Can we use Web 2.0 in Health Care?

Friday, December 8, 2006  | Sally Lakeman


I'd like to start by getting straight to the question, can we use current Web 2.0 social networking applications in health care? Wikipedia describes Web 2.0 as "supposed second generation of Internet-based services—such as social networking sites, wikis, communication tools, and folksonomies—that emphasize online collaboration and sharing among users."

Many of you will be familiar with some of the greater success stories, namely, the recent sale of YouTube.com which sold for US$1.65 billion and myspace.com. These sites provide users with the ability to generate their own content, in-fact, they are 95-100% user generated meaning that the site owners provide the tools for users to develop their own content driven areas. It's social networking in an online environment.

Certainly for the younger generation, posting videos or blogs is now increasingly second nature, but now, especially with some of the older sites, people in mature age brackets are getting online and developing their own content as well. In short, we are seeing a very broad age range that are highly motivated to participate.

That last sentence should be spiking interest in many of you, because, as health care providers, these indicators in certain situations can make delivering health care a success or not.

There are some incredible technical health care solutions coming out at the moment. Many are driven by the provider and target specific conditions or age groups but they can appear very medical in their nature. People can find this rather confronting. Using social networking tools, is it possible for us to deliver health solutions that encourage the patient to actively participate in an online environment? Can we create an online space where people can not only manage their conditions but are encouraged to create, participate and collaborate in driving online health applications.

 

Member Comments


There are aspects of Web 2.0 that will be useful to healthcare such as improved web interfaces and communities around conditions and deseases, but I think much more fundemental is the need for end-to-end standards for secure data exchange. Imagine the home monitoring devices being able to connect up to a personal health site on the web and then those sites in turn being able to transfer securely to a physician's EMR. Think of all those poor clipboard manufacturers gong out of business and smile.

Leon Barzin

Director IT
MA Medical Society

 

Posted by: Leon Barzin
12/12/2006

 

With tongue inserted halfway in cheek, may I suggest that "we" -- presumably meaning healthcare and other professionals -- will not so much "use" Web 2.0 tools as they will use us. Professional caregivers are fair fodder for content generated by consumers and patients, right? Right now, on sites like yelp.com, patients are rating and commenting upon Boston institutions and even individual doctors from whom they're received care (144 comments on Boston-area "health and medical" providers last time I checked). The same will soon be true across the globe.

So an additional question to ponder is, Since this is going to happen, and often, how will "we" engage our commentators? Does every rating and remark, however well- or ill-founded, sit there for months if not years, without rejoinder? That ain't the way this is going to shake out. Welcome to Web 2.5 -- user-generated content matched against service provider response. I foresee new roles for both sides; let the matches begin. And who's going to referee? All our lawyer friends pining to do arbitration -- new roles await you, too. This Web 2.0 stuff is headed off in directions we can scarcely imagine.

Michael Barrett

Managing Partner
Critical Mass Consulting

Mike is Managing Partner of Critical Mass Consulting, a healthcare and life sciences consultancy focused on information technology use by physicians, consumers, hospitals, health plans, and medical device and pharmaceutical firms. Before founding his own firm, he was Senior Analyst at Forrester Research for health care. Mike has evaluated hundreds of products, companies, business models and business plans in healthcare, pharmaceuticals, and medical devices. He’s also written extensively on IT’s role in healthcare and the life sciences for the California Health Care Foundation (CHCF) and Forrester. Reports for CHCF include Patient Self-Management Tools: An Overview (June 2005) and Electronic Medical Records: A Buyers’ Guide for Small Physician Practices (October 2003), both available for viewing at www.chcf.org. Projects for Forrester include When EMRs Meet Clinical Trials (March 2003), Making ePrescribing Pay Off (April 2002), and Web Clinical Trials Break Through (July 2001). Mike is the originator of Forrester’s Healthcare Unbound concept. He conceived the idea and wrote Forrester’s early, seminal report of the same name. Critical Mass Consulting focuses much of its research and strategic analysis in this area, in conjunction with work for clients on personal health records, disease management programs, and physician-patient messaging. Prior to embarking on a consulting career, Mike served as CEO and General Counsel of an independent practice association (IPA) consisting of 95 surgeons specializing in ear, nose, and throat disorders, and of a healthcare system composed of 70 home health nursing agencies in Massachusetts, Connecticut, and Rhode Island. Mike ran daily operations and legal affairs as these operations contracted with insurers, delivered services to patients, purchased technology, and negotiated with medical supply and pharmaceutical companies. Before entering the private sector, Mike practiced law and ran successfully for four terms in the Massachusetts State Senate. As Senate chair of the Committee on Health Care, he focused on HMO reform and biotechnology’s role in the state economy. Mike graduated from Harvard College magna cum laude and from the Northeastern University School of Law. After law school, he served as law clerk to Federal District Court Judge June L. Green in Washington, DC. He is an active member of the Massachusetts Bar. Mike can be reached at mbarrett@cmass.us.

