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