Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Hurrah for Web 2.0
- Hope Leman (22 December 2006)
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Less technology than use
- Adrian Midgley (25 December 2006)
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Infomed 2.0 is an example of what we can do with Web 2.0 patterns
- Pedro Urra (25 December 2006)
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Wikisurgery - a wiki dedicated to surgeons
- Riaz A Agha (26 December 2006)
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Web 2.0 and Evidence-based Medicine
- Noha Gawargeos, George El-Nimr, Consultant Neuropsychiatrist/lecturer, Stoke-on-Trent (27 December 2006)
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Wiki with caution
- Sean N Neill (27 December 2006)
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Cochrane Collaboration
- Ben Toth (27 December 2006)
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Blogs and Radiologists
- Sumer Kumar Sethi (28 December 2006)
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Web 2.0 - this is only the start of a new era!
- John Sandars (28 December 2006)
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Wiki and 'Healthcare Information For All by 2015'
- Neil M Pakenham-Walsh (31 December 2006)
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Web 2.0 is really web as a database
- Arindam Basu (2 January 2007)
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Re: Web 2.0 is really web as a database
- Jeffrey I Ellis (3 January 2007)
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Medicine 2.0
- Ward D Merkeley, M.D. (4 January 2007)
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The lesson Web 2.0 teaches us
- Hojjat Salmasian (7 January 2007)
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It is not Web 2.0 but the advance of plug-in tools
- Alec Holt (7 January 2007)
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Health computer literacy
- CARLOS MARTÍNEZ DE LA SERNA (9 January 2007)
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PLoS and Web 2.0
- Virginia Barbour (10 January 2007)
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Transforming medical communication
- Nnamdi Udezue (16 January 2007)
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The imperfect and evolving knowledge base
- Kevin P Balanda (27 January 2007)
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Web 2.0 and change in medicine
- Greg Judd (7 February 2007)
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Web 2.0 is About Ordinary People, Not Platforms
- John M Grohol (7 February 2007)
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Web 2.0 and Medical Podcasting
- Craig B Dalton (15 February 2007)
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Web 2.0 and Health Computer Illiteracy
- Victor E Castilla (10 March 2007)
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The GP and the Geek
- Elly BI Van Reusel (14 June 2007)
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Semantic web 2.0
- Rahul Shetty (2 August 2007)
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Ways to web 3.0
- Simon Hoelzer (30 January 2008)
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Hope Leman, Library technical pecialist Good Samaritan Regional Medicl Center
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As a staffer in a medical library who spends hours reading blogs searching for Web 2.0 tools to facilitate document delivery to medical people, I would like to say how grateful I am to medical librarian bloggers like Dean Giustini and David Rothman. They alert medical librarians and clinicians to key developments, techniques and tools that enable those of us who want to become ultra-equipped to find whatever we can that medical people need as quickly as we possibly can and for as little money as we can possibly can so that money can be spent on patient care rather than poured into the already bulging coffers of medical publishers who profit by monopolizing information, much of which of which was produced at the expense of taxpayers. The days is nigh when the general public will cotton on to the fact that they shouldn’t have to pay twice or even three times over by subsidizing universities and governmental research institutes and then paying through the nose to read what Elsevier and Blackwell allow them to. I use free Web 2.0 tools daily to turn Word documents into PDFs and to send large files via Dropload and other free web tools. I use RSS feeds from PubMed to keep up on what is being published. Librarians can become data-laden and data-distributing machines thanks to Web 2.0 and to the rise of open access. Competing interests: None declared |
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Adrian Midgley, GP, on holiday. Exeter EX1 2QS
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Not to take issue with the excellent article in any of its conclusions, I just remark that Web 2 seems less a technology or group of technologies than the way we use them.