 

Posted by: Michael Barrett
12/12/2006

 

Web 2.0's claim of ushering "social networking sites, wikis, communication tools, and folksonomies—that emphasize online collaboration and sharing among users" does not acknowledge the existence of such vibrant communities as Bulletin Board Services, Usenet newsgroups and post-Netscape online discussion forums since 1980's & 90's. The difference is that the scope of participation has expanded.

I think that Web 2.0 is a culture of online expression than a technology platform. On the enterprise side, by using the new web based business models in ERP and CRM (http://www.workday.com, Google Spreadsheets), only the data would be owned and online software or equipment would be leased. Healthcare would probably have the greatest benefit - end of all incompatible standards, introduction of universal access and end of multibillion dollar EMR integration industry.

On the consumer side, some areas where social collaboration can have immediate effect could be
 - Discussions among patients of rare disorders for better data collection and documentation
 - Phase 4 monitoring of adverse events by pharma - faster, cheaper
 - Discussion about outcomes among physicians involved in clinical research or practice (www.sermo.com)

The participation of patients in online discussions is a great step in patient education and compliance. But privacy concerns can prevent full exploration of benefits. People could be more forthcoming about their experiences at restaurants than with a disease condition.

The other issue is credibility. It is easy to post "...But if I had to choose on my own again, no way I'd go here..." about a leading Harvard hospital (Source:Yelp.com) but it could be a source of serious misinformation to others. While it may make healthcare service providers more responsive to patients' needs, these could also turn out to be marketing/sabotage tools. User reviews at Amazon.com are a sad reminder of this phenomenon.

Pushwaz Virk

Fellow, Healthcare Management
Harvard University

I find myself where technology meets medicine.

 

Posted by: Pushwaz Virk
12/12/2006

 

During the past few years we have witnessed a most remarkable revolution - Large Scale People Knowledge Exchange facilitated through the use of mass networking tools. These range from online news sites such as Digg.com which is all about “user powered content” to social-networking sites such as MySpace and You Tube.

What is even more remarkable about this revolution is this – The e-contributors work for FREE. Now that is an innovative business model! The story is of course somewhat different for those who create the business models allowing the e-contributors to spend their extra time working on a non-paying job. For example Chad Hurley and Steve Chan – the founders of You Tube made a handsome return on their investment when Google paid $1.65 billion for the company. There are however signs that in future some e-contributors are likely to get some form of remuneration. Also, this general wealth generation can and often does end up benefiting society as a whole.

The driving force behind the e-contributors is varied. E-contributors can include Open-source developers, angry customers, dissatisfied employees, those who genuinely want to help and inform and sometimes those who would falsify information for their own benefit.

Having set the scene, lets now move on to the question of whether “We can use current Web 2.0 social networking applications in health care?” - The answer ? – Of course yes. As long as we do our best to ensure the integrity of the data.

Web 2.0 is no longer just for the non-professional. It has already started to find its way to corporate institutions. Reportedly Goldman Sachs tracks its alumni by using a social networking programme called SelectMinds. The 2007 Office Suite from Microsoft is to have a social network tool referred to as Knowledge Network. This will be used to create a profile of the user’s expertise. IBM uses Dogear (An internal network tool) to allow employees to share beneficial documents and web pages.

A major company recently announced its intention to start looking for solutions to health related problems that would benefit from the application of the Internet in general and Web 2.0 in particular. And Google must mean business here, as issues related to health care and health information is now a major focus for its Vice President Adam Bosworth. In fact as you may have already noticed, mainly using Google co-op, Google has already begun the process of making it easier for users to locate the health related information they are seeking. For example, typing say “diabetes” into Google will give you the option of refining your query by selecting from a list containing other relevant information such as Symptoms and Treatments.

In parallel with the above developments there are also initiatives to help protect the public from unscrupulous medical web sites. In dealing with the issue of people buying prescription drugs from shady web sites, the Royal Pharmaceutical Society of Great Britain recently “launched a pilot scheme to protect the public from unscrupulous drug-pushing on illegal websites. The aim is that, within a few months, buyers will be able to identify credible online pharmacies taking part in the trial by a logo attributed only to bona fide, RPSGB-registered pharmacies. “ The situation in the USA may be worse as drug prices in the U.S. can exceed those in other developed countries by up to 67%. The situation is somewhat exacerbated due to the fact that around 46 million Americans lack health insurance. One thing is certain - the shady operators are extremely determined. Reportedly nearly 25% of all emails (that is around 15 billion messages/day) are spam advertising drugs, mostly counterfeits.

