: Paula Otero, MD is Pediatrician working at the Department of Health Informatics at the Hospital Italiano de Buenos Aires, Argentina and Assistant Professor of Medical Informatics at the School of Medicine of the same institution. She is Co-Chair International Medical Informatics Association (IMIA) Working Group on Education. (WG01)
Her primary informatics focus concerns on the development of electronic medical records, information retrieval, e-learning and patient safety.
The Hospital Italiano de Buenos Aires since 1998 has gradually implemented a full-scale Health Information System and currently is the only institution that has a 4 year medical informatics residency training program.

A/Prof. Terry HANNAN Moderator Replied at 3:59 PM, 12 Jul 2012

John Kemboi: Program Coordinator for REACH Informatics -AMPATH . His roles include a coordinating a capacity building program for the East African region aimed at supporting the Implementation and developement of Health Informatics. Fellowship and shortcourses opportunities available. He is also the Data Manager for the AMPATH -CDC Study.

A/Prof. Terry HANNAN Moderator Replied at 4:00 PM, 12 Jul 2012

Heimar Marin: Heimar de Fátima Marin, RN, MS, Ph.D., FACMI is a nurse who has devoted her professional career to improving patient care using information and communication technologies. She is Full Professo and Director of the graduate Program in Health Informatics at the Federal University of São Paulo (UNIFESP). She is Member at the American College of Medical Informatics. Heimar Marin was also the President of Brazilian Society of Health Informatics (2002–2008); she is Associate-editor of the International Journal of Medical Informatics; and Elected Chair (2009–2012) of the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NI SIG). Currently, she is the Executive Director of the Strategic Committee in Information Technology at UNIFESP and member of the Board of Trustees of the Hospital São Paulo, a teaching hospital of Universidade Federal de São Paulo.

NGENZI Joseph Lune Replied at 4:37 PM, 12 Jul 2012

Interesting Topic

The use of E learning can be a cost effective tool for Human Health
Capacity Building in developing countries and increase academic
collaboration opportunities

I have done some experiential learning in this regards the best way is to
start with the current existing infrastructure and equipment or system you
have and improve while you are implementing. If we wait for everything to
be fine we will never implement anything.



Sandeep Saluja Replied at 7:51 PM, 12 Jul 2012

May I bring out two aspects of elearning which are important and pertinent?

Most CME activity for doctors is sponsored or supported by industry.There is need to develop and encourage unbiased learning.A major limitation is that while doctors are happy to go to hotels and resorts to attend lectures,there is little motivation to participate in learning which is devoid of these frills.While one possible way may be to make it compulsory to get CME points from non industry sponsored academic sources,the other may be to think of positive incentives like some sort of recognition for doctors who do so.
The other aspect is that for professionals,much more important than structured learning,is learning on case to case basis.We should develop e forums where doctors and other health professionals can interact and discuss actual cases.However,such forums need expert moderators and it should be possible for the moderator to invite recognized authorities to to intervene when needed.

A/Prof. Terry HANNAN Moderator Replied at 9:37 PM, 12 Jul 2012

Dear Sandeep, your comments raise very important issues realting to eLearning and medical education. Our traditional educative models do not work and I believe our four panellists will provide exciting new perspectives on this topic. In recent weeks I had published my review of the publication "Medicine In Denial" by L. Weed & L. Weed. The folllowing text is part of that review and is applicable to eLearning. I hope this helps.
“Medicine in Denial” describes an ingrained cultural phenomenon extending across the whole health care system, beginning with the initial stages of health education. One dimension of this phenomenon, as stated in the book, is that “Medical students emerge from this [medical training] process with insufficient sensitivity to patient uniqueness and the fallibility of medical knowledge.” The authors expand this concept further in the following way.
“In assuming that students must be indoctrinated with received knowledge as preparation for real patient care, medical schools trap student minds in what Tolstoy called “the snare of preparation.” Like a drug, such education has toxicity as well as benefit. One of its toxic effects is to reinforce a basic human need to deny uncertainty” (pp. 202-203)
The book quotes Dr. Jay Katz, who described “how readily any awareness of uncertainty succumbs to venerable authority and orthodoxy. These powerful defences against awareness of uncertainty continue to rule professional practices.”[ Katz J. The silent world of doctor and patient. New York: Free Press - Macmillan, 1984. p. 179. ] The traditional defense against uncertainty is misguided faith in our “clinical judgment.” Now we have added new defenses –- misguided reliance on simplistic “evidence-based” medicine standards and crude electronic tools.