Copyright licencing - on a model more that of the Creative Commons and other CopyLeft and CopyFighting movements than the Microsoft and old content-provider model of selling the same thing over and over - is important. Those of us writing in Ganfyd (http://ganfyd.org ) the medical collaborative textbook can be assumed to think that the Ganfyd licence which attempts to solve the worst problem of the Wikipedia - attribution and reputation - is a good solution for professional resources. It is, naturally, available for the rest of you to use, copy, modify and reuse. Competing interests: I was one of the initiating team for http://ganfyd.org mentioned in the article. I wrote the first draft of the Ganfyd licence |
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Pedro Urra, CEO Infomed Cuba
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Web 2.0 is the buzzword that resumes the main changes that come from the maturity of Internet and the tools that give today more freedom to users in order to create and collaborate in Internet. Infomed is a health national network that have been heavelly using INternet in the last 15 years. The tools are ready to be used and people have been learning and sharing ways to networking. With web 2.0 approach we have a model to improve user participation and to create services in a power solving cycle. Now, we have tools to create solutions. For example create your own toolbar in 15 minutes. See for example the Infomed toolbar (http://infomed20.MyBlogToolbar.com ) or put a video about your project in You tube or Google videos, and share it with people all over the world. The content and the goals continue to be crucial, experiences as Honcodey (a code of quality and responsability for medical sites) and many other methods to build governance (craig list experience)in the net are now usefull to combine with blogs, wikis and other media. We can orquestate solutions and we can move present systems to have services. Infomed is moving in that sense and our experience is quite good. It is not technology that counts, and when technology becomes so easy as the web 2.0 services now available in the net, the main problem is to have something good to share. Goals, common projects and teamwork can now profit of a mature internet. Competing interests: None declared |
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Riaz A Agha, Managing and Executive Editor International Journal of Surgery
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I enjoyed reading the article by Dean Giustini which is a useful summary of web 2.0 use in the context of medicine. I have recently written two editorials discussing web 2.0 in general and wiki's in particular following the launch of two new online platforms theijs.com and wikisurgery.com :
Introducing the IJS.com: Transforming an international audience into a global community Introducing Wikisurgery.com: The blueprint for a surgical architecture of participation
At the International Journal of Surgery, we understand that our audience needs to get access to relevant information fast and web 2.0 technologies allow you to do just that. I believe that web 2.0 is a combination of a structural web architecture which provides a platform for user participation together with a willingness and desire from the audience to use the technology to gain access to relevant information in a timely manner and to meet new people, form connections and a community which represents something more than just linear information flow.
The shared database of information which can be organised by peers over time is of instrinsic value, as well as the shared people connections which form over time as well. Web 2.0 sites have that power to evolve into sites that mean far more than lots of eye balls looking at the same screen. With the devolution of editorial power comes real and active community participation, allowing for richer discussion and debate amongst the community without editors or technological barriers getting in the way.
The rapid success of our two new online platforms demonstrates that the surgical community needed something more and their participation and feedback will shape the ongoing development of these platforms over time
Competing interests: None declared |
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Noha Gawargeos, SHO in Psychiatry Keele Rotation, George El-Nimr, Consultant Neuropsychiatrist/lecturer, Stoke-on-Trent
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Dear Sir, we read with interest your article entitled “How Web 2.0 is changing medicine” that was published in BMJ in the 23-30 December 2006 issue. While it is acknowledged that such web initiatives is where the future of evidence-based practice may actually lie, it is rather shocking how little is offered in the way of training in this area. Health care professionals tend to flag this up in different forums. It appears that individuals’ interest is still the main determining factor on whether this kind of resources is utilised. It is somewhat alarming to envisage that patients cared for by more IT able professionals will stand a better chance in receiving an evidence-based care. Those who are confident enough to join “the interactive websites’ world”, are frequently faced with the lack of internationally agreed regulations in relation to ethical and medico-legal liability that is usually attached to discussing individual patients or sharing copyright protected scientific materials. The lack of strict frameworks that govern the quality of evidence that would be available on certain websites is another obvious concern. Even though further training is strongly recommended to professionals at different levels of seniority, it appears that search engines and even more traditional training forums will continue to have a place in the foreseeable future! Competing interests: None declared |
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Sean N Neill, Anaesthetic SpR Royal Hampshire County Hospital, SO22 5DG
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Thank you for this excellent editorial it goes a long way to highlight some exciting web developments. In response to subtitle's question; a medical wikipedia may be the next step, but only if it is introduced very cautiously.
The current medical wikis are not as the author suggests, “continually updated,” as there is no dedicated ongoing peer review process to appraise new contributions and updates. This could lead to serious safety issues. For example in anaesthesia, if an epidural dose of local anaesthetic was erroneously recommended for intrathecal use, the consequences could disastrous for any inexperienced trainee following the advice.
There is no such thing as a free lunch and “a low cost alternative to commercial point of care tools like UpToDate,” may not have the same access to the current evidence base to support the recommended practice.
If medical wikis are to be used they should be tightly regulated in accordance with the principals of evidence based medicine, with constant peer review, so as to maintain medical accuracy and patient’s wellbeing at all times.