In conclusion Web 2.0 has a major role to play in the education and empowerment of the patients. This in turn can have a major impact on the lowering of the long term health care costs and improving productivity. Not only has web 2.0 a place in the efficient and evidence-based disease management but perhaps more importantly it can also be of great importance in the area of disease prevention.

Sepe Sehati

Sepe Sehati

Biomedical scientist
Oxford Brookes University

Dr Sepe Sehati is a well-established academic, a seasoned biomedical researcher and an experienced entrepreneur. He holds a bachelor of Engineering with honours in Electronic Engineering, an MSc in Medical Electronics & Physics and a Doctorate in Bioengineering from University of Oxford in England. A published photographer, poet, inventor and a do-it-yourself enthusiast, Sepe finds that his “renaissance style” range of activities make a major contribution in keeping active the innovation channels essential to his multidisciplinary work as a biomedical scientist. Sepe has been involved in research in the following areas; sound transmission through normal and diseased lungs, wound healing, clinical risk management, clinical complaint management, Internet re-configurability of digital systems including medical instruments and ambulatory monitoring, recording & analysis of clinical data over the Internet. His research findings have been extensively presented and published. Some of the journals in which he has published include; American Journal of Applied Physiology, Physiological Measurement, Nursing Management and British Journal of Anaesthesia. In his capacity as the Director of Research at Oxford Brookes University he has experience of managing the activities of a number of other Science and Technology related research groups. In addition he is actively involved in lecturing in the areas of; Medical Technology, Technology Management, Digital Design and Electronic Computer Aided Design. He consults for companies both in the UK and USA and in 2001 was the recipient of a lucrative offer to become the CEO of a US based healthcare company. One of Sepe’s current areas of interest is the innovative application of technology to healthcare in order to help achieve not only a more efficient system, but also to deal with preventative issues (such as early disease detection) and remote disease management. Working with politicians both in the UK and USA he has painstakingly completed some ground work in this area. However, given the often extremely slow pace with which even the existing and simple non “rocket science” technologies and techniques are integrated into healthcare, Sepe passionately believes that there has for some time now been a powerful case for large-scale patient empowerment through the use of simple (and existing) technologies. This fully scalable approach effectively endorses a bottom-up rather than a top-down approach to healthcare by fully equipping the patients who will in turn be able to tap into the unprecedented power of emerging technologies (such as Web 2.0). It is most likely that it is the patients who will slowly but surely bring such extremely valuable tools inside the walls of their physician’s surgery, clinical laboratories and hospitals. Some of the immediate areas to benefit include global patient education and networking, total health record management (including drug interactions and allergies) and out of hospital patient support. There are currently a number of companies well positioned to enter this interesting area of work which apart from doing some real good to mankind will inevitably prove to be very lucrative. Indeed, in the words of Benjamin Franklin “The most acceptable service to God is to do good to man”. Dr S Sehati is an elected Fellow of the Royal Society of Medicine and remains a Common Room Member at Green College, University of Oxford – his alma mater. December 2006

 

Posted by: Sepe Sehati
12/18/2006

 

Thank you to everyone for your thought provoking comments.

Patient self-management seems to be an issue with many layers.

I believe that Web 2.0 will play a big role in the future and once health professionals find the right way to utilise it, we will see major benefits.

Sally Lakeman

Director, ClickMedia
ClickMedia

I work for an e-health Network with a Health Department in Australia. I was lucky enough to begin working for a Population Health Division who had great vision and saw much opportunity to deliver education and support via technology. My role is to manage the overall delivery of the E-health Network's technical infrastructure and also help guide it's long term strategies and goals.

Websites:

http://www.clickmediapro.com http://www.interactivehealth.com.au http://technhealth.blogspot.com/ http://www.yourzone.com.au

 

Posted by: Sally Lakeman
12/21/2006

 

Let me bring a new dimension to this discussion based on output from a online discussion group focussing on providing health information to health workers in developing countries. Here is an excerpts of my posting based on use of Wikis and Web 2.0 for health information presentation:

The phenomenon of Web 2.0 has been predicted to be the next dotcom boom but this might not be as big as the first one, this the assertion of a writer from a December edition of Times Mgazine (December 25, 2006) dedicated to users of Web 2.0 social tools such as You Tube, MySpace and others. The user as the author and finisher of information and contents makes this tool an interactive and collaborative platform for generating boundless ideas and information.

Wiki, a Web 2.0 knowledge platform as exemplified by the popularity of Wikipedia has been evalauated to be as accurate and big as the traditional Encyclopaedia Britannica in a study carried out by the influential Nature Journal (http://news.com.com/2100-1038_3-5997332.html). So the position of Guistini in the BMJ article makes a case for the potential application of this tool to leverage open source and free medical knowledge especially for developing countries where fees for journal subscriptions are prohibitive and unaffordable.