SHAD SALIM AKHTAR Replied at 12:04 AM, 13 Jul 2012

Irrespective of our emotional response, e`learning is going to be the
future at least for this generation of doctors. It is not only didactic
lectures and presentations. The very search for an answer of a query of a
tech hooked patient may take hours to clarify what he should have made of
the information collected from internet jargon. I think that may be an
important form of CME if encouraged by providing peer reviewed information
free on the net. eMedicine from Medscape is doing a great service in this
regard and need to be commended. Patronage of such sites by us all would be
beneficial to the community in the long run. One way to come out of the
clutches of the industrial hold on what we must know and what we must not.

Prof. Shad Salim Akhtar

A/Prof. Terry HANNAN Moderator Replied at 8:06 AM, 13 Jul 2012

With apologies to John Kemboi for my oversight. Here is his correct short biosketch.
John K. Kemboi is the Coordinator of the REACH informatics program. He is involved with the coordination of the REACH informatics short courses and the selection of the Health Informatics fellows. He has played a bigger role in his previous position as a Data Manager for the CDC RECORDS Study program responsible for the implementation of primary healthcare information system based on OpenMRS. Specifically he has been a key player in building the human capacity within the health care institutions through training users and working with the healthcare stakeholders in building EMR tools such as forms and reports. Currently he still plays the role of building the human capacity to meet the challenges of implementing and developing health informatics through coordination of short courses training and curriculum development. He has coordinated over 20 shortcourses training in Africa targeting Developers, Implementers, Data Manager, analysts, researchers and clinical managers.

Joaquin Blaya, PhD Moderator Replied at 12:52 PM, 16 Jul 2012

I completely agree with your second point about the need to have more
forums (or fora perhaps...) where professionals of a certain type can
interact and review cases. I know there are many of these that already
exist (for example you can look at the telemedicine panel and a couple of
forums were mentioned there (

Joseph, I also agree with you about using current technologies, in a blog
article on this same topic (
I briefly mention how we done here in Chile used Moodle, one of the most
popular course management systems, to create a course on mHealth for
tuberculosis and hepatitis-C health care workers. We had to learn how to
use moodle and also to create the material (presentations and exercises to
be done by the participants), but the entire structure of having that be
available online to students was done in Moodle after buying a hosting
(turned out to be US$20 a month or so). This method, however, does require
that the student have enough internet connection to download the
presentations and upload any exercise they have to do. But one question,
are you looking specifically to implement an eLearning project?

Also, does anyone know of more examples of eLearning courses or forums that
could be useful?

Gerente de Desarrollo, eHealth Systems <http://www.ehs.cl/>
Research Fellow, Escuela de Medicina de Harvard <http://hms.harvard.edu/>
Moderador, GHDOnline.org <http://www.ghdonline.org/>

NGENZI Joseph Lune Replied at 1:47 PM, 16 Jul 2012

Joachim, I agree with you that the use of learning management systems such
as moodle combined with well planned audio conference or videoconference
session or chat session can help remote learners to access session and
participants can learn.

In venues where there is a good internet desktop videoconference system may
reach many more isolated learners where they access teaching session via
their personal laptops with webcam but room based videoconference venues
offers high quality sessions. The room based session quality video which
makes a difference in human interaction.

I am glad that these days I have what it takes to run high definition
sessions the second challenge is to mobilize more events and collaboration
opportunities to maximize the benefits of such investment and to show all
that it works well.

Joseph, Rwanda

Paula Otero Replied at 2:04 PM, 16 Jul 2012

I am looking forward for a week of interesting discussion about e-learning, which is a topic we are all "passionate" about.
I agree with Joseph's comment that in developing economies there isn´t a perfect time for implementing or starting a training course. You have to work with what you locally have and properly address the local needs. Trying to extrapolate a positive health IT experience from another setting might not always be the best way to go.
I believe that providing training while people have a "hands-on" experience is a good way to start, you can use experience from the outside but the local view is fundamental so that the training experience can be completely fullfilled.
Shad's comment that learning is more than lectures and presentations is one of the topics I wish to hear other comments, the creation of a elearning course or full training program is not simply changing how the students access from in person sessions to online sessions, it is a completely different way of learning so we need to be able to adapt to this new way of learning and teaching since all or most of us learned the old fashioned way.

