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"How web 2.0 is changing medicine: are doctors ready for health 2.0?"
- The most actively growing part of the web is "social media" - e.g.. wikis, blogs, bboards, and collaboratively-developed community sites like Flickr and YouTube.
- Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his/her own health and care pathway.
- Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day. http://www.tedeytan.com/2008/05/02/889
- Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create,we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself. http://content.healthaffairs.org/cgi/reprint/28/2/361
- Health 2.0 is a more patient-centred participatory model of healthcare, emphasizing online (public or private) interactivity between consumers, health providers and librarians using social networks...and an ability to share medical evidence, patient data and anecdote to improve health outcomes on a global scale
- In a Journal of Medical Internet Research article entitled "Health 2.0 and medicine 2.0: tensions and controversies in the field" the authors compare health 2.0 and medicine 2.0. They differ from the older term eHealth in their additional emphasis on social networking among patients and providers. Medicine 2.0 should focus on the use of web 2.0 in medicine while health 2.0 should focus on patient applications. The authors ask for more clarity in the use of these terms...
- traditional telehealth – remote contact with a patient through phone calls or video conferencing
- wireless, handheld devices - wireless inhalers for asthmatics; USB handheld pulse oximeter for blood oxygen monitoring;
Statement of problem
- Health 2.0 is not well-understood or defined; in the absence of evidence, most of what is written is conjecture
- the purpose of this article is to synthesize writing in the area and to stimulate thought and debate
- So what is health 2.0? subset of web 2.0 tools in medicine specifically for patients with its own set of trends and tools
- "web 2.0" services are available for patients to share information and social support; for patients, the accessibility and transparency that social media allows is very important and comforting; outside of Facebook and Twitter, they include patient blogs, customer rating and review sites and social networking services; the content there has been "patient-generated" and is growing exponentially
- traditionally, patients have been passive recipients of care but now want to take a more active role in decision-making
- Why? patients have been highly dependent on doctors historically to select their treatments and recovery plan; they have been expected to follow the advice of their health care providers with no expectation to participate actively
- meanwhile, because of Google, patients are reading more; sharing stories and acting as guides, information gatherers and online advocates; good health information is not always easy to locate; even approved websites do not often provide information in a form patients want
- patients also want to access the information held about them in health records; there are several online services that consumers can now use to build their own customized personal health files
- sharing information doesn't kill patients - medical errors do; social and informational support acts as a buffer against error
- shared decision-making is a kind of digital immune system for the information age; social support is potentially limitless whereas health care resources are not
- physicians should not be expected to be all-knowing; experts yes but not omniscient; the best chance we have of improving healthcare systems is to adopt more collaborative models and involve everyone
Like its older more established cousin web 2.0, health 2.0 provides the technological means to reframe the 21st century doctor-patient relationship. The most-popular web 2.0 sites such as Facebook, Flickr, Twitter, Wikipedia and YouTube are just the beginning for patients who envision something better, something more equitable. Physicians and health librarians must look at new web tools for they portend sociocultural changes in medicine beyond what we experience online. In fact, health 2.0 is a means to personalize health delivery and a way to match tools to patients' needs. PatientsLikeMe is one such tool among several that began in the United States including Everyday Health, Revolution Health and Inspire.
Much of the unidirectional communication that happens at hospitals and clinics is a remnant of a more paternalistic age. Health 2.0 is a tidy way to refer to a group of trends that position patients as active participants in their care. The term also refers to a shared model of responsibility that brings physicians and patients together to make decisions. In an age of ubiquitous access, patients experience a sense of empowerment like never before. This is because medicine has been an impenetrable discipline where information flow was limited. But given the social tools now available to patients, health information is accessible in all forms. More shared participatory models are a critical aspect of health 2.0. In dealing with disorders or diseases, patients may encounter communication problems with their health care providers or experience poor standards of care; health 2.0 helps them to understand their problems so that they can be more integral to finding solutions. Hughes (2009) says that four tensions exist in health/medicine 2.0: lack of clear definitions; loss of control over information that doctors normally safeguard; dangers of inaccurate information; issues of ownership and privacy.
