Health 2.0 for UK SpRs

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A 45minute talk on the basics of Web 2, IT and medicine, particularly focussing on Web 2 tools that can be used by doctors and patients. Also a brief look at accessing these and other tools via portable means, demonstrated with my iPhone.

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  • Health 2.0 for UK SpRs

    1. 1. Colin Mitchell SpR Geriatric Medicine / GIM
    2. 2. Objectives <ul><li>Convince you that this is important </li></ul><ul><li>Briefly review existing technology used in Medicine </li></ul><ul><li>Introduce Health 2.0 </li></ul><ul><ul><li>What is Web 2.0? Some general concepts </li></ul></ul><ul><ul><li>The wisdom of the crowds </li></ul></ul><ul><ul><li>How Health 2.0 can affect our practice </li></ul></ul><ul><ul><li>… and our patients’ lives </li></ul></ul><ul><ul><li>Demonstrate some 2.0 resources that are already available </li></ul></ul><ul><li>Fiddle about with my iPhone </li></ul>
    3. 3. IT in Medicine – The Future? C
    4. 4. What did IT ever do for us? C
    5. 5. IT in Healthcare – The Present <ul><li>Communication </li></ul><ul><li>Organisation / Team-working </li></ul><ul><li>Robots </li></ul><ul><li>Advanced imaging & image distribution </li></ul><ul><li>Patient tracking </li></ul><ul><li>Electronic records </li></ul><ul><li>Simulation / e-training </li></ul><ul><li>Knowledge access / sharing </li></ul><ul><li>E-prescribing with decision support </li></ul><ul><li>Diagnosis support </li></ul><ul><li>Mind reading </li></ul>
    6. 6. IT in Healthcare – The Present <ul><li>Communication </li></ul><ul><li>Organisation / Team-working </li></ul><ul><li>Robots </li></ul><ul><li>Advanced imaging & image distribution </li></ul><ul><li>Patient tracking </li></ul><ul><li>Electronic records </li></ul><ul><li>Simulation / e-training </li></ul><ul><li>Knowledge access / sharing </li></ul><ul><li>E-prescribing with decision support </li></ul><ul><li>Diagnosis support </li></ul><ul><li>Mind reading </li></ul>
    7. 7. 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
    8. 8. Decision Support <ul><li>E- prescriptions, Electronic health records </li></ul><ul><li>Knowledge-based DSS </li></ul><ul><ul><li>Uses an “inference engine” </li></ul></ul><ul><ul><li>Outputs suggestions based on existing knowledge </li></ul></ul><ul><li>eg E-prescribing: </li></ul><ul><ul><li>Suggests generic medicines </li></ul></ul><ul><ul><li>Identifies drug interactions </li></ul></ul><ul><ul><li>Asks how long a course of antibiotics is for </li></ul></ul>
    9. 9. 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?
    10. 10. What is it?
    11. 11. Web 2.0? <ul><li>Wikipedia: </li></ul><ul><li>“ 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.” </li></ul>http://en.wikipedia.org/wiki/ Web_2.0 & Image under CCL from http://hello.eboy.com
    12. 12. Web 2.0? <ul><li>Wikipedia: </li></ul><ul><li>“ 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.” </li></ul>http://en.wikipedia.org/wiki/ Web_2.0 & Image under CCL from http://hello.eboy.com
    13. 13. Some non-medical examples…
    14. 14. FAIL
    15. 15. Politics 2.0 http://www.barackobama.com
    16. 16. <ul><li>A Tale of Two Planes </li></ul><ul><li>Northwest Airlines Flight 1829, 3 rd January 1999. Lands in Detroit at 14.45. Passengers finally disembark at 21.42. </li></ul><ul><li>American Airlines Flight 1348, 29 th December 2006. Diverted to Austin TX. An 8-hour delay before disembarking. </li></ul><ul><li>The difference? </li></ul><ul><li>A discussion in the comments section on the American-Statesmen ’s website, an online petition, national media, and the US Congress. </li></ul>Organizing without organizations From “Here Comes Everybody” by Clay Shirky. Pub 2008 by Penguin Books
    17. 17. OK, enough about Web 2.0, what about…
    18. 18. Dr. Google <ul><li>Googling for a diagnosis—use of Google as a diagnostic aid: internet based study (2006) </li></ul><ul><ul><ul><li>2 Investigators armed with Google </li></ul></ul></ul><ul><ul><ul><ul><li>vs </li></ul></ul></ul></ul><ul><ul><ul><li>26 Case Records of the Massachusetts General Hospital </li></ul></ul></ul><ul><li>Blinded to the diagnosis, investigators extracted 3-5 key features of the case and Googled them </li></ul><ul><li>The 3 most prominent/ appropriate diagnoses were then selected from the search results </li></ul>Tang & Ng. BMJ. 2006 December 2; 333(7579): 1143–1145
    19. 19. 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
    20. 20. Reaction to Dr. Google <ul><li>A spokeswoman for the Patients Association: </li></ul><ul><ul><li>&quot;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?” </li></ul></ul>
    21. 21. Reaction to Dr. Google <ul><li>A spokeswoman for the Patients Association: </li></ul><ul><ul><li>&quot;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? ” </li></ul></ul>
    22. 22. Wisdom of the Crowds <ul><li>An experiment... </li></ul>
    23. 24. How many… <ul><li>Blue diamonds? </li></ul><ul><li>Green circles? </li></ul>
