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Educating for Quality Healthcare:
Improving Outcomes through
Innovative Applications of
Internet-based Technology
Professor J C Taylor
Deputy Vice-Chancellor (Global Learning Services)
The University of Southern Queensland
Presentation to the
Educating for Quality Healthcare
International Symposium
28 July 2003
Joseph Schumpeter (1934) predicted
that every 50 years or so, technological
revolutions would cause
"gales of creative destruction”
in which old industries would be swept
away and replaced by new ones.
Technological Changes
 Steam Power - 1780s to the 1840s
 The Railways - 1840s to the 1890s
 Electric Power - 1890s to the 1930s
 The Motor Car - 1930s to the 1980s
 Information Technology - 1980s to ?
Pace of Change
1. Radio:
50 million users in 38 years
2. Television:
50 million users in 13 years
3. The Internet:
50 million users in 5 years
Common Prediction:
One billion users by the year 2003
Internet Access Population (millions)










USA
Japan
China
UK
Germany
South Korea
Brazil
Australia
Netherlands
Sweden
165.7
56.1
45.8
34.3
32.1
25.6
13.9
10.6
9.7
6.1
Total global population estimated at 580 million
Source: A C Nielsen, June 2003
e-Readiness Rankings: Leaders
e-Readiness ranking
1
2
3 (tie)
3 (tie)
3 (tie)
6
7
8
9
10 (tie)
10 (tie)
12
13
Country
Sweden
Denmark
Netherlands
US
UK
Finland
Norway
Switzerland
Australia
Canada
Hong Kong
Singapore
Germany
e-Readiness score
8.67
8.45
8.43
8.43
8.43
8.38
8.28
8.26
8.25
8.20
8.20
8.18
8.15
Source: The Economist Intelligence Unit eBusiness Forum, March 2003
e-Readiness Rankings: Contenders
e-Readiness ranking
14
15
16
17 (tie)
17 (tie)
19
20
21
22
23
24
25
Country
Austria
Ireland
South Korea
Belgium
New Zealand
France
Taiwan
Italy
Portugal
Spain
Japan
Israel
e-Readiness score
8.09
7.81
7.80
7.78
7.78
7.76
7.41
7.37
7.18
7.12
7.07
6.96
Source: The Economist Intelligence Unit eBusiness Forum, March 2003
The Knowledge Explosion
Over 90% of the relevant literature in many
technical fields, such as biotechnology,
astronomy, computers and software, and
environmental sciences, has been produced
since 1985.
Traditional programmatic approaches to
education simply cannot keep up………...
J B Quinn (2001)
The Knowledge-based
Economy
There are increasing signs that our current
paradigms for higher education, the nature of
our academic programs, the organization of
our colleges and universities, and the way
that we finance, conduct and distribute the
services of higher education may not be able
to adapt to the demands of our time.
J J Duderstadt (2001)
Prediction
'The death of distance as a
determinant of the cost of
communications will probably be the
single most important economic
force shaping society in the first half
of the 21st century'.
Cairncross (1997)
Thesis
Interaction between Internet
systems and educational processes
will revolutionize traditional
approaches to higher education
and continuing medical education.
Leadership Challenge
A market-driven restructuring of
continuing medical education as an
industry – while perhaps both alien
and distasteful to the academy – is an
important perspective from which to
view the future.
Annotated list of worthwhile CME links
to more than 230 Online CME sites
offering more than 11000 courses and
more than 19000 hours of CME credit.
http://www.cmelist.com/list.htm
This site is managed by Bernard M Sklar, M.D., M.S.
[email protected]
Why you should bother
• …Online CME is always there,
waiting for you, 24 hours a day, 7
days a week, at home or at the office
• You can proceed at your own speed
• No travel costs
• Very inexpensive
Family Practice
• A family doctor might start at the
Family Practice Section of the CME
List, and go from there to the
• American Academy of Family
Physicians site or to
• FamilyPractice.com, sponsored by
the American Board of Family
Practice
Internist
• An internist might start at the Internal
Medicine section of the Online CME
List, and go from there to
• Clinical Problem Solving Cases,
sponsored by ACP/ASIM, or to
• Johns Hopkins Advanced Studies in
Medicine
Cardiologist
• A cardiologist could start at the
Cardiology section of the Online
CME List and go to
• CardioVillage (University of Virginia)
or
• Baylor University’s extensive list of
cardiology offerings
Fast, Flexible and Fluid
The transition from the Industrial to the
Information Age was encapsulated by
Dolence and Norris (1995), who argued
that to survive organisations would
need to change from rigid, formula
driven entities to organisations that
were “fast, flexible and fluid”.