Heimar Marin Replied at 3:07 PM, 16 Jul 2012

Dear All,
The itens for discussion are important and relevant. As Joaquin mentioned Moodle Plataform, I agree: it is easy to use and has some functionalities that allows students in distance regions access and participation. In Brazil we have the UAB - Universidade Aberta do Brasil - that established the distance education programs across the country including distant "vilas" inside Amazon. In our case, at the first version, for the Health Informatics Specialization Course (one year program) we had 10 sites (we call "polos")distributed in the country. In our case, we had 500 students. We finalize with less than 200 and that was a lesson to learn - how to balance the amount of hours and study, how to evaluate the program and so. With that, I would like to bring this also for discussion: of course we need the technology, of course we need the content, but how to customize, to give the right course to the right student, and how to evaluate.
I will continue later with our second phase: now, I am going to get my flight to Baltimore (around 15 hours travel).....



Om G Replied at 4:13 PM, 16 Jul 2012

Having been involved for a few years in e-learning, I'd like to comment:

Recognizing that it is fundamentally different is important to the result. Online and e- learning tools are not merely an adjunct to lecture programs. The outcome and benefits rely heavily upon participation and use of the available tools.
Learning can be enhanced greatly by the group dynamic and peer participation but this requires educators to foster a culture of active engagement. They have to use the tools not only for outbound messaging but also to identify students who may be fading into the shadows.

Curricula with clear objectives is almost more important in the e-learning space because screen based interaction quickly generates patterns of behavior and tunnel vision. Reminders about objectives and fresh dialogue will help to keep everyone on track.

Tool choice is also important. Make sure to conduct testing and dry runs before bringing in students. Subjecting them to an online experiment is a sure way to quickly lose interest.

So, hands on lessons with ample documentation will provide a very valuable experience that can be referred to by others and add to the body of examples of e-health implementation and how your unique problems were solved.

Sent from my ephone.
May contain incomplete thoughts.

Sandeep Saluja Replied at 8:08 PM, 16 Jul 2012

Joaquin very rightly mentions that many fora exist but for them to be educative also,one needs to restructure them and use them like ward rounds where the professor uses a case to illustrate some issues.Since there can not be one teacher in such a forum,the solution may be have to an expert clinician as a moderator who can put some points from his side but also have the privilege to invite different experts to comment on specific issues.

A/Prof. Terry HANNAN Moderator Replied at 8:15 PM, 16 Jul 2012

Sandeep, as a senoir Consultant Physician your point about the "professor" who at the present time would be educated in the traditional models needs to be challenged (not you the professor). L. Weed covers this extensively in his book "Medicine In Denial" that I have cited in an earlier posting. This can also be covered by Dr. Mark Smith's statement (Californian Health Care Foundation), "“We must remove ourselves from the ‘unscientific, non data driven personal recommendations’ for care”.

Joaquin Blaya, PhD Moderator Replied at 3:53 PM, 17 Jul 2012

One question that I had is what are the available courses or online
material in health informatics that individuals or organizations could
use. In part the courses that are provided by institutions, but also
online materials that one could study by oneself or an institution
could try to help their employees by providing these materials or
online courses.

Do the panelists or others know of sites where there are these
materials or perhaps a single site which links to these?


Gerente de Desarrollo, eHealth Systems
Research Fellow, Escuela de Medicina de Harvard
Moderador, GHDOnline.org

Jai Ganesh Replied at 10:58 PM, 17 Jul 2012

Have a look at

Health Informatics Forum Massive Open Online Course


Patricia Abbott Replied at 8:08 AM, 18 Jul 2012

Hello to all! After a move from Johns Hopkins to the University of Michigan (in record setting triple digit heat), I have finally found my router and gotten connected to the internet. I feel like a starving person being handed a cookie!. Maybe we should add connectivity to Maslow's Hierarchy. :)

To the point of Joaquín & Jai - yes, there is a set of courses that will release from the Health Informatics Forum via a MOOC. As the author of 4 of those courses - what I can say is that the materials are designed for instructors to use - not necessarily for a student to "take". They are a great resource and are absolutely open source (Creative Commons) - but everyone should view them as the equivalent of a giant text book. Let me explain......

As a long time health educator, I may find a text book that I really like, but I never teach from the front cover to the back cover. Some chapters I leave out. Some chapters I pick and choose what I want to use. Some I may totally disagree with. Some may not be appropriate for my students. The 20 Health IT (HIT) courses that will release via the MOOC should be viewed in this way. Several of the courses are targeted towards the US Healthcare system, which may not be appropriate for your students. Some of the courses were designed to teach technical people the language of healthcare, so nurses, doctors, pharmacists, etc. would not need that. Some of the courses teach the fundamentals of networking topologies - and not everyone needs that.

The point is that this is a TREMENDOUS resource and should be used by anyone who finds value in it. Because it is open sourced - just give attribution per Creative Commons licensing - and make it your own. They have been downloaded from the National Training and Dissemination Center over 250,000 times by approximately 93 different countries. Once it is out on the MOOC - I suspect these numbers will increase even further.

