Web 2.0 technologies in healthcare

If you thought the internet and email were amazing, you ain’t seen nothing yet. New Web 2.0 technologies are already being developed and having an impact on healthcare.

Nick Saalfeld sets out to find out what patients, doctors and policy makers are doing with collaborative and multi-media technologies.

Internet technologies have changed the way almost everyone works. We can now communicate at lightning speed, work with peers on the other side of the world and find information at the click of a mouse.

But things in the internet world move fast. A bunch of new technologies, known as Web 2.0, are already emerging and promise to transform the way we work and communicate even further.

Early internet services like email and websites are now often called “Web 1”: generally, they offer basic one-to-one communication only. Web 2.0 tools are characterised by:

• Being highly collaborative (think forums, groups, shared workspaces)
• Using multiple data sources intelligently to reach useful conclusions (think putting useful data together to get a real time picture of what is going on in a service)
• Using multimedia (think video, audio and graphics)
• Go-anywhere availability (think wireless and mobile, on the wards or at home)

This all sounds like fun, but since that steady stream of patients flows in the real world rather than in virtuality, can these Web 2.0 tools really make a difference to the way healthcare is provided?

“Sometimes virtuality is just what the patient ordered.”

First Contact

Well, sometimes virtuality is just what the patient ordered. The Spanish Society for Family and Community Medicine has set up a virtual clinic in SecondLife, the online virtual world popular with many teenagers.

Staffed by real clinicians, the virtual clinic answers questions on emotional and sexual issues that its young clients might feel uncomfortable discussing in the “real world.” Of course, the patient should see their own doctor for a full consultation but if this initial contact leads to more worried teenagers seeking help, then the virtual clinic has done its job.

David Doherty, business development director at 3G Doctor, a consultation service offered across 3G video mobiles, agrees. “We’ve had lots of calls with patients who feel more comfortable talking to someone other than their regular family doctor,” he says.

A frequent objection to these remote services, whether delivered by PC or phone, is that patients cannot receive the same level of service as with a face-to-face consultation.

Not so, says Mr Doherty. “Patients often say that they aren’t getting enough time with their doctor, but they’re often saying ‘time’ as a proxy for ‘attention’, because what they’re really missing out on is enough attention.”
Before a consultation with 3G Doctor, the patient fills in an interactive questionnaire based on an extensive medical knowledge base. “This enables patients to take as much time as they want telling us about their health and many find it easier to be more open through this more impersonal approach,” Mr Doherty says.

“By ensuring our remote doctors are properly prepared, the patient can benefit from 100 per cent of their attention in the consultation.” Anyway, he adds, patients are often only looking for advice and reassurance – perhaps in relation to something they have seen on the internet.

“One of the unforeseen problems of the Web 1 internet has been a surfeit of information. Web 2.0 technologies have much to offer here.”

Too much information?

Ah yes. The internet. One of the unforeseen problems of the Web 1 internet has been a surfeit of information. There is too much generic medical reference available online, and its quality and reliability are patchy at best.

Many GPs are frustrated that they seem to be the last resort for some patients, after they have picked up some dubious advice from www.got-a-nasty-lump.com.

Web 2.0 technologies have much to offer here. Collaborative web tools are leading to the creation of online communities that are much better at ranking the value of information than basic web pages. From colitis to cancer, online support groups are directing users to what is good, and enabling them to share opinions and advice.

These communities usually make very little formal distinction between the medically qualified, the patient, and the carer or family. This can be uncomfortable for clinicians - particularly when users start commenting on the care they have received and even on the doctor who delivered it.

On the other hand, they are deeply democratic, holding out the possibility of breaking down the emotional barriers that traditionally stand between patient and physician.

There isn’t always wisdom in crowds, of course. The MMR vaccine fiasco is a perfect example of the way in which rumour and reality can become confused, and online discussions can speed up the misinformation process. However, far more good than bad is being done in these online meeting places.

Richard Smith, former editor of the British Medical Journal, blogger and editor of Cases Journal, a classic example of Web 2.0 collaboration, says: “Web 2.0 communities are a bottom-up thing: grass roots and collaborative. And providing better healthcare needs to include the patient community.

“Whilst doctors are in the business of treating disease, maintaining a level of health for the nation needs to involve people doing something for themselves. Doctors can respond to diseases, but online communities can help keep us all healthier in the long term.”

Patient Power

In particular, emotional support services are often an afterthought for the NHS and many patients are finding them online. Matthew Zachary’s website, I’m too Young for This, shares his experiences as a young survivor of cancer, and has grown to support many others in the same situation.

His website was one of Time Magazine’s 50 best websites of 2007 and serves as a support group, campaign outfit and data repository all in one. Mr Zachary emphatically endorses the power of social media (albeit in US-oriented language).

“Social media utilities have yielded patient-driven opportunities to not only build communities but also to improve the psychosocial quality of life, as clearly demonstrated by our organisation,” he says. “Without these new turnkey platform solutions, organised communities - grass roots or otherwise - would not be possible, let alone activated to truly drive social change.”

Several sites, PatientsLikeMe for example, have formalised this support network structure and are rapidly connecting individuals with similar treatment experiences. This site only has around 250 UK members at the moment, but membership is characterised by an astonishing willingness to be open about health issues and experiences.

Again, the impersonal nature of the internet seems to make patients feel more, rather than less, comfortable sharing their knowledge.

Doctor to Doctor

If that’s the patients’ stories, what about doctors? Are they connecting in online communities and via Web 2.0 collaborative tools? 

Not as much as they should, says Richard Smith: “I think it’s primarily an age issue; although of course there are younger doctors, and they are adopting these tools first. Practitioners use the web and they consult by email, but we’re definitely at the beginning of properly using social networks in the medical profession.

“Secondly, some doctors think that the internet is frivolous; there’s a tradition which holds that doctors are refined and occupy a more rarefied social space. Finally, there’s obviously the fear, whether well-founded or not, of identity theft and other security issues.”

Dr Smith, a long-term blogger, does sees the trend emerging though and last year discovered the networking site, Facebook. “On Facebook there are several Healthcare 2.0 networking groups”, he says, “and several businesses are producing social networking platforms designed for doctors.”

As well as social networks, Web 2.0 is changing the way medical and scientific reference is disseminated.
Medical experts are used to publishing case examples as part of academic publications and Cases Journal makes this simpler: without the expense of paper and printing, the cost of publishing cases is negligible.

Cases Journal will publish any case; leading ultimately to a highly searchable database of cases. Consultants will easily be able to identify similar cases to those presented in the surgery or theatre, and are therefore better equipped to diagnose, or spot anomalies.

“Lord Darzi’s final report, High Quality Care for All, pays specific attention to the potential of Web 2.0 technologies and to the new demands they will put on the NHS.”

Policy into practice

Meanwhile, policy makers and managers are catching up. Lord Darzi of Denham, who recently published a ten year vision for the NHS, seems to be a big fan of technology. In the year that he headed up the Next Stage Review of the health service, he blogged on its website and arranged consultations, meetings and a model operating theatre in Second Life.

More importantly, his final report, High Quality Care for All, pays specific attention to the potential of Web 2.0 technologies and the new demands they will put on the NHS. It proposes that the health service itself should do some distinctly Web 2.0 things, such as building collaborative portals to help staff spread best practice and building up the NHS Choices website to include patient views on their care.

Maybe not every medical professional needs to be on Facebook, or share their world-view every five minutes via Twitter, but patients will no longer settle for isolationism from the medical community.

As Matthew Zachary says: “The medical provider establishment needs to get a bearing on how it's going to going to stop being an 'establishment'. It needs to get with the times and to begin understanding this new era of physician/patient communications.” 


Read our recent article on Lord Darzi's report