The Global Lifelong
Learning Economy
What type of institutions will
survive?
Will your institution
survive?
Increasing Competition
The Cambridge e-MBA
Cambridge University’s business school
has joined forces with FT Knowledge,
part of the global communications group
Pearson plc, to offer this new degree
from September 2001.
Fast, Flexible and Fluid?
791 years ago Cambridge University passed
a rule Requiring all students to reside in the
town of Cambridge, England. In 2000 that
rule was revoked. The 800 year-old rulebook
had to be altered to make way for the
university’s first Internet-enabled program,
the global e-MBA.
Email reply received from
University of Cambridge MBA
Office on 13 March 2003.
“Thank you for your enquiry concerning
the Cambridge MBA course. We do not
have on-line learning or distance
learning, we have considered this but
decided not to pursue this.”
Increasing Competition
AllLearn (an e-learning partnership between
Oxford University, Stanford University and Yale
University) is offering 75 short courses in a
dozen disciplines in the Fall Semester, starting
7th October, 2002
http://www.alllearn.org
Future Projections
 A recent IBM report forecasts a threefold
(US$4.5 trillion) jump in global education
expenditure during the next 13 years.
 The World Bank expects the number of
higher education students will more than
double from 70 million to 160 million by
2025.
(Source: Richard Gluyas, New Nabs e-School Deal
http://finance.news.com.au, 22 April 2000).
Future Projections
 By 2005, e-learning will be the single most
used application on the web.
 Corporate investment in e-learning will
grow from US$2.1 billion in 2001 to
US$33.4 billion in 2005.
(Source: Harris, Logan & Lundy, Gartner Research,
2001).
The Big Picture
 Change is the only constant.
 Growth is the only certainty.
Five Generations of Distance
Education Technology
 The Correspondence Model
 The Multimedia Model
 The Telelearning Model
 The Flexible Learning Model
 The Intelligent Flexible Learning Model
First Generation
CHARACTERISTICS OF DELIVERY TECHNOLOGIES
MODELS OF
INSTITUTIONAL
VARIABLE
DISTANCE EDUCATION
HIGHLY
ADVANCED
FLEXIBILITY
COSTS
AND ASSOCIATED
REFINED
INTERACTIVE APPROACHING
ZERO
DELIVERY TECHNOLOGIES Time Place Pace MATERIALS DELIVERY
THE CORRESPONDENCE
MODEL
• Print
Yes
Yes Yes
Yes
No
No
Second Generation
CHARACTERISTICS OF DELIVERY TECHNOLOGIES
MODELS OF
INSTITUTIONAL
VARIABLE
DISTANCE EDUCATION
HIGHLY
ADVANCED
FLEXIBILITY
COSTS
AND ASSOCIATED
REFINED
INTERACTIVE APPROACHING
ZERO
DELIVERY TECHNOLOGIES Time Place Pace MATERIALS DELIVERY
THE MULTIMEDIA MODEL
Yes
Yes Yes
Yes
No
No
• Audiotape
Yes
Yes Yes
Yes
No
No
• Videotape
Yes
Yes
No
• Computer-based learning
(eg CML/CAL)
Yes
Yes Yes
Yes
Yes
No
No
• Interactive video
Yes
Yes Yes
Yes
Yes
No
• Print
Yes
Yes
Third Generation
CHARACTERISTICS OF DELIVERY TECHNOLOGIES
MODELS OF
INSTITUTIONAL
VARIABLE
DISTANCE EDUCATION
HIGHLY
ADVANCED
FLEXIBILITY
COSTS
AND ASSOCIATED
REFINED
INTERACTIVE APPROACHING
ZERO
DELIVERY TECHNOLOGIES Time Place Pace MATERIALS DELIVERY
THE TELELEARNING MODEL
• Audio-teleconferencing
No
No
No
No
Yes
No
• Videoconferencing
No
No
No
No
Yes
• Audiographic
communication
No
No
No
Yes
Yes
No
No
• Broadcast TV/Radio and
Audio-teleconferencing
No
No
No
Yes
Yes
No
Fourth Generation
CHARACTERISTICS OF DELIVERY TECHNOLOGIES
MODELS OF
INSTITUTIONAL
VARIABLE
DISTANCE EDUCATION
HIGHLY
ADVANCED
FLEXIBILITY
COSTS
AND ASSOCIATED
REFINED INTERACTIVE APPROACHING
ZERO
DELIVERY TECHNOLOGIES Time Place Pace MATERIALS DELIVERY
THE FLEXIBLE LEARNING MODEL
• Interactive multimedia (IMM)
Yes
Yes Yes
Yes
Yes
Yes
• Internet-based access to
WWW resources
Yes
Yes Yes
Yes
Yes
Yes
• Computer mediated
communication (CMC).