Patti Abbott
University of Michigan

Attached resource:

Patricia Abbott Replied at 11:07 AM, 18 Jul 2012

Bringing up a few prior points made by several participants (and adding a few of my own):

1.) Learning ("e-learning" or not) is specific to context.
a.) How do we accomplish this? Can technology assist via adaptive techniques?

2.) "Know thy user" which I always quickly follow with "and you are NOT thy user".

3.) Simply digitizing learning material will not result in better learning outcomes. As Sandeep wrote on July 16 - "for them to be educative also,one needs to restructure them."

It would be interesting to hear your perspectives on these points.

Finally, I wanted to add a link here to one of my favorite online talks. Maybe you have seen it already, but just in case you haven't click on the link to watch Sugata Mitra talk about his "Hole in the Wall Project: How Kids Teach Themselves." What lesson can we take from Mitra's work and apply to e-Health education?

Patti Abbott

Attached resource:

A/Prof. Terry HANNAN Moderator Replied at 1:08 AM, 19 Jul 2012

Patti (and to other panellists), I am very interested in how you percieved the need to change the "learning" paradigms but more importantly what were the "intellectual shifts/gear changes" you felt you needed to make to advance this new learning and how e-Learning helped. Do any of you have experiences of "learning changes and adpations" in your developed academic environments as separate from new "poorly developed" social environments?

A/Prof. Terry HANNAN Moderator Replied at 1:44 AM, 19 Jul 2012

Patti I have just been mesmerised by this 20 minute presentation by Sugata Mitra. It dramatically eliminates many preconceived perceptions about education for the haves and have nots. Also education overall. Thank you for this. I have made a distribution list and dispersed it. I hope you find thyat acceptable.

Paula Otero Replied at 6:08 AM, 19 Jul 2012

Terry, I believe that currently elearning has become a useful way of delivering courses for students not only in high but also low resource settings. The possibility of being trained without leaving your home and in your own time is a good option for professionals that wish to advance in their academic development but cannot leave their everyday activities and for example take a "sabatical" for properly take courses in person. In our case when we started the Spanish version of OHSU-AMIA 10x10 course in spanish our purpose was to provide a course that would offer a background for professionals that were already working on ehealth (specially clinical information systems) but were not able to access to a proper training due to different barriers like high costs and language. We reached out to all spanish speaking countries in the latinamerican region. When we survey our students, one of the reasons they chose the course was the possibility of taking it while still being at home and not taking time-off.

Paula Otero Replied at 6:14 AM, 19 Jul 2012

The MOOC inititive is great and I am looking forward to see how it works. The ONC materials are excellent and specially when you can use them based on the CC licence. The challenge is trying to adapt them to the local setting. In this case many of the topics are not fully aplicable for example in Latinamerica. So I hope that in the future different training resources repositories appear that may enhance the development of educational curricula in HIT.

John Kemboi Replied at 10:35 AM, 19 Jul 2012

I would like to add a perspective on the impact of e-Learning to developing countries. A recent African conference on e-Learning identified the challenges that hinder the development of online learning. But first it is important to appreciate the potential benefits of e-Learning to a developing country more so on creating an educated manpower to steer the country. Healthcare provision is one sector that can benefit greatly on the e-learning strategy. Health workers are faced with changing techniques and technologies in provision of health and getting update knowledge is impossible to be administered through a class room setup. It is inevitable that physical class rooms and facilities are expensive that is why we resort to virtual classrooms facilitated through e-Learning. Impact that ICT creates is aimed at reducing costs and time spend on accessing information (knowledge and skills) leading to learning. Somehow it is true to put it simple that 'internet has allowed gaining of more knowledge'. But more can still be gained through use of ICT.
African is still facing infrastructure challenges such as erratic power shortages or no grid lines, weak ICT infrastructure, poor educational funding and access. One possible way is to look for cheaper means of communication that could utilize the available resource. Something positive thing happening is the spread of mobile communication and the provision of cheaper smart phone. If we could tap more from the mobile communication to enhance e-learning that could be a plus despite the expensive bandwidth. 3G networks are getting into the rural areas and other smaller towns. My point is how to allow the low resourced regions get access to e-Learning. Other means is creating learning booths or centers for such regions and as the technology advances I guess they will be able to access the information from their comfort zones. Some information on the African steps can be access from AMREF.

Take note of typhos........