Competing interests: None declared |
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Ben Toth, Health Perspectives Ltd Canon Frome, UK HR8 2TD
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In some respects the Cochrane Collaboration prefigured Web 2.0. Open and collaborative in style, it employed the Web technologies available to it at the time. I wish though that it would make use of the technologies now becoming available. But it is locked into a fruitless commercial publishing model despite being almost entirely funded by the public. Competing interests: None declared |
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Sumer Kumar Sethi, Radiologist, Consultant India
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I totally agree that web 2.0 or the Web created by people themselves is the one of the biggest revolution in the world of information exchange, be it any field from politics to medicine blogs and wikis have influenced everthing. Although, i would say that there is still a definite role for peer reviewed journals in building up the knowledge base and giving authentic information, there role has been changed ever since blogs have come the big way. One of the things which can be taken as result of evolution of Web 2.0 would be this eLetter concept, earlier it would have taken ages to get a small response to people and that too will each to the limited number of subscribers, beauty of Web 2.0 is fast access and freedom to discuss. I would like to submit my experience in blogging as a radiologist. I used my blog "Sumer's radiology Site" http://sumerdoc.blogspot.com or http://www.indianradiology.com to put up interesting current radiology info and debates and got amazibng response, i recently completed one lakh visitors on my site and my readership is comparable to India's only Radiology Journal if not more, with many readers commenting on important issues and many patients coming with their Radiological queries. In short Web 2.0 is the biggest revolution in the world of medicine information exchange and is bound to change the way we use internet for medicine!! Competing interests: None declared |
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John Sandars, Senior Lecturer in community based education Medical Education Unit, University of Leeds LS2 9LN
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Web 2.0 is here to stay! The changes that are now beginning to be felt in healthcare are only a reflection of much wider changes in Society, especially among the younger generation. There has been increasing unease by many people at the information that they obtain from the Internet. In previous times, a presence on the Internet required sophisticated and expensive technology but now the technological entry level for any individual wishing to have a presence on the Internet has been substantially reduced. Any individual or organisation can now easily have a blog, wiki, podcast or a place on any of the countless social bookmark and social network sites. This has created an opportunity for new information to be rapidly disseminated and discussed by numerous people without the control of a provider who may be manipulating the content. The information seeker can now pick and choose from a wide variety of information sources that not only reflect the range of facts but also the breadth of opinion about the presented facts. The above situation is uncomfortable for many people.There is a natural desire to create "authoritative" or "evidence based" information sources, such as a medical Wikipedia, but this does not reflect the concept or the developing nature of Web 2.0. It is is merely a "text book on the web" but in a disguised form. The future of Web 2.0 will be an evolution into Web 3.0 and beyond. Emerging new technologies are already providing exciting glimpses into the future. Individuals will be able to create personalised networks of information sources and opinion that are also shared with other individuals in much wider networks. These overlapping networks will be adaptive so that an emergent knowledge base is developed. This knowledge base will be more responsive to any information need than any created source can be. This is no longer a dream but an emerging reality. We are at the start of a new era of how the Internet is being used, both within and outside healthcare. The potential benefits of sharing both information and opinion are vast. We must look outside of the box and begin to embrace and develop the new opportunities that Web 2.0 and beyond can offer healthcare. Competing interests: None declared |
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Neil M Pakenham-Walsh, Coordinator, HIFA2015 Campaign 16 Woodfield Drive, Charlbury OX7 3SE
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Giustini concludes: "An expert (that is, doctor) moderated repository of the knowledge base, in the form of a medical wiki, may be the answer to the world's inequities of information access in medicine if we have the will to create one." The implications of this statement are profound. Over 20,000 people die every day in the developing world, many for the simple reason that the carer (mother, nurse, doctor) did not know what to do or when to seek help. The availability of reliable, relevant, easy-to-use information continues to be a major barrier to the delivery of effective care in the developing world, particularly at the community level. As Giustini implies, medical (health) wiki may be (part of) the answer. Wikis could readily be produced at low cost, in different languages, and in different formats for different readerships (parents, community health workers, nurses, clinical officers, doctors). Furthermore, wiki is 'Open Access', so the content can be readily reproduced, translated and adapted. Also, local publishers, health educators and others will be free to transfer content to different media, including print and audio, for the benefit of those without access to the internet. As other respondents have said, wiki present important challenges such as quality control. If done right, wiki has the potential to improve, dramatically, not only the relevance, but also the reliability of healthcare information available in the developing world. If done wrong, it has the potential to do harm. In order to maximise the potential and minimise the risks, there needs to be a collaborative, interdisciplinary approach that links efforts at global, regional and national levels. To discuss how wiki and other approaches can help meet the information needs of healthcare providers in developing countries, readers are invited to join a dedicated email forum 'Healthcare Information For All by 2015'. HIFA2015 brings together hundreds of doctors, nurses, publishers, librarians and other professionals worldwide, with two-thirds from Africa, Asia, South America, Eastern Mediterranean and Western Pacific regions. Together we are working towards a common goal: "By 2015, every person worldwide will have access to an informed healthcare provider." 