- discussion forums, improved management of care, online communities, role of sociability in health, sociable communities as part of health plan, access to health information, provision of emotional support, virtual town square, medicine in the 'long tail, virtual settlements, digital posts are archaeological and cyber-remnants of psychosocial interest
- Health 2.0 is about equal participation and ultimately patient-empowerment
- active participation of patients and family members in healthcare is important
- to draw on interactive capabilities of web 2.0 tools and technologies; patients used social networking sites to research how others made decisions and coped with illness; emailed their physicians for second opinions, and checked ratings of hospitals
- internet based support to cope better with illness stressors
- linking patients to relevant health information; help them to participate in discussion by adding their opinions, thoughts and ideas
- consumers create and manage their own health portfolio
- traditional biomedical approach to illness alone is less effective than patient-centered approach
- good patient-centered care is based on best evidence and patient values; sometimes this can run counter to biases and intuition
- shared decision-making model to encourage evidence-based choices
- empowerment? natural byproduct of accessible information in all forms from anecdote and patient narrative to medical evidence and expert opinion
- important to make rational decisions (transparency) based on patient values (outcomes over costs)
- Actors in healthcare are focused on increasing value for patients
- acknowledges limitations of science; modern healthcare; of physicians
- Relies on interoperability of health systems and EHRs
- Four pillars of health 2.0: connectivity, interaction, social software, openness
- catalyst for creating competition to deliver better outcomes at lower cost
- Information is more available due to increased transparency; waves of innovation at all points along health care continuum
- providers educate, prevent, diagnose, prepare, intervene, recover, monitor and manage
- increase in personal health and outcomes information creates roles for infomediaries and related services providers
- new web 2.0 framework with its inherent social networking and collaboration tools make "long tail" of medicine more efficient
- patient-centred care has developed as a rejection of excessive authority in medicine
Types of web 2.0 use in healthcare
The following are examples discussed in the medical literature:
|| Case example in academic literature
| Staying informed
|| Used to stay informed of latest developments in a particular field
|| RSS, Podcasts and search tools (BMJ, 2006)
|| All (medical professionals and public)
| Medical education
|| Use for professional development for doctors, and public health promotion for by public health professionals and the general public
|| How podcasts can be used on the move to increase total available educational time (Sandars, 2007) or the applications of these tools to public health (Crespo, 2007)
|| All (medical professionals and public)
| Collaboration and practice
|| Web 2.0 tools use in daily practice for medical professionals to find information and make decisions
|| Google searches revealed the correct diagnosis in 15 out of 26 cases (58%, 95% confidence interval 38% to 77%) in a 2005 study (Tan, 2006)
|| Doctors, Nurses
| Managing a particular disease
|| Patients who use search tools to find out information about a particular condition
|| Shown that patients have different patterns of usage depending on if they are newly diagnosed or managing a severe long-term illness. Long-term patients are more likely to connect to a community in Health 2.0 (Ferguson, 2007)
| Sharing data for research
|| Completing patient-reported outcomes and aggregating the data for personal and scientific research
|| Disease specific communities for patients with rare conditions aggregate data on treatments, symptoms, and outcomes to improve their decision making ability and carry out scientific research such as observational trials (Frost, 2008)
|| All (medical professionals and public)
- CareFlash - http://www.careflash.com/
- Care2 - http://www.care2.com/
- Curetogether - http://www.curetogether.com/
- DailyStrength - http://dailystrength.org/
- e-Patients - http://e-patients.net
- eHealthMe – http://www.ehealthme.com/
- Facebook – http://www.facebook.com/
- FitBit - http://www.fitbit.com/
- GoogleHealth – http://www.google.com/health/
- HealthChapter - http://healthchapter.com/
- HelloHealth - http://www.hellohealth.com/
- iGuard - http://iguard.org/
- Inspire - http://www.inspire.com/
- MDJunction - http://www.mdjunction.com/
- Medsphere - http://medsphere.org/
- Microsoft HealthVault - http://www.healthvault.com/
- My Digital Health - http://www.mydigitalhealth.com
- MyFamilyHealth - http://www.myfamilyhealth.com/home
- PatientsLikeMe - http://patientslikeme.com/
- PsychCentral – http://psychcentral.com/
- RevolutionHealth - http://www.revolutionhealth.com/
- Trusera - http://www.trusera.com/health/
- 23andMe - https://www.23andme.com/
- Wellsphere - http://www.wellsphere.com
- Webicina.com - http://www.webicina.com/
- Where are we with the tradition of assuming that 'doctor knows best'? What conditions require F2F interaction and what don't?
