Colin Mitchell SpR Geriatric Medicine / GIM

Objectives Convince you that this is important 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 … and our patients’ lives Demonstrate some 2.0 resources that are already available Fiddle about with my iPhone

Convince you that this is important

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

… and our patients’ lives

Demonstrate some 2.0 resources that are already available

Fiddle about with my iPhone

IT in Medicine – The Future? C

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

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

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 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. Presented contrast pattern Reconstructed contrast patterns Mean of reconstructed contrast pattern

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

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?

What 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

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.”

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

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.”

Some non-medical examples…

FAIL

Politics 2.0 http://www.barackobama.com

A Tale of Two Planes Northwest Airlines Flight 1829, 3 rd January 1999. Lands in Detroit at 14.45. Passengers finally disembark at 21.42. American Airlines Flight 1348, 29 th 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 From “Here Comes Everybody” by Clay Shirky. Pub 2008 by Penguin Books

A Tale of Two Planes

Northwest Airlines Flight 1829, 3 rd January 1999. Lands in Detroit at 14.45. Passengers finally disembark at 21.42.

American Airlines Flight 1348, 29 th 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…

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

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

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?”

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? ”

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...

An experiment...

How many… Blue diamonds? Green circles?

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):

ILI: Influenza-Like Illness – CDC data on presentations with flu symptoms from ‘sentinel’ outpatient facilities

Wikipedia / Health Wikis Not definitive, but excellent. How? http://en.wikipedia.org/ http://www.ganfyd.org/ http://www.AskDrWiki.com/ Or… Create your own:

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

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

Over 10 million users MMORPG or MUVE… SimTeach: 2 nd Life Jeremy Kemp - San Jose State University. http://www.simteach.com/

Over 10 million users

MMORPG or MUVE…

SimTeach:

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

For Doctors

Up-to-date knowledge ‘pushed’ to you

Diagnosis support

Personal support

Connected learning / teaching

‘ Expert’ patients

Remote / Virtual care

iMedix

RateMDs.com

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

My Google Health:

https://www.google.com/health/p/

SugarStats

Relief in Site

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

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 our careers to the crowds?

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 our careers to the crowds?

IWGC – Patients rating Doctors Screenshot from NHSblogdoctor – The original was removed, appropriately.

(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

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

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 Apps I use – Safari web browser – BNF, RCP guidelines etc Google – includes voice search Wikipedia, WikiTap (with multimedia links) Epocrates Cardiocalc, Medical Calc PubSearch Converter – eg Stone to Kg for LMWH NetNewsWire – RSS reader

Apps I use –

Safari web browser – BNF, RCP guidelines etc

Google – includes voice search

Wikipedia, WikiTap (with multimedia links)

Epocrates

Cardiocalc, Medical Calc

PubSearch

Converter – eg Stone to Kg for LMWH

NetNewsWire – RSS reader

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.

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

Thank you. Yes please Noooo! Hi! I see you’re finished. Would you like me to tell Dr Lewis about any of your other hobbies?