Update (Feb. 22nd, 2010): Thanks to Kevin, MD for featuring this post on “Twitter and Facebook Can Help Conduct Group Patient Visits”! I’m very honored!
The concept is simple. Group Medical Visits already exist. So:
In my undergrad English lit courses, I heard a lot about “character is destiny”. Which is a fancy way of blowing things out of proportion – e.g., Romeo and Juliet didn’t die via the quality of being “star-crossed”, but because they were super emo.
Well, this week, I watched a TED talk by Bill Davenhall (below) that claimed “geography is destiny”.
This idea is not so exaggerated. Just watch it (9 min.):
There’s the classic equation:
and of the three aspects, Davenhall argues that “environment” has been ignored for far too long by physicians.
The success of electronic medical records (EMR) depends on much more than the EMR itself, but intuitive, smart software is still important. In this post (Merry Christmas!), I will talk about one tough issue in particular, the search problem, and why a “finder” like Google Wave (June, November) might be a good idea.
Yesterday, I read an article (National Post) on MyLifeBits, a kind of Electronic “Life” Record. Since 1998, Gordon Bell, a principal investigator at Microsoft, has led a project to “go paperless”, essentially scanning, recording, logging every single thing in his life.
The motivation?:
I’m not cluttered with having to remember any of this stuff. I just have to remember that it’s in there, and that I’ve looked at it.
Dr. Vartabedian (@Doctor_V) recently posted about the pre-emptive strike delivered by a patient’s mother as DrV was trying to explain the condition. The weapon? Google!
I recently discussed endoscopic biopsy results with a patient’s mother. Her child had inflammation in the upper intestinal tract with cells called eosinophils. As I began to explain the basics of tummy irritation and the significance of the eosinophils in her daughter’s duodenum she cut me off, “Actually doctor, you don’t need to go into too much detail, just spell ‘eosinophil’ for me if you would.”
As it turns out mom was more interested in getting to Google than listening to how I think her daughter’s biopsy results related to her problem.
On one hand, the technology is facilitating patient education and empowerment in a myriad of ways. Knowing the name of a condition, I can look up treatments; knowing my symptoms, I can follow a flow-chart JPEG and self-diagnose; tracking how I eat/sleep/exercise/smoke/drink/etc. via DailyBurn-esque services, I can analyze habits from the comfort of my home. But the flip side is that the infosphere lacks guidance: accessibility to information is not a problem, yet accessibility to knowledge is.
Remember Google Answers? Nowadays, it has been written about in articles counting down the top Google Labs failures (couldn’t compete with Yahoo! Answers), but I believe it is useful to recall the reason for its creation. Google Answers employed real people who searched the Google inundation for the answers to your questions. The important point is that they didn’t simply give link lists; they tailored and annotated the answers extensively. It was like having a personal tour-guide to your own question. Similarly, the best-case scenario for the patient is to have a personal tour-guide to his condition, but the internet alone fails at this. It is a bit like being given the map, but not the guide.
As DrV pointed out: “The internet isn’t going anywhere. If anything the web’s capacity to support patients will only improve.” It is only natural that patients and their families’ use of the web will grow more sophisticated, whether they are looking because it’s the middle of the night and they can’t go to the doctor, because they aren’t comfortable talking about their condition, or simply because they are interested in trying out these tools for themselves. We cannot begin to elucidate the gamut of reasons. Therefore, the paramount task of physicians will be to master the web to better support tech-savvy patients.
Physicians should explore the web themselves and know what their patients will be seeing when they Google, something that DrV call Pre-Emptive Online Health Literacy. For example, a patient might find that the treatment for his condition that garners the most hits or that is treated in the most detail on Wikipedia is the not the one his doctor recommends; the doctor should be ready to explain why certain information on the web is not applicable to the patient’s specific situation.
1 Monologue + 1 Monologue /= Dialogue! If the doctor is able to anticipate the results of patient empowerment and act accordingly, then we have synergy. This is what makes the web truly useful.
By now many of us know about Google Wave and have watched the truly epic introductory video. I won’t try to summarize the OMG!PONIES effect – you’ve got to see it to believe it.
What I will say is this: Wave has been framed as the technology that could kill email, IM, photo/music/video sharing, and more; and it has also been getting quite a bit of attention for its potential to become the quintessential collaborative tool in science and medicine.
Cameron Neylon who writes the blog Science in the Open summarized the (tentative) excitement superbly:
Those of us interested in web-based and electronic recording and communication of science have spent a lot of the last few years trying to describe how we need to glue the existing tools together, mailing lists, wikis, blogs, documents, databases, papers. The framework was never right so a lot of attention was focused on moving things backwards and forwards, how to connect one thing to another. That problem, as far as I can see has now ceased to exist. The challenge now is in building the right plugins and making sure the architecture is compatible with existing tools. But fundamentally the framework seems to be there. It seems like it’s time to build.
I think that quote really hits the nail on the head. The volume of medicine 2.0 tools is growing faster than ever, but that growth is also kind of digging itself into a hole.
For example, it’s been discussed that if Nature could only combine all its great Science 2.0 tools, including Connotea, Precedings, Second Nature (the Nature island in Second Life!), Nature Blogs, Nature Podcasts, etc., into a one-stop resource, then there would be no question that every scientist on the planet would use it. As it stands, the dispersion seems like a safe way for Nature to experiment with a lot of ideas and see what sticks. The stickies thrive in semi-obscurity; the un-stickies disappear into the web 2.0 deadpool (as popularized by TechCrunch).
But I guess we can’t really blame Nature for being cautious…the one-stop resource is truly a daunting feat. Take Facebook, for example. Facebook has been (in my opinion, unsuccessfully) trying to do this via the Applications feature. Maybe some people can’t live without their photos, SuperWall, iLike profile (seriously, where would iLike be without Facebook?), and What Pirate Are You? results on the same site, but to me the addends are just overcomplicated and distracting. Science 2.0 has to overcome that and set standards – Wave might be just what we need.
With my pre-adulation out of the way, here are links to Science in the Open’s and HealthySpacesRx’s excellent follow-up posts, which throw out a few possible applications of Wave in medicine.
So, as I see it, the first major issue to watch as we integrate Wave with medicine will be the task of developing these mysterious Wave participants that I’ve been calling Bots. As a related example, consider that most physicians are more keen to adopt the iPhone than EMR simply because existing EMR systems are poorly designed, and because EMR vendors haven’t opened up their APIs to facilitate the kind of application-developing that drives the Apple AppStore. Similarly, the success of Wave in medicine will depend on a strong community consisting of developers who will make these peer-review, language translation, video support “participants” possible.
With the tools in place, we must also carefully consider the implications of Wave and its imitators on existing controversies relating to privacy and accessibility. Who will be allowed to participate in the Wave? How will Wave participants be authenticated? How much access should patients have to their own Wave? Do patients even own the data? These are discussions that are not only important for Wave, but also for the notion of EHR in general.
Finally, what about the human touch – does Wave pose a threat? Are we, as patients, ready to become patients 2.0 to such an extent? What kind of proof-of-principle and education will get us there? Surely it will take much more than an hour-and-a-half-long video?
Stay tuned for more updates.
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This work by Elizabeth Han is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 Canada License.
