E-HEALTH SOLUTION FOR INTERACTIVE KNOWLEDGE TRANSLATION: E-HEALTH SOLUTION FOR INTERACTIVE KNOWLEDGE TRANSLATION: AN ONLINE PORTAL FOR PEDIATRIC PAIN MANAGEMENT IN THAILANDAN ONLINE PORTAL FOR PEDIATRIC PAIN MANAGEMENT IN THAILAND

Raza AbidiRaza Abidi11, Salah Hussini, Salah Hussini11, Wimorat Sriraj, Wimorat Sriraj22, Somboon Thienthong, Somboon Thienthong22, Allen Finley, Allen Finley33, Paula Forgeron, Paula Forgeron33

1 1 NICHE Research Group, Faculty of Computer Science, Dalhousie University, Halifax, CanadaNICHE Research Group, Faculty of Computer Science, Dalhousie University, Halifax, Canada2 2 Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 3 3 Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada

ObjectivesObjectives

• To improve the management of pediatric pain within hospitals in Northern Thailand by sharing the experiential knowledge—i.e. practice-related knowledge about what worked, what did not work and what are the most practical practices—of pediatric pain practitioners

• To foster an online community of pediatric pain practitioners that translates its collective experiential knowledge to:

• Develop best practices for pediatric pain management• Influence the adoption of guidelines to standardize care

• To elevate the awareness of pediatric pain amongst health practitioners from clinical, psycho-social, cultural and economic perspectives

ApproachApproach

• Active collaboration between Thai and Canadian pediatric pain practitioners to plan and execute the effective delivery of multiple knowledge translation activities in line with local care practices.

• Leverage E-Health technologies to develop an online collaboration framework to:• Connect specialists, physicians, nurses and administrators across rural & urban hospitals• Explicate and share case-specific and practice-related experiential knowledge about pediatric pain

management by and for Thai health professionals working across rural and urban hospital settings. • Encourage collaborative problem-solving to achieve on-the-job education • Understand the collaboration patterns within the pediatric healthcare community to design more

effective knowledge translation programs• Apply a knowledge-sharing model—LINKS (Leveraging INternet based Knowledge Sharing) to

systematically develop and manage an online pediatric pain knowledge sharing frameworkLINKS specifies healthcare knowledge sharing solutions at three interrelated levels1.Operational level addresses functional issues in terms of technical infrastructure design metrics, and occupational strategies to establish a culture of collaboration between knowledge workers 2.Compliance level addresses the perceived trust in the knowledge being shared. 3.Conceptual level predicates knowledge sharing as a function between healthcare knowledge, knowledge sharing context and a knowledge sharing medium.

LINKS defines healthcare knowledge sharing in terms of the following conceptual elements1. Knowledge Modality is the experiential knowledge of healthcare practitioners—i.e. their innate skills, experiences and intuitive judgments about what really works and how to make it work. 2. Knowledge Sharing Context is pediatric pain management, and it entails four elements: (a) topic of the discussion, (b) motivation for knowledge sharing; (c) temporal orientation of the shared knowledge with respect to the evolving patient conditions; and (d) type of the practitioner sharing knowledge (i.e. specialist, nurse, etc) 3. Knowledge Sharing Medium is an interactive online discussion forum.

MethodologyMethodology

Our research methodology involves four (4) activities1. Understanding the practitioner communityWe conducted a survey of 780 Thai practitioners (Nurses: 79.2%, Physicians: 10.2%, Pharmacists: 10.6%) with a response rate of 68.33% to assess their knowledge access and knowledge use activities. Key finding were: Knowledge seeking behavior: In the absence of published

evidence, how do you seek knowledge?Discussion with senior physician 73.9%Discussion with head nurse 56.8%Discussion with colleagues in your department 56.7%Discussion with ward nurse 53.7%Discussion with nursing educator 30.0%Discussion with team leader 25.9%

What is your preferred medium to seek knowledgeAttend workshop 86.7%Visit to an expert site at another hospital67.7%Learn from an expert at your hospital 65.5% Learn from an expert from a different hospital 58.5%Learn from a book or writing material 55.0%

Learn from website 42.2% What is your access to a computer and internet

Access to computer 94.7%Use computer in your daily work 86.2%Access to the internet 76.4%Use internet to contact expert 23.0% Access online discussion forum 31.7%

Other pediatric pain practice questions• Do you have time to read journal 42.7%

(yes)• Clinical guidelines are helpful 97%

(agree)• Would you be given time to develop new guideline for

pediatric pain management 65.6% (yes)• In the absence of research evidence, it’s important get a

recommendation from an expert 86.1 (agree) Analysis Summary: Practitioners are keen to have clear guidelines on pediatric pain management and are willing to have discussions and to collaborate to develop such clinical guidelines.

2. Development of an online knowledge sharing environmentWe developed a web portal to support knowledge sharing between the pediatric pain practitioner community. The pediatric pain web portal features a Library of Resources, Discussion forum and Practitioner Directory

Online Discussion Forum allows practitioners to engage with one another to share their knowledge around specialized topics pertaining to pediatric pain management. To streamline the experience, the discussions are organized as Topics Sub-Topics Discussion Threads

Discussion threads withhold experiential knowledge of the pediatric pain practitioner community Participants pose a question/issue Community engages in an online dialogue Knowledge is explicated, critiqued, validated, disseminated and translated into practice

3. Training Knowledge Sharing Facilitators as ‘Collaboration Agents’To stimulate and sustain a vibrant knowledge sharing environment we engaged a team of nurse

facilitators who (a) encourage busy practitioners to engage in knowledge sharing; and (b) promote meaningful discussions. We trained the nurse facilitators through a series of hands-on workshops about how to use the web portal and the discussion forum, its features and the policies.

DiscussionDiscussion Project is in progress with active use of the web portal and the discussion forum to share

knowledge around a variety of pediatric pain management topics Availability of the right knowledge will help change practices and attitudes about pediatric pain. Our E-Health solution has allowed rural and junior practitioners to connect with (urban) expert

and experienced practitioners for clinical advice. We now have a community of practitioners who are developing guidelines for pediatric pain management based on their local experiences.

Our E-Heath solution is transferable to other countries, including Canada, to help facilitate the sharing of invaluable experiential knowledge and translating it into practice.

Innovative technology-driven solutions should be applied to improve pediatric care delivery

This research is part of the project “Pediatric Pain in Rural and Urban Thailand . This work is carried out with the aid of a grant from the International Development Research Centre, Ottawa, Canada.

4. Study and Analysis of Efficacy of the E-Health SolutionWe plan to perform Social Network Analysis to understand the communication patterns between

the community; and Content Analysis to validate the explicated experiential knowledge.