Yes
Yes Yes
Yes
Yes
No
Fifth Generation
CHARACTERISTICS OF DELIVERY TECHNOLOGIES
MODELS OF
INSTITUTIONAL
VARIABLE
DISTANCE EDUCATION
HIGHLY
ADVANCED
FLEXIBILITY
COSTS
AND ASSOCIATED
REFINED
INTERACTIVE APPROACHING
ZERO
DELIVERY TECHNOLOGIES Time Place Pace MATERIALS DELIVERY
THE INTELLIGENT FLEXIBLE
LEARNING MODEL
• Interactive multimedia
Yes
Yes Yes
Yes
Yes
Yes
• Internet-based access to
WWW resources
Yes
Yes Yes
Yes
Yes
Yes
• CMC, using automated
response systems
Yes
Yes Yes
Yes
Yes
Yes
• Campus portal access to
institutional processes &
resources
Yes
Yes Yes
Yes
Yes
Yes
Ask a
question/
send an
email
NO
Incoming
“new”
admin
question
from
student
Search / Match
USQAssist:
Self-service
Knowledge Base
Previous Questions
Previous Answers
“Immediate”
admin
feedback to
student
YES
Trigger
USQ staff
member –
“New
Answer”
5th Generation
Application
Metadata
Schema Model
NO
Duty Tutor
Incoming
“new”
academic
question
from
student
Search / Match
Reusable Learning
Objects Database
Previous Questions
<meta tags>
Previous Answers
<meta tags>
New Answer
“Immediate”
academic
feedback to
student
YES
Trigger
5th Generation
Application
Overview of Medical
Infomatics Epilepsy
System
Case Details
Doctor /
Medical
Professional
Local DB
Medications /
Side Effects
Reports
Central Database
Computer
Medical
Professional
Web Server
Reports
Patient /
General Public
Patients Computer
Patient /
Public
Patient search screen – Patient name is typed
in and the search button is pressed.
•
Screen showing results of a search for “Tom”.
•
Patient is selected from the list.
•
Patient details are displayed.
•
Extra details are selected from tabs at top.
•
This screen shows the history of the the patient.
•
Details can be reviewed and updated on this screen.
•
This screen lists the seizure details for the patient.
•
These can be reviewed and updated from this screen.
This screen displays current and past medications on the
left hand side, with details for the selected one listed on the
right hand side.
Screen where notes can be entered in an unstructured
manner about the patient and their treatment.
Upload to Web Site
• Collected details are uploaded to the central
website on a regular basis. Updates for
medication and side-effects are downloaded
to the client.
• Once the details are uploaded, analysis
can be performed and reports produced
and made available.
• 110 system CDs have been distributed
– with the assistance of Novartis, a
further 1000 CDs are to be distributed.
