Cross Talk on the power of information
In the latest of his regular columns, journalist Mike Cross examines the use of clinical performance information by online consumers in web communities, and concludes that despite the fears of professionals, it’s no bad thing.
My local newspaper, which circulates in a relatively leafy part of North London, warns readers in apocalyptic terms: "Crime maps to hit house prices." It's worried about a plan by the new mayor of London to post US-style maps of reported crimes on the web.
A surgeon friend, meanwhile, is alarmed about the NHS in England's decision to post details of individual surgeons' operative mortality rates on the web. "Will I ever dare to take a high-risk patient again?" he asks.
Both, in their ways, are displaying fears about the power of information. As it happens, I have more sympathy with the surgeon than with the newspaper, but I think both fears are misplaced. The way to assuage them is not by restricting the publication of information, but by encouraging it. “A wave of available data on everything from carbon footprints to violations of immigration law is transforming British public life.”
I use the words "power of information" deliberately. It's a year since Ed Mayo and Tom Steinberg released their report of that name, which urged the government to embrace the free-ranging spirit of "web 2.0" by engaging in citizen-led web communities. Against most expectations, ministers quickly grasped the concept, and the new thinking is beginning to shape policies across government.
A wave of available data on everything from carbon footprints to violations of immigration law is transforming British public life.
A different “Freedom of Information”
Nowhere is the potential power of information greater than in healthcare. But although officialdom seems happy to be bold about collecting and disseminating data – nurses’ ratings for “compassion”, for example – it is still nervous about letting go of the data entirely. The underlying philosophy still seems to be “We own the data and ensure its accuracy: you can read it, but you can’t republish it.”
Such thinking is understandable, but in the Web 2.0 age of mashups, wikis and blogs, obsolete.
According to the think-tank Demos, Web 2.0 is already transforming healthcare, whether we like it or not. A new report, “The Talking Cure”, enthuses about the potential of Wikis to inform both health policy and personal care. “The point about Web 2.0 is that information no longer flows from publisher to reader, but takes on the character of a conversation.”
The authors urge policy-makers to “take inspiration from Wikipedia and allow patients to contribute to and comment on (though perhaps not edit) professional information. This will have clinical benefits while also sending the clear signal that information should be owned by and be under the control of patients."
To get to this point, a cultural change is needed: "The NHS needs to stop seeing information as a health supplement. It now forms an integral part of health interactions. In an internet-enabled population, the ability to find, understand and critique health information has a profound influence on the way patients approach their treatments and consultations.”
Judgement: sifting the data, finding the facts
The essential word here is “critique”. The point about Web 2.0 is that information no longer flows from publisher to reader, but takes on the character of a conversation.
In conversations, we are used to hearing our words mashed up, manipulated, and thrown back at us in unexpected ways. Some of us will admit doing it ourselves. And unless we move in very rarified circles, a high proportion of the data generated by everyday conversations is complete tosh.
Our brains cope by assigning values based on both the source and the content of such data. In conversation with a taxi driver, we would probably trust their knowledge of one-way streets than their knowledge of immigration statistics.
So it goes with electronic data. Most of the conversations we generate with our web 2.0 tools and techniques will be complete tosh. Some web-enabled crank will surely manipulate operative death data in a way that departs completely from reality and which, if anyone believed them, would be damaging to public health.
That’s what terrifies my surgeon friend. But in conversation, we don’t gag cranks. We handle them by quietly correcting their facts and, in the final resort, moving on. So long as the real facts, all the facts, are still there to check, they will penetrate the noise. Truth is powerful stuff.
About the author: Michael Cross is a freelance journalist specialising in healthcare informatics and e-government. He is a member of the British Computer Society.