'Healthcare Information For All by 2015' was launched in Mombasa, Kenya, on 26th October 2006, in collaboration with the Association for Health Information and Libraries in Africa. HIFA2015 is supported by several leading health organisations, including the British Medical Association. Further information is available at www.hifa2015.org. There is also a specialised 'sister' group, CHILD2015, which looks at the information and learning needs of providers of healthcare for children in developing countries. CHILD2015 has 400 members and is run in collaboration with the International Child Health Group of the Royal College of Paediatrics and Child Health. To join the HIFA2015 (CHILD2015) email groups, please email your name, organisation and brief description of professional interests to: hifa2015-admin@dgroups.org (child2015-admin@dgroups.org) With thanks, Neil Neil Pakenham-Walsh MB,BS Coordinator, HIFA2015 Campaign Coordinator, Global Healthcare Information Network 16 Woodfield Drive Charlbury, Oxfordshire OX7 3SE, UK Tel: +44 (0)1608 811338 Email: neil.pakenham-walsh@ghi-net.org Web: http://www.ghi-net.org Web (HIFA2015): http://www.hifa2015.org HIFA2015 email group: http://www.dgroups.org/groups/hifa2015 CHILD2015 email group: http://www.dgroups.org/groups/child2015 Join HIFA2015 and CHILD2015 - send your name, organisation and brief description of your professional interests to hifa2015-admin@dgroups.org and child2015-admin@dgroups.org "Healthcare Information For All by 2015: By 2015, every person worldwide will have access to an informed healthcare provider" Competing interests: None declared |
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Arindam Basu, Consultant Otolaryngologist Guru tegh Bahadur Medical Center, 11 DL Khan Road, Kolkata, India, 700 027
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Dean Giustini deserves serious appreciation for raising a very important issue in BMJ. Indeed, he has cogently argued the case of Web 2.0 as very important repository of medical knowledge editable in real-time by physicians. However, I was also expecting to read the glimpse of how it all came about as O'Reilly coined the term web 2.0 to differentiate the emerging fusion of interactivity and web as a database as opposed to the static delivery of contents over the Internet. In addition to blogs, wikis, and social bookmarking sites, there are now emergening mashups that collect materials from diverse pages/sites and puts them together and get updated real time. Pubmed offers these possibilities in their Entrez utilities and there are other efforts as well. Mashups and the use of Web as a progrmmable database will likely to dramatically change the way we practice medicine across the world, as information and updates can be pushed far more effectively to the desktops, laptops and handhelds of doctors and patients alike in real time. In all, it was good to read a nice article by Dean Giustini. Sincerely, Arindam Basu arin.basu@gmail.com Competing interests: None declared |
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Jeffrey I Ellis, Dermatologist SUNY Downstate Medical Center
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Outstanding article & rapid response discussion. Clearly a topic with great
interest. Bravo!
I especially appreciated comments left by Arindam Basu & Ben Toth. A full list of Web 2.0 projects related to medicine would be a long one. However, I would like to highlight one not mentioned in the article. JournalReview.org
allows open access, post publication peer review, of any article indexed in
PubMed. Similar to BMJ's rapid response, but with a few distinctions. Some might say, it is a PubMed mashup. JournalReview.org has been presented in several international meetings, and has been discussed in several articles to date. We are actively developing JournalReview.org to make it even better, including enhancement of our RSS feed tools. Any and all feedback is welcome. jellis@JournalReview.org Competing interests: Founder of JournalReview.org |
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Ward D Merkeley, M.D., Emergency Physician Holy Family Hospital Spokane WA USA 99203
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Medicine 2.0 This well written editorial identifies and discusses many relevant developments in the evolution of the internet and Medical content. The role of Web 2.0 will play in the next few years is elaborated in detail. In addition, the discussion on the need for Wikipedias for Medicine is considered. There will obviously be many more individuall authors contributing to Medical content via nontraditional routes. One may ask how the more traditional Medical Publishing businesses will react and respond to the challenges ahead? Before suggesting an answer to this question, let us compare a how traditional Medical Publishing House Web operations compare with the anticipated newer Medical Plublishing House 2.0 business model. Traditional Medical Publisher Web 1.0 language HTML, traditional databases, SQL, minimal access to businesses, Traditional Publishing Houses, closed or more inflexible organizational model, Microsoft, tendency toward elitism, older conservative generation authorship via personal article publication proprietary, i.e. UpToDate personal knowledge, protected and restricted Journals, textbooks, etc, closed organizations Medical