However, the use of Wiki for medical knowledge must be promoted with some caution, in that the veracity of the information must be tightly controlled through strict editing and quality control so as to safeguard patient outcomes and minimise risks.

A proposal for the use of Wiki for medical information might be to develop a generic and global platform for exchange of ideas and information relating to all aspects of medical care and systems, but not necessarily used for patient care or health planning. Then specific, subject based Wiki can be developed to present evidence-based and good practice medical knowldege from reputable sources. Here the users will still have the control, but information posted here must meet requirements for high quality medical information and to be suitable for evidence-based patient care and health system planning.

The use of Wiki for health information generation and presentation in developing countries is in line with the clamour of Open Source software movement, which promotes low-cost and easily accessible software fordevelopment, however, Wiki is web-based. So the question is how do you give access to health workers in these regions where Internet penetrance is near zero? Especially at the community or primary level of the health system where access to health information is non-existing? I believe at the macro level, health knowledge can be made available on Wiki, but more research is needed on how to present health information at the point of care or need in a contextural manner.

The answer might not be far-fetched, the use of mobile and wireless technologies could be a potential solution. These technologies are widely adopted and accessible to most users in developing countries, so the development of health information on this platform is highly necessary toleverage the global health knowldege for healthcare in developing countries. This could be made possible by the convergence of Web 2.0 and mobile technologies.

Web 2.0 and Wiki have been developed and standardized for mobile platforms. W3C has developed standards for optimizing Web 2.0 for mobile devices (http://www.w3.org/TR/mobile-bp/) . As a matter of fact mobile Wikipeadia is at the beta testing stage. Many open source initiatives have developed softwares for Mobile Web 2.0(http://www.mobileread.com/forums/showthread.php?t=6143). This development could be tapped for health information and knowldege presentation, simple Web 2.0 tools like RSS feeds can provide platforms for delivering contextural health information to health workers empowered with handheld computers or smartphones at the community level. This can be used with simple mobile tool like SMS even if full mobile or wireless internet connectivity is not available.

The combination of free source of health information and knowledge to be enabled by Wiki and the ubiquity and low-cost of ownership and avaliabilty of mobile technologies in developing countries could make the vision of HIFA2015 achievable and feasible in a timely manner.

Interested readers can join the discussion on this list: HIFA2015@dgroups.org.

Adesina Iluyemi

PhD Candidate
University of Portsmouth

I am a dentist by training with Masters degree and postgraduate Royal College of Surgeons, England diploma in Dental Public Health. I am presently a PhD candidate at the Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK studying Mobile Health Information System(Telehealth) in developing countries context and focussing on the use of mobile technologies to support community health workers. I am also interested in the use of mobile technologies for the management of chronic disease patients especially HIV/AIDS.

 

Posted by: Adesina Iluyemi
1/3/2007

 

I would also like to know if this is possible? Would you be kind enough to respond?

William@lee-robinette.com
www.lee-robinette.com
Healthcare Staffing Professionals.

William Lee

Principal - Co-Founder
Lee and Robinette Healthcare Staffing

Nationwide Full service Healthcare Staffing firm. F-T-E, Contract and Per Diem.

 

Posted by: William Lee
4/3/2007

 

Whether we want it or not, so web 2.0 technologies (many of which are really a revival of perhaps older ideas of the first dot.com boom but with better prepared users and more robust/scalable technologies)will become part of health care processes. Just to add to the list of web 2.0 technologies already mentioned, I would like the increasign likely role of massive multiplayer virtual environments such as Secondlife and mobile micro blogging through twitter or Jaiku in future health care applications. We have already done some notable work in emergency preparedness in Secondlife, check out www.play2train.org Please get in touch with me if you are interested to visit us in our virtual environment.

Ramesh Ramloll

Research Assistant Professor
Institute of Rural Health, Idaho State University

More information about myself can be found at www.play2train.org http://irhbt.typepad.com/virtually_yours/

 

Posted by: Ramesh Ramloll
4/14/2007

 

Is mobility lost in the Web 2.0 experience?

I second the comment by Adesina above that when mobile, full desktop connectivity is often impractical or unwieldy.

Or is mobility only paramount for alerting or monitoring use cases?

Sean Wheeler

Research Scientist
France Telecom R&D, Boston

 

Posted by: Sean Wheeler
4/17/2007

 

I'm writing to let you know about the Special Issue on "Pervasive Health Care Services and Technologies," which is scheduled for publication on April 1, 2008.

You can find the Call for Paper for this Special Issue at: http://www.hindawi.com/journals/ijta/si/phst.html

Rania Khalil

business development specialist
Hindawi publishing corporation

 

Posted by: Rania Khalil
5/13/2007

 

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