- Bedside manner is a term describing how healthcare professionals handle patients and is essential in building the doctor-patient relationship. A good virtual bedside manner is one that reassures and comforts patients while remaining a partner in care
- point of editorial: to consider effects of web 2.0; put a human face on medicine; observation and evidence now drive modern medicine
- Applying medical evidence to individual patients is a very social process; conversations are needed over the information itself
- Is health 2.0 a strategic part of health reform? Do we want patients to be doctor-dependent? or wired and web-savvy?
- educating patients to discern between sites, using tools with patients; improve access including removing blocks to web 2.0 sites
- What are the tensions in relying on Dr. Google? is finding information a precursor to evaluating it?
- What roles can health librarians assume in health 2.0? connective; emancipatory;
- Should health librarians be able to lead patients to these social media tools?
- Does healthCare need to become more consumer-oriented? personalized? PatientsLikeMe & CureTogether are prime examples
- Health 2.0 accelerator – platforms (again) to add value for end consumer using the better together model.
- Public Health Media: Microsoft’s H1N1 Center, Google Flu Trends
- Web 2.0 reflects an evolution in the cultural, intellectual and creative exchange of information
- Web 2.0 influences health behaviours; health promotion is a logical area in which individuals seek opinions from others and communicate their experiences
- is the active participation of the citizen in his or her health and care pathway with the interactive use of Information and Communication Technologies.
Peripheral but interesting
- Google has changed the whole landscape
- Measuring patient satisfaction is an important quality improvement technique
- the web offers ways to understand patient satisfaction and to hear stories about healthcare encounters
- patient narratives told online, in real-time, on social networking and on social rating sites are part of health 2.0
- patient-generated, publicly available information complements existing data and provides insights into patient values, perspectives and expectations - and can suggest ways to improve the patient's experience along the continuum of care.
- Barras C. Innovation: is the future of healthcare online? New Scientist. July 2009.
- Bleicher P. Health 2.0: do it yourself doctoring. Appl Clin Trials. 2008;17(10):38-42.
- Bos L, Marsh A, Carroll D. Patient 2.0 empowerment. International Conference on Semantic Web & Web Services, SWWS08.
- Bottles K. Patients, doctors and Health 2.0 tools export. Physician Executive Journal. 2009.
- Conn J. Health 2.0: the next generation of Web enterprises. Modern Healthcare. 2007;11 December.
- Eytan E. My definition of Health 2.0: the transition to personal, participatory health care.
- Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10(3):e22.
- Ferguson, T. ePatients white paper. 2007.
- Fox S, Jones S. The social life of health information. Pew Internet / California Healthcare Foundation. 2009.
- Frost JH, Massagli MP, Wicks P. How the social web supports patient experimentation with a new therapy: the demand for patient-controlled and patient-centered informatics. AMIA Annu Symp Proc. 2008;6:217-21.
- Hawn C. Take two aspirin and tweet me in the morning: how Twitter, Facebook, and other social media are reshaping health care. Health Aff. 2009;28(2):361-8.
- Haynes VD. Web health sites harness power of social networks; patients learn from patients. 'A significant advance in what sites are doing'. Washington Post. 2009.
- Health 2.0 is trademarked health 2.0 includes list of Health 2.0 companies
- Health 2.0: technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of “user generated” medical information a healthy trend? Economist. 2007;6:73-74.
- Hughes B, Joshi I, Wareham J. Health 2.0 and medicine 2.0: tensions and controversies in the field. J Med Internet Research. 2008;(3):e23.
- Lane SH, Twaddell JW. Should social media be used to communicate with patients? Am J Matern Child Nurs. 2010;35(1):6-7.
- Manhattan Research White Paper. Physicians and web 2.0: 5 things you should know about the evolving online landscape for physicians.
- Medicine 2.0 Congress is similar or identical to health 2.0, but also includes "Science 2.0"
- Newman T. The power of stories over statistics. BMJ. 2003;327:1424-1427.
- Sarasohn Kahn J. The wisdom of patients - social media in health care. THINK Health for California Healthcare Foundation, 2008.
- Shreeve definition: health 2.0 organization
- Spring H. If you cannot beat them, join them! Using health 2.0 and popular Internet applications to improve information literacy. Health Info Libr J. 2011;28:148–151.
- Tan H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. BMJ. 2006;333:1143-5.
- Wahlgren E. The doctor will see you now . . . online: American Well powers virtual visits.