Attached resource:

Joaquin Blaya, PhD Moderator Replied at 11:47 AM, 19 Jul 2012

If I was an organization that was trying to incorporate eLearning for my
clinicl staff (for example a Ministry of Health or a hospita/health center)
to learn the basics of health IT and also the use of one or more tools. Do
you have tips or suggestions for the best way to do it?

Gerente Tecnológico, eHS (www.ehs.cl)
Moderador, GHDonline.org
Fellow, Escuela de Medicina de Harvard

Erwin J. Haeberle Replied at 3:25 PM, 19 Jul 2012

Perhaps some of you will find the following useful:
These courses have been available - and very popular - for many years in many countries. Some of the translations are still incomplete, but the complete curriculum is already available in English, Chinese (simplified and traditional), Russian, Czech, and Hungarian.
The STD/AIDS course is also available in Spanish and Portuguese.
I would be interested in hearing from colleagues who can profit from this free offer and use it for their own purposes.

Patricia Abbott Replied at 3:28 PM, 20 Jul 2012

Joaquin asks - "If I was an organization that was trying to incorporate eLearning for my
clinical staff (for example a Ministry of Health or a hospital/health center)
to learn the basics of health IT and also the use of one or more tools. Do
you have tips or suggestions for the best way to do it?"

First I think this is a two part question - first- how to get the foot in the door (I mean trying to influence people that they NEED HIT in the first place) and second - how best to do it.

The first part is something I can say that I personally deal with a lot. People don't know what they don't know - change is hard - and there are many competing demands- particularly at the MOH. It is hard to get the ear of the Permanent Secretary (IMHO - the real "holder of the power"at a MOH) when they are really focused on the MDGs. Money flows in based on how many immunizations are given and how many maternal lives are saved, etc. Making the argument for increased HIT education can be a really a tough sell because the benefit is not immediate in regards to reimbursement/payback.

How to get someone to take the long-term view and see the power of e-learning for HIT? I think that these sorts of efforts must be driven by an "internal champion". Finding internal champions at a MOH is beginning to get a bit easier-- my experience over the last decade is that many at that level did not "get it" therefore no resources would be allocated. I think that informatics is gaining traction and the WHO is beginning to more readily call for use of informatics methods and applications in population health efforts. Whether you love the WHO or despise it - they CAN influence a MOH.

Coming back around to Joaquin's question - how to incorporate eLearning into clinical staff efforts- I think that finding the internal champion is critical. Getting that person or that group on board can then help to influence others to follow along. If there *is no* internal champion, then I think the best way to incorporate e-learning (and get it accepted) is to create a champion. Creating a champion means using powers of persuasion.

So, if the MOH does not "get it" yet and there is no champion, it works well to have someone of equal stature (maybe from another MOH or someone who previously worked for a MOH) offer, for example, a short webinar or a session on "E-health and what it can do for you" followed up by a "How to use e-Learning to teach basic HIT concepts." My experience has been that having a peer present material that resonates (i.e. it satisfies the WIIFM of "whats in it for me" test) with an immediate follow-up of HOW - is the best way to get in the door. Be aware that this is a long-term effort and often unfolds over weeks and months.

Wow, such a long answer for Joaquin's question. In short:
1.) The drive and need must come from the inside. Culture eats strategy for lunch.
2.) There has to be benefit for the user. Adding more stuff to a busy staff for little to no discernible benefit is fatal. Satisfy the WIIFM.
3.) Find the champion, educate, and build the business case for e-Learning of HIT.
4.) Once you meet # 1 & # 2 & # 3 -make sure that these is a plan to find/develop/modify the materials so that it resonates with users. As Paula Otero said earlier - you have to adapt the materials so that they fit.
5.) Have something tangible to kick off # 4. Make sure that after you get folks excited about HIT e-Learning that they can actually get started with something.

Consider yourself lucky if your MOH already "gets it" and you don't have to start with the influencing part. Cheers!


A/Prof. Terry HANNAN Moderator Replied at 6:40 PM, 20 Jul 2012

Concluding comments on eLearning panel discussion by A/Prof. Terry Hannan.
As the eLearning discussion panel closes I would like as the Moderator to first of all thank all the panellists for their commitments. All have you have been very busy with professional and domestic issues and your participation coincided with the northern summer period. This is often a time for relaxation. To all those who contributed to the fruitful discussions I would also like to say thanks for contributing to our better understanding of this extensive topic. A discussion brief on the eLearning panel will be posted in the near future.

Joaquin Blaya, PhD Moderator Replied at 10:55 AM, 29 Aug 2012

Just wanted to let everyone know that the discussion brief for this panel has been posted at http://www.ghdonline.org/tech/discussion/expert-panel-elearning-and-you---imp...

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