Post on 15-Jun-2015
HEALTH 2.0:
Colin MitchellSpR Geriatric Medicine / GIM
How IT and the Social Web Will Change Healthcare
Objectives
Convince you that this is important Convince you that spoonfeeding you information about…
SLE or something is unproductive Briefly review existing technology used in Medicine Introduce Health 2.0
What is Web 2.0? Some general concepts The wisdom of the crowds How Health 2.0 can affect our practice …the way we learn and keep up-to-date …and our patients’ lives Demonstrate some 2.0 resources that are already available Show you how to use them yourselves
Fiddle about with my iPhone
IT in Medicine – The Future?
C
IT in Healthcare - The Future?
What did IT ever do for us?
C
IT in Healthcare – The Present
Communication Organisation / Team-working Robots Advanced imaging & image distribution Patient tracking Electronic records Simulation / e-training Knowledge access / sharing E-prescribing with decision support Diagnosis support Mind reading
IT in Healthcare – The Present
Communication Organisation / Team-working Robots Advanced imaging & image distribution Patient tracking Electronic records Simulation / e-training Knowledge access / sharing E-prescribing with decision support Diagnosis support Mind reading
IT in Healthcare – The Present
Communication Organisation / Team-working Robots Advanced imaging & image distribution Patient tracking Electronic records Simulation / e-training Knowledge access / sharing E-prescribing with decision support Diagnosis support Mind reading
MentalismPresented
contrast pattern
Reconstructed contrast patterns
Mean of reconstructed
contrast pattern
Miyawaki Y, Uchida H, Yamashita O, Sato M-a, Morito Y, Tanabe HC, Sadato N, Kamitani Y (2008) Visual Image Reconstruction from Human Brain Activity using a Combination of Multiscale Local Image Decoder. Neuron 60(5):915-929.
Decision Support
E-prescriptions, Electronic health records Knowledge-based DSS
Uses an “inference engine” Outputs suggestions based on existing knowledge
eg E-prescribing: Suggests generic medicines Identifies drug interactions Asks how long a course of antibiotics is for
The Problem with Decision Support
Yes please Sod off
Hi! I see you’re looking after a patient with a history of chest pain! Would you like my help?
Technology and access to information is already changing how we work
What will medicine be like in the future?
For Patients?
For Doctors?
Medicine – 20 years from now
HEALTH 2.0What is it?
Web 2.0?
Wikipedia:
“The term ‘Web 2.0’ describes the changing trends in the use of World Wide Web technology and web design that aim to enhance creativity, communications, secure information sharing, collaboration and functionality of the web.”
http://en.wikipedia.org/wiki/Web_2.0 & Image under CCL from http://hello.eboy.com
Web 2.0?
Wikipedia:
“The term ‘Web 2.0’ describes the changing trends in the use of World Wide Web technology and web design that aim to enhance creativity, communications, secure information sharing, collaboration and functionality of the web.”
http://en.wikipedia.org/wiki/Web_2.0 & Image under CCL from http://hello.eboy.com
WHAT IS THE INTERNET FOR?Some non-medical examples…
FAIL
Politics 2.0
http://www.barackobama.com
A Tale of Two Planes
1. Northwest Airlines Flight 1829, 3rd January 1999. Lands in Detroit at 14.45. Passengers finally disembark at 21.42.
2. American Airlines Flight 1348, 29th December 2006. Diverted to Austin TX. An 8-hour delay before disembarking.
• The difference?
• A discussion in the comments section on the American-Statesmen’s website, an online petition, national media, and the US Congress.
Organizing without organizations
HEALTH 2.0OK, enough about Web 2.0, what about…
Dr. Google
Googling for a diagnosis—use of Google as a diagnostic aid: internet based study (2006)
2 Investigators armed with Google vs
26 Case Records of the Massachusetts General Hospital
Blinded to the diagnosis, investigators extracted 3-5 key features of the case and Googled them
The 3 most prominent/ appropriate diagnoses were then selected from the search results
Tang & Ng. BMJ. 2006 December 2; 333(7579): 1143–1145
NEJM Case Google diagnosis Final diagnosis Google
correct?
5 Infective endocarditis Infective endocarditis Yes
6 Gastrointestinal bleed Linitis plastica with bowel obstruction No
7 Cushing's syndrome Cushing's syndrome secondary to adrenal adenoma Yes
8 Eosinophilic granuloma, osteoid osteoma Osteoid osteoma Yes
9 Extrinsic allergic alveolitis, tuberculosis, BOOP Hot tub lung secondary to Mycobacterium avium No
10 Amyotrophy Ehrlichiosis No
11 Tuberculosis, lymphoma Lymphoma Yes
12 Neurofibromatosis type 1 Neurofibromatosis type 1 Yes
14 Uveitis Vasculitis No
15 Amyloid Amyloid light chain Yes
16 Hyperaldosteronism Phaeochromocytoma No
17 Acute chest syndrome Acute chest syndrome Yes
18 Tuberous sclerosis Endometriosis No
19 Aspergillus Aspiration pneumonia, brain abscess No
22 Graft versus host disease West Nile fever No
25 Cirrhosis Pylephlebitis No
26 Hypertrophic obstructive cardiomyopathy Hypertrophic obstructive cardiomyopathy Yes
27 Spongiform encephalopathy (Creutzfeldt-Jakob) Creutzfeldt-Jakob disease Yes
28 Churg-Strauss syndrome Churg-Strauss syndrome Yes
29 Polymyositis or dermatomyositis Dermatomyositis secondary to non-Hodgkin's lymphoma Yes
30 Cat scratch disease Cat scratch disease Yes
31 Henoch-Scholein purpura Cryoglobulinaemia No
33 juvenile polyposis + HTT, links to MADH4 mutation MADH4 mutation (HTT plus juvenile polyposis) Yes
34 Toxic epidermal necrolysis syndrome Toxic epidermal necrolysis syndrome Yes
36 Encephalitis MELAS No
37 Long QT syndrome, Brugada syndrome Brugada syndrome Yes
Reaction to Dr. Google
A spokeswoman for the Patients Association: "Doctors have a very wide knowledge when it
comes to diagnosing conditions. But we would be concerned if they were using websites to diagnose people. What would happen if they gave the patient the wrong information?”
Reaction to Dr. Google
A spokeswoman for the Patients Association: "Doctors have a very wide knowledge when it
comes to diagnosing conditions. But we would be concerned if they were using websites to diagnose people. What would happen if they gave the patient the wrong information?”
Wisdom of the Crowds
• An experiment...
How many…
Blue diamonds? Green circles?
ILI: Influenza-Like Illness – CDC data on presentations with flu symptoms from ‘sentinel’ outpatient facilities
Google Flu Trends
http://www.google.org, http://www.google.com/trends
Sarah Palin:
Flu (aggregate):
Google Flu Trends
This is the result:
Ginsberg et al (2008) Detecting influenza epidemics using search engine query data. Nature (ePub Nov 18, 2008)
Wikipedia / Health Wikis
Not definitive, but excellent. How? http://en.wikipedia.org/ http://www.ganfyd.org/ http://www.AskDrWiki.com/ Or… Create your own:
MedBlogs & RSS
Social Bookmarking
Users rate stories / websites / videos / papers More recommendations = higher ranking Choose a channel by
Topic Bookmarker
Reddit – http://science.reddit.com/ Delicio.us - http://delicious.com/bengoldacre Biowizard Digg (with recommendation engine)
All this can be channeled into your RSS feed
Twitter, Flickr and tagging
CCL: Markus Angermeier @ Aperto.de
Podcasts, iTunes & iTunesU
Email, CPD and forums
Doctors.net.uk
Health 2.0 – What does it change?
For Doctors Up-to-date knowledge ‘pushed’ to you Diagnosis support Personal support Connected learning / teaching ‘Expert’ patients Remote / Virtual care
Using Web 2.0 now
Split into 3 groups then we’ll go to the library computer lab.
Objectives for the next hour (* = difficulty level)
1. The 3 groups (40 mins):1. Create an F2 blog***
2. Find a hot-topic medical article, comment on it, then post it on a blog*
3. Set up Google Reader and subscribe to some Medical RSS feeds**
2. Explain what you did to the rest of the group
3. Discuss if this is useful or all high-tech hot-air
Using Web 2.0 now
HEALTH 2.0 FOR PATIENTS
iMedix
My Google Health:
https://www.google.com/health/p/
Electronic Records
SugarStats
Relief in Site
RateMDs.com
Health 2.0 – What does it change?
For Patients Potentially better informed Access to knowledge and expert opinion ‘Ownership’ / Individual responsibility Chronic care load distributed Support – clinical and social
Problems / Unintended Consequences
Poor comprehension of the new media Wikipedia controversy Blocking ‘social’ websites
Cyberchondria Access to records
Consumerist patients Will NHS patients finally ‘choose’?
Can we trust the internet with our medical history?
Can we trust the government with it?
What about trusting our careers to the crowds?...
Problems / Unintended Consequences
Poor comprehension of the new media Wikipedia controversy Blocking ‘social’ websites
Cyberchondria Access to records
Consumerist patients Will NHS patients finally ‘choose’?
Can we trust the internet with our medical history?
Can we trust the government with it?
What about trusting our careers to the crowds?...
IWGC
IWGC
IWGC
Should we trust our careers to the wisdom of the crowds?
Patients in control – a good thing?
PORTABLE MEDICAL IT(Literally) at your fingertips
Access
Critical to obtain information & participate SmartPhones
Windows Mobile iPhone Google Android Palm Pre (soon)
Netbooks Web access (firewalls) Installed System Applications
iPhone
App Store currently has 131 medical apps But dwarfed by Windows Mobile
Podcasts Web access through Safari Many apps are free
All (except PubSearch – 59p) in this demo are free applications
iPhone Apps
iPHONE
In summary…
IT and the internet are changing how we interact, and allowing us to act together.
Web / Health 2.0 is about the power of crowds, without hierarchy.
Doctors have to be part of the crowd, as contributors and evaluators as well as moderators.
Having an understanding of all this is important to be able to practice medicine in the information age.
Using it could make you a better doctor, now.
Questions?
http://obamicon.pastemagazine.com