Publisher 2.0 Web 2.0 languages AJAX, PHP,Ruby, XHTML, XSL, opensource, open source databases, Apache mySQL, maximum access community, Emedicine, BMJ openness, Google tendency towards liberalism, younger more tech savy, collaborative public publications Wikipedia Medicine, collective intelligence, open and accessible, Web broadcasting, Wikis, Blogs, open community Medical knowledge creation and its dissemination is evolving rapidly with new Web 2.0 tools and applications. Especially exciting are tools to video uploading either from a PC camera or from other video sources. With these creative tools will come new responsibilities. One major problem will be verifying and certifying collaborative medical information so users both professional and the public will trust and rely on the information. This is an exciting opportunity to port the western model of peer- review of articles and evidence based medicine to developing countries. This will benefit the the larger global community. Some of the more creative and nimbler traditional Medical Publishing Houses will play a major and helpful role in achieving this goal. Ward Merkeley, M.D. Holy Family Hospital Spokane WA USA
Competing interests: None declared |
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Hojjat Salmasian, Medical student and researcher Tehran University of Medical Sciences
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When I first read Tang and Ng’s article about using Google as a diagnostic aid [1], I wondered if English Wikipedia [2] was a better choice for such a study. Neither of the two is specialized in medicine, and both of them let the user to search through millions to billions of records of information. Accurate results appear first in Google results because they are referenced my by others, while Wikipedia offers millions of records gathered by collaboration of its editors on providing correct unbiased information. Unlike Google which applies algorithms which return ordered results from the unordered mass of information, the built-in search facility on the Wikipedia web site is not a powerful tool. I repeated Tang and Ng’s searches in Wikipedia, and also by limiting Google to search only in English Wikipedia. I was not blind to the final diagnosis of each case record, but it doesn’t bias the conclusion I’m going to make in the end. What I tried to evaluate was whether searching Wikipedia with exact or similar search terms would have resulted in the final diagnosis appearing in the first ten results of the search. I ended up with the same number of correct diagnoses, but I had to remove some keywords or replace them by synonyms in most of the cases. Searching Wikipedia by its own search engine resulted in much lower positive answers. There were cases (like the 8th record with Osteoid Osteoma) which the searches could not result into the answer, because no such article yet existed on Wikipedia. Ironically, there were cases (26 and 27) where Wikipedia searches resulted in a larger set of differential diagnoses than what reported by Tang and Ng. Unlike medical databases like PubMed, neither Google nor Wikipedia generally allow the user to use advanced search algorithms like combining logical operators (AND, OR) and using parentheses. This will make designing a structured search strategy for them far from easy in some cases. Nevertheless, regarding the swift evolution of Web 2.0 solutions including wikis and blogs, we should expect someday where they totally outrun the older Web 1.0 solutions in general, technical and medical fields. What a general physician looks for in UpToDate or DynaMed today, may be more easily found in Ganfyd in near future. Web 2.0 was first defined as a new development platform, but changed its meaning to democracy. [3] It substituted publishing with participation, and changed stickiness to syndication. It also brought new management models with itself, which were later acquired in Office 2.0 and Library 2.0. One should also look forward application of this model in health care and medical practice. References 1- Tan H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. BMJ 2006;333:1143-5. 2- http://en.wikipedia.org/wiki/ 3- http://www.paulgraham.com/web20.html 4- http://en.wikipedia.org/wiki/Web_2#See_also Competing interests: Web 2.0 development experience |
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Alec Holt, Director of Health Informatics University of Otago
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Giustini [1] is correct The Internet is changing medicine. However it is futile to define Web 2.0, as it is the advancing and evolving of languages, ontologies and plug-in tools that make Web 2.0. Maybe we should call it 2nd generation Internet, similar to how Software Development is classified. The next generation will come along as there are significant advances to current languages, tools and technologies. Maybe advanced evidence-based medical agents are on the horizon? I am particularly enthusiastic by the increased interactivity levels allowed and the convergence of technologies occurring. The convergence of next generation Internet tools with mobile phones, for example, could provide healthcare information for all. All these resources and tools are indeed helping doctors make better decisions and empowering the patients. References 1. Giustini D, How Web 2.0 is changing medicine. BMJ 2006;333:1283- 1284 (23 December), doi:10.1136/bmj.39062.555405.80 Competing interests: None declared |
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CARLOS MARTÍNEZ DE LA SERNA, In charge of the health section of www.elmundo.es On line edition of Spanish newspaper EL MUNDO, 28002, Madrid (Spain)
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I have read with interest the editorial and the collaborations published about how Web 2.0 is changing medicine. The emergence of social internet in the health sector can be labelled as a revolution. Though, there are some critical points that need to be emphasized. Beside others, the lack of what can be called health computer literacy creates a barrier for some of the people with greater need of access to health information and resources. In my opinion, goverments and academic institutions should address this problem, one of the greatest challenges in the coming years for a balanced development of internet. Competing interests: None declared |
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Virginia Barbour, Managing Editor PLoS Medicine Public Library of Science, 7 Portugal Place, Cambridge CB5 8AF
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At the Public Library of Science we completely agree that Web 2.0 is the future of scientific and medical publishing. Our latest journal, PLoS ONE (www.plosone.org), launched on Dec 20th, is the first journal that begins to use this technology to allow true interaction between authors and readers. The journal is based on an open source software platform and is currently ‘in beta’; the features available at launch are just the beginning. So far more than 140 papers have been published. We’d encourage anyone with an interest in the future of the web and medical publishing to visit the journal and test out its features. Competing interests: Editor at PLoS |
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Nnamdi Udezue, Entrepreneur / Locum SHO London SE22 8JH
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Web 2.0 reflects the evolution of the "web as platform". The author suggests that the term is nebulous, but deeper analysis and reflection on the phrase coined by O'Reilly media does in fact shed light in the meaning of the term. Current models of computing are based on the concept of the the "desktop as a platform". Prior to the desktop era was the time of the minicomputer as a platform. To access the benefits of computing, users required an expensive machine, which performed the bulk of the computation process. Software was delivered via floppy disk, and subsequently, CDs and DVDs. Web 2.0 software is delivered via the internet, and much of the computing that delivers the value we get through technology (such as a Google search) is invisible to the end user. Web based software is delivered via the internet without the need for the user to download or install an application. (Youtube vs Windows media player). As mobile technology matures, we may see the emergence of the mobile network as a platform, which will provide new ways of delivering knowledge and healthcare. Web 2.0 has been seized by hi-tech marketers and has become a buzzword to the stage that it's meaning is partly lost. It is more of a mindset and approach than a specific technology. The primary benefit is easier communication and collaboration. Clinicians with interests in healthcare and technology should aim to understand the benefits of emerging technologies in order to the translate the technophile's fascination with features into benefits to aid both the clinician and the patient. Web 2.0 is rather like pornography - hard to describe, but I know it when I see it. Competing interests: Developing a Web 2.0 collaboration platform for doctors |
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Kevin P Balanda, Associate Director Institute of Public Health on Ireland
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I would like first to commend Dean Giustini for his excellent editorial; he has given a very useful overview of the evolving Web 2.0 tools that are now available. While these new Web 2.0 tools provide us with significant and exciting opportunities, a number of the Rapid Responses also recognize some of the challenges they pose. I would like to raise an issue that has not been mentioned and that applies not only the clinical medicine but also to public health. In very many, if not most, cases the traditional evidence base is not as strong or as unequivocal as we would like. Consequently, we routinely draw on other sources of knowledge to support our decison making. Knowledge managers refer to the importance of 'tacit' as well as 'explicit' knowldge. Experiential knowledge and local contextual information play a key role. For me, one of the very exciting things about Web 2.0 is that it provides us with tools to share the different types of knowledge that are needed to support decision making. But accessibility is not always enough! Having provided access to all this additional information, we cannot ignore the need to support practitioners as they struggle to use it in their daily professional lives. How does a practitioner seeking particular guidance judge the quality of the different pieces of information available to them? How do they assess the relevance of the various pieces? What weight do they give to them, and how do they bring them all together? These are real issues not only for public health but also for clinical practice. I believe that if we are to fully realize the potential of Web 2.0 we must not focus only on the technology but must also pay some attention to the people who we hope will use it! As practitioners, we need web skills to actually use the technology. We must be encouraged to contribute our knowledge and experience - we mustn't think that "publication bias" is not an issue for Web 2.0! We need training to use the information that will become available. And we must not ignore how all this can contribute to the traditional evidence base. The future is very exciting. There are great gains to be had if we we keep an eye on the bigger picture! Thanks again to Dean Guistini for his valuable contribution. Competing interests: None declared |
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Greg Judd, seated 06824
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Thoughtful comments here, but it seems most address internet replication of conventional models of information uptake in healthcare, rather than innovative applications of technology to health improvement. Does anyone really believe that faster & easier access to narrative content on illness/injury conditions represents as large a potential change in the way health care is practiced as do applications which improve more direct capture of diagnostic & condition information, systematic patient monitoring, etc? Competing interests: None declared |
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John M Grohol, Publisher PsychCentral.com, 01950
