® MedBiquitous’ Emerging Virtual Patient Architecture Valerie Smothers Deputy Director MedBiquitous Prepared for the Johns Hopkins Division of Health Sciences Informatics February 16, 2007

® Disclosure I have no relevant financial relationships to disclose.

® Learning Objectives By the end of this session, you will be able to: Articulate the need for virtual patients Compare existing approaches to virtual patients Describe components of the MedBiquitous Virtual Patient Architecture

® Quandry How do you teach clinical reasoning and protect patient safety? Let the student watch attendings and residents and listen to lectures Have an attending closely monitor student interaction with a patient and provide feedback Do small group exercises that explore certain cases or types of cases and how to handle them Use tools that simulate the clinical environment

® Simulating the Clinical Environment Can be expensive and time consuming to develop these tools Often home grown and disconnected from other learning systems Need a way to share resources and integrate with external resources and systems

® MedBiquitous Mission To advance healthcare education through technology standards that promote professional competence, collaboration, and better patient care. Non-profit, member-driven, standards development organization

® Fast Facts 60 member organizations 7 working groups ANSI process Openness Transparency Consensus Due Process Work with leading organizations that can drive adoption (AAMC, ABMS, ACCME, NBME, FSMB, AMA, AAFP, VA) Professional Profile Learning Objects Activity Report Metrics Virtual Patient Competency Point of Care Learning

® Building the Foundation Professional Profile E-portfolio Healthcare LOM Activity Report Virtual Patients Competency Metrics SCORM for Healthcare POC Learning

® MedBiquitous Goals Better tracking and evaluation of professional education and certification activities Easier discovery of relevant education and information resources when and where needed Interoperability and sharing of high quality online education Coordination and tracking of competence assessment data

® Virtual Patients Interactive computer programs that simulate real life clinical scenarios Some examples: Sarah Jane, St. George’s University of London (narrative, node based) Web SP, Karolinska Institute (linear w/data)

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® Component based approach Enables sharing and reuse of entire virtual patient or components Engaging and relevant Provides feedback on practice Hewlett funded grant for VP player (Tufts) U of Edinburgh, Pittsburgh, NYU, Tufts, Karolinska Institute implementing Virtual Patients

® MedBiquitous Virtual Patient Working Group Susan Albright, Tufts University Chris Candler, M.D., Association of American Medical Colleges David Davies, Ph.D., IVIMEDS Parvati Dev, Stanford University Shona Dippie, HEAL Rachel Ellaway, Ph.D., University of Edinburgh Uno Fors, D.D.S., Ph.D., Karolinska Institute Robert Galbraith, M.D., National Board of Medical Examiners Michael Hagen, M.D., American Board of Family Medicine Grace Huang, M.D., Harvard University Carol Kamin, University of Colorado Joy Leffler, WE MOVE Ross Martin, M.D., Pfizer J.B. McGee, M.D., University of Pittsburgh Sandra McIntyre, M.Ed., HEAL Yanko Michea, M.D., University of Connecticut Dick Moberg, Moberg Research Kitty O'Meara, Oregon Health and Science University Beth Powell, Centers for Disease Control Dan Rehak, Ph.D., Carnegie Mellon University Kathie Rose, National Board of Medical Examiners Kevin Souza, University of California, San Francisco Hemal Thakore, M.D., University College, Dublin Greg Thompson, M.D., Medantic Marc Triola, M.D., New York University Nabil Zary, Karolinska Institute

® The MVP Architecture Virtual Patient Data Data Availability Model Media Resource Activity Model Global State Model

® Personal and clinical data Similar to a clinical chart May include references to healthcare terminologies Draft schema available Virtual Patient Data

® Images, animations, videos, etc. Leverages IMS Content Packaging to catalogue, uniquely identify, and package resources with other components. Media Resource Content Package chest_anatomy.jpg id=xyz123 respiration.mov id=xyz234 circulation.fla id=xyz345 Virtual Patient Data id=xyz5 Activity Model id=xyz456

® Aggregates virtual patient data and media resources for reference in an activity Enables progressive disclosure of virtual patient data and media resources Data Availability Model Part 1: Patient History Part 2: Diagnostics Media Resources Virtual Patient data Text Interview item Diagnostic test DAM

® Integrates VPD, MR, and DAM into a cohesive learning activity Many models are possible Linear Branching Free flow Activity Model

® Top level modeling of student activity Virtual ward Multiplayer game Global State Model

® What’s the benefit? Facilitate the exchange and reuse of virtual patients across institutions Promote a more engaging (and safe) way to learn and assess Expose students to conditions they may not see in the hospital

® What do you see as opportunities for leveraging virtual patients?

® Working Group Participation Teleconferences every 6 weeks Groupware to facilitate collaboration Contact me for more information