Enrolled Students
USQ 2003




All students
On-campus
Off-campus (Australia)
Off-campus (Overseas)
22,908
5,720
12,606
4,582
Note: Students studying solely online
887
USQ’s International Students 2003











Singapore
1,598
Malaysia
2,327
Hong Kong
565
South Africa
288
United Arab Emirates
114
Japan
93
Pacific Islands
180
India
18
Canada
98
China
195
Germany
188
Total, incl. students from 67 other countries 6,976
The GOOD System provides a simple way to
Create, Manage & Re-purpose content
XML (eXtensible Markup Language)
RENDITIONS: Print
STYLE
SHEET:
XSL
Web
CD
DVD
XSL
XSL
XSL
XML
CONTENT
REPOSITORY:
INPUT:
DTD
(Document Type Definition)
XML Editor
Ask a
question/
send an
email
NO
Incoming
“new”
admin
question
from
student
Search / Match
USQAssist:
Self-service
Knowledge Base
Previous Questions
Previous Answers
“Immediate”
admin
feedback to
student
YES
Trigger
USQ staff
member –
“New
Answer”
5th Generation
Application
USQAssist
Self-Service Knowledge Base
During the first half of 2003 the system
received:
 an average 9,075 hits per week;
 95, 322 student contacts;
 61,579 answers viewed;
 23,079 searches performed;
 3,566 questions using the “Ask a
Question” facility.
During S1, the e-CRM also managed a
further 37,755 email queries.
USQAssist
Self-Service Knowledge Base
Student support staff also save
25% of their time through the use
of the knowledge-base for the
automatic generation of
suggested answers to email,
phone and face-to-face enquiries
The PC-ePhone
http://www.usqonline.com.au
Using the Internet as a
mode of delivery will not
automatically improve
student learning.
Laurillard (2002)…..“ The
academic world has called each
new technological device – word
processing, interactive video,
hypertext, multimedia, the Webinto the service of the
transmission model of learning.”
The Potential of e-Learning

From transmission to
transaction

From the independent learner
to the inter-dependent learner
Communication Areas
Content Areas
Group Areas
Student
Areas
Computer Mediated
Communication (CMC)
There is a fundamental qualitative
difference between a traditional oncampus tutorial and asynchronous
written communication online.
Important Qualitative
Difference
Compared to the spontaneous and less
structured nature of oral discourse,
asynchronous discussion online engenders a
disciplined and rigorous form of thinking
based on the reflective and explicit nature of
the written word.
Brown & Duguid (2000) emphasised
the importance of regarding
learning as a social act:
“Practice is an effective teacher,
and community of practice an
ideal learning environment.”
Lave & Wenger (1991) emphasised
the importance of the social
context in which the learner is
immersed, and learning as
legitimate peripheral participation
in a community of practice.
In the online context, legitimate
peripheral participation has
become associated with the term
“Lurker”.
“One of the “silent majority” in an
electronic forum; one who posts
occasionally or not at all but is known
to read the group's postings regularly.”
(The Jargon dictionary, 2002)
Student Participation
Profiles
 Proactive
Workers
 Peripheral
Lurkers
 Parsimonious Shirkers
Overview of Participation and
Performance
Student SubGroups
Average
Number:
Discussion
Board Hits
Average
Number:
Messages
Posted
Average:
GPA
The Workers
193
38
5.43
The Lurkers
129
13
5.41
The Shirkers
36
4
4.30
Outcome
The academic performance of the
lurkers was on average not much
less than that of the workers,
thereby supporting the notion of
learning as legitimate peripheral
participation.
The Future
The success of the lurkers augurs
well for the use of e-learning
facilitated by intelligent databases
and the flexibility inherent in
interacting with
virtual cohorts of students.
Metadata
Schema Model
NO
Duty Tutor
Incoming
“new”
academic
question
from
student
Search / Match
Reusable Learning
Objects Database
Previous Questions
<meta tags>
Previous Answers
<meta tags>
New Answer
“Immediate”
academic
feedback to
student
YES
Trigger
5th Generation
Application
5th Generation
In effect, fifth generation distance
provides students with better quality
tuition and more effective pedagogical
and administrative support services at
lower cost.
The e-Revolution
“Any new technology environment
eventually creates a totally new
human environment”.
Marshall McLuhan