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The crux of the author’s argument – that Web 2.0 is changing medicine – never seems fully explored in this article. Yes, while it’s interesting the doctor’s blogs – which have existed for at least 8 or 9 years – help people digest random little nuggets of information, I’m not sure how reading such information is changing medicine. New technologies like RSS add to my information overload, they haven’t readily reduced it. If Web 2.0 is about collaboration, transparency and sharing, then its heart is clearly ordinary, everyday people. Companies are not at the heart of the power of Web 2.0, people are. So while a company like Google (which has only more recently embraced many of the core concepts of Web 2.0) is successful and popular, its future popularity may very well be reliant on a completely different model of innovative search – for instance, one powered by people, not computer algorithms. Wikipedia is popular not merely because it uses the wiki architecture, but because it also brings a sufficient quantity of people together in a single, unifying purpose. Arguably the best example of how Web 2.0 has made an impact in the world of medicine, The Flu Wiki, is missing from this article. I have seen physicians joining the conversation and collaborative efforts more in the past few years than in the prior decade, largely because of the growing mainstream use of Web 2.0 tools in people’s lives in general. But people use Web 2.0 applications not because search engines are failing them (in fact, it remains the primary method of looking for health information online (1, 6)), but because the collaboration and sharing strongly speaks to humanity’s intrinsic social nature. If I contribute to Wikipedia or Digg, I do so because I want to be a part of a shared social conversation. The combined knowledge of hundreds or thousands of users is generally thought to be greater and more helpful than a single individual’s. There are looming issues for the Web 2.0 community as well. Accuracy remains a concern for health information, since an important but incorrect notation can have significant consequences in a person’s care or treatment. Such incorrect notations have caused harm in the past (5), and there’s no evidence Wikipedia’s system has changed to catch future occurrences. While Wikipedia appears generally reliable (2), there remain concerns about its consistency and the variability of its information (3). Ratings from individual users remain biased and unscientific, but rarely do websites note that one should not draw conclusions based upon user ratings (4). What is of little concern when purchasing your next summer beach read becomes of greater concern when others will be making health care judgments based upon the data. One of the true joys of Web 2.0 is how easy it is to begin today. You can edit, contribute and work on any article you’d like at Wikipedia instantly. No software to learn or download, and there’s no requirements for membership to become an editor. While efforts like the Public Library of Science’s online journals are an important step for open source journals, future online journals will go one step further – allowing anyone and everyone to contribute peer-reviewed articles at no cost. Because Web 2.0 has shown us that information can not only be social in nature, it can also be free to everyone. References 1. Fox, S. Online health search 2006. Pew Internet and American Life Project. 29 Oct 2006.
2. Giles, J. Internet encyclopaedias go head to head. Nature 438, 900-901. 15 Dec 2005.
3. Grohol, J.M. Web 2.0: Consistency, Relevancy and Reliability—Blog. 25 Feb 2006.
4. Magnus, P.D. Epistemology and the Wikipedia. Presented at the North American Computing and Philosophy Conference. Troy, NY. 8 Aug 2006.
5. Seigenthaler, J. A false Wikipedia ‘biography.’ USA Today. 29 Nov 2005. 6. Tan H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study. BMJ 2006;333:1143-5.
Competing interests: None declared |
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Craig B Dalton, Public Health Physician Newcastle 2300
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Web 2.0 has brought medical podcasting to the fore - it is easy to syndicate from a wide range of podcasts and produce and dissmeminate summaries of the latest medical journal abstracts for rapid release because of the increased bandwidth available, and the ease of subscription and playback courtesy of iTunes and portable MP3 players. It remains to be seen whether the podcasts will evolve to focus on more in depth education or snippets of 'awareness raising' (journaljunkie.com's focus) or a mixture. Many universities are delivering their course material via podcast for students to catch up or consolidate. Competing interests: The author is a director of Journaljunkie.com |
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Victor E Castilla, currently an applicant for the certification of ECFMG none
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This is a good article about tools that can make doctors' jobs easier and more efficient. The web 2.0 is about freedom and sharing( weren't those the purposes of the creation of the internet?), the main difference with the old web is the fact that now we don't have to know about language of computers to create a blog, to share files online, to create discussion groups, etc. There are directories of web 2.0 like http://www.go2web20.net/ where we can find the tools we are looking for. But are doctors prepared to take advantage of these tools? Are doctors taking an active participation of this revolution? are they applying Web 2.0 concepts? And if the answer is no, who is responsible for that? Who has to teach the doctors how to use these "new" technologies? In my opinion this is a responsibility of each one of us. If we learn, know and apply what already exists, the change this article talks about will come to pass sooner. Competing interests: None declared |
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Elly BI Van Reusel, general practioner Manila, Philippines
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I got to the article of Dean Gustini through http://del.icio.us.com and really liked it.
As a general practioner - first in a big multidisciplinary centre in Belgium, now in a community-based ngo-program in Manila, I can not but look at it the practical sight. How does the internet improve the quality of care I deliver to my patients? I like to bring to the attention the pioneer-work done by collegues of mine in Belgium in using websites with medical information during the consultation to answer patient unattended needs and/or doctors educational needs.
Online On-the-Spot, Evidence-based medicine in de spreekkamer, Huisarts Nu 2003, 32(10), 513 – 518. http://www.pubmed.be/oos.php?lang=en
Patient Educ Couns. 2007 May 29; : 17540531 Online on-the-spot searching increases use of evidence during consultations in family practice. Van Duppen D., Aertgeerts B., et al.
Contrary to the wave in IT-development were more and more information becomes free, it is obvious that this is not the tendance for medical science. Example is the BMJ itself who stopped partially sharing there information for free through the internet. http://www.indymedia.org.uk/en/regions/london/2003/08/275054.html
On the other hand the commercial influenced medical websites become more and more professional and user-friendly in there appearance. http://www.merckmedicus.com/pp/us/hcp/hcp_home.jsp
The real challenge for us general practioners - who most of the time are not geeks- will not be to get the information, but to filter it, and to asses it's scientifical value.
Competing interests: None declared |
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Rahul Shetty, physician Canada G1P 4R1
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Web 2.0 is the extension of the web 1.0,in fact it represents the true power of Internet as envisioned by Sir Timothy John Berners- Lee.But,the proliferation of numerous websites and also information resources has also diluted the quality of information. Today,we need to wade across vast repository of online information if we need to collect good quality information. The Search is dominated by SEO (Search Engine Optimized )techniques and also numerous other analytics which makes only SEO rich websites rank on top of the list and really good informed websites are way below. Moreover,the web as of today is not semantic enough to retrieve results of what we actually need,but it is a pile of huge amount of content.In the world of medicine,although for physicians the current web may help in arriving at rapid diagnosis,yet patients need to be careful as many users tend to use information provided in Internet to diagnose or treat any illness, disease, health problem, or metabolic disorder without consulting physicians or health care providers.This is one of the dangerous side effect of uncontrolled web 1.0 proliferation. Wiki and blogs maintained by physicians could be one significant step in resolving these issues. http://www.medicine20.org/wiki Competing interests: Semantic Web development analysis and its impact on Medicine. |
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Simon Hoelzer, CEO SwissDRG Inc. 3004 Berne
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Dean Giustini describes in his excellent editorial the hype about the web 2.0 and possible implications of further developments of a „web 3.0“ in medicine. Convenient and open access to medical knowledge is the key to more efficient science and patient care. Web 2.0 / 3.0 suggest newer version of the internet but the evolution has been and will be continuous. The concepts of a Web 2.0 are enabled by easier tools to create and distribute own content for publication, such as wikis, social networks or RSS. They have emerged in the last three years. Contrary, the technologies and concepts of a semantic web (3.0) are already available. But the creation of semantics isn’t for free and it can’t be delegated nor to the machine nor to a non-expert.
Enrich textual knowledge Information handling and knowledge management are boosted by the internet infrastructure, computing power, networking, and all mentioned approaches to enrich and structure the data. Semantic annotations, semantic links to related information sources, tagging and others transform the web towards a distributed database with defined entities and relations. But the reality isn’t a set of keywords, nor do we know all the keywords, topics or relations in advance. There is even evidence that “uncontrolled”, e.g. social tagging by an heterogeneous community is just as well as the use of an intelligent ontological framework handled by few. Both methods have to be used complementary. A controlled vocabulary such as SNOMED CT and domain ontologies are constantly developing. But in the end there will be some highly relevant information, up to now unknown and hidden data that is unmatched to the used models. The search for information = knowledge creation Finding best evidence in medicine isn’t easy. Turning data into information’s isn’t the strength of a machine (PC) but of human mankind, i.e. domain experts and the observations of the community (including physicians and patients). We definitely need the wisdom of the crowd and the experts. Semantic annotations will help to structure available evidence in order to build trusted clinical information. In the next years we have to enable and motivate the actors to use semantic annotations to reach that long term goal. Unfortunately the benefits are not visible immediately. In the meantime the tools for data mining, search engine technology and the statistical methods to exploit semantically structured data will evolve. And Medicine will be a moving power for these fields of Applied Informatics. Competing interests: None declared |
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