Colin Mitchell
SpR Geriatric Medicine / GIM
HEALTH 2.0:
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

Mentalism
Presented contrast
pattern
Reconstructed
contrast patterns
Mean of
reconstructed
contrast pattern
MiyawakiY, Uchida H, Yamashita O, Sato M-a, MoritoY, Tanabe HC, Sadato
N, KamitaniY (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
Hi! I see you’re looking
after a patient with a
history of chest pain!
Would you like my help?
Sod off
Yes please

Medicine – 20 years from now
Technology and access to information is already changing how we work
What will medicine be like in the future?
For Patients?
For Doctors?

What is it?
HEALTH 2.0

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, communicat
ions, 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, communicat
ions, 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

Some non-medical examples…
WHAT IS THE INTERNET FOR?

FAIL

Politics 2.0
http://www.barackobama.com

Organizing without organizations
A Tale of Two Planes
Northwest Airlines Flight 1829,
1.
3rd January 1999. Lands in
Detroit at 14.45. Passengers
finally disembark at 21.42.
American Airlines Flight 1348,
2.
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.

OK, enough about Web 2.0, what about…
HEALTH 2.0

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 Google
Google diagnosis Final diagnosis
Case correct?
5 Infective endocarditis Infective endocarditis Yes
6 Gastrointestinal bleed Linitisplastica with bowel obstruction No
7 Cushing's syndrome Cushing's syndrome secondary to adrenal adenoma Yes
8 Eosinophilicgranuloma, osteoidosteoma Osteoidosteoma 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-Scholeinpurpura 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?

Google Flu Trends
Sarah Palin:
Flu (aggregate):
ILI: Influenza-Like Illness – CDC data on presentations with flu symptoms from ‗sentinel‘ outpatient facilities
http://www.google.org, http://www.google.com/trends

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

Doctors.net.uk
Email, CPD and forums

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)
The 3 groups (40 mins):
1.
Create an F2 blog***
1.
Find a hot-topic medical article, comment on it, then post
2.
it on a blog*
Set up Google Reader and subscribe to some Medical
3.
RSS feeds**
Explain what you did to the rest of the group
2.
Discuss if this is useful or all high-tech hot-air
3.

HEALTH 2.0 FOR PATIENTS

iMedix

Electronic Records
My Google Health:
https://www.google.com/health/p/

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

Patients in control – a good thing?
Should we trust our careers to the wisdom of the crowds?

(Literally) at your fingertips
PORTABLE MEDICAL IT

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