    24. 25. <ul><li>ILI: Influenza-Like Illness – CDC data on presentations with flu symptoms from ‘sentinel’ outpatient facilities </li></ul>Google Flu Trends http://www.google.org, http://www.google.com/trends Sarah Palin: Flu (aggregate):
    25. 26. Wikipedia / Health Wikis <ul><li>Not definitive, but excellent. How? </li></ul><ul><li>http://en.wikipedia.org/ </li></ul><ul><li>http://www.ganfyd.org/ </li></ul><ul><li>http://www.AskDrWiki.com/ </li></ul><ul><li>Or… </li></ul><ul><li>Create your own: </li></ul>
    26. 27. MedBlogs & RSS
    27. 28. Social Bookmarking <ul><li>Users rate stories / websites / videos / papers </li></ul><ul><ul><li>More recommendations = higher ranking </li></ul></ul><ul><ul><li>Choose a channel by </li></ul></ul><ul><ul><ul><li>Topic </li></ul></ul></ul><ul><ul><ul><li>Bookmarker </li></ul></ul></ul><ul><li>Reddit – http://science.reddit.com/ </li></ul><ul><li>Delicio.us - http://delicious.com/bengoldacre </li></ul><ul><li>Biowizard </li></ul><ul><li>Digg (with recommendation engine) </li></ul><ul><li>All this can be channeled into your RSS feed </li></ul>
    28. 29. Twitter, Flickr and tagging CCL: Markus Angermeier @ Aperto.de
    29. 30. Podcasts, iTunes & iTunesU
    30. 31. <ul><li>Over 10 million users </li></ul><ul><li>MMORPG or MUVE… </li></ul><ul><li>SimTeach: </li></ul>2 nd Life Jeremy Kemp - San Jose State University. http://www.simteach.com/
    31. 32. Health 2.0 – What does it change? <ul><li>For Doctors </li></ul><ul><ul><li>Up-to-date knowledge ‘pushed’ to you </li></ul></ul><ul><ul><li>Diagnosis support </li></ul></ul><ul><ul><li>Personal support </li></ul></ul><ul><ul><li>Connected learning / teaching </li></ul></ul><ul><ul><li>‘ Expert’ patients </li></ul></ul><ul><ul><li>Remote / Virtual care </li></ul></ul>
    32. 34. iMedix
    33. 35. RateMDs.com
    34. 36. <ul><li>My Google Health: </li></ul><ul><li>https://www.google.com/health/p/ </li></ul>Electronic Records
    35. 37. SugarStats
    36. 38. Relief in Site
    37. 39. Health 2.0 – What does it change? <ul><li>For Patients </li></ul><ul><ul><li>Potentially better informed </li></ul></ul><ul><ul><li>Access to knowledge and expert opinion </li></ul></ul><ul><ul><li>‘ Ownership’ / Individual responsibility </li></ul></ul><ul><ul><li>Chronic care load distributed </li></ul></ul><ul><ul><li>Support – clinical and social </li></ul></ul>
    38. 40. Problems / Unintended Consequences <ul><li>Poor comprehension of the new media </li></ul><ul><ul><li>Wikipedia ‘controversy’ </li></ul></ul><ul><ul><li>Blocking ‘social’ websites </li></ul></ul><ul><li>Cyberchondria </li></ul><ul><ul><li>Access to records </li></ul></ul><ul><li>Consumerist patients </li></ul><ul><ul><li>Will NHS patients finally choose ? </li></ul></ul><ul><li>Can we trust the internet with our medical history? </li></ul><ul><li>Can we trust our careers to the crowds? </li></ul>
    39. 41. IWGC – Patients rating Doctors Screenshot from NHSblogdoctor – The original was removed, appropriately.
    40. 42. (Literally) at your fingertips
    41. 43. Access <ul><li>Critical to obtain information & participate </li></ul><ul><li>SmartPhones </li></ul><ul><ul><li>Windows Mobile </li></ul></ul><ul><ul><li>iPhone </li></ul></ul><ul><ul><li>Google Android </li></ul></ul><ul><ul><li>Palm Pre (soon) </li></ul></ul><ul><li>Netbooks </li></ul><ul><li>Web access (firewalls) </li></ul><ul><li>Installed System Applications </li></ul>
    42. 44. iPhone <ul><li>App Store currently has 131 medical apps </li></ul><ul><ul><li>But dwarfed by Windows Mobile </li></ul></ul><ul><li>Podcasts </li></ul><ul><li>Web access through Safari </li></ul><ul><li>Many apps are free </li></ul><ul><ul><li>All (except PubSearch – 59p) in this demo are free applications </li></ul></ul>
    43. 45. iPhone Apps
    44. 46. iPhone <ul><li>Apps I use – </li></ul><ul><ul><li>Safari web browser – BNF, RCP guidelines etc </li></ul></ul><ul><ul><li>Google – includes voice search </li></ul></ul><ul><ul><li>Wikipedia, WikiTap (with multimedia links) </li></ul></ul><ul><ul><li>Epocrates </li></ul></ul><ul><ul><li>Cardiocalc, Medical Calc </li></ul></ul><ul><ul><li>PubSearch </li></ul></ul><ul><ul><li>Converter – eg Stone to Kg for LMWH </li></ul></ul><ul><ul><li>NetNewsWire – RSS reader </li></ul></ul>
    45. 47. In summary… <ul><li>IT and the internet are changing how we interact, and allowing us to act together. </li></ul><ul><li>Web / Health 2.0 is about the power of crowds, without hierarchy. </li></ul><ul><li>Doctors have to be part of the crowd, as contributors and evaluators as well as moderators. </li></ul><ul><li>Having an understanding of all this is important to be able to practice medicine in the information age. </li></ul><ul><li>Using it could make you a better doctor, now. </li></ul>
    46. 48. Questions? http://obamicon.pastemagazine.com
